Atilla Icli

Mean platelet volume in patients with prehypertension and hypertension

Patients with hypertension have evidence of platelet activation. Mean platelet volume (MPV), an indicator of platelet activation has been shown to be elevated in patients with hypertension. Prehypertension is also associated with an increase in cardiovascular morbidity and mortality. The aim of this study was to assess the MPV in patients with prehypertension and hypertension. This study included newly diagnosed and untreated 87 prehypertensive patients, 30 hypertensive patients and 35 normotensive control subjects matched for age, gender, and body mass index. All patients and controls gave informed consent. The MPV values of patients with prehypertension and hypertension were significantly higher than those of the control group (8.4 +/- 0.8 and 8.8 +/- 0.7 versus 7.9 +/- 0.5 fl; p < 0.05 and p < 0.001 respectively). It was also higher in hypertensives than in prehypertensives (8.8 +/- 0.7 versus 8.4 +/- 0.8 fl; p < 0.05). However, we found that the presence of the hypertension (beta = 0.28, P = 0.003) was only significant predictors of higher MPV in a multivariable model that adjusted for other variables. We have shown that, MPV, an indicator of platelet activation was significantly higher in patients with prehypertension and hypertension when compared with control subjects. We have also showed that MPV was also higher in patients with hypertension than in patients with prehypertension. However, presence of the hypertension was only significant predictor of higher MPV.

Effect of Smoking Cessation on Mean Platelet Volume

The aim of this study was to assess the values of mean platelet volume (MPV) in regular smokers and the effect of smoking cessation on MPV. The study group consisted of 116 regular smokers (57 females and 59 males; mean age 46.3 ± 12.7 years) and the control group was composed of 90 healthy volunteers (49 females and 41 males; mean age 47.7 ± 8.3 years). Platelet indices were assessed in regular smokers and control participants. Platelet indices were measured at 3 months after smoking cessation in these 101 participants. The MPV values were significantly higher in smokers than those of controls (8.8 ± 0.9 vs 8.0±0.8 fL, respectively; P < .001). The MPV values decreased significantly at 3 months when compared with the baseline values (8.9 ± 1.0 vs 7.9 ± 0.7 fL, respectively; P < .001). We have found that serum MPV values were significantly higher in regular smokers than in controls. Serum MPV values decreased significantly at 3 months after smoking cessation.

Effects of normal blood pressure, prehypertension, and hypertension on autonomic nervous system function

BACKGROUND Autonomic nervous system plays an important role in blood pressure (BP) regulation, and large proportion of patients with hypertension have increased sympathetic and decreased parasympathetic activity. Heart rate recovery (HRR) is a simple non-invasive measurement for investigating autonomic nervous system influence on the cardiovascular system; however, this methodology has not been used to evaluate autonomic nervous system in subjects with prehypertension (PHT). Accordingly, the present study was designed to evaluate HRR in subjects with PHT. METHODS AND RESULTS We measured HRR of 91 subjects with PHT, 44 patients with hypertension, and 53 normotensive healthy volunteers. HRR was significantly lower in the HT and PHT groups as compared to the control group (24.4 ± 5.7, 26.0 ± 8.4, 30.0 ± 8.7; hypertension, PHT, and control groups, respectively), but it did not significantly differ between HT and PHT groups. HRR was significantly and inversely correlated with age, systolic and diastolic BP, fasting and postprandial glucose level, waist circumference, total cholesterol, LDL cholesterol and non-HDL cholesterol, whereas exercise duration and METs were positively correlated with HRR. In multivariable analysis, we found that systolic BP, postprandial glucose level and exercise duration were independent predictors of lower HRR. CONCLUSIONS HRR, a non-invasive measurement analyzing the dysfunction in autonomic nervous system, was reduced in subjects with PHT as compared to normotensives, and the subjects with PHT had HRR as lower as patients with HT did. Our findings are supportive for the hypothesis that autonomic dysregulation is present in an early stage of essential hypertension.

Platelet indices in patients with acute pulmonary embolism

Abstract Previous studies have demonstrated that platelet activation occurs in patients with acute pulmonary embolism (PE). The aim of this study was to assess the mean platelet volume (MPV), an indicator of platelet activation in patients with acute PE. The study group consisted of 107 patients with acute PE. Seventy subjects matched for age, gender, body mass index (BMI) and frequency of concomitant diseases served as control group. All patients and control subjects underwent physical examination and echocardiography. We measured MPV values and platelet counts on admission. MPV was significantly higher among patients with acute PE when compared with control group (9.6 ± 1.0 vs. 8.1 ± 0.8 fL respectively; < 0.001). Platelet count was significantly lower among acute PE patients when compared with control group (227.1 ± 77.0 vs. 268.7 ± 58.4 × 109/L, respectively; < 0.001). MPV was correlated with right ventricular (RV) diameter (p < 0.001, r = 0.33) in correlation analysis. In linear regression analysis, MPV was independently correlated with RV dimension (β = 0.29, p = 0.001). We have shown that MPV, an indicator of platelet activation, was increased in patients with acute PE and it was correlated with RV diameter. Platelet count was decreased in patients with acute PE.

Metoprolol vs. carvedilol or carvedilol plus N-acetyl cysteine on post-operative atrial fibrillation: a randomized, double-blind, placebo-controlled study

AIMS Carvedilol and N-acetyl cysteine (NAC) have antioxidant and anti-inflammatory properties. Aim was to evaluate the efficacy of metoprolol, carvedilol, and carvedilol plus NAC on the prevention of post-operative atrial fibrillation (POAF). METHODS AND RESULTS Patients undergoing cardiac surgery (n = 311) were randomized to metoprolol, carvedilol, or carvedilol plus NAC. Baseline characteristics were similar. The incidence of POAF was lower in the carvedilol plus NAC group compared with the metoprolol group (P < 0.0001) or the carvedilol group (P = 0.03). There was a borderline significance for lower POAF rates in the carvedilol group compared with the metoprolol group (P = 0.06). Duration of hospitalization was lower in the carvedilol plus NAC group compared to the metoprolol group (P = 0.004). Multivariate independent predictors of POAF included left-atrial diameter, hypertension, bypass duration, pre-randomization and pre-operative heart rates, carvedilol plus NAC group vs. metoprolol group, and carvedilol plus NAC group vs. carvedilol group. CONCLUSION Carvedilol plus NAC decreased POAF incidence and duration of hospitalization compared with metoprolol and decreased POAF incidence compared with carvedilol.

Gamma-glutamyltransferase in acute coronary syndrome patients without ST elevation and its association with stenotic lesion and cardiac events.

BackgroundThere are limited data on prognostic value of gamma-glutamyltransferase (GGT) in acute coronary syndromes (ACS) with non-ST-segment elevation (NSTE-ACS). We investigated GGT levels and their association with significant stenosis and major cardiac events (MACE) in NSTE-ACS patients. Methods and resultsThis study included 237 patients with NSTE-ACS (ACS group), and age-matched and sex-matched controls with normal coronary arteries (control group). ACS group was divided into subgroups with and without significant stenosis. Serum creatine kinase-MB, troponin T and GGT levels were measured. ACS patients were followed up for MACE (composite of cardiac death, myocardial infarction, recurrent angina, and hospitalization) during 12 months. Median GGT level was higher in ACS group than control group (32 vs. 16 U/l, P=0.001). NSTE-ACS was independently associated with hypertension [odds ratio (OR): 2.83, P=0.001], smoking (OR: 2.19, P=0.015), GGT [OR: 1.16, 95% confidence interval (CI): 1.11–1.21, P=0.001] and ejection fraction (OR: 0.92, P=0.01). GGT level was also higher in patients with significant stenosis than those without significant stenosis (37 vs. 22 U/l, P=0.001). Presence of significant stenosis was independently associated with GGT level (OR: 1.17, 95% CI: 1.12–1.23, P=0.001). At 12 months, MACE-free survival was slightly poor in ACS patients with upper GGT tertile compared with those with lower GGT tertile (77 vs. 97%, P=0.06). ConclusionIn NSTE-ACS patients, increased GGT levels can be associated with significant stenosis and MACE.

Mean platelet volume is elevated in patients with myocardial infarction with normal coronary arteries, as in patients with myocardial infarction with obstructive coronary artery disease

Abstract Although the majority of cases of acute myocardial infarction are caused by atherosclerotic coronary artery disease (CAD), it can also occur in people with normal coronary arteries. One of the possible mechanisms causing myocardial infarction with normal coronary arteries (MINC) is transient occlusion of the infarct-related artery owing to platelet hyperactivity and thrombosis. Mean platelet volume (MPV), an indicator of platelet activation, has been shown to be elevated in patients with unstable angina and myocardial infarction in the setting of obstructive CAD. However, the value of MPV in patients with MINC is not known. The aim of this study was to assess the MPV in patients with MINC. We retrospectively studied 47 patients with MINC, 63 patients with myocardial infarction resulting from single coronary artery disease (MISC) and 55 control subjects. MPV values were recorded in all study patients and control subjects. The MPV values of patients with MINC and MISC were significantly higher than those of the control group (9.1±1.8 and 9.4±1.0 versus 8.3±1.4 fl; p<0.05 and p<0.001, respectively). There were no significant differences in MPV values between the MINC and MISC groups. We show for the first time that MPV is significantly higher in patients with MINC compared with control subjects. Concurring with previous studies, we also show that MPV is significantly higher in patients with MISC compared to control subjects.

Effects of prediabetes and diabetes on left ventricular and coronary microvascular functions

BACKGROUND Coronary flow reserve (CFR) provides independent prognostic information in diabetic patients with known or suspected coronary artery disease. However, there have been no substantial data to evaluate CFR in prediabetics. Accordingly, we aimed to evaluate CFR in subjects with prediabetes using second harmonic transthoracic Doppler echocardiography. METHODS AND RESULTS We measured CFR of 65 subjects with prediabetes, 45 patients with overt type 2 diabetes, and 43 sex and age matched normoglycemic healthy subjects with normal glucose tolerance. Ages, gender, existence of hypertension or hypercholesterolemia, smoking status were similar among the groups. CFR was significantly lower in diabetics (2.15 ± 0.39) than in prediabetics (2.39 ± 0.45) and controls (2.75 ± 0.35); in addition, it was significantly lower in prediabetics than controls. Only 2 (5%) of control subjects had abnormal CFR (<2) but 11 (17%) prediabetic subjects and 19 (42%) diabetic patients had abnormal CFR. We found that only age (β=-0.31, P<0.01) and presence of the diabetes (β=-0.57, P<0.01) were significant predictors of lower CFR in a multivariable model that adjusted for other variables. CFR was significantly and inversely correlated with age (r=-0.15, P=0.04), fasting glucose level (r=-0.27, P=0.001), postprandial glucose level (r=0.43, P<0.001), hemoglobin A1C level (r=-0.34, P<0.001), LDL cholesterol level (r=0.22, P=0.009), mitral A velocity (r=-0.27, P=0.001) and Tei index (r=-0.19, P=0.02), whereas mitral E/A ratio, mitral Em (r=0.18, P=0.02), mitral Em/Am ratio (r=0.23, P=0.004) were significantly and positively correlated with CFR. CONCLUSION CFR is impaired in subjects with prediabetics, but this impairment is not as severe as that in diabetics.

Mean platelet volume is associated with culprit lesion severity and cardiac events in acute coronary syndromes without ST elevation.

We investigated the association of mean platelet volume (MPV) with culprit lesion severity and major cardiac outcomes (MCOs) in patients with acute coronary syndrome (ACS) with non-ST elevation (NSTE). This study included 344 patients with NSTE-ACS who had significant coronary stenosis at least 50%. They were divided into high MPV group (n = 109, upper tertile >9.9 fl) and low MPV group (n = 235, lower and mid tertile ⩽9.9 fl) according to MPV values on admission. They were followed up for MCOs during 12 months. MCO consisted of the composite end-point of cardiac death, myocardial infarction (MI), recurrent angina or hospitalization. High MPV was independently associated with NSTE-MI [odds ratio (OR) 4.24, 95% confidence interval (CI) 2.52–7.15, P = 0.001] and severe culprit stenosis (≥80%) (OR 4.05, 95% CI 2.39–6.83, P = 0.001). MPV of 9.9 fl was predictive of severe culprit stenosis with a sensitivity of 73% and specificity of 77% (P < 0.001). At 12 months, MCO rate was higher in high MPV group than low MPV group (39 vs. 26%; P = 0.016). This difference resulted from death (6.4 vs. 2.1; P = 0.06) and recurrent angina (16.5 vs. 8.9%; P = 0.045). The MCO-free survival was worse in patients with high MPV than those with low MPV (61 vs. 74%; P = 0.01). In Cox regression analysis, high MPV remained an independent predictor of MCO (hazard ratio 1.52, 95% CI 1.01–2.29, P = 0.04) after adjusting for baseline characteristics. Elevated MPV was independently associated with NSTE-MI presentation and severity of culprit stenosis in NSTE-ACS patients. Moreover, MPV greater than 9.9 fl was predictive of a 12-month MCO.

Evaluation of total oxidative status and total antioxidant capacity in patients with endemic fluorosis

The objective of the present study was to determine the plasma total oxidative status (TOS) and total antioxidant capacity (TAC) in patients with endemic fluorosis. A total of 79 (35 males and 44 females; mean age 44.0 ± 11.9 years) patients with endemic fluorosis and 55 (23 males and 32 females; mean age 48.3 ± 8.5 years) age-, sex- and body mass index-matched healthy controls were included in this study. The urine fluoride levels and plasma TOS and TAC levels were measured. The urine fluoride levels of fluorosis patients were significantly higher than control subjects as expected (1.91 ± 0.15 vs. 0.49 ± 0.13 mg/L, respectively; p < 0.001). TOS was significantly higher in fluorosis group than in control group (17.55 ± 3.82 vs. 15.06 ± 4.31 μmol H2O2 Eq/L, respectively; p = 0.001). TAC was significantly lower in fluorosis group than in control group (1.60 ± 0.36 vs. 1.82 ± 0.51 mmol Trolox Eq/L, respectively; p = 0.004). Oxidative stress index (OSI) was significantly higher in fluorosis group than in control group (11.5 ± 3.8 vs. 8.8 ± 3.7, respectively; p < 0.001). Correlation analysis in all the groups indicated that TAC was negatively correlated with urine fluoride (r = −0.25, p = 0.003), TOS was positively correlated with urine fluoride (r = 0.34, p < 0.001) and OSI was positively correlated with urine fluoride (r = 0.36, p < 0.001). The results of our study demonstrate that oxidative stress plays an important role in the pathogenesis of the endemic fluorosis.