Eosinophils are associated with thromboembolic events. Since eosinophils are eliminated in the pulmonary vasculature, right-to-left shunt (RLS) through patent foramen ovale may increase eosinophils in the peripheral blood. In this report, we evaluated the eosinophils of patients with regard to the presence of RLS and its quantity. In this retrospective observational study, we analyzed the complete blood cell count (CBC) of patients with RLS (n=47) and without RLS (n=31) diagnosed by contrast echocardiography (CE). RLS was identified as mild (5-10 bubbles) and moderate shunt (10-25 bubbles). Age and CBC were not significantly different between the groups, with the exception of eosinophils. Patients with RLS had higher eosinophils percentage compared to patients without RLS (3.1 ±1.5 vs. 1.7 ±0.7, p=0.001). Additionally, eosinophils percentage was significantly higher in the mild RLS group (2.4 ±0.9 vs. 1.7 ±0.7, p=0.016) and the moderate RLS group (4.3 ±1.6 vs. 1.7 ±0.7, p=0.001) compared to normal subjects. Also, it was significantly higher in the moderate RLS group compared to the mild group (4.3 ±1.6 vs. 2.4 ±0.9, p=0.001). Eosinophils percentage was higher in patients with mild and moderate RLS compared to normal individuals. Moreover, the eosinophil rate was higher in patients with moderate RLS than in patients with mild RLS.

Today, percutaneous coronary treatment and anticoagulation therapies are commonly used worldwide, which is why the incidence of reported left ventricular (LV) thrombus decreased. Despite modern methods, we still encounter thromboembolic complications resulting in morbidity and mortality in a large number of patients, especially after silent infarctions. Because of high embolism risk, early detection of LV thrombus is crucial. We present the rare and interesting case of a 34-year-old patient diagnosed with a large, fragmented, very mobile left ventricular apical thrombus after silent myocardial infarction due to total occlusion of left anterior descending coronary artery. '+st+' Tanaka D, Unai S, Diehl JT, Hirose H. Surgical removal of a large mobile left ventricular thrombus via left atriotomy. World Journal of Clinical Cases: WJCC. 2014;2(2):32. Wu JC, Solomon SD. Long-Term Consequences and Prognosis After Myocardial Infarction. Essential Echocardiography: A Companion to Braunwald's Heart Disease E-Book. 2018:204. Ates İ, Ulucan S, Kaya Z, Dogru M, Katlandur H, Keser A. Longitudinally Giant Left Ventricular Thrombus after Anterior Wall Myocardial Infarction. Acta Medica Anatolia. 2015;3(4). Domenicucci S, Chiarella F, Bellone P. Role of echocardiography in the assessment of left ventricular thrombus embolic potential after anterior acute myocardial infarction. Congestive Heart Failure. 2001;7(5):250-5. Chen C, Webster G, Morganroth J. Large mobile pedunculated left ventricular thrombus: Identification by two-dimensional echocardiography. Clinical Cardiology. 1981;4(4):189-92. Ye F, Silverstein BV, Khuddus MA, Bray CL, Lee AC. Giant Left Ventricular Thrombus in a Patient with Acute Ischemic Stroke: A Case Report and Minireview. Case Reports in Cardiology. 2018;2018. Nili M, Deviri E, Jortner R, Strasberg B, Levy MJ. Surgical removal of a mobile, pedunculated left ventricular thrombus: report of 4 cases. The Annals of Thoracic Surgery. 1988;46(4):396-400. Yalçın M, Katırcıoğlu EG, Yazman S, Tayfur KD, Ürkmez M. Troponin I levels before bypass surgery after acute myocardial infarction; When to operate? J Surg Med. 2018;2(3):228-32. Copyright (c) 2020 İbrahim Halil İnanç, Enes Alıç, Alper Karakuş This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Background: To evaluate the diagnostic utility of basal and post‐exercise QRS‐T angle in patients with stable coronary artery disease (CAD).Methods: This cross‐sectional and observational study analyzed 190 patients with stable angina. The QRS‐T angle is measured on the 12‐lead electrocardiograms at baseline and just after stopping the treadmill stress test in patients undergoing conventional coronary angiography (CAG). The pre‐ and post‐exercise QRS‐T angle and ΔQRS‐T angle were analyzed.Results: Of the 190 patients, 66 (34.7%) were assigned to group 1 (patients with coronary lesion) and 124 (65.3%) to group 2 (patients without coronary lesion) after CAG. There was no statistically significant difference in QRS‐T angle between groups at baseline (pre‐exercise) (30.7 ± 17 vs. 27.8 ± 12.8, p = .233). The QRS‐T angle value was significantly higher in group 1 than in group 2 (68.8 ± 40.3 vs. 22.7 ± 21.5, p = .01) after exercise (post‐exercise). The ΔQRS‐T angle was also significantly higher in group 1 than in group 2 (38.1 ± 37.6 vs. −5.1 ± 22.9, p = .01). Receiver operating characteristic curve revealed that the cut‐off value of QRS‐T angle (post‐exercise) for the coronary obstruction was >51.5° with 81% of sensitivity and 66% of specificity (AUC: 0.832, p = .001, CI: 0.769–0.894). Duke treadmill score for coronary stenosis was >1.5 with 77% of sensitivity and 69% of specificity (AUC: 0.814, p = .001, CI: 0.749–0.878).Conclusion: It could be proposed that post‐exercise QRS‐T angle and Δ QRS‐T angle are significantly associated with coronary obstruction in patients with stable angina and appear to be more sensitive than the Duke treadmill score and traditional electrocardiographic parameters.