Alparslan Sahin

Association of Endogenous Melatonin with Uric Acid and Traditional Cardiovascular Risk Factors in Healthy Young Male

BACKGROUND Uric acid may act as an antioxidant; high serum uric acid levels are often associated with cardiovascular disease, such as coronary artery disease. Melatonin plays a role as a direct free radical scavenger and indirect antioxidant. No study has examined the relationships between endogenous melatonin and uric acid in order to predict the risk of future cardiovascular disease in males so far. To better characterize a possible relationship, we studied the association of endogenous melatonin with uric acid and traditional cardiovascular risk factors such as plasma lipids, and glucose in healthy young males. MATERIAL AND METHODS Twenty-one male participants [mean age: 22.6 2.5 (18-26) year], non-smoking; their medication or alcohol consumption history were studied. Blood samples for measuring melatonin concentrations were collected in the supine position between 13:30-14:30 hours. After centrifugation, plasma samples were immediately frozen at -20°C until analysis. RESULTS Although we found a significant negative correlation between the levels of endogeneous melatonin and uric acid (p=0.01, r=-0.51), we did not find any correlation among the melatonin and other antropometric, hemodynamic and biochemical parameters in male subjects (p>0.41). CONCLUSIONS The present study demonstrated a significant negative correlation between the levels of endogeneous melatonin and uric acid in healthy young males.

Assessment of carotid body tumor and its association with tetralogy of fallot: effect of the chronic hypoxia.

This is a rare combined presentation of Tetralogy of Fallot and carotid body tumor (CBT). Hypotheses and further discussion provides data for the development of CBT as a response to chronic hypoxemia. This present study demonstrates and discusses such an occurrence.

An Expanding Role of Biomarkers in Pulmonary Arterial Hypertension

BACKGROUND Pulmonary Arterial Hypertension (PAH) is a chronic disease which may cause or result from multiple cardiopulmonary disorders. The disease has complex pathophysiological mechanisms and involves many systematic, cellular and molecular changes. Therefore, it is crucial to find out underlying mechanisms and detect biomarkers to achieve early and proper diagnosis, evaluating disease severity, for follow-up and monitor response to treatment. Many biomarkers for PAH have been investigated but yet no such biomarker has been found specific and easily accessible to use for the patients. This review aims to identify an expanding role of biomarkers in PAH. METHOD We searched an expanding role of biomarkers such as asymmetric dimethylarginine (ADMA), von Willebrand factor (vWF) and endothelin for PAH in the literature. RESULTS Thirty-four actual papers were included in this review for searching an expanding role of biomarkers in the PAH. CONCLUSION The search for a proper biomarker for PAH patients is an ongoing process. Currently we do not have a PAH-specific, easily accesible, low-priced biomarker for PAH patients. One of the reasons of that is that PAH has a complex etiology and the diesase eventually alters multiple systems. So far, only BNP/NT-proBNP has been mainly approved and widely used for risk assesment in patients with PAH. Ongoing studies, development in the technology and understanding the underlying mechanisms in the pathophysiology of PAH, will eventually lead us to find proper biomarker(s), for PAH, which will also improve patient outcomes and decrease treatment costs in PAH.

Acute effects of cardiac resynchronization therapy on arterial distensibility and serum norepinephrine levels in advanced heart failure

BACKGROUND Cardiac resynchronization therapy (CRT) has become an accepted method for treating refractory heart failure (HF). Arterial distensibility is an index of arterial stiffness and a surrogate marker for atherosclerosis. The present study aims to assess the acute effects of ventricular resynchronization therapy with biventricular stimulation on arterial distensibility, echocardiographic parameters and serum norepinephrine levels in patients with drug refractory HF. METHODS Fourteen cardiac HF patients (53.6 ± 9.1; 39-67 years, 7 woman) were enrolled for CRT. Patients had an advanced cardiac HF (NYHA III-IV functional class) due to non-ischemic dilated cardiomyopathy, with a left ventricular ejection fraction (LVEF) < 35% and QRS duration ≥120 ms. Blood samples for norepinephrine and B-type natriuretic peptide were collected before 24 h biventricular implantation and after 48 h of CRT. Transthoracic echocardiography was used to evaluate arterial distensibility and cardiovascular condition. RESULTS Although systolic blood pressure, diastolic blood pressure, LV end-diastolic diameter, LV end-systolic diameter, serum B-type natriuretic peptide, and serum norepinephrine levels significantly decreased after CRT implantation; EF and aortic distensibility significantly increased (p < 0.05). There was no significance in the hemodynamic and echocardiographic values, norepinephrine and B-type natriuretic peptide levels in pre- and post-CRT between man and woman. CONCLUSIONS The major findings of this study are that in patients with cardiac HF in acute period, after implantation of CRT serum norepinephrine levels decrease and the arterial distensibility improves.

Outcomes and effectiveness of bilateral percutaneous transluminal renal artery stenting in patients with critical bilateral renal artery stenosis

BACKGROUND The aim of this study was to assess the effects of percutaneous bilateral renal artery stenting in patients with atherosclerotic renal artery stenosis and in-hospital and 4 month outcome of the procedure, focusing on the changes in renal function and blood pressure. METHODS Five consecutive patients (mean age: 64.8 ± 9.7 years, 1 women) with bilateral renal artery stenoses underwent percutaneous interventions. We compared blood pressure, number of oral antihypertensive medications, and renal function changes preprocedure and postprocedure at 4 months follow-up. RESULTS A total of 5 bilateral atherosclerotic renal artery stenosis patients underwent percutaneous transluminal renal angioplasty and 10 stents were placed. Although systolic and diastolic blood pressures were significantly decreased in follow-up period, glomerular filtration rates were not significantly changed as compared with baseline data (p = 0.009, p = 0.008, p = 1.00, respectively). Also, the number of oral antihypertensive medications were significantly decreased at follow-up period (p = 0.03). CONCLUSIONS Bilateral renal artery stenting provides a beneficial outcome such as stabilization of renal functions, significant improvement in blood pressure control and reduction in the number of oral antihypertensive medications at follow-up.

Admission Haemoglobin Levels and Its Related Factors at Percutaneous Coronary Intervention for the Management of Acute Coronary Syndrome in Octogenarian Patients: Assessment of Gender Differences and In- Hospital Outcomes

Anaemia has the potential to worsen the myocardial ischemia in acute coronary syndrome. In this paper, admission haemoglobin levels and the factors related to haemoglobin concentrations and in-hospital outcomes of percutaneous coronary intervention were analysed for the management of acute coronary syndrome in female and male octogenarian patients. We analyzed data of 2.256 consecutive patients who underwent percutaneous coronary intervention with bare metal and/or drug eluting stent implantation. Either the femoral artery or brachial artery approach was used. 50 of 2256 consecutive patients were octogeneric and Hb and white blood cell levels were analyzed. Mean admission haemoglobin levels were significantly elevated in male octogenarian patients as compared with female octogenarian patients (12.10 ± 1.37 mg/dl, 11.24 ± 1.03 mg/dl, p=0.02, respectively). Pearson correlation analysis between haemoglobin and clinical, angiographic, procedural characteristics, biochemical and hematologic values showed that haemoglobin was only correlated negatively with leukocytes (r=-0.35; p=0.01). Admission haemoglobin concentrations were significantly elevated in male octogenarian patients as compared with female. Only blood leukocyte levels were found to be significantly associated with haemoglobin concentration. Therefore, anaemia and leucocytosis may be associated with worse in-hospital outcomes at percutaneous coronary intervention for the management of acute coronary syndrome in female octogenarian patients