The β-thalassaemia mutations in the population of Cyprus

We have identified the beta-thalassaemia alleles in nearly all known Turkish Cypriot beta-thalassaemia homozygotes and in over 700 Greek Cypriot beta-thalassaemia heterozygotes living on the island of Cyprus. The data confirmed earlier observations that the IVS-I-100 (G-->A) mutation is present for about 74-80%, while three other alleles [IVS-II-745 (C-->G), IVS-I-6 (T-->C), IVS-I-1 (G-->A)] occur at frequencies of 5-8%. Nearly identical percentages were observed for the two Cypriot groups, quite different from those for beta-thalassaemia patients from Greece and Turkey. This suggests close contacts between the two Cypriot communities during many centuries without a major recent influence from Greek or Turkish beta-thalassaemia carriers.     

The association between thrombotic and inflammatory biomarkers and lower‐extremity peripheral artery disease

Lower‐extremity peripheral artery disease (LEAD) is associated with increased rates of mortality and morbidity. The aim of this study was to evaluate the associations among inflammatory and thrombotic markers and lower‐extremity peripheral disease. A total of 280 patients were enrolled in this study. Of these patients, 152 patients had LEAD on peripheral angiography that was performed because of suspected lower‐extremity peripheral disease based on history, physical examination, and non‐invasive tests. The control group consisted of 128 patients without LEAD on peripheral angiography. Patients with LEAD were classified according to trans‐atlantic inter‐society consensus (TASC) II classification. Subsequently, patients in TASC A to B were defined as having mild to moderate peripheral artery disease, and those in TASC C to D were defined as having advanced peripheral artery disease. Thrombotic and inflammatory markers, such as the neutrophil‐to‐lymphocyte ratio (NLR), the high‐sensitivity C (hs‐C) reactive protein level, the monocyte‐to‐high‐density lipoprotein‐cholesterol ratio, the fibrinogen to albumin ratio (FAR), and whole‐blood viscosity at high shear rate (HSR) and low shear rate (LSR), were evaluated in this population. The NLR, the monocyte‐to‐high‐density lipoprotein‐cholesterol ratio, the FAR, and whole‐blood viscosity, both at a LSR and a HSR, were significantly higher in patients with lower‐extremity peripheral disease compared with patients without lower‐extremity peripheral disease. We determined that lower‐extremity peripheral disease severity was correlated with the NLR, monocyte‐to‐high‐density lipoprotein‐cholesterol ratio, FAR, whole‐blood viscosity at LSR, and whole‐blood viscosity at HSR (r = 0.719, P = .004; r = 0.25, P = .008; r = 0.691, P = .002; r = 0.546, P < .001; and r = 0.448, P = .001, respectively). However hs‐C reactive protein levels were similar between patients with or without LEAD (2.47 ± 1.32 1.61 ± 0.91 P = .685). In addition, there was no correlation between the severity of LEAD and hs‐C reactive levels. In this study, we determined that the levels of inflammatory and thrombotic biomarkers are elevated in peripheral artery disease, and these levels predict disease severity.     

Altered coronary flow properties in diffuse coronary artery ectasia

Objectives The purpose of this study was to investigate coronary blood flow properties in patients with diffuse coronary artery ectasia (CAE) associated with exercise-induced myocardial ischemia.Methods Seventeen patients with diffuse CAE and without coexisting coronary artery stenosis were enrolled in the study (CAE group). CAE was defined as luminal dilatation 1.5 to 2 times that of the adjacent normal coronary artery segment or the diameter of the corresponding coronary artery of the control group when there was no normal segment. The age- and sex-matched control group (n = 20) comprised patients with normal epicardial coronary arteries. Coronary blood flow velocities were obtained invasively by use of Doppler scanning flow wire. Coronary flow reserve (CFR) was measured by administration of intracoronary papaverine as the hyperemic stimulus. Volumetric coronary blood flow was estimated by multiplying the velocity time integral of coronary blood flow with the cross-sectional area of the coronary artery and the heart rate.Results Fifteen patients with CAE, but none of the patients in the control group, had electrocardiographic signs of myocardial ischemia at peak exercise on ergometry. Baseline average peak velocities (APVs) of coronary blood flow were similar in the 2 groups. Peak hyperemic APVs of coronary blood flow were lower in the CAE group than in the control group (17.5 ± 7.4 cm/s vs 41.5 ± 12.6 cm/s, respectively, P < .001). Volumetric coronary blood flow was significantly higher in the CAE group than in the control group, both at rest and at hyperemia (146.3 ± 71.2 cm³/min vs 45.1 ± 16.1 cm³/min, respectively, P < .001, and 202 ± 87.3 cm³/min vs 104.1 ± 37.6 cm³/min, respectively, P < .003). The mean CFR of the CAE group was significantly reduced compared with that of the control group (1.51 ± 0.31 vs 2.67 ± 0.52, respectively, P < .001).Conclusions The CFR is significantly reduced in patients with diffuse CAE compared to a matched control group. Although volumetric coronary blood flow is significantly higher in CAE, microcirculatory dysfunction that is reflected as depressed CFR may be the underlying cause of exercise-induced myocardial ischemia. (Am Heart J 2003;145:66-72.)     

Hyperhomocysteinaemia and coronary artery disease in the Turkish population

OBJECTIVE: Many studies have demonstrated a strong association between elevated plasma total homocysteine (Hcy) levels and vascular disease. The objective of this study was to examine the relation between homocysteine levels and coronary artery disease in Turkish patients. METHODS AND RESULTS: In this study plasma homocysteine levels were measured in control and patient groups. A significant coronary artery lesion was defined as a stenosis of > or = 70% as shown by coronary angiography and determined by on-line quantitative measurements; treatment was by coronary angioplasty. Total plasma Hcy level was measured before the coronary intervention. Plasma homocysteine levels were measured by an HPLC method in patients with a definite diagnosis of coronary artery disease and compared with age- and sex-matched controls. Patients with coronary artery disease had significantly higher mean homocysteine concentrations than control subjects (geometric mean +/- 95% CI: 12.5 +/- 1.1 micromol/l vs. 8.60 +/- 1.07 micromol/l, p<0.001). Eighty-three (59%) members of the patient group and 14 (21%) members of the control group had plasma homocysteine concentrations above the 11.3 micromol/l, which represents the concentration which includes the uppermost quintile of the control group distribution (odds ratio 4.35, 95% CI; 2.1-8.94). CONCLUSION: Results of this study indicate that high plasma levels of homocysteine in Turkish subjects are associated with coronary artery disease. Our data suggest that focusing public health initiatives on this issue may reduce the high prevalence of cardiovascular disease in the Turkish population.     

Coronary artery aneurysm formation after balloon angioplasty and stent implantation.

This study describes coronary angiographic and intravascular ultrasound evaluation of late coronary artery aneurysms after percutaneous balloon angioplasty and bailout stent implantation. Intravascular ultrasound distinguishes true aneurysms from pseudoaneurysms. The discussion is focused on the etiology and prognosis of this rare complication.     

Association between the severity of heart failure and the susceptibility of myocytes to apoptosis in patients with idiopathic dilated cardiomyopathy

BACKGROUND: Bcl-2 proto-oncogene, an inhibitor of apoptosis and Bax proto-oncogene, an inducer of apoptosis play critical roles in the molecular circuit controlling apoptosis in cardiac muscle. The ratio of Bax to Bcl-2 proto-oncogene determines survival or death after an apoptotic stimulus. We speculated that susceptibility of myocytes to apoptosis determined as the Bax/Bcl-2 ratio might vary with the severity of heart failure. METHODS AND RESULTS: We studied immunohistochemically 108 endomyocardial biopsy specimens from 30 patients with idiopathic dilated cardiomyopathy (mild heart failure, n=14; moderate or severe heart failure, n=16) with the use of Bcl-2 and Bax monoclonal antibodies. The expression of each protein was determined semiquantitatively as the fraction of myocytes labeled with specific monoclonal antibodies using a digital morphometric analysis system. Patients with mild heart failure showed significantly increased Bax/Bcl-2 ratio than the patients with advanced heart failure (1.59+/-1.26 vs. 0.34+/-0.43, P=0.002). The expression of Bcl-2 was found to be independent of the severity of heart failure whereas the expression of Bax was significantly higher in patients with mild heart failure compared to the patients with moderate or severe heart failure (52.1+/-29.3 vs. 21.6+/-22.4%, P=0.005). Additionally, Bax/Bac-2 ratio was inversely correlated with the mitral E-interventricular septum distance, left ventricular end-systolic and end-diastolic diameter. CONCLUSION: The susceptibility of myocytes to apoptosis is significantly increased in the early phase of heart failure but it decreases with worsening of the disease due to depressed expression of Bax onco-protein. Increased myocyte susceptibility to apoptosis may have a role in the transition from mild heart failure to severe in patients with idiopathic dilated cardiomyopathy.     

False-positive results obtained with stress myocardial SPECT in patients with right bundle branch block

PURPOSE: Right bundle branch block (RBBB) is a conduction defect that often is accompanied by nonspecific patient symptoms. The objective of this study was to evaluate the false-positive results obtained with TI-201 myocardial SPECT in patients with RBBB. METHODS: Thirty-one patients (24 men, 7 women; age range, 35 to 78 years; mean age, 39 +/- 14 years) had nonspecific chest pain and electrocardiograph-proved RBBB, normal results of echography, and normal results of coronary angiography. None of them had a previous history or evidence of myocardial infarction. All patients underwent stress-rest TI-201 myocardial SPECT; 24 had normal images but 7 showed hypoperfusion in the inferolateral segments, both visually and quantitatively. RESULTS: TI-201 myocardial perfusion scintigraphs must be evaluated carefully in RBBB because false-positive results are likely to occur as a result of functional changes produced by dissynchronous activation between the ventricles.     

Angiographic restenosis in ephesos coronary stents: experience from a large medical center in Ankara, Turkey

Coronary stent restenosis, which emerges in late periods after implantation, has not been completely abolished. Our aim was to investigate the restenosis rates of Ephesos coronary stents. In all, 96 patients (66 men) with 135 Ephesos coronary stents were included. Control angiograms were performed after 160 +/- 60 days. Quantitative coronary analysis was performed during the procedure and control angiogram. The stents were divided into 2 groups according to the presence or absence of restenosis. Groups were compared with clinical and angiographic variables. Restenosis was observed in 31 (23%) of 135 stents. Preprocedure percent diameter stenosis was higher (P = .02), whereas minimum lumen diameter ( P = .02), mean age (P < .001), and hypertension incidence ( P = .043) was less, and there was a trend toward smaller stent size ( P = .054) in the restenosis group. By multivariate analysis, age <50 years (P < .001) and stent size <3.0 mm (P = .016) were independent predictors of restenosis. Ephesos coronary stents seems to have acceptable restenosis rates.     

Angiographic and clinical follow-up after coronary implantation of the ACS Multilink Duet stent: a single center experience.

As a growing variety of coronary stents become available on the market and the results of randomised trials may be difficult to apply to less selected patients, detailed information about the immediate and long term results achieved with one device can be helpful for the interventional cardiologist. The purpose of the present study was to test the applicability, angiographic and clinical results of the ACS Multilink Duet coronary stent in a relatively unselected group of patients undergoing coronary angioplasty immediately and in the long term. From November 1998 to May 2000, 337 ACS Multilink Duet coronary stents were implanted in 285 patients in our clinic. Data were collected retrospectively from the catheterization laboratory records and patient charts. Restenotic lesions and chronic total occlusion stenting were excluded from analysis (45 patients and 60 stents were excluded leaving 240 patients, 262 lesions and 277 stents for analysis). In 3 cases (1%) the ACS Multilink Duet stent did not cross the lesion and another device was used. One patient (0.4%) died due to acute occlusion of the proximal left anterior descending artery and cardiogenic shock within 4 hours after the procedure. Three patients (1.25%) had subacute thrombosis and q wave myocardial infarction during the hospital course, while four additional patients, out of 197, in whom one month clinical data were available had myocardial infarction (2 q waves and 2 non-q waves) after hospital discharge in the first month (2.03%). After 6 months from the procedure angiographic follow-up data were available for 108 patients (45%), 111 lesions (42.4%) and 117 stents (40.4%). They had complex lesions, B2-C type accounting for 42.3% of the cohort, and lesions requiring 2.5 mm diameter stents were also included and constituted 11.1% of the study cohort. Restenosis occurred in 24 patients (21.4%) and in 25 stents (22.2%). Comparing the patients with and without restenosis, diabetes mellitus and complex lesion morphology (B2-C) were found to be more frequent in the restenosis group (p<0.01, p<0.01). Lesions suitable to stent with a stent diameter of 3.5 mm or more had less restenosis with respect to smaller diameters (p=0.022). For a single stent diameter restenosis rates, regarding the stent length were 14.2% for 8 mm and 13 mm, 18.6% for 18 mm, and 37.5% for 23 mm and 28 mm (p=not significant). The Multilink Duet stent, in a cohort of relatively unselected patients, has a high rate of applicability, an acceptable rate of subacute occlusion, and a low rate of restenosis.