Background and ObjectivesCoronary collateral circulation (CCC) has been attributed as inborn bypass mechanisms supporting ischemic myocardium. Various factors have been postulated in CCC. Whole blood viscosity (WBV) has been an underappreciated entity despite close relationships between multiple cardiovascular diseases. WBV can be calculated with a validated equation from hematocrit and total plasma protein levels for a low and high shear rate. On the grounds, we aimed to evaluate the association between WBV and CCC in patients with chronic total occlusion.Subjects and MethodsA total of 371 patients diagnosed as having at least one major, chronic total occluded coronary artery were included. 197 patients with good CCC (Rentrop 2 and 3) composed the patient group. The poor collateral group consisted of 174 patients (Rentrop grade 0 and 1).ResultsPatients with poor CCC had higher WBV values for a low-shear rate (LSR) (69.5±8.7 vs. 60.1±9.8, p<0.001) and high-shear rate (HSR) (17.0±2.0 vs. 16.4±1.8, p<0.001) than the good collateral group. Correlation analysis demonstrated a significant negative correlation between the grade of CCC and WBV for LSR (β=0.597, p<0.001) and HSR (β=0.494, p<0.001). WBV for LSR (β=0.476, p<0.001) and HSR (β=0.407, p<0.001) had a significant correlation with the synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) score. A multivariate analysis showed that the WBV for both shear rates were independent risk factors of poor CCC (WBV at LSR, OR: 1.362 CI 95%: 1.095-1.741 p<0.001 and WBV at HSR, 1.251 CI 95%: 1.180-1.347 p<0.001).ConclusionWBV has been demonstrated as the overlooked predictor of poor coronary collateralization. WBV seemed to be associated with microvascular perfusion and angiogenesis process impairing CCC development.
This study demonstrated that the successful AFCA might concurrently impair the ANS parameters. The autonomic imbalance between the sympathetic and parasympathetic activity after AFCA could either become antiarrhythmic and/or proarrhythmic based on which of the two components was going to prevail after successful AFCA. The impaired ANS balance after PVAI might also be another hypothetical mechanism for AF recurrence particularly in the absence of PV reconnection.
Ramadan interferes with circadian rhythms mainly by disturbing the routine patterns of feeding and smoking. The objective of this study was to investigate the circadian pattern of ST elevation acute myocardial infarction (STEMI) during the month of Ramadan. We studied consecutive STEMI patients 1 month before and after Ramadan (non-Ramadan group-NRG) and during Ramadan (Ramadan group-RG). The RG group was also divided into two groups, based on whether they chose to fast: fasting (FG) and non-fasting group (NFG). The time of STEMI onset was compared. A total of 742 consecutive STEMI patients were classified into 4 groups by 6 h intervals according to time-of-day at symptom onset. No consistent circadian variation in the onset of STEMI was observed both between the RG ( P = .938) and NRG ( P = .766) or between the FG ( P = .232) and NFG ( P = .523). When analyzed for subgroups of the study sample, neither smoking nor diabetes showed circadian rhythm. There was a trend towards a delay from symptom onset to hospital presentation, particularly at evening hours in the RG compared with the control group. In conclusion, there was no significant difference in STEMI onset time, but the time from symptom onset to hospital admission was significantly delayed during Ramadan.
The echocardiographic LVOT TVI and TAPSE values as functional parameters of left and right ventricular function change with body position, and these hemodynamic changes may explain why HF patients willingly adopt RLDSP.
Background: İn coronary artery disease, the positive contribution of the presence of coronary collateral circulation to the course of the disease is known. As for the factors that trigger the formation of collateral circulation and interactions at the cellular level, no satisfactory results have yet been reached. Studies on this issue will also pave the way for potential treatment opportunities in the future. The aim of this study is to try to determine the relationship between coronary collateral circulation and elabela and apelinergic system.Methods: This is a cross sectional study. Totally 150 subjects were included the study. Demographic data, laboratory test data, and comorbidities were collected from the hospital data. Welch, One Way Anova, Chi-Square, and Kruskal-Wallis H tests were used for comparison of the groups. Games-Howell, Tukey HSD, and Dunn tests were used for post-hoc analysis where necessary.Results: Evaluating the differences between the groups in terms of the parameters examined. Looking at which groups the differences arise from; it was observed that the statistically significant difference observed for elabela, HDL-C, NT-ProBNP, LVEF and HS-C-Reactive protein was between all groups separately.Conclusions: In this study, we aim to reveal a positive relationship between the development of coronary collateral vessels and apelinergic systems. Our results indicated that Elabela protein could be evaluated as a potential agent for treatment.
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