BackgroundSince cardiovascular diseases are associated with high mortality and generally undiagnosed before the onset of clinical findings, there is a need for a reliable tool for early diagnosis. Carotid intima-media thickness (CIMT) is a non-invasive marker of coronary artery disease (CAD) and is widely used in practice as an inexpensive, reliable, and reproducible method. In the current study, we aimed to investigate prospectively the relationship of CIMT with the presence and extent of significant coronary artery narrowing in patients evaluated by coronary angiography for stable angina pectoris.MethodsOne hundred consecutive patients with stable angina pectoris and documented ischemia on a stress test were included in the study. The patients were divided into two groups according to the result of the coronary angiography: group 1 (39 patients) without a noncritical coronary lesion, and group 2 (61 patients) having at least one lesion more than 50% within the main branches of the coronary arteries. All of the patients underwent carotid Doppler ultrasound examination for measurement of the CIMT by a radiologist blinded to the angiographic data.ResultsThe mean CIMT was 0.78 ± 0.21 mm in Group 1, while it was 1.48 ± 0.28 mm in Group 2 (p = 0.001). The mean CIMT in patients with single vessel disease, multi-vessel disease, and left main coronary artery disease were significantly higher compared to Group 1 (1.2 ± 0.34 mm, p = 0.02; 1.6 ± 0.32 mm, p = 0.001; and 1.8 ± 0.31 mm, p = 0.0001, respectively). Logistic regression analysis identified CIMT (OR 4.3, p < 0.001) and hypertension (OR 2.4, p = 0.04) as the most important factors for predicting CAD.ConclusionsThe findings of this study show that increase in CIMT is associated with the presence and extent of CAD. In conclusion, we demonstrated the usefulness of carotid intima-media thickness in predicting coronary artery disease but large-scale studies are required to define its role in clinical practice.

Chronic kidney disease (CKD) is associated with increased risk of cardiovascular disease and death. We evaluated the association between CKD and severity of coronary artery stenosis by calculating SYNTAX Score in patients with left main coronary artery and/or 3-vessel coronary artery disease. Coronary angiograms of 217 patients were assessed. Chronic kidney disease was staged using the estimated glomerular filtration rate (eGFR, mL/min per 1.73 m(2)) prior to coronary angiography. Patients were divided into 5 groups according to the National Kidney Foundation Kidney Disease Outcome Quality Initiative (NKF KDOQI) Clinical Practice Guidelines (14). Patients with eGFR >90 mL/min per 1.73 m(2) (group 1), patients with eGFR 60 to 89 mL/min per 1.73 m(2) (group 2), patients with eGFR 30 to 59 mL/min per 1.73 m(2) (group 3), patients with eGFR >15 to < 30 per 1.73 m(2) and dialysis patients with eGFR < 15 per 1.73 m(2) were combined as group 4. The risk of significant lesion complexity increased progressively with decreasing kidney function (P = .001). Estimated glomerular filtration rate was a strong predictor of higher SYNTAX Score.

Among patients with eGFR between 30 and 60 mL min(-1) 1.73 m(-2) undergoing coronary angiography, oral administration of N-acetylcysteine + theophylline in addition to saline hydration has a beneficial effect in the prevention of CIN.

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.

Coronary artery disease (CAD) is the main cause of death in patients with chronic kidney disease (CKD). We investigated whether CKD stage affected coronary lesion morphology in patients with established CAD. Coronary angiograms of 264 patients were evaluated. Chronic kidney disease was staged using the estimated glomerular filtration rate (eGFR) from the serum creatinine prior to coronary angiography. Patients were divided into 3 groups: dialysis or severe decrease in GFR <30 mL/min per 1.73 m(2) (group 1; n = 60), patients with moderate kidney failure (group 2; n = 116), and patients with normal renal function or mild decrease in GFR (group 3; n = 88). The likelihood of CAD and lesion complexity increased with decreasing eGFR (P = .001). Patients with CKD also had more significant CAD. The risk of significant coronary obstruction and lesion complexity increased progressively with decreasing eGFR. The eGFR may predict lesion complexity among patients with CKD undergoing coronary angiography.

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.

trial fibrillation (AF) is the most frequent reason for hospital admission and is also the most common sustained cardiac arrhythmia, occurring in 0.4% of the adult population. 1,2 Its prevalence is age-related and increases significantly to 1-4% after 60 years of age. [1][2][3] Owing to the age structure of Turkey's population and the increasing morbidity and comorbidity, one must assume that this arrhythmia will reach an even higher prevalence. AF is associated with a significantly higher risk of systemic embolism, congestive heart failure and death. [1][2][3][4] AF and hypertension are 2 prevalent, and often coexisting, conditions in the adult population. 5-7 Their incidence increases with age, and they are responsible for considerable morbidity and mortality. 5,6 The purpose of the present study was to determine whether a strategy that attempts to restore and maintain sinus rhythm (SR) in AF will improve survival and exercise capacity among patients with hypertension. MethodsPatients aged >18 years who had hypertension and persistent AF for >48 h were included in the study. AF was defined as having: an absence of P-waves, course or fine fibrillatory waves, and completely irregular R-R intervals.The diagnosis of essential hypertension was defined as having BP >140/90 mmHg, or current use of antihyperten- Patients suffering from valvular heart diseases, coronary artery disease, heart failure, thyroid disease, renal failure, sick sinus syndrome, pulmonary embolism, acute pericarditis, diabetes mellitus, chronic obstructive lung disease, hypertrophic obstructive cardiomyopathy and atrial thrombus were excluded from the study.The patients were randomly assigned to either the rhythm control group or rate control group. The patients were kept under observation for a minumum follow-up period of 3 years, with regular weekly visits in the 1 st month and then once a month thereafter. The composite endpoints of the study were embolism, death and exercise capacity for both groups.At baseline, resting 12-lead ECG was obtained, and transthoracic echocardiography (TTE), transesophageal echocardiograph (TEE) and exercise tests were performed. At every control visit, a 12-lead ECG was taken. At the end of the 1 st year all patients underwent exercise testing.The TTE and TEE studies were performed with an Acuson 128 XP/5 ultrasound system. M-mode TTE was used to measure the left atrial dimension at end-systole and the LVEF, according to the recommendations of the American Society of Echocardiography. Food consumption was stopped at least 4 h before the TEE was done. Patients received local pharyngeal anesthesia (1% lidocaine spray) as the only premedication, and were given effective anticoagulation either with heparin or warfarin (INR levels 2.0-3.0 or APTT 2 times control, 60-80 s) before the TEE. Patients in whom the TEE did not detect any thrombus were cardioverted to SR. For cardioversion (CV), amiodarone (administered intravenously (iv)) was used (300 mg over 1 h, then 15-20 mg/kg for the remaining 23 h). If CV was not ach...

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.