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Biomedical subjects

Yesim Guray

Publications and source records attributed to Yesim Guray.

At least 19 recordsLinked to original sources
PubMed2006

Fine vs. coarse atrial fibrillation: which one is more risky?

BACKGROUND: Atrial fibrillation (AF) is a frequent arrhythmia, associated with morbidity and mortality. It is identified by two types on surface electrocardiogram as fine and coarse AF. We aimed to search the association of subtypes of AF with clinical parameters. METHODS: Eight hundred and eleven consecutive patients, who had AF attack which lasted longer than 24 h or more, were evaluated along with clinical and laboratory data. RESULTS: Coarse AF was noticed in 51.7% (n = 419), and fine AF in 48.3% (n = 392). Sex was associated with subtype of AF such that coarse AF was present in 46.5% of male patients, but in 56.1% of female patients (p = 0.009). Coarse AF was present in 85.3% of patients with mitral stenosis, whereas it was present in 35.3% of patients with normal heart valve (p < 0.001). ). Patients having fine AF were significantly older than those having coarse AF (64 +/- 12, 57 +/- 13 years, p < 0.001). 19.6% of those with coarse AF had history of cerebrovascular event (CVE), whereas 13.5% of those with fine AF had history of CVE (p = 0.021). After controlling for age in the multivariable logistic regression analysis, presence of coarse AF (B = 1.585, p = 0.031) was found to be independently associated with the history of CVE. CONCLUSION: AF is identified by two morphological forms on the surface electrocardiogram. These two forms were found to be associated with different clinical parameters, acting on vascular endpoints differently.

Aged↗
PubMed2006

Ventricular septal defect and Swyer-James (Macleod's) syndrome together: a case report.

Swyer-James (MacLeod's) syndrome is a rare entity that is characterized by the hyperlucent appearance of one or more lobes of one lung, diminished ipsilateral hilar shadow and hardly visible arterial structure on chest radiography. Ventricular septal defect is the most common childhood congenital heart defect and, if left untreated, this will result to irreversible pulmonary hypertension, reversing of the shunt and Eisenmenger's syndrome. In this case report, we describe a 19-year-old female patient who had diagnosis of VSD and Swyer-James syndrome at the same time.

Adult↗
PubMed2006

Atrial natriuretic peptide predicts impaired atrial remodeling and occurrence of late postoperative atrial fibrillation after surgery for symptomatic aortic stenosis.

BACKGROUND: Aortic stenosis (AS) and atrial fibrillation (AF) are commonly encountered in clinical practice. Natriuretic peptides (NP) are endogenous cardiac hormones, which have been shown to increase in patients with heart failure, and valvular or congenital heart disease. We aimed to determine the association between atrial NP (ANP) and late postoperative AF after surgery for AS along with temporal changes in plasma ANP levels and left atrial (LA) volumes. METHODS: 22 patients (16 males/6 females, mean age: 61 years) with symptomatic AS and 8 healthy volunteers (5 males/3 females) were enrolled into our study. All the patients studied underwent transthoracic echocardiography, which was repeated during the follow-up. N-terminal ANP (N-ANP) was studied initially and at the 2-month follow-up. Postoperatively, the patients were followed up for 12 months for AF attacks. RESULTS: Patients with AS had significantly higher levels of N-ANP, left ventricular (LV) end-diastolic pressure, E/A ratio, LV mass and LA volumes compared to the controls. Patients with postoperative AF attacks were significantly older, had higher N-ANP levels and LV end-diastolic pressure in addition to higher LA volumes and longer symptom duration compared to patients without AF. Age at the time of operation (p = 0.011) and N-ANP at the 2nd month (p = 0.047) were found to be independent predictors for late AF attacks during follow-up in regression analysis. Besides, N-ANP (p < 0.001) at the 2-month follow-up independently predicted impaired LA remodeling. CONCLUSION: ANP might be an important factor to identify AS patients at risk for late postoperative AF attacks.

Aortic Valve Stenosis↗
PubMed2006

Relation of coronary collateral vessel development in patients with a totally occluded right coronary artery to the metabolic syndrome.

Development of coronary collaterals (CCs) is triggered by the gradient between arteries due to obstruction and myocardial ischemia. Presence of CCs that feed the jeopardized myocardial area may limit the infarct size after coronary occlusion and may even provide a survival benefit. However, some patients develop good CCs, whereas others do not. The metabolic syndrome (MS) has been identified as a secondary target to decrease cardiovascular risk, although the effect of MS on development of CCs has not been investigated. We prospectively enrolled 596 consecutive patients (337 men and 259 women; mean age 56 +/- 8 years) who underwent coronary angiography at our center and were found to have total occlusion of the right coronary artery. Patients were then classified as having good CCs (Rentrop's grades 2 to 3) or poor CCs (Rentrop's grades 0 to 1). There were significant differences in terms of body mass index (kilograms of body weight divided by square meters of height), glucose levels, triglyceride levels, and years with angina pectoris between those with good and poor CCs. Prevalences of diabetes mellitus were 27.1% among patients with good CCs and 44% among those with poor CCs (p <0.001). Presence of MS was significantly higher in patients with poor CCs than in those with good CCs (78.4% vs 49.2%, p <0.001). In regression analysis, duration of angina pectoris (beta = 0.347, 95% confidence interval [CI] 0.266 to 0.453, p <0.001), presence of diabetes mellitus (beta = 1.829, 95% CI 1.021 to 3.279, p = 0.042), wall score (beta = 2.379, 95% CI 1.356 to 4.173, p = 0.003), and presence of MS (beta = 2.993, 95% CI 1.541 to 5.813, p = 0.001) were independent predictors of angiographically determined poor CCs. In conclusion, MS seems to be independently associated with poor CCs in patients with an occluded right coronary artery.

Aged↗
PubMed2006

Differential diagnosis and management of acute profound thrombocytopenia by tirofiban: a case report.

Although the glycoprotein IIb/IIIa receptor inhibitors have improved outcomes of patients with acute coronary syndrome (ACS), therapy with these agents may cause thrombocytopenia with bleeding complications. This adverse effect is seemed to be rare with tirofiban. In this report, we describe a case of acute profound thrombocytopenia within two hours of tirofiban administration and review the differential diagnosis and the management of thrombocytopenia.

Acute Disease↗
PubMed2006

Metabolic syndrome negatively impacts early patency of saphenous vein grafts.

BACKGROUND: Coronary artery bypass grafting has been performed for a long period utilizing saphenous vein grafts, the fate of which might be crucial to prognosis following the operation. Metabolic syndrome, on the other hand, has become an increasingly important part of cardiovascular practice. We examined whether there was any negative effect of metabolic syndrome on saphenous vein graft patency in a relatively short term (< or =5 years). METHODS: Coronary angiograms of 314 consecutive patients (mean age 62.6+/-8.5 years), having at least one saphenous vein bypass graft within the last 5 years, were evaluated. RESULTS: One hundred and twenty-one patients (group 1) had either an occluded saphenous vein graft or a saphenous vein graft with a significant lesion, and 193 patients (group 2) had patent saphenous vein grafts. Metabolic syndrome was present in 46.2% of all patients (n=145), in 57% of patients in group 1 and in 39.4% of patients in group 2 (P=0.002). Having metabolic syndrome increased the risk of saphenous vein graft occlusion or having a significant lesion on saphenous vein grafts by 2.04-folds. In multivariable logistic regression, smoking (P=0.015, odds ratio=1.88), metabolic syndrome (P=0.019, odds ratio=1.81) and diabetes mellitus (P=0.048, odds ratio=1.36) were found to be associated with poor venous graft fate in the relatively short-term period after bypass. CONCLUSION: Metabolic syndrome seems to impact saphenous vein graft patency negatively in the relatively short term.

Coronary Angiography↗
PubMed2006

Metabolic syndrome increases the risk of significant coronary artery involvement in patients with peripheral artery disease.

BACKGROUND: Peripheral artery disease is a common condition, mainly associated with clinical cardiovascular risk factors. Patients with peripheral artery disease suffer from coronary artery disease-related complications. On the other hand, metabolic syndrome, as a constellation of specific risk factors, represents a risk factor for cardiovascular mortality. Metabolic syndrome might increase the risk of significant coronary artery disease in patients with peripheral artery disease. We aimed to examine the association of metabolic syndrome with the angiographically shown coronary artery involvement in patients with peripheral artery disease. METHODS: Two hundred and forty-seven patients with peripheral artery disease (mean age 60+/-9.5 years, 223 men/24 women), who were referred to coronary angiography, were evaluated. The resting ankle-brachial pressure index was measured with the patient in supine position. Patients with >70% diameter stenosis were considered to have significant coronary artery disease. RESULTS: In all, there were 223 male/24 female patients with mean ankle-brachial pressure index of 0.7+/-0.2, and mean age of 60+/-9.5 years. Metabolic syndrome was present in 53% (n=131) of all patients. Significant coronary artery disease was more frequently encountered in patients with peripheral artery disease and metabolic syndrome than in those without metabolic syndrome (73.3 vs. 40.5%, P<0.001). The presence of metabolic syndrome increased the risk of having significant coronary artery disease in patients with peripheral artery disease by 4.027 fold. Lower ankle-brachial pressure index (P=0.038, B=2.567), older age (P<0.001, B=1.075), presence of metabolic syndrome (P=0.015, B=2.247), and presence of diabetes mellitus (P<0.001, B=1.293) were found to be independent predictors of significant coronary artery disease in patients with peripheral artery disease in multivariable regression. CONCLUSION: Metabolic syndrome seems to increase the risk of significant coronary artery disease in patients with peripheral artery disease.

Chi-Square Distribution↗
PubMed2005

Association of lipid profile with echocardiographic Wilkins score in patients with moderate to severe mitral stenosis: possible impact on prognosis.

BACKGROUND: Association of valvular heart disease and lipid profile might be important as in the case of aortic stenosis. However, it has not been so far considered in detail the probable association of other valvular diseases, particularly of mitral stenosis (MS) with lipid profile. In our study, we aimed to search possible association of echocardiographic mitral valve score, evaluated according to Wilkins score, with lipid parameters in a group of patients with mitral stenosis, who were referred for possible percutaneous balloon valvuloplasty. MATERIAL AND METHOD: We retrospectively reviewed 401 patients (316 female, 85 male), who were referred as possible candidates for PMBV, with moderate to severe MS of predominantly rheumatic origin. Mitral valve was evaluated according to Wilkins score by an experienced author as indicated. RESULTS: Mean age of all patients was 36.6+/-11.3 years, and was not different in both genders. Mean mitral valve area was 1+/-0.1 mm2. Considering all patients, total Wilkins score was significantly, but mildly correlated with ratio of total/HDL cholesterol ratio (r=0.174, p=0.02). Presence of more than one recurrent attack of rheumatic fever, narrow mitral valve area, high total/HDL cholesterol and being male were independent predictors of poor echocardiographic Wilkins score (>8). CONCLUSION: We think that Wilkins echocardiographic score of mitral stenosis, particularly of leaflet thickening, might well be associated with serum lipids, probably as the same extent does aortic stenosis.

Adult↗
PubMed2005

The effects of mobile phones on pacemaker function.

OBJECTIVES: The electromagnetic field generated by different systems have well-recognized adverse effects on pacemaker functions. The aim of this study is to evaluate the adverse effects of mobile phones on pacemaker functions. METHODS AND RESULTS: A total of 679 patients with permanent pacemakers were enrolled in this study. The study was performed in two steps. Pacemaker lead polarity was unipolar in the first step and bipolar in the second step. Pacemaker sensitivity was first at nominal values, it was then reduced to the minimal value for that pacemaker and tested again. Two mobile phones were symmetrically located on both sides of the pacemaker pocket with the antennas being equidistant at 50, 30, 20 and 10 cm and in close contact with the pocket. The tests were performed when both mobiles were opened, on stand-by, were receiving a call, during the call and were closed. Thirty-seven patients with pacemakers were adversely affected (5.5%) (33 VVI-R pacemakers were converted to asynchronous mode, and 3 were inhibited, 1 DDD-R pacemaker developed ventricular triggering). When the lead polarity was unipolar, the rate of adverse effect was higher when compared to the bipolar state (4.12% and 1.40%, p<0.01). The increase in sensitivity was not an independent factor on the rate of being affected (p>0.05). The rate of observing an adverse effect increased as the pacemaker got older (p<0.05). CONCLUSIONS: Mobile phones might have adverse effects on pacemaker functions under certain conditions. This does not result in any symptoms other than the inhibition of pacemakers, and pacemaker functions return to normal when the mobile phones are removed away from the patient.

Aged↗
PubMed2005

Late saphenous vein graft occlusion in patients with coronary bypass: possible role of aspirin resistance.

BACKGROUND: Late venous graft thrombosis, leading to recurrent ischemia, is frequently encountered in old, degenerated vein grafts with advanced atherosclerotic plaque formation. Aspirin has been indicated to maintain venous graft patency in the post-operative period. However, there is considerable evidence that aspirin resistance is of concern in patients with venous grafts. MATERIAL AND METHOD: Prospectively enrolled 14 patients (11 male, 3 female, Group 1), who were shown to have at least one occluded saphenous vein graft on their late control coronary angiogram after bypass operation, were compared for the presence of aspirin resistance by PFA-100 with age- and sex-matched 14 patients (10 male, 4 female, Group 2), who were found patent and well-functioning vein grafts without wall irregularities on late post-operative coronary angiograms (mean 6.5+/-2.5 years), enrolled as a control group. RESULTS: Mean CT of collagen/epinephrine cartridge in Group 1 was 197+/-85 s and significantly less than in Group 2 (279+/-44 s; p=0.011). It was found that 50% of patients in Group 1 were so-called aspirin resistant, whereas in Group 2, this ratio was 7.1% (p=0.033). BMI (p=0.038, Beta=-0.322), uric acid level (p=0.023, Beta=-0.355), and CT by collagen/epinephrine cartridge (p=0.008, Beta=0.431) were independently predicting late occlusion of saphenous vein graft. CONCLUSION: Aspirin resistance is highly prevalent in patients with occluded venous grafts at a relatively late period.

Aged↗
PubMed2005

Aortic pulse pressure and aortic pulsatility are associated with angiographic coronary artery disease in women.

BACKGROUND: Studies indicated that both aortic pulse pressure (PP) and aortic pulsatility are independently associated with angiographic coronary artery disease (CAD). However, most of these studies included a majority of male subjects, and women were underrepresented. OBJECTIVE: We investigated the relation of aortic PP and aortic pulsatility derived from invasively measured ascending aortic pressure waveform and presence of angiographic CAD in women undergoing diagnostic coronary angiography. METHODS AND RESULTS: From September 2003 to April 2004, 262 unselected female subjects undergoing first cardiac catheterization were consecutively included in the study. Systolic, diastolic and mean pressure waveforms of the ascending aorta were measured during cardiac catheterization with a fluid-filled system. Aortic pulsatility was estimated as the ratio of aortic PP to mean pressure. Angiographic CAD was detected in 175 (67%) patients. In multiple-adjusted logistic regression, both aortic PP and aortic pulsatility were significantly associated with the presence of CAD (for a 10-mmHg increase in PP: odds ratio [OR] = 1.3, 95% confidence interval [CI] = 1.1-1.76; for a 0.1 increase in aortic pulsatility: OR = 1.8, 95% CI = 1.3-2.4). When patients were divided into tertiles according to the level of aortic pulsatility, it was noted that multiple-adjusted OR of presence CAD was 2.2 (95% CI = 1.1-4.4) for the middle tertile of the aortic pulsatility level and 5.9 (95% CI = 2.7-12.8) for the highest tertile of the aortic pulsatility level compared with the lowest tertile. CONCLUSION: In female subjects referred to coronary angiography, ascending aorta PP and aortic pulsatility are significantly associated with the presence of angiographic CAD and these associations are independent of age and other cardiovascular risk factors.

Aged↗
PubMed2005

Metabolic syndrome is associated with extension of coronary artery disease in patients with non-ST segment elevation acute coronary syndromes.

BACKGROUND: Metabolic syndrome (MS) comprises a group of factors that are associated with increased risk for cardiovascular events. Acute coronary syndromes account for the most important part of cardiovascular events with considerable morbidity and mortality. We aimed to investigate the association of MS with extension of coronary artery disease in patients presenting with non-ST segment elevation (NSTE) acute coronary syndromes (ACS). METHODS: Three hundred and six consecutive patients (220 men, 86 women patients) with the diagnosis of NSTE ACS, who were hospitalized within the first 24 h of their chest pain in the coronary care unit, were prospectively enrolled into our study. Patients with elevation of troponins (T or I) were classified as NSTE myocardial infarction (MI) and otherwise as unstable angina pectoris (USAP). Components of MS were noted as previously identified. Coronary angiograms were evaluated by two authors, who were blinded to the study plan and each other, via Sullivan's method. RESULTS: MS was noted in 49% of all patients, and was significantly more common in women than in men (62.8 versus 43.6%, P=0.003). The mean total stenosis score of patients with MS was significantly higher than for those without MS (16+/-6 versus 12+/-5, P<0.001), and the mean extension score of patients with MS was significantly higher than for those without MS (63+/-29 versus 44+/-26, P<0.001). The presence of MS together with some clinical factors and poor total cholesterol/high-density lipoprotein cholesterol ratio, hypertension and diabetes mellitus, was found to be independently predictive of extension of coronary artery disease (CAD) in a group of patients presenting with NSTE ACS. CONCLUSIONS: MS is independently associated with CAD extension, and hence, might account for poor cardiovascular outcomes through CAD extension in patients with NSTE ACS.

Acute Disease↗
PubMed2004

Level of awareness of on-treatment patients about prescribed statins.

BACKGROUND: Statins are frequently prescribed drugs for patients with coronary heart disease according to evidence-based medicine. However, compliance with these agents has still been far from ideal, since they require long term, probably life long therapy. We conducted a survey on patients who were already on statin treatment and evaluated their level of awareness of prescribed statins. METHODS: 236 participants (117 male, 119 female), who had been on treatment with statins for at least three months, were enrolled in our study after giving informed consent. Patients were asked close-ended survey questions. RESULTS: Only 5.5% of participants were on statin treatment for primary prevention, and 16.1% of them had a CHD equivalent, defined as those with clinical manifestations of noncoronary forms of atherosclerotic disease (peripheral arterial disease, abdominal aortic aneurysm, carotid artery disease) and diabetes mellitus. Most participants (70%) stated that they had been using statins to decrease cholesterol, whereas 16.5% stated that they had no idea. More than half of the participants (58%) stated that they did not know how long they would have to keep using their statins, whereas 21% replied that they would use them continuously. One fifth of participants had some idea about side effects. Participants in whom statin therapy was started during hospitalisation for coronary angiography and/or PCI more frequently answered that statins should be used continuously (49% vs. 12% not hospitalised, p < 0.01). Also, therapy adjustment by the physician led to a better understanding of the need for continuous use (55% vs. 31% without medication change, p < 0.001), as was the case for patients with < 2 co-medications (36% vs. 17% with > 2 co-medications, p 0.002). Presence of other risk factors did not have any impact on level of awareness. CONCLUSION: Comprehensive information at initial prescription, initiation of statins during hospitalization, dose adjustment during follow up, and as little co-medication as possible seem to increase the level of awareness of the benefits of long-term statin treatment. This might result in better compliance rates.

Adult↗
PubMed2004

Lipid profile of patients with aortic stenosis might be predictive of rate of progression.

BACKGROUND: Aortic stenosis is one of the most commonly encountered valvular pathology requiring surgery in developed countries. There are similarities between risk factors for coronary atherosclerosis and the development of aortic stenosis. We designed a retrospective study, evaluated the lipid profile and previous echocardiographic recordings of patients with aortic stenosis, and searched the association of rate of progression and lipid profile. METHODS AND RESULTS: The annual rates of progression in the peak and mean aortic gradients were 8.5 +/- 3.2 and 6.7 +/- 2.2 mm Hg/year, respectively. We classified the annual rate of progression of peak aortic gradient into 2 groups, group 1 with <10 mm Hg ("slow progressors") and group 2 with > or =10 mm Hg annual rate of progression ("fast progressors"). The annual rate of progression in group 1 was significantly higher than that in group 2, both in peak and mean aortic gradients (12 +/- 2 mm Hg and 6.4 +/- 1.6 mm Hg; 9 +/- 1.3 mm Hg and 5.2 +/- 1.1 mmHg; P <.001 for both). There was a highly significant difference between group 1 and group 2 for total cholesterol/high-density lipoprotein (HDL) cholesterol level ratio (7.1 +/- 1.4 vs 5.2 +/- 1.3, P <.001). There was a significant correlation between annual rate of progression in peak gradient and total cholesterol/HDL cholesterol level ratio (r = 0.399, P =.009). Smoking (P =.024, Beta = 0.26), presence of coronary heart disease (P =.011, Beta = 0.31), and total cholesterol/HDL cholesterol level ratio (P =.004, Beta = 1.98) were independently predictive of fast progression of the peak aortic gradient in the regression analysis. CONCLUSION: In a small group of patients from Turkey with aortic stenosis, there seems to be an association between the rate of progression and total cholesterol/HDL cholesterol level ratio, with fast progression occurring in the group with higher ratios.

Aged↗
PubMed2004

Fistulous connection between internal mammary graft and pulmonary vasculature after coronary artery bypass grafting: a rare cause of continuous murmur.

A 58-year-old male who had undergone coronary artery bypass grafting (CABG) using left internal mammary artery and a sequential saphenous vein graft 2 years ago presented with new onset angina. His initial physical examination revealed an unexpected continuous murmur over the left sternal border, and two-dimensional echocardiography has failed to identy the cause. Cardiac catheterization then performed and revealed patent left internal mammary artery and saphenous vein grafts. Besides, selective injection of the left internal mammary artery graft also showed a fistula formation between left internal mammary artery graft and pulmonary vasculature of the left upper lobe. He was managed conservatively because of the severely diseased left anterior descending artery distal to internal mammary artery anastomosis and low pulmonary artery pressure. The development of fistulous connection between internal mammary artery and pulmonary vasculature is an extremely rare complication following CABG. Patients with such fistulae usually present with chest pain due to coronary steal syndrome. A new heart sound, especially a continuous murmur, may be detected during physical examination. Surgical correction is indicated in the event of refractory angina, growing fistula causing heart failure or endarteritis. Otherwise, a conservative approach with instruction of the patient for prophylactic precautions of subacute bacterial endocarditis may be recommended for asymptomatic patients.

Angina Pectoris↗
PubMed2004

Mean platelet volume and exercise stress test.

BACKGROUND: Long-term moderate or strenuous physical activity is associated with a considerable reduction in cardiovascular morbidity and mortality. However acute exercise leads to a transient activation of the thrombotic system. Healthy individuals can react this by increasing their fibrinolytic capacity acutely. However, patients with ischemic heart disease, lacking fibrinolytic potential, may be at considerable risk for acute ischemic events if exposed to heavy physical exertion. Platelet size has been shown to reflect platelet activity. The mean platelet volume (MPV) can reflect changes in either the level of platelet stimulation or rate of platelet production. DESIGN AND METHODS: We evaluated Treadmill exercise test (TMET) and compared MPV values (fl) before and after TMET in 63 consecutive patients who, then, underwent coronary angiography and found to have significant coronary artery disease in more than one coronary artery (>70% diameter stenosis in left anterior descending, right coronary or circumflex artery and >50% diameter stenosis in left main coronary artery). Sixty-three male patients were enrolled as a patient group with a mean age of 52.43 +/- 4.08 years and with strongly positive exercise test (> or =2 mm ST segment depression, horizontal or down-sloping). Thirty-five patients without significant coronary artery disease were selected as a control group with a mean age of 52.66 +/- 4.39 years having undergone TMET. RESULTS AND DISCUSSION: In the patient and control groups, mean MPV values before TMET were the same, 8.52 +/- 0.63 and 8.45 +/- 0.58 respectively. Following TMET within 30 minutes, mean MPV were 10.03 +/- 0.96 and 8.50 +/- 0.45 respectively ( p < 0.001). When pre and post-TMET MPV values were evaluated together, the patient group had a significant increase in the MPV ( p < 0.001), whereas, the control group had no significant increase in the MPV ( p = 0.379). It was concluded that exercise possibly makes patients with significant coronary artery disease, more susceptible to a thrombotic event through various routes, one of that is platelet activation that could be measured indirectly via MPV. Healthy subjects react this thrombotic process by increasing their fibrinolytic capacity acutely. Patients with ischemic heart disease, particularly those with significantly narrowed coronary arteries, known to lack fibrinolytic capacity and have high shear stress, on the other hand, might face ischemic events, including sudden death following acute exercise.

Blood Platelets↗
PubMed2004

Poor coronary collateral circulation is associated with higher concentrations of soluble adhesion molecules in patients with single-vessel disease.

OBJECTIVE: As the endothelium and inflammatory cells play a crucial role in the development of collaterals after a sudden or slowly progressing stenosis of coronary arteries, the levels of soluble endothelial adhesion molecules (CAMs) including vascular cell adhesion molecule (VCAM-1) intercellular adhesion molecule-1 (ICAM-1) and E-selectin were compared between patients with poor coronary collaterals and patients with well-developed collaterals. METHODS: In the study, 97 non-diabetic subjects with single-vessel disease were included. Collateral supply to the stenotic coronary artery was determined by angiographic grading system of 0-3 (Rentrop et al. J Am Coll Cardiol 1985; 5:587-592). Serum levels of adhesion molecules were measured by enzyme-linked immunosorbent assay. RESULTS: Patients were divided into two groups according to the collateral degree (group A: 50 patients with grade 0 and 1; group B: 47 patients with grade 2 and 3 collaterals). The groups were well matched with respect to baseline clinical and angiographic characteristics. Levels of soluble VCAM-1 (mean+/-SEM; 875+/-26.6 versus 742.7+/-35.1 ng/ml; P=0.004), ICAM-1 (322.4+/-12.4 versus 269.4+/-13.3 ng/ml; P=0.005), and E-selectin (43.6+/-2.6 versus 33+/-2.4 ng/ml; P=0.004) were found to be significantly higher in group A in comparison with group B. In addition, when patients were divided into four groups according to the collateral degree, patients with grade 0 collaterals had the highest values and those with grade 3 collaterals had the lowest values for all these molecules. CONCLUSIONS: We concluded that poor collateral circulation is associated with increased levels of soluble CAMs in patients with obstructive coronary artery disease. However, further studies are needed to elucidate the exact role of these inflammatory markers in the setting of poor collateral circulation.

Collateral Circulation↗