Baris Ikitimur

The prognostic value of circulating microRNAs in heart failure: preliminary results from a genome-wide expression study.

Introduction Recent studies have demonstrated the potential of microRNAs (miRNA) as biomarkers in various cardiovascular disorders. The aim of the present study was to quantitatively evaluate the expression levels of miRNAs in patients with chronic congestive heart failure (CHF) in order to identify differential expression profiles as biomarkers with prognostic values. Materials and method The study included 20 clinically stable [New York Heart Association (NYHA) II] and 22 decompensated (NYHA III and IV) CHF patients and 15 healthy controls. miRNA profiling was performed using a microarray method. Dysregulated miRNAs were evaluated for their biomarker potential. Results Microarray profiling revealed an increase in the expression of miR-21, miR-650, miR-744*, miR-516-5p, miR-1292, miR-182, miR-1228, miR-595, miR-663b, miR-1296, miR-1825, miR-299-3p, miR-662 miR-122*, miR-3148 and miR-518e* and a decrease in the expression of miR-129-3p, miR-3155, miR-3175, miR-583, miR-568, miR-30d, miR-200a-star, miR-1979, miR-371-3p, miR-155-star and miR-502-5p in sera of CHF patients. The prognostic value of miR-182 [area under the curve (AUC) 0.695] was found to be superior to pro-brain type natriuretic peptide (NT-proBNP; AUC 0.350) and high-sensitivity C-reactive protein (hs-CRP) (AUC 0.475) by receiver operator characteristic (ROC) analysis. Cox regression analysis showed that miR-182 could predict cardiovascular mortality (Pu200a=u200a0.032). Conclusion We demonstrated the increased expression levels of circulating miRNAs in CHF as compared with controls. Moreover, miR-182 was found to be a potential prognostic marker in CHF.

The Prognostic Significance of Narrow Fragmented QRS on Admission Electrocardiogram in Patients Hospitalized for Decompensated Systolic Heart Failure

Narrow fragmented QRS (fQRS) has recently been recognized as a significant predictor of prognosis in various cardiovascular diseases.

Effectiveness of a lead cap in radiation protection of the head in the cardiac catheterisation laboratory

Introduction During the past 30 years, interventional cardiology has advanced dramatically resulting in outstanding increases in occupational radiation exposure of interventional cardiologists. Despite the remarkable changes in fluoroscopic procedures, radiation protection technology is not much different from how it was decades ago. Moreover, new evidence on occupational radiation suggests that low doses of ionising radiation exposure may be associated with the development of cancer in interventional cardiologists and radiologists1-6. The brain is of particular interest, because it is one of the least protected organs during interventional procedures2. The trunk and the thyroid are protected with lead aprons, and the eyes are protected by lead glasses; however the head is completely exposed. The annual head dose sustained by a cardiologist generally ranges between 20 and 30 mSv, and in some cases may reach up to 60 mSv per year7. This indicates a dose 10 times higher than whole body exposure8. Ceiling-suspended lead shields reduce radiation doses to the brain but they are designed to protect the face and head from primary scatter radiation from the patient. Therefore, a significant amount of secondary radiation scattered from the laboratory walls may reach the operator’s head, despite the presence of a ceilingmounted glass shield. Until now, operators have not used protective garments to protect their head from radiation.

Role of myeloperoxidase in cardiology.

Myeloperoxidase (MPO) is an enzyme found in myeloid cells, particularly in neutrophils, and to a lesser extent in monocytes and tissue macrophages. MPO plays an important role in the host defense against bacteria and viruses. Since MPO is also an important enzyme in the inflammatory process, and inflammation is a key component in the development and progression of atherosclerotic and other forms of cardiovascular disease, there is ongoing interest in the use of MPO as a biomarker in different fields of cardiology. We aimed to review the current state of literature regarding the role of MPO in cardiovascular disease, especially highlighting the practical implications of the fast growing data from clinical studies.

The relationship between circulating microRNAs and left ventricular mass in symptomatic heart failure patients with systolic dysfunction.

BACKGROUNDnIn recent years, many microRNAs (miRNAs) were shown to be dysregulated in specific tissues playing critical roles in the pathogenesis and progression of heart failure (HF). Left ventricular (LV) mass (LVM) has long been recognised as an important prognostic marker in systolic HF patients.nnnAIMnWe hypothesised that circulating miRNAs may be associated with LVM in systolic HF patients. The present study aimed to evaluate the relationship between previously reported and novel dysregulated circulating miRNAs and echocardiographically determined LVM in symptomatic HF patients with LV systolic dysfunction.nnnMETHODSnForty-two consecutive patients diagnosed with NYHA II-IV symptomatic systolic HF and a control group consisting of 15 age- and sex-matched healthy volunteers were enrolled. After labelling extracted RNA, poly-A tails were added. RNAs were later hybridised on a GeneChip miRNA 2.0 array. After hybridisation and staining, arrays were scanned to determine miRNA expression levels, and differentially expressed miRNAs were identified.nnnRESULTSnEighteen miRNAs were found to be upregulated in serum of HF patients, while 11 were demonstrated to be downregulated. When the association between dysregulated miRNAs and echocardiographic findings was investigated, miR-182 (p = 0.04), miR-200a* (p = 0.019), and miR-568 (p = 0.023) were found to be inversely correlated with LVM index (LVMI), while miR-155 (p = 0.019) and miR-595 (p = 0.04) were determined to be positively correlated with LVMI.nnnCONCLUSIONSnThe results of our study revealed that dysregulated circulating miRNAs were correlated with anatomic changes in LV, in terms of LVMI, in symptomatic HF patients with systolic LV dysfunction.

An unusual adverse effect of sildenafil citrate: acute myocardial infarction in a nitrate-free patient.

Myocardial infarction (MI) associated with sildenafil citrate is seen rarely in patients without any history of coronary artery disease. We report a nitrate-free patient with a history of cardiovascular risk factors who developed acute MI after taking sildenafil. A 44-year-old man diagnosed with acute anterior ST segment elevation MI 120u2005min after self-administration of 150u2005mg sildenafil was admitted before attempting any sexual intercourse. The coronary angiography revealed 99% occlusion of the left anterior descending artery (LAD) and a bare-metal stent was implanted. He was discharged after 5 days without any complication. Sildenafil may cause coronary steal or may lead to vasodilation causing hypotension in patient with pre-existing cardiovascular disease, especially in patients on nitrate therapy. Our patient was nitrate free, with normal blood pressure values. Emotional stimulation associated with anticipated sexual activity may have been a triggering factor for vulnerable coronary plaque rupture.

Evaluation of the clinical utility of urocortin 1 in systolic heart failure

BACKGROUNDnUrocortin 1 (UCN1) has cardiostimulatory, vasodilatory, diuretic and natriuretic effects, and its expression increases in heart failure (HF).nnnAIMnTo determine UCN1 levels in patients with HF, to evaluate UCN1s relationship with various clinical parameters, and to assess UCN1 as a diagnostic marker in HF, compared to pro-B-type natriuretic peptide (pro-BNP).nnnMETHODSnWe investigated serum levels of UCN1 and pro-BNP in 90 consecutive patients with systolic HF (left ventricular ejection fraction [LVEF] ≤ 45%) and 90 healthy controls. Serum UCN1 and pro-BNP levels were measured using the ELISA method. Transthoracic echocardiography was performed to determine LVEF and pulmonary artery systolic pressure (PASP). Glomerular filtration rate (GFR) was estimated using the Cockcroft-Gault formula.nnnRESULTSnUCN1 level was higher in HF patients (391.5 [357.0-482.0] pg/mL, p < 0.001). UCN1 was positively related with NYHA class (r = 0.89, p < 0.001), and PASP (r = 0.39, p < 0.001); and negatively related with LVEF (r = -0.46, p < 0.001), and GFR (r = -0.21, p = 0.046). A significant positive correlation was found between pro-BNP and UCN1 levels (p < 0.001, r = 0.96). Receiver operating characteristic (ROC) curves yielded an area under the curve (AUC) of 0.99 (95% CI 0.98-1.00,p < 0.001) for UCN1 and 1.00 (p < 0.001) for pro-BNP in the diagnosis of HF.nnnCONCLUSIONSnUCN1 increases with worsening HF and left ventricular dysfunction. It may be used as a diagnostic biomarker in systolic HF, but the incremental value of measuring UCN1 in patients tested for pro-BNP is questionable.

Apelin in ST segment elevation and non-ST segment elevation acute coronary syndromes: a novel finding

BACKGROUNDnApelin is a novel endogenous peptide with inotropic and vasodilatory properties.nnnAIMnTo investigate the role of apelin in the prognosis of acute coronary syndromes (ACS) and to assess the relationship between apelin and other diagnostic and prognostic markers.nnnMETHODSnSeventy-six patients with ACS (mean age 62.1 ± 10 years) were evaluated in terms of their plasma apelin-36 concentrations, ejection fraction (EF), high sensitivity C-reactive protein (hsCRP), creatine kinase (CK), CK-MB and troponin I levels. The study group consisted of 35 ST elevation myocardial infarction (STEMI) and 41 non-ST elevation (NSTE) ACS patients. Patients were followed up for one year for cardiovascular outcomes.nnnRESULTSnThere was no significant relationship between apelin and TIMI, GRACE, GENSINI scores, hsCRP and EF in STEMI and NSTE-ACS groups (p > 0.05). Apelin showed positive correlations with CK, CK-MB and troponin I in patients with NSTE-ACS, but a negative correlation in patients with STEMI (p < 0.05). There were no statistically significant differences between patients reaching the composite end point at one year with regard to apelin levels.nnnCONCLUSIONSnApelin was positively correlated with cardiac biomarkers in patients with NSTE-ACS but negatively correlated in patients with STEMI. In STEMI, generally larger amounts of myocardial cells are subjected to infarction compared to NSTE-ACS, which may explain why apelin levels decrease with increasing CK, CK-MB and troponin levels in STEMI patients.

Prognostic utility of serum vitronectin levels in acute myocardial infarction.

BackgroundVitronectin (VN) functions as a regulator of platelet adhesion and aggregation, coagulation, and fibrinolysis. The aim of this study was to assess the prognostic significance of serum VN levels in patients with acute myocardial infarction (MI).MethodsIn this study 62 patients admitted with ST-elevation myocardial infarction (STEMI), or non-ST-elevation myocardial infarction (NSTEMI) were enrolled. Serum VN levels were measured within 6xa0h after onset of chest pains.ResultsThe VN serum levels were higher in MI patients with a mean of 2.257xa0µg/ml (range 1.541–4.493xa0µg/ml) in the STEMI group, 1.785xa0µg/ml (range 1.372–4.113xa0µg/ml) in the NSTEMI group, and 1.222xa0µg/ml (range 1.033–1.466xa0µg/ml) in the controls (pu2009=u20090.012). Major adverse cardiovascular events could be predicted at 6 months using VN levels independently of other variables [odds ratio (OR) 9.87, 95u2009% confidence interval (CI) 2.54–47.37, pu2009=u20090.001]. There was a significant positive correlation between VN levels and the Gensini score in NSTEMI patients (ru2009=u20090.436, pu2009=u20090.013).ConclusionThe VN level may be relevant as a clinical biomarker for adverse cardiovascular outcomes not only in patients with ischemic heart disease undergoing coronary interventions, as previously reported, but also in coronary artery disease patients presenting with acute MI.ZusammenfassungHintergrundVitronectin (VN) ist ein Regulator der Thrombozytenadhäsion und -aggregation, der Koagulation und Fibrinolyse. Ziel der vorliegenden Studie war es, die prognostische Bedeutung des VN-Serumspiegels bei Patienten mit akutem Myokardinfarkt (MI) zu ermitteln.MethodenAn dieser Studie nahmen 62 Patienten teil, die wegen ST-Strecken-Hebungs-Infarkt (STEMI) oder Nicht-ST-Strecken-Hebungs-Infarkt (NSTEMI) stationär aufgenommen worden waren. Dabei wurde der VN-Serumspiegel innerhalb von 6xa0h nach Beginn der Thoraxschmerzen bestimmt.ErgebnisseBei Patienten mit MI war der VN-Serumspiegel mit einem Durchschnittswert von 2,257xa0µg/ml (Spannbreite: 1,541–4,493xa0µg/ml) in der STEMI-Gruppe höher als in der NSTEMI-Gruppe mit 1,785xa0µg/ml (Spannbreite: 1,372–4,113xa0µg/ml) und bei den Kontrollen mit 1,222xa0µg/ml (Spannbreite: 1,033–1,466xa0µg/ml; pu2009=u20090,012). Größere unerwünschte kardiovaskuläre Ereignisse innerhalb von 6xa0Monaten konnten anhand der VN-Werte unabhängig von anderen Variablen prognostiziert werden [Odds Ratio (OR): 9,87; 95%-Konfidenzintervall (95%-KI): 2,54–47,37; pu2009=u20090,001). Es bestand bei NSTEMI-Patienten eine signifikante positive Korrelation zwischen dem VN-Wert und dem Gensini-Score (ru2009=u20090,436; pu2009=u20090,013).SchlussfolgerungRelevanz weist der VN-Wert als klinischer Biomarker für ungünstige kardiovaskuläre Verläufe möglicherweise nicht nur bei Patienten mit ischämischer Herzerkrankung auf, bei denen – wie bereits früher berichtet – eine Koronarintervention erfolgt, sondern auch bei Patienten mit koronarer Herzkrankheit und akutem MI.

The relationship between aortic stiffness and serum hyaluronidase levels in patients with diabetes mellitus and hypertension

Abstract The aim of this study was to investigate the association of serum hyaluronidase and nitric oxide (NO) levels with arterial stiffness in patients with hypertension (HT) and diabetes mellitus (DM). A total of 101 patients with diagnosis of DM and HT were enrolled in this study. The patients were divided into three groups as follows: only hypertensive (I), only diabetic (II) and both diabetic and hypertensive (III). Serum hyaluronidase levels were negatively correlated with aortic strain (AS) and aortic distensibility (AOD) in all groups, whereas a significant positive correlation was noted between serum hyaluronidase levels and aortic strain index (ASI) (all p-values < 0.05). There was a significant negative correlation between serum hyaluronidase and NO levels in all patients (p < 0.001). When the correlation between serum hyaluronidase and serum NO levels was investigated in the individual patient groups, a negative correlation was found in groups I, II and III (p = 0.017, p < 0.001 and p < 0.001, respectively). A significant relationship between plasma hyaluronidase level and parameters of aortic stiffness was found in patients with HT and/or DM. We suggest that the pathophysiological mechanisms responsible for the development of arterial stiffness in subjects with impaired endothelial function may involve pathological changes in the HA metabolism.