Akar Yılmaz

No association between vitamin D levels and inflammation markers in patients with acute coronary syndrome

PURPOSE A modern concept regards acute coronary syndrome (ACS) as an auto-inflammatory disorder. The purpose of the present study is to assess the plasma levels of inflammation related to biomarkers and cytokines in ACS patients and to correlate the values with 25-hydroxy vitamin D3 (calcidiol). There are no previously published reports concerning serum concentrations of inflammatory markers in patients with hypovitaminosis D in ACS. PATIENTS AND METHODS Eighty-eight consecutive patients with ACS [n=47 ST elevation myocardial infarction (STEMI), n=41 unstable angina pectoris (USAP)] were enrolled within 12h after symptoms. The blood samples were collected on admission in order to evaluate calcidiol, serum amyloid A (SAA), interleukin (IL)-6, interleukin (IL)-10, tumor necrosis factor-alpha (TNFα) and high sensitivity C-reactive protein (hsCRP). RESULTS Calcidiol, TNFα and SAA levels were significantly lower (p=0.01, p<0.01 and p<0.01 respectively), whereas hsCRP levels were significantly higher (p<0.01) in STEMI group as compared to USAP group. In the STEMI group, there were negative correlations between SAA and hsCRP (r=-0.347; p=0.01) and SAA and IL-6 (r=-0.356; p=0.01). There was a positive correlation between IL-6 and hsCRP (r=0.529; p<0.01). In the USAP group, it was found that there were a strong negative correlation between SAA and hsCRP (r=-0.75; p<0.01) and a positive correlation between IL-6 and TNF-α (r=0.54; p<0.01). CONCLUSION This study demonstrates that calcidiol levels are not associated with the inflammation markers in patients with acute phase ACS.

Decrease of Urotensin II activity can impact on the volume status in predialysis chronic kidney disease

Abstract Urotensin II (U-II) was thought to be one of the mediators of primary renal sodium retention due to effects on renal sodium excretion. For this purpose, the relationship between U-II and overhydration was investigated. A total of 107 patients were enrolled in the study. According to body compositor monitor analysis, fluid overload up to 1.1 L, was considered normohydration. Patients were divided according to hydration status; overhydrate (n = 42) and normohydrate (n = 65) were studied in both groups. Pulse waveform velocity propagation for arterial stiffness and blood pressure analysis and echocardiographic left ventricular and left atrial indices were performed with known fluid overload-related parameters. U-II levels were measured by using Human ELISA kit. In overhydrated group, U-II levels were significantly lower. All parameters (blood pressure, arterial stiffness parameters, echocardiographic data, age, gender, diabetes, U-II, hemoglobin) correlated with overhydration, were determined by linear regression model (method = enter), when considered together, U-II was found to be an independent predictor from other conventional overhydration-related parameters. Male sex, left ventricular mass index, left atrial volume index, hemoglobin value were found to be independent predictors for overhydration. Considering the association of low U-II levels with adverse cardiovascular events and its role in sodium retention, we think that low U-II levels can be accepted as a potential therapeutic target in patients with hypervolemic cardio-renal syndrome.

Thrombolytic therapy delay is independent predictor of mortality in acute pulmonary embolism at emergency service

Acute pulmonary embolism (PE) carries a high risk of morbidity and mortality. Delays in diagnosis or therapy may result in sudden, fatal deterioration; therefore, rapid diagnosis and an appropriate therapeutic approach are needed. We aimed to investigate the effect of delaying thrombolytic administration on the mortality rate in a suspected PE. We retrospectively analyzed 49 consecutive patients who were aged 18 years or older and received thrombolysis for a high‐risk PE without a major contraindication. All patients were classified according to the time of onset of the thrombolytic therapy. Patients experiencing cardiopulmonary arrest were analyzed from the time of admission to thrombolytic administration with 10‐minute cutoff values. Data were analyzed by a regression analysis and a receiver operating characteristic (ROC) analysis for significant and independent associated risk factors and in‐hospital mortality. Mortality was seen in 17 of the 49 cases. Thirteen of these had received thrombolytic therapy 1 hour after their emergency department (ED) admission. Among all cases, the mortality rate was 35%. The ROC analysis indicated that a > 97‐second delayed thrombolytic administration time was associated with mortality with 53% sensitivity and 91% specificity (area under the curve, 0.803; 95% confidence interval, 0.668–0.938). In the logistic regression, a 5‐minute delay in thrombolytic therapy (beta = 1.342; 95% confidence interval, 1.818–2.231; p = 0.001) was associated with in‐hospital mortality in the multivariable model. No major bleeding complications were seen in PE survivors. We conclude that early onset thrombolytic therapy in the ED for high‐risk and hemodynamically worsening patients appears safe and life‐saving.

High prevalence of severe vitamin D deficiency in patients with acute myocardial infarction

Abstract Background: Vitamin D deficiency is associated with acute coronary syndrome (ACS). We aimed to evaluate calcidiol status and its relationship with coronary angiography findings in two selected groups of ACS patients. Methods: We investigated two groups of patients with ACS: 75 patients with ST-segment-elevation myocardial infarction (STEMI) and 68 patients with unstable angina pectoris (USAP). The ACS diagnosis was confirmed by coronary angiography findings. Biochemical parameters were studied at the first visit of the patients with automated instruments and ready-to-use kits. Results: Calcidiol levels were significantly lower in the STEMI group compared to the USAP group (p<0.001), while the prevalence of calcidiol deficiency in the STEMI group was significantly higher (p<0.001). Serious calcidiol deficiency (<4 ng/mL) was present in 17% of the STEMI group and in 7% of the USAP group. We did not observe any significant relationship between calcidiol status and coronary angiography findings. Conclusions: Our results support the previously described associations between ACS and calcidiol deficiency. Besides, we report a more severe calcidiol deficiency and an extraordinarily high prevalence of vitamin D deficiency or insufficiency in these patients.

Early and Midterm Outcomes of Percutaneous Treatment of Symtomatic Stenosis of Lower Extremity and Chronic Limb Ischemia

Objectives: Our goal is to evaluate the effectiveness, reliability, advantages and the results of early-to-mid-term of percutaneous treatment of lower extremity strictures. Background: Technological advances in the past decade have shifted revascularization strategies from traditional open surgical approaches toward lower-morbidity percutaneous endovascular treatments for patients with lower extremity peripheral arterial disease (PAD). The role of endovascular interventions is also expanding in the treatment of limb-threatening ischemia. Especially in chronic limb ischemia and foot ulcers, diabetic patients with inoperable, there is growing interest below the knee interventions. Methods: Between May 2011 and May 2013, 85 patients with stenosis of the lower limb arteries (iliac-femoral-popliteal-below the knee) and treated percutaneously, enrolled in the study. Although medical therapy, patients with intermittent claudication and have >70% stenosis in iliac or femoral artery, stenting procedure was performed after primary stenting or balloon angioplasty. Symptomatic patients with >70% stenosis of popliteal or below-knee artery, balloon angioplasty was performed. After the patients were followed up clinically. Results: Tecnical success was achieved in 84 patients (98,8%). Predilatation before stent placement, 33,3% of cases performed. Post dilation procedure was performed in 66,6% of patients with used the self-expanding stent. 84 patients with iliac-femoral artery stenosis, stenting procedure is applied and concomitantly 6 patients with popliteal artery and distal to the stenosis, the balloon angioplasty was performed. Average follow-up time was 10,0 6,3 months. (1 – 25 Months). Including death, myocardial infarction, major bleeding complications were not observed depending on percutaneous procedures. Iliac stent in a patient as a complication inferior vena cava fistula formation, this complication was treated using a stent-graft. 7 patients with diabetes and foot wounds that never heal, healed wounds were observed during follow-up after the procedure. In the clinical follow-up, claudication complaints decreased and increased walking distances observed. Conclusion: Technical success rate and early-midterm outcomes of percutaneous treatment for PAD are magnificent. We believe that percutaneous treatment methods in lower extremity arterial stenosis, will be more widespread with percutaneous treatment techniques and operator experience increases.