Background: Left ventricular (LV) rotation, twist, and torsion are important aspects of thecardiac performance. Myocardial fibrosis can be identified as the late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR). In this study, we investigated the associationbetween myocardial fibrosis and LV rotational parameters in patients with nonischemic dilated cardiomyopathy (NDC). Methods: Twenty-two NDC patients were enrolled. LV dimensions, volumes and ejection fraction (EF) were measured, conventional tissue Doppler imaging data was acquired. Speckletracking imaging was performed to measure LV deformation, LV rotational parameters. Bloodsamples were obtained for NT-proBNP. Late gadolinium enhanced cardiac magnetic resonance (LGE-CMR) was used to assess cardiac fibrosis index. Results: Myocardial deformation was similar between LGE+ and LGE– groups. LGE+patients have significantly higher basal and lower apical systolic rotation, lower twist andtorsion when compared to LGE– patients. However, untwisting rate was similar between thegroups. Torsion was significantly correlated with LVEF and MR-index. Patients with reversedapical systolic rotation had significantly greater NT-proBNP values, basal systolic rotation andsignificantly lower apical systolic rotation, torsion, and MR-index. Conclusions: Cardiac fibrosis index is closely related with myocardial torsion and LV systolicfunction and may be used for the evaluation of cardiac condition. Reversed apical systolicrotation indicated more extensive cardiac fibrosis as it may reflect severe LV dyssynchrony andpoor LV performance. Background: Left ventricular (LV) rotation, twist, and torsion are important aspects of thecardiac performance. Myocardial fibrosis can be identified as the late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR). In this study, we investigated the associationbetween myocardial fibrosis and LV rotational parameters in patients with nonischemic dilated cardiomyopathy (NDC). Methods: Twenty-two NDC patients were enrolled. LV dimensions, volumes and ejection fraction (EF) were measured, conventional tissue Doppler imaging data was acquired. Speckletracking imaging was performed to measure LV deformation, LV rotational parameters. Bloodsamples were obtained for NT-proBNP. Late gadolinium enhanced cardiac magnetic resonance (LGE-CMR) was used to assess cardiac fibrosis index. Results: Myocardial deformation was similar between LGE+ and LGE– groups. LGE+patients have significantly higher basal and lower apical systolic rotation, lower twist andtorsion when compared to LGE– patients. However, untwisting rate was similar between thegroups. Torsion was significantly correlated with LVEF and MR-index. Patients with reversedapical systolic rotation had significantly greater NT-proBNP values, basal systolic rotation andsignificantly lower apical systolic rotation, torsion, and MR-index. Conclusions: Cardiac fibrosis index is closely related with myocardial torsion and LV systolicfunction and may be used for the evaluation of cardiac condition. Reversed apical systolicrotation indicated more extensive cardiac fibrosis as it may reflect severe LV dyssynchrony andpoor LV performance.

Combination of dual antiplatelet therapy (DAPT) with glycoprotein (GP) IIb/IIIa inhibitors can increase bleeding risk. In this study, we aimed to investigate bleeding complications of different DAPTs with concomitant tirofiban use in patients with acute coronary syndrome (ACS). This retrospective study included 224 consecutive ACS patients (mean age 56.6±11.1 years, 193 men) who were given conventional dose of tirofiban (25 μg/kg per 3 minutes followed by an infusion of 0.15 μg/kg/min for 24 hours) in addition to DAPT (300 mg aspirin followed by 100 mg/day + 600 mg clopidogrel followed by 75 mg/day or 180 mg ticagrelor followed by 90 mg twice daily or 60 mg prasugrel followed by 10 mg/day). Any intra-hospital bleeding complications were noted. Of the 224 patients, 115 were given ticagrelor and 32 were given prasugrel. Mean hemoglobin fall was similar between the patients taking ticagrelor/prasugrel and those taking clopidogrel. Ten patients taking ticagrelor and one patient taking prasugrel had hemoglobin fall ≥3 g/dL versus two patients in clopidogrel group (p=0.228). Gastrointestinal bleeding (two patients taking ticagrelor), hematoma at access site (three patients taking ticagrelor), and cardiac tamponade (two patients taking ticagrelor) rates were also similar. Creatinine levels were associated with hemoglobin fall ≥3 g/dL (p=0.032, Odds ratio 2.189, 95% confidence interval 1.070–4.479). There was no relation between hemoglobin fall ≥3 g/dL and antiplatelet agent, age, sex, hypertension, or diabetes. Tirofiban may be given to patients receiving ticagrelor or prasugrel with a bleeding rate similar to clopidogrel. Close monitoring for bleeding risk is recommended, especially in patients with higher creatinine levels.

Multidetector row computed tomography (MDCT) is an attractive noninvasive imaging modality to detect coronary atherosclerotic plaques which may be underestimated by conventional angiography. However, its routine clinical use is limited due to contrast-associated problems, high cost, inapplicability at bedside and exposure to radiation. Thus, exploring safer and more practical measurements to predict occult coronary artery disease (CAD) is required. To demonstrate the predictive value of aortic elastic properties for occult CAD diagnosed by MDCT. Forty subjects with angiographically normal coronary arteries were consecutively included in our study. They underwent MDCT including indications and were divided into a no CAD group (23 subjects, 11 males, 46 ± 8 years) and an occult CAD group (17 subjects, 12 males, 48 ± 10 years), with respect to the presence of coronary plaque. As a control group, 19 consecutive patients with angiographically proven CAD (16 males, 52 ± 6 years) were included. Aortic stiffness index (ASI), aortic distensibility and aortic strain were calculated from the aortic diameters measured by echocardiography and blood pressure obtained by sphygmomanometry. It was found that ASI, aortic distensibility and aortic strain were significantly different in the occult CAD group compared to the no CAD group (p = 0.008, p = 0.01, p = 0.03, respectively) and to the evident CAD group (p = 0.01, p = 0.02, p = 0.02). They also differed significantly between the no CAD and the evident CAD groups. Receiver operating characteristics analysis for ASI, to distinguish between the occult CAD group and the no CAD group, revealed an area under the curve of 0.80 (confidence interval 0.68-0.94, p = 0.004) and that the cut-off value of 3.42 could significantly predict patients with occult CAD (sensitivity: 78%; specificity: 63%). Measurement of ASI is an easily applicable and safe method with its non-radiographic ability for the assessment of aortic stiffness, and it may be useful to predict subclinical atherosclerosis in clinical practice. A cut-off value of 3.42 for ASI may guide to refer individuals to preventive strategies to reduce atherosclerosis progression.

Anadolu Kardiyoloji Dergisi, Anadolu Kardiyol Derg, The Anatolian Journal of Cardiology, Anatol J Cardiol, Cardiology, Cardiovascular Medicine, Surgery, Pediatric Cardiology, Angiology