Ozgur Ciftci

The authors sought to evaluate coronary microvascular function and left ventricular diastolic dysfunction using transthoracic Doppler echocardiography in burn patients. In this study, 32 adult burn patients with partial or full-thickness scald burns that were hospitalized and treated were included. The control group was matched for age and sex and was composed of otherwise healthy volunteers. Transthoracic Doppler echocardiography examinations and simultaneous laboratory tests for cardiac evaluation were performed on the sixth month after burn injury as well as with the control group. High-sensitivity C-reactive protein levels were significantly higher in the burn patients than in controls (5.17 ± 3.86 vs 2.42 ± 1.78; P = .001). Lateral isovolumic relaxation time was significantly higher in the burn injury group than in the control group (92.7 ± 15.7 vs 85.5 ± 8.3; P = .03). Baseline coronary diastolic peak flow velocity of the left anterior descending artery was similar in both groups. However, hyperemic diastolic peak flow velocity and coronary flow velocity reserve (2.26 ± 0.48 vs 2.94 ± 0.47; P < .001) were significantly lower in the burn injury group than in the control group. Coronary flow velocity reserve was significantly and inversely correlated with high-sensitivity C-reactive protein, burn ratio, creatinine, and mitral A-wave max velocity. At the sixth month of treatment, burn patients had high-sensitivity C-reactive protein levels during this period, suggesting that inflammation still exists. In addition, subclinical coronary microvascular and left ventricular diastolic dysfunction can occur in burn patients without traditional cardiovascular risk factors. However, these results must be supported by additional studies.

Introduction: In this study, we examined the effects of Brucella infection on endothelial dysfunction. Flow-mediated dilatation (FMD) measurement is indicator of the endothelial function, and abnormal values indicating endothelial dysfunction are accepted as the first stage of atherosclerosis. Methodology: Twenty-four patients who had been treated for acute brucellosis two years before, and who had had no relapses in the follow-up, were prospectively included in the study, along with 30 healthy individuals in the control group. Results: While the highly sensitive C-reactive protein (hs-CRP) value was 2.42 ± 1.45 in the patient group, it was 1.72 ± 0.61 in the control group (p = 0.025). While the FMD value was 3.50 ± 1.58 in the patient group, it was 5.88 ± 1.88 in the control group (p < 0.001). While the percentage increase in FMD was 9.88 ± 4.92 in the patient group, it was 17.49 ± 6.3 in the control group (p < 0.001). It was observed that FMD value, the percentage increase in FMD, and basal radius were correlated with hs-CRP (r = -0.644, p < 0.001; r = - 0.558, p = 0.002; r = 0.444, p = 0.018, respectively). The carotid artery intima media thickness (IMT) value was found to be 0.61 ± 0.17 in the patient group and 0.49 ± 0.12 in the control group (p = 0.004). Conclusions: The abnormal FMD and IMT values observed in brucellosis patients might be an indicator of more frequent arterial dysfunction, increased cardiovascular risk, and atherosclerosis.

The long-term results of coronary artery bypass surgery depend mostly on the type of the grafts. For a long time, it has been accepted that arterial grafts are superior to venous grafts. In this study, we evaluated the angiographic patency rates of arterial and venous grafts. The study took place between 2003 and 2013 in the Departments of Cardiovascular Surgery in Baskent University. The study included 52 patients with recurrent ischemic symptoms (of total 2183 coronary artery bypass surgery patients) following coronary artery bypass surgery. The patients were evaluated by control angiography during over mid- and long-term postoperative period (mean, 75.25 ± 35.15 months). Based on the angiographic findings, the grafts were divided into 3 groups: severe stenosis, moderate stenosis, and patent. The preoperative demographics (age, gender, hypertension or diabetes mellitus) were similar in the three groups. The mean numbers of distal anastomoses were 3.27 ± 0.89 (range 2-5), the degree of native coronary artery stenosis for radial artery anastomosis was 79.65 ± 17.72, and the mean numbers of radial artery and saphenous vein grafts were 1.19 ± 0.44 and 1.10 ± 0.89, respectively. The patency rate was 80.77%for radial arteries, 63.2% for saphenous veins, and 82.4% for left internal thoracic arteries in the three groups. The internal thoracic artery graft was confirmed to be the best option for aorta-coronary bypass surgery, as it has the highest patency rate compared to the other grafts. Radial artery and saphenous vein patency rate were also seen to be similar in the long-term.

Background: The aims of this study were to investigate the appearance of paradoxical ventricular septal motion (PSM) after coronary artery bypass graft (CABG) surgery and to identify factors that might be related to this abnormality.Methods: This prospective study included 119 consecutive patients (38 women, 81 men) who underwent CABG. Patients who underwent on-pump surgery (22 women, 45 men) and patients who underwent off-pump surgery (16 women, 36 men) were studied separately. All subjects underwent preoperative angiographic septal perfusion evaluation, pre- and postoperative echocardiography, and standard electrocardiographic and laboratory investigations, including troponin I and CK-MB levels. Multivariate logistic regression analysis was also performed for a variety of related parameters.Results: Significant differences in EuroSCORE, length of intensive care unit stay, length of hospital stay, PSM (assessed using echocardiography), septal perfusion (observed using preoperative angiography), postoperative pleural effusion, and intensive care unit recidivism were observed between the two groups (P < .05). Moreover, postoperative PSM was correlated with septal perfusion (r = -0.687**, P < .001), type of operation (r = -0.194*, P = .035), diabetes mellitus (r = 0.273**, P = .003), carotid stenosis (r = 0.235*, P = .011), the number of distal anastomoses (r = 0.245**, P = .008), pleural effusion (r = 0.193*, P = .037), and intensive care unit recidivism (r = 0.249**, P = .007). However, multivariate analysis demonstrated that only preoperative septal perfusion (odds ratio: 0.037; 95% confidence interval: 0.011-0.128; P < .05) constitutes an independent risk factor for PSM (P < .05).Conclusions: This study demonstrated that preoperative septal perfusion deficiency represents an independent risk factor for postoperative PSM in patients undergoing CABG. Further investigations addressing the timing of the appearance of PSM and the correlation of this finding with perfusion imaging studies may provide new details concerning the mechanisms that underlie this abnormality.

Coronary microvascular impairment may cause myocardial ischemia and systolic dysfunction in patients with idiopathic dilated cardiomyopathy (IDC).

Introduction: There are only a limited number of studies on the link between mild renal failure and coronary artery disease. The purpose of this study is to investigate the effects of mild renal failure on the distal vascular bed by measuring the coronary flow reserve (CFR) in transthoracic echocar-diography after coronary artery bypass grafting (CABG)Methods: The study included 52 consecutive patients (12 women and 40 men) who had undergone uncomplicated CABG. The patients were divided into 2 groups. Group 1 included patients with a preoperative glomerular filtra-tion rate (GFR) of 60-90 (mild renal failure), and group 2 included those with a GFR >90. The CFR measurements were carried out through a second harmonic transthoracic Doppler echocardiography.Results: The mean age was 60.08 ± 1.56 years in group 1 and 60.33 ± 1.19 in group 2. The mean preoperative CFR was 1.79 ± 0.06 in group 1 and 2.05 ± 0.09 in group 2. The mean postoperative CFR was 2.09 ± 0.08 in group 1 and 2.37 ± 0.06 in group 2. There was a statistically significant difference between the 2 groups as to preoperative creatinine clearance, preopera-tive estimated GFR, postoperative day 7 creatinine clearance, postoperative month 6 creatinine clearance, postoperative day 7 estimated GFR, postoperative month 6 estimated GFR, pre-operative CFR, and postoperative CFR (P < .05). After bypass surgery, there was a significant increase in the mean postopera-tive CFR, when compared with the mean preoperative CFR (P = .001).Conclusion: In our study, we detected a decrease in CFR in patients with mild renal failure. We believe that in patients undergoing CABG for coronary artery disease, mild renal failure can produce adverse effects due to deterioration of the microvascular bed.