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Allopurinol improves endothelial function and reduces oxidant-inflammatory enzyme of myeloperoxidase in metabolic syndrome

ObjectiveIn this study, we tested in patients with metabolic syndrome whether allopurinol through decreasing oxidative stress improves endothelial function, and ameliorates inflammatory state represented by markers of myeloperoxidase, C-reactive protein (CRP) and fibrinogen.MethodsIn a randomized, double-blind fashion; subjects with metabolic syndrome were treated with allopurinol (n = 28) or placebo (n = 22) for one month. Before and after treatment, blood samples were collected and the flow-mediated dilation (FMD) and isosorbide dinitrate (ISDN)-mediated dilation of the brachial artery were performed.ResultsBaseline clinical characteristics of the allopurinol and placebo groups demonstrated no differences in terms of clinical characteristics, endothelial function and inflammatory markers. After the treatment with allopurinol, FMD was increased from 8.0 ± 0.5 % to 11.8 ± 0.6% (P < 0.01), but there were no change in the placebo group. In both groups, ISDN-mediated dilation is unaffected by the treatment. As a marker of oxidative stress, allopurinol significantly reduced malondialdehyde. Moreover, myeloperoxidase levels were reduced by the treatment with allopurinol (56.1 ± 3.4 ng/ml vs. 44.4 ± 2.4 ng/ml, P < 0.05) but there were no change in the placebo group. Surprisingly, neither CRP nor fibrinogen levels were affected by the treatment in both groups.ConclusionXanthine oxidoreductase inhibition by allopurinol in patients with metabolic syndrome reduces oxidative stress, improves endothelial function, ameliorates myeloperoxidase levels and does not have any effect on CRP and fibrinogen levels.

P-wave Dispersion is Increased in Pregnancy Due to Shortening of Minimum Duration of P: Does This Have Clinical Significance?

Most pregnant women complain of palpitation, and various kinds of arrhythmias can be observed during pregnancy. We investigated P-wave and QT dispersion during pregnancy. Healthy pregnant women (n = 162) and healthy age-matched, non-pregnant women (n = 150) were included. We performed electrocardiography and transthoracic echocardiography and determined serum oestradiol levels in both groups, and performed Holter monitoring in the pregnant group only. Resting heart rate, P-wave dispersion, left ventricular diastolic diameter, left atrial diameter and serum oestradiol levels in the pregnant group were significantly higher than in the control group. Minimum P-wave duration was shorter in the control group than in the pregnant group; however, there was no statistically significant difference in maximum P wavelength and corrected QT dispersion between the groups. No atrial fibrillation was detected in the pregnant group during Holter monitoring. Shortening of the minimum P-wave duration leads to increased P-wave dispersion during pregnancy. In contrast to other pathologies with increased P-wave dispersion, paroxysmal atrial fibrillation is absent in pregnant women; this may be a result of the stable maximum P wavelength that is present during pregnancy.

The CHA2DS2-VASc score as a predictor of left atrial thrombus in patients with non-valvular atrial fibrillation.

Objective: To investigate whether or not the CHA2DS2-VASc score predicts left atrial (LA) thrombus detected on pre-cardioversion transoesophageal echocardiography (TEE). Materials and Methods: The medical records of patients who had undergone TEE were reviewed to assess the presence of LA thrombus prior to direct-current cardioversion for atrial fibrillation (AF). The CHA2DS2-VASc score was calculated for each patient. Clinical TEE reports were reviewed for the presence of LA thrombus. Patients with a valve prosthesis or rheumatic mitral valve disease were excluded from this study. Results: A total of 309 patients were identified. The mean age was 70.1 ± 9.8 years and 151 (49%) patients were males and 158 (51%) were females. LA thrombus was seen in 32 (10.3%) of the 309 patients. Fifty (16.2%) patients had a low CHA2DS2-VASc score (0-1), 230 (74.4%) had an intermediate score (2-4) and 29 (9.4%) had a high score (5-9). The incidence of LA thrombus in the low, intermediate and high CHA2DS2-VASc score groups was 0, 4.4 and 68.7%, respectively. The LA thrombus risk increased with increasing CHA2DS2-VASc scores. On multivariate logistic analysis, the CHA2DS2-VASc score (OR 3.26, 95% CI 2.3-4.65; p = 0.001) and age (OR 0.93, 95% CI 0.88-0.98; p = 0.004) were independent risk factors for LA thrombus in patients with non-valvular AF. Conclusion: A high CHA2DS2-VASc score was independently associated with the presence of LA thrombus in patients with non-valvular AF.

CA-125 level is associated with right ventricular echocardiographic parameters in patients with COPD.

Objective: A few studies have shown that elevated CA-125 levels are associated with chronic obstructive pulmonary disease (COPD). However, there are no data concerning the associaton between serum CA-125 levels and right ventricular (RV) function in COPD patients. This study aimed to evaluate the relationship between CA-125 level and RV echocardiographic parameters in COPD patients. Methods: Fifty-two patients with COPD (39 male/13 female, mean age 68.9 ± 5.7 years) were studied. The control group consisted of 30 age-sex matched healthy volunteers (23 male/7 female, mean age 64.2 ± 6.3 years). Patients were divided into two subgroups: patients without pulmonary hypertension (group I, n = 25) and with pulmonary hypertension (group II, n = 27). Conventional echocardiographic parameters, tissue Doppler imaging (TDI) and CA-125 level measurements were performed in all subjects. Results: Patients in group II had significantly higher CA-125 levels than those in group I and controls (P < 0.01). CA-125 levels in group I were also higher than control group (P < 0.05). CA-125 levels were correlated with left ventricle E/A ratio, systolic pulmonary artery pressure (sPAP), RV myocardial performance index, and RV fractional area change (r = 0.37, 0.56, 0.34, and - 0.42, respectively, all with P < 0.05). There was an independent correlation between CA-125 levels and sPAP values (&bgr; = 0.76, P < 0.001) Conclusions: Our results show an independent correlation between CA-125 levels and systolic pulmonary artery pressure in COPD patients. The clinical utility of these results at this point in time is unknown and deserves future research.

Abnormal elastic properties of the aorta in the mitral valve prolapse syndrome.

Background — Mitral valve prolapse (MVP) is the most common valvular heart disease representing a generalized disease of connective tissue in the primary form. Elastic properties of the aorta with primary MVP may be expected to be increased.We aimed to determine the aortic elasticity in the primary form of MVP. Methods and results — Twenty male patients with a primary form of MVP not having any sign of Marfan syndrome and joint hyperlaxity syndrome and twenty healthy individuals were included in the study.Aortic strain, aortic distensibility index and aortic stiffness index were calculated by using aortic diameters obtained by echocardiography and blood pressures measured by sphygmomanometer. When comparing the MVP group and the control group it was found that the aortic stiffness index was increased (P<0.05) whereas the aortic distensibility and strain index were decreased (P<0.05) in the MVP group. There was no significant difference between the characteristics of the groups (P>0.05). Conclusion — We concluded that the elastic properties of the aorta were decreased in the primary form of MVP, unexpectedly.Therefore, results of decreased aortic elasticity should also be followed up in patients with MVP.

Aortic elastic properties in young pregnant women

This study aimed to investigate the aortic elastic properties of young pregnant women by comparing them with those of age-matched healthy females. The study group consisted of 21 pregnant women at a mean age of 26 ± 1 years; 22 healthy women at a mean age of 25 ± 1 years constituted the control group. Doppler-color echocardiographic variables and serum estradiol (E2) levels were measured from both groups. The blood samples were obtained from the control group in the first week after menstrual bleeding. Diastolic and systolic blood pressure (DBP and SBP, respectively) were measured with a sphygmomanometer. Systolic and diastolic aortic diameters (AOS and AOD, respectively) were measured 3 cm proximal to the aortic valves. Aortic elastic properties were assessed according to the following formulas: 1, Aortic strain = (AOS − AOD)/AOD; 2, Aortic distensibility = 2 × (AOS − AOD)/(PP × AOD); 3, Aortic diameter change = AOS − AOD; 4, Aortic stiffness index = ln(SBP/DBP)/(AOS − AOD)/AOD. The results were expressed as mean ± standard deviation and compared by t-test between groups. P < 0.05 was considered as statistically significant. All women in the study group were in their first pregnancy and second trimester. The height and weight were 160 ± 5 vs 164 ± 6 cm and 60 ± 9 vs 54 ± 3 kg in the study vs control groups, respectively (P < 0.05). The AOD was 26 ± 3 vs 26 ± 4 mm and AOS 29 ± 3 vs 28 ± 4 mm. Pulse pressure was 43 ± 3 vs 45 ± 8 mmHg in the study vs control groups, respectively (P > 0.05). The serum E2 level was significantly higher in pregnant women (21 300 ± 2 300 pg/ml). Derived aortic elastic properties in pregnant women were also increased significantly (P < 0.0005). The indexes of aortic elastic properties are altered and aortic stiffness is decreased among young pregnant women. This may be due to the adaptation mechanisms including high estradiol levels detected in pregnancy.

Abnormal aortic elasticity in patients with liver steatosis

AIM Non-alcoholic fatty liver disease (NAFLD) may be associated with insulin resistance. We aimed to evaluate elastic properties of aorta in patients with NAFLD. MATERIAL AND METHOD Ninety-two patients with NAFLD and 47 healthy subjects were performed ultrasonographic and echocardiographic examination. Aortic stiffness index (ASI), aortic distensibility (AD) and aortic strain (AS) were compared between healthy subjects and patients and also among grade I and II liver steatosis. Statistical analysis was performed by Independent-Samples t-test, Pearsons correlation test using SPSS 11.0. RESULTS ASI was significantly increased whereas AS and AD were reduced (p>0.05) in patients compared to normal ones. ASI was significantly increased while AD and AS slightly increased in patients with grade II liver steatosis compare to grade I. SBP and DBP, cholesterol levels, fasting blood glucose (FBG) were also increased and doppler flow parameters of mitral inflow were abnormally changed in those patients. ASI was positively correlated with FBG, ALT and ALP levels, LDL cholesterol, heart rate and deceleration time of mitral E wave. CONCLUSION Elastic properties of aorta were abnormally changed in patients with NAFLD. Multiple hemodynamic abnormalities probably associated with insulin resistance may be accountable for abnormal elastic properties of aorta.

Comparison of hemodynamic and neuroendocrine changes during total intravenous anesthesia and inhalation anesthesia

Abstract Background: Various aspects of anesthesia and surgery cause stress-induced endocrine and metabolic changes in organisms due to stimulation of the sympathoadrenergic system. Intravenous and inhalation anesthetic agents alter endocrine and metabolic responses to surgical stimuli. Objective: The objective of this study was to compare the effects of 2 anesthesia methods on patient response to surgical stress. Three components of general anesthesia were involved: hypnosis, analgesia, and muscle relaxation. Methods: Patients were randomly assigned to 1 of 3 groups: Group I received total intravenous anesthesia (TIVA) using propofol and alfentanil. Group II received inhalation anesthesia and was divided into 2 subgroups: group IIA received isoflurane, and group IIB received sevoflurane. Patients from all 3 groups underwent assessment of hemodynamic variables (heart rate, systolic blood pressure [SBP], and diastolic blood pressure [DBP]) and endocrinologic variables (plasma levels of blood glucose, C peptide, insulin, catecholamines [epinephrine, norepinephrine], and cortisol). Results: Sixty patients were enrolled in the study and assigned to 1 of the 3 groups (20 per group). Heart rate decreased significantly ( P P P P P P P P P P P P P Conclusions: Based on our results, we concluded that hemodynamic and neuroendocrine responses to surgical stress are better controlled with TIVA compared with inhalation anesthesia.

Assessment of interventricular septal motion using colour tissue Doppler imaging in adult patients with atrial septal defect.

We aimed to characterize changes in interventricular septum (IVS) motion and any relationship between them and the pulmonary-to-systemic flow ratio (Qp/Qs) in adult patients with atrial septal defect (ASD). Patients and controls were studied using colour tissue Doppler imaging (TDI). The septum length (SL) and distance from the colour change point (CCP) on the IVS to the aortic valve (the CCP distance) were measured on parasternal long axis views. Values normalized for body surface area, and the CCP distance to SL ratio, were calculated. Q p /Q s values were correlated with CCP distance, normalized CCP distance and CCP distance: SL ratio. Statistically significant differences in CCP distance, normalized CCP distance and CCP distance: SL ratio were found between the two groups. In the ASD group, there was no correlation between Q p /Q s and the echocardiographic measurements. The point between the motions in two different directions from the IVS shifted toward the apex in ASD patients compared with controls, and may be a mechanism involved in paradoxical septal motion.

Two giant coronary artery aneurysms accompanying aortic aneurysms

positive with Staphylococcus aureus. Because of the uncertain diagnosis, we planned computerized tomography (CT) of the chest. Computerized tomography revealed a pseudoaneurysm of the ascending aorta (Fig. 4). The patient underwent emergency aortic surgery. Although, intensive management and antimicrobial therapy was given, she developed multiple organ failure and died in the postoperative period. The present case demonstrates a mycotic aortic aneurysm, which is a rarely considered but serious complication of bacterial endocarditis. Mycotic aneurysm is an infrequent complication of arterial infection. Infected aortic aneurysm occurs about 0.7%-2.6% of all aortic aneurysms. Awareness and recognition of imaging features associated with infected aneurysms are all important for early diagnosis and institution of adequate therapy. Infected aneurysms are likely to rupture, with reported rupture rates of 53% to 75%. Urgent surgical intervention followed by long-term antibiotic therapy is the preferred treatment approach.