Asife Şahinarslan

Relationship between total and differential leukocyte counts and isolated coronary artery ectasia.

BackgroundCoronary artery ectasia (CAE) is a clinical entity characterized by localized or diffuse dilatation of more than or equal to 1.5 times that of the normal adjacent segments of vessels. Although the etiopathogenesis is not clearly understood, some studies have shown that CAE may be a form of atherosclerosis and has more potent inflammatory properties. Leukocytes have a crucial role in the development of inflammatory processes. We aimed to investigate a possible relationship between leukocytes and the coronary ectatic process without coronary artery disease (CAD) and to compare it with the inflammatory atherosclerotic process related to leukocytes. Methods and resultsThe study population consisted of 371 patients. We divided the patients into three groups: 42 patients with isolated CAE as group I, 279 patients with CAD as group II, and 50 control participants with normal coronary arteries (NCA) as group III. The counts of total leukocytes (7348±1898, 7569±1619, and 6770±1748 cells/mm3, P=0.002), neutrophils (4260±2169, 4529±1380, and 4040±1649 cells/mm3, P=0.037) and monocytes (630±216, 583±198, and 480±140 cells/mm3, P<0.001) were significantly different among the CAE, CAD, and NCA groups, respectively. The CAE group also had significantly higher leukocyte and subtype counts than the nonobstructive CAD subgroup and NCA group. ConclusionThis study demonstrates that total and differential leukocyte counts, which play an important role in inflammation, are increased in patients with isolated CAE. In conclusion, this studys findings show that leukocytes may play an important role in the development of CAE independently of the atherosclerotic process.

Neutrophil-to-lymphocyte ratio is increased in patients with rheumatic mitral valve stenosis?

Objective The role of systemic and chronic inflammatory processes in the pathophysiology of rheumatic heart valve disease is well known. The neutrophil-to-lymphocyte ratio (NLR) was shown to be an indicator of systemic inflammation. In this study, we aimed to investigate relationship between NLR as a marker of systemic inflammation and rheumatic mitral valve stenosis (RMVS). Methods This is a retrospective study. Among patients who underwent transthoracic echocardiography between January 2008-March 2013, 314 patients with RMVS were included retrospectively in the study. The control group included 57 healthy persons who underwent transthoracic echocardiography during the study period. Basal characteristics and NLR were compared between the two groups. Independent predictors of RMVS were determined by logistic regression analysis. Results Basal characteristics were similar among the groups (age, 50.2±14.2 vs. 49.2±13.0, p=0.60). The NLR was significantly higher in patients with RMVS [2.9 (0.6-13.0) vs. 2.1 (0.7-5.8), p<0.001]. Besides, C-reactive protein (CRP) was also higher in the RMVS group [5.99 (0.3-23.7) vs. 2.98 (0.6-6.3), p=0.001]. In the regression analysis, NLR (OR: 2.24, p=0.04), CRP (OR: 1.34, p=0.03), and left atrial diameter (OR: 1.21, p=0.001) were independent predictors of RMVS. In the correlation analysis, there was a significant positive correlation between NLR and CRP (r=0.43, p<0.001). Conclusion We found that NLR was significantly increased in RMVS. Furthermore, NLR was an independent predictor of the presence of RMVS in our study population. According to these findings, NLR can be used as a predictor of RMVS. Since it is an easily available and cheap method, it can easily be used in daily clinical practice. Increased NLR can also be a sign of ongoing chronic inflammation in patients with RMVS.

Increased serum YKL-40 level is associated with the presence and severity of metabolic syndrome.

Objective: Metabolic syndrome (MS) is defined by a cluster of interdependent physiological, biochemical, and clinical risk factors and linked to a state of chronic inflammation. YKL-40 is known as an inflammatory glycoprotein, which is secreted by various cell lines during inflammation. Thus, we aimed to assess the association of serum YKL-40 levels with the presence and severity of MS. Methods: In this prospective cross-sectional study, a total of 177 consecutive patients [n=114 MS present and n=63 MS absent] were enrolled. MS was defined according to National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) criteria. Serum YKL-40 and hs-CRP levels were measured for all participants. Results: Serum YKL-40, hs-CRP and white blood cell count (WBC) were significantly higher in the MS present group (p<0.05). There was a graded relationship between increasing number of MS components and serum YKL-40 level (p<0.05). In addition, serum YKL-40 level was positively correlated with hs-CRP level (r=0.467, p<0.001) and WBC count (r=0.251, p=0.001). In multivariable regression analysis, serum YKL-40 [1.022 (1.011–1.033), p<0.001] and hs-CRP [1.346 (1.111–1.632), p=0.002] were remained as independent predictors for the presence of MS. In the ROC curve analysis, using a cut-off level of 147.0, YKL-40 well predicted the presence of MS with a sensitivity of 73.7% and specificity of 69.8% (AUC: 0.785; 95% CI: 0.718–0.853, p<0.001). Conclusion: In this study, we demonstrated that serum YKL-40 level was significantly associated with the presence of MS. According to these findings, we concluded that serum YKL-40 may be a novel and useful indicator for MS. (Anatol J Cardiol 2016; 16: 953-8)

Acute inferior myocardial infarction with low atrial rhythm due to propyphenazone: Kounis syndrome

Kounis syndrome which is the concurrence of acute coronary syndromes with allergic or hypersensitivity reactions is now better known and the knowledge about this phenomenon is becoming larger. We want to present a case which developed transient ST elevation myocardial infarction with low atrial rhythm soon after propyphenazone usage. Despite the large knowledge about the pathogenesis of acute coronary syndromes, there is little data about the role of mast cells in this complex. Now the data about the concurrence of acute coronary events and hypersensitivity reactions are growing with new publications. We want to present a patient with transient ST elevation myocardial infarction after ingestion of propyphenazone. The patient was a 49 year old male. He was admitted to our hospital with complaints of a pressure like chest pain for nearly 30 min, palpitation and lightheadedness. In his physical examination body temperature was 36.4 °C, his blood pressure was 80/50 mm Hg, pulse rate was 63 bpm and except extensive rashes on the skin other physical findings were normal including all heart sounds. He was an ex-smoker as a cardiovascular risk factor and had no other risk factors for cardiovascular diseases. He implied that he had experienced the same symptoms 3 months before, about 30 min after taking propyphenazone for his headache. This time he took propyphenazone for headache after about 30 min his symptoms have begun again. Because of his admission electrocardiogram was compatible with acute inferior myocardial infarction with low atrial rhythm, he was began to prepare for immediate coronary angiography (Fig. 1). For his low blood pressure saline infusion was began. 300 mg acetylsalicylic acid was chewed by the patient and 25 mg ranitidine by intravenous route had been given to the patient. During that period for about 10 min his chest pain diminished and in a few minutes his chest pain completely relieved. The electrocardiogram was completely normal including complete ST resolution (Fig. 2). To rule out a probable coronary obstruction, the patient was admitted to the catheterization laboratory and coronary

Association of rs10757274 and rs2383206 Polymorphisms on 9p21 locus with Coronary Artery Disease in Turkish Population

Background and Objectives Genetic predisposition is an important risk factor for coronary artery disease (CAD). In this study, we aimed to evaluate the impact of rs10757274 and rs2383206 polymorphisms in chromosome 9p21 on presence and severity of CAD in a Turkish population. Subjects and Methods A total of 646 patients who underwent coronary angiography were included in this study. Coronary vessel score and Gensini score were calculated to assess the angiographic severity of CAD. Alleles of AA, AG, and GG were determined for rs10757274 (polymorphism-1) and rs2383206 (polymorphism-2) polymorphisms located in chromosome 9p21 from the blood samples. Results There was a significant difference between the alleles in polymorphism-1 in the presence of coronary artery disease (38.9% in AA, 48.0% in GG and 56.4% in AG, p=0.017). However, there was no difference between the alleles in polymorphism-2. According to vessel scores, there was a significant difference between the alleles in polymorphism-1 (AA 0.71±1.04, GG 0.88±1.07, AG 1.06±1.12, p=0.018). In polymorphism-2, vessel scores did not show a difference between the alleles. In polymorphism-1, there was a significant difference in Gensini score (p=0.041). Gensini scores did not differ between the alleles in polymorphism-2 (p>0.05 for all). In multivariate analyses, none of the alleles was an independent factor for presence of CAD. Conclusion The presence of rs10757274 polymorphism including AG allele in chromosome 9p21 was related to CAD. However, this relationship was not independent of other cardiovascular risk factors.

Relationship between plasma asymmetric dimethylarginine level and autonomic dysfunction in diabetic patients

OBJECTIVES We aimed to investigate the relationship between plasma asymmetric dimethylarginine (ADMA) levels and heart rate variability (HRV) in diabetic patients. STUDY DESIGN The study included 100 patients (44 men, 56 women) with type 2 diabetes mellitus. The patients were divided into two groups based on the use of oral antidiabetics (n=67; mean age 54.6±7.8 years) or insulin (n=33; mean age 51.6±8.8 years). Plasma ADMA levels were measured and HRV parameters were calculated from 24-hour Holter EKG recordings. The findings were compared with those of a control group consisting of 42 nondiabetic individuals (mean age 52.8±6.2 years). RESULTS Compared to the control group, plasma ADMA levels were significantly higher (p=0.007) and all HRV parameters were significantly reduced in both diabetic groups. However, ADMA levels and HRV parameters were similar in the two diabetic groups (p>0.05). Correlation analysis showed no significant relationship between plasma ADMA levels and HRV parameters. CONCLUSION Our findings show that plasma ADMA levels are increased and HRV is reduced in diabetic patients, indicating that these patients have both endothelial dysfunction and autonomic dysfunction, but plasma ADMA levels cannot be used to evaluate autonomic dysfunction.

Biventricular thrombus and associated myocardial infarction in a rheumatoid arthritis patient: a case report and literature review

Autoimmune diseases including rheumatoid arthritis have an increased incidence of cardiovascular disease. Rheumatoid arthritis (RA) confers a prothrombotic state and is associated with venous thrombosis, but its association with arterial thrombosis and embolism is not clear. In present report, we introduce a unique case of a 42-year-old woman with RA, who was admitted to the emergency service with back pain and diagnosed as having large right and left ventricular thrombus and myocardial infarction, associated with embolization of the thrombus. We also review the literature about RA and arterial and intraventricular thrombosis.

Association of red blood cell distribution width with presence and severity of rheumatic mitral valve stenosis

OBJECTIVE As an indicator of variability in circulating erythrocyte size, red cell distribution width (RDW) is linked to chronic inflammation. The association of rheumatic heart valve stenosis and inflammation is also well-known. This study aimed to assess the relationship between RDW and presence and severity of rheumatic mitral valve stenosis (RMVS). METHODS A total of 417 consecutive patients with RMVS, and 81 age- and -gender matched healthy control subjects were included in the study between February 2009 and April 2014. Transthoracic echocardiography and demographic characteristics were recorded for all participants. RESULTS Baseline characteristics were similar in the two groups. However, median RDW was significantly higher in patients with RMVS compared to control group (14.4% [11.3-19.6] vs. 13.6% [11.6-18.1], p<0.001). Additionally, both median C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR) were also higher in the RMVS group; (6.1 [0.4-24.2] vs. 3.6 [0.3-15.3] mg/dl, p=0.001 for CRP, and 2.8 [0.4-10.6] vs. 2.1 [0.7-5.7], p<0.001 for NLR respectively). In regression analysis, RDW (OR: 1.504, p=0.005), CRP (OR: 1.139, p=0.008), NLR (OR: 1.528, p=0.018) and left atrial diameter (OR: 1.218, p<0.001) were found as independent predictors of the presence of RMVS. Furthermore, there was a significant positive correlation between CRP (r=0.140, p=0.007) and NLR levels (r=0.276, p<0.001) with RDW levels. Furthermore, we determined that RDW levels increased in parallel with severity of mitral stenosis (mild, moderate and severe) [13.7% (12.9-14.8), 14.4% (13.4-15.4), 14.8% (13.6-16.3), p<0.001, respectively]. CONCLUSION The study demonstrated significantly higher RDW in patients with RMVS. Furthermore, RDW independently predicted the presence of RMVS. RDW is an easily available marker, and because of its correlation with common inflammatory indicators may also be a sign of chronic inflammatory continuum in patients with RMVS.

The impact of volume overload on right heart function in end-stage renal disease patients on hemodialysis

The aim of this study was to evaluate the impact of volume overload on echocardiographic parameters used for the assessment of the right ventricle (RV) and right atrium (RA), to determine volume‐independent parameters and to noninvasively investigate the physio‐mechanics of RV and RA by examining end‐stage kidney patients before and after hemodialysis (HD).

Cardiac computed tomography and radiation

Son yıllardaki teknik gelişmeler nedeniyle kardiyovasküler hastalıkların tanısında bilgisayarlı tomografinin yeri gün geçtikçe artmaktadır. Ancak bu işlem sırasında kullanılan radyasyon dozu, buna bağlı oluşabilecek potansiyel sonuçlar konusunda tartışma yaratmaktadır. Elimizde henüz bilgisayarlı tomografide kullanılan radyasyon dozunun yol açabileceği istenmeyen etkiler konusunda net veriler bulunmamaktadır. Bu derlemede bilgisayarlı tomografi ve radyasyon riski ile ilgili literatürdeki veriler gözden geçirilmiştir. Bilgisayarlı tomografide kullanılan radyasyon dozunu azaltmak için alınabilecek önlemlerin başında testin doğru endikasyonla, uygun hastada yapılması gelmektedir. Bunun yanında son yıllarda geliştirilen radyasyon azaltıcı teknolojiler ve kişiye özgü çekim teknikleri sayesinde kullanılan radyasyon dozu belirgin ölçüde azaltılabilmektedir. Klinisyenlerin radyasyon riskinin azaltılması açısından kullanılması gereken teknikler konusunda bilgi sahibi olmaları ve çalıştıkları merkezdeki teknik olanakların farkında olmaları önem taşımaktadır.