Contrast-induced acute kidney injury (CI-AKI) is associated with increased mortality, morbidity, and prolonged hospitalization. Patients with acute coronary syndrome (ACS) have a 3-fold higher risk of developing CI-AKI. The aim of our study was to evaluate the predictors of CI-AKI and long-term prognosis in patients with ACS who developed CI-AKI (1083 patients were enrolled). Contrast-induced acute kidney injury was defined as an increase of ≥0.5 mg/dL and/or an increase of ≥25% of pre-percutaneous coronary intervention (PCI) to post-PCI serum creatinine levels within 48 to 72 hours after the procedure. Primary end point was defined as all-cause mortality, myocardial infarction, and cerebrovascular event at long-term follow-up (36 ± 12 months). Contrast-induced acute kidney injury occurred in 178 (16.4%) of the 1083 patients. The primary end points were significantly high in patients with ACS who developed CI-AKI ( P < .001). The occurrence of CI-AKI was identified as an independent predictor of primary end point. Risk of CI-AKI development was more frequently seen in patients with ACS. Also, patients who developed CI-AKI have worse prognosis at long-term follow-up. Additional preventive treatment strategies need to be developed in this group of patients.

Procalcitonin (PCT) is implicated as an inflammatory marker in early atherosclerosis. In order to investigate the clinical consequences of increased PCT levels in acute coronary syndrome (ACS), 77 patients (29 with non-ST-elevation myocardial infarction [MI], 34 with ST-elevation MI and 14 with unstable angina pectoris) were included and followed up for 6 months. The PCT levels were determined at initial presentation and within 48 h of admission. Five patients died during hospitalization and their PCT levels within 48 h of admission were significantly higher than survivors (n = 72) (0.588 +/- 0.56 versus 0.399 +/- 1.33 ng/ml, respectively). The PCT levels within 48 h post-admission in the nine patients who died within 6 months were also significantly higher compared with the survivors (0.451 +/- 0.44 versus 0.406 +/- 1.37 ng/ml, respectively). It is concluded that higher PCT levels within 48 h post-admission may reflect an inflammatory state that is associated with increased early and 6-month mortality.

This is the first report of CMHI. This issue should be suggested during assessment of patients with unexpected conduction abnormalities, because abandonment of honey intake results in prompt symptomatic and electrocardiographic improvement.

Myxomas are the most common benign tumors of the heart. This study presents single-institutional 22 years experience on cardiac myxomas. The records of 9756 consecutive cases of open heart surgery between 1985 and 2007 revealed 0.23% myxoma. Age ranged between 12 and 77 years and male to female ratio was 7:17. Myxomas originated from the left atrium (15 patients), mitral valve (3 patients), right atrium (2 patients), right atrium and right ventricle (2 patients), right ventricle (1 patient), and left ventricle (1 patient). Three patients were operated for multiple myxomas. Myxomas were resected through right atriotomy, right atriotomy and pulmonary arteriotomy, left atriotomy, biatrial approach, or left ventriculotomy depending on the tumor location. Mean follow-up time was 11.5 years. Mortality occurred in 6 patients (1 early, 5 late deaths). No myxoma recurrence was detected. Myxomas should be resected leaving no remnant mass, without delay when they are diagnosed.

SUMMARYThe Tei index is an echocardiographic index of combined systolic and diastolic function, calculated as isovolumetric relaxation time plus isovolumetric contraction time divided by ejection time. The aim of this study was to define the correlation of the Tei index with left ventricular dilatation and mortality in patients with acute myocardial infarction (AMI).A total of 77 patients (58 men, 19 women) with a mean age of 53 ± 12 years, who had presented with an AMI in our clinic between June 2001 and February 2002 were compared with a control group of 88 healthy subjects (63 men, 25 women) with a mean age of 55 ± 6 years. Echocardiographic evaluation was carried out within 24 hours and the third month of AMI, using a 3.5 MHz probe with pulse wave Doppler recordings by the adult cardiac mode of an Acuson C 256 echocardiograph.There were statistically significant differences between the 2 groups in all echocardiographic parameters, except mitral A wave. Thirteen patients died during the follow-up period of 3 months. The Tei index was significantly higher in the patients who died compared with those who survived (0.70 ± 0.10 versus 0.61 ± 0.10; P < 0.001). The patients who had heart failure after AMI had a mean Tei index value of 0.76 ± 0.27, whereas the patients who did not have heart failure after AMI had a significantly lower Tei index value of 0.60 ± 0.32 (P < 0.05). Patients were divided into 2 groups according to their Tei index. Patients with a > 0.60 Tei index had significantly higher end-systolic and enddiastolic volumes compared to patients with a < 0.60 Tei index (P < 0.001 for both) in the acute phase of AMI. Within 3 months, patients with a Tei index < 0.60 had a significant reduction in end-diastolic volumes (P < 0.01), whereas the end-diastolic volumes did not change significantly in patients with an index > 0.60 (P = 0.19).The Tei index is an important indicator of left ventricular dysfunction and death after AMI. A greater Tei index at the onset of AMI is associated with a higher incidence of subsequent cardiac death, CHF, and progressive LV remodeling. (Int Heart J 2006; 47: 331-342)

Our findings indicate that women with metabolic syndrome have a better antioxidant status and higher ApoA levels compared with men. Our findings suggest the existence of a higher oxidative stress index in men with metabolic syndrome. Considering the higher risk of atherosclerosis associated with men, these novel oxidative stress parameters may be valuable in the evaluation of patients with metabolic sydrome.

Recent trials have favoured ventricular rate control in atrial fibrillation (AF) management, however the present study investigated whether the restoration and maintenance of sinus rhythm with longterm anticoagulation therapy was superior in terms of embolic events and death in 534 patients with an AF duration > 48 h. Patients were randomized and received sinus rhythm control with either aspirin (group 1) or warfarin (group 2), or they were given ventricular rate control (group 3). Cardioversion to sinus rhythm was attempted in 425 patients and was successful in 387 (91.1%) of them. After 3 years' follow-up there were 12, two and 15 embolic events in groups 1, 2 and 3 respectively (significant difference between groups 1 and 2, and 2 and 3) and overall mortalities were four, two and 12, respectively (significant difference between groups 2 and 3). It is concluded that patients with an AF duration > 48 h might benefit considerably from sinus rhythm restoration and long-term warfarin therapy in terms of embolic events and mortality.

In concordance with these findings, the ejection fraction was slightly higher in Group A than in Group B, although this was not statistically significant (47% versus 44%). This trend continued during a 6-month follow-up after randomization. Our findings suggest that early administration of aldosterone blockers provides additional benefits after AMI, reducing the incidence of post-MI angina pectoris and rhythm and conduction disturbances.