Berkay Ekici

Is mean platelet volume associated with the angiographic severity of coronary artery disease

BACKGROUND Platelet activation and aggregation play key roles both in the pathogenesis of atherosclerosis and in the developmentof acute thrombotic events. Platelet volume is a marker of platelet activation and function, and is measured usingmean platelet volume (MPV). AIM To determine the relationship between MPV and angiographic Gensini and SYNTAX scores, which give information about the severity and complexity of coronary artery disease (CAD). METHODS This study included 435 consecutive patients undergoing elective coronary angiography. The complete blood countand biochemical examination of blood were obtained after 12 h of fasting. The independent association between MPV andthe severity of CAD was statistically evaluated using PASW Statistics 18 for Windows. RESULTS Mean age of the study population was 58.4 ± 9.3 years, of whom 196 were female (45.1%) and 239 male (54.9%). Of the patients, 63.2% had CAD, 31.7% had diabetes mellitus, 61.8% had hypertension, 56.6% had hyperlipidaemia, and 38.6% were smokers. Mean Gensini score was 20.7 ± 31.1. According to Gensini scores, 160 of the patients (36.8%) hadnormal coronary arteries (Gensini score: 0), 134 of the patients (30.8%) had minimal CAD (Gensini score: 1-19), and 141 ofthem (32.4%) had severe CAD (Gensini score ≥ 20). Mean MPV values were 8.4 ± 1.0 fL in the group that had no CAD,8.7 ± 1.0 fL in the group with minimal CAD, and 9.3 ± 1.5 fL in the group with severe CAD. According to Spearman correlationanalysis, the positive relationship found between MPV and Gensini score was statistically significant (p < 0.001,r = 0.290). Likewise, SYNTAX score was also associated with MPV (p < 0.001, r = 0.504). CONCLUSIONS We determined a positive correlation between MPV and Gensini and SYNTAX scores. Therefore, this simple haematology test can be used in determining cardiovascular disease burden besides other risk factors during routine clinical practice. For further information about this topic, large-scale studies are needed.

Neutrophil to lymphocyte ratio is associated with more extensive, severe and complex coronary artery disease and impaired myocardial perfusion

OBJECTIVES We investigated the relation between neutrophil to lymphocyte ratio (N/L) and the extent, severity, and complexity of coronary artery disease (CAD) and myocardial perfusion. STUDY DESIGN One hundred and fifty-one patients who underwent coronary angiography with stable angina pectoris (SAP) (n=93) or acute coronary syndrome (ACS) (n=58) were included in the study. Blood samples were drawn before coronary angiography. Gensini and SYNTAX scores and myocardial blush grade (MBG) were assessed. RESULTS Neutrophil counts were 4.4±1.4 and 5.0±1.6 in the SAP and ACS groups (p=0.018), whereas lymphocyte counts were 2.2±0.7 and 2.1±0.7, respectively (p=0.104). N/L was 2.2±1.2 in the SAP and 2.6±1.0 in the ACS (p=0.002) groups. In patients with SAP, N/L was significantly correlated with Gensini and SYNTAX scores (Gensini score r=0.32, p=0.002; SYNTAX score r=0.36, p=0.000), but there was no significant correlation between N/L and MBG. In the ACS group, N/L had a more powerful association with both Gensini and SYNTAX scores (Gensini r=0.42, p=0.001; SYNTAX r=0.51, p=0.000). N/L was negatively correlated with MBG in ACS patients (r= -0.48, p=0.000). Significant correlations persisted both in the SAP and ACS groups after correcting for age, diabetes, hyperlipidemia, and statin use; however, the associations were weaker. Cut-off N/L to predict moderate to severe CAD according to SYNTAX score was 2.26, with 72% sensitivity and 71% specificity (area under the curve [AUC]: 0.772, 95% confidence interval [CI] 0.679-0.865, p<0.001). CONCLUSION N/L is associated with severe, extensive and complex CAD and may be used to predict moderate to severe involvement in patients with CAD.

The effect of emotional status and health-related quality of life on the severity of coronary artery disease

BACKGROUND Coronary artery disease (CAD) is the most common form of heart disease and a leading cause of death worldwide. Extensive clinical and statistical studies have identified several factors that increase the risk of CAD and myocardial infarction. AIM To investigate the relationship between severity of CAD, anxiety, depression, and health-related quality of life (HRQoL). METHODS A total of 225 patients (116 men, 109 women) who underwent elective coronary angiography were included. All patients were assessed for the presence of cardiovascular risk factors and ongoing medications. A biochemical examination of blood was performed in all patients before the procedure. The 225 patients were divided into three groups (a control group, and minimal and significant CAD groups) based on their Gensini score, which evaluates the severity of CAD. The Nottingham Health Profile (NHP) was used to measure HRQoL. Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale (HADS). RESULTS A significant positive correlation was found between HADS and Gensini scores (HADS-anxiety: r = 0.139, p = 0.038; HADS-depression: r = 0.156, p = 0.019). A significant positive correlation was also determined between NHP-total and Gensini scores (r = 0.145, p = 0.029). According to the NHP, energy (p = 0.048) and physical mobility status (p = 0.021) were better in the control group than they were in the CAD groups. CONCLUSIONS Our study demonstrates that anxiety, depression, and HRQoL are related to CAD severity. Therefore, emotional status and HRQoL should be evaluated during routine clinical treatment of CAD.

Epicardial adipose tissue thickness can be used to predict major adverse cardiac events.

ObjectiveIncrease in epicardial adipose tissue (EAT) thickness is associated with subclinical and manifest coronary artery disease. In addition, it is associated with the severity and extent of coronary atherosclerosis. We aimed to investigate whether increased EAT thickness is associated with adverse cardiovascular outcomes. Patients and methodsTwo hundred consecutive patients who were admitted with stable angina pectoris, unstable angina pectoris or acute myocardial infarction (MI), and had undergone coronary angiography were included and followed for revascularization, nonfatal MI, hospitalization for heart failure and cardiovascular death for 26 (5–30) months. ResultsThere were significantly more revascularizations, nonfatal MI and cardiovascular death in patients with an initial EAT thickness more than 7 mm (P<0.001 for all). Significant predictors of cardiovascular death were identified as an EAT thickness more than 7 mm [hazard ratio (HR) 1.9, 95% confidence interval (CI) 0.4–8.3, P=0.039] and diabetes (HR 3.42, 95% CI 0.7–17.5, P=0.014) in the multivariate Cox regression analysis. Event-free survival for cardiovascular death in the EAT up to 7 mm group was 97.9%, whereas it was 90.7% in the EAT more than 7 mm group (P=0.021). In addition, significant predictors of MI were identified as an EAT thickness more than 7 mm (HR 2.4, 95% CI 0.6–10.0, P=0.021) and diabetes (HR 3.4, 95% CI 1.0–11.2, P=0.04). Event-free survival for MI in the EAT up to 7 mm group was 96.4%, whereas it was 68.2% in the EAT more than 7 mm group (P=0.001). ConclusionIncrease in EAT thickness independently predicts adverse cardiac events including MI and cardiovascular death.

The relationship between serum uric acid levels and angiographic severity of coronary heart disease

BACKGROUND Many studies have shown that the serum uric acid (SUA) level is associated with atherosclerosis. AIM To determine the relationship between the SUA level and the presence and severity of coronary heart disease (CHD). METHODS A total of 705 patients who underwent coronary angiography were included in this study. All patients were assessed for the presence of cardiovascular risk factors and ongoing medications. SUA levels were measured in all patients before the procedure after 12 h of fasting. The severity of CHD was assessed by the SYNTAX score. The independent association between the SUA and the severity of CHD was statistically evaluated using IBM SPSS Statistics 21 for Windows. RESULTS The mean age of the study population was 60.2 ± 11.0 years. 252 were female (35.7%) and 453 were male (64.3%). Of the patients, 59.0% had significant CHD, 34.6% had diabetes mellitus, 67.7% had hypertension, 55.3% had hyperlipidaemia, and 45.4% were current smokers. The mean SYNTAX score was 10.6 ± 12.9. According to the SYNTAX score, 289 of the patients (41%) had normal coronary arteries and non-significant CHD (controls, SYNTAX score: 0), 236 of the patients (33.5%) had mild CHD (SYNTAX score: 1-22), 97 (13.8%) had moderate CHD (SYNTAX score: 23-32), and 83 (11.8%) had severe CHD (SYNTAX score: ≥ 33). The mean SUA values were 5.3 ± 1.5 mg/dL in the control group, 5.6 ± 1.4 mg/dL in the mild CHD group, 6.2 ± 1.6 mg/dL in the moderate CHD group, and 6.5 ± 1.7 mg/dL in the severe CHD group. According to Spearmans rho analysis, a positive correlation between the SUA levels and the SYNTAX score was determined to be statistically significant (p < 0.001, r = 0.239; p = 0.002, r = 0.148 in men; p = 0.001, r = 0.204 in women). CONCLUSIONS In this study, we found a positive correlation between the SUA level and the SYNTAX score. Therefore, this routine biochemical test can be used for the evaluation of the severity of CHD besides other risk factors in clinical practice. However, larger scale randomised studies are needed to show the effects of SUA on the severity of CHD.

Duration of migraine is associated with cardiac diastolic dysfunction.

OBJECTIVE Migraine is a common type of headache accompanied or preceded by signs of central and autonomic nervous system dysfunction. Autonomic dysfunction has been suggested to be a potential contributor to impaired cardiac diastolic function. Cardiac diastolic dysfunction is characterized by normal left ventricular contractility but impaired ventricular relaxation. It is a growing clinical entity implicated in morbidity and mortality due to heart failure. The aim of this study was to determine if any relationship exists between migraine and diastolic dysfunction. METHODS Migraineurs (N = 55), and age- and sex-matched healthy controls (N = 52) were evaluated by conventional and tissue Doppler echocardiography. Migraine-related disability in the previous 3 months was assessed by the Migraine Disability Assessment questionnaire. Baseline characteristics were recorded, and blood samples were collected. RESULTS The groups did not differ in terms of sex or age. The migraine group had higher lipid levels compared with the control group. Diastolic dysfunction was significantly higher among the 30 migraineurs with a history of migraine of 10 years or more compared with the 25 migraineurs with a history of less than 10 years, (P = 0.003). In logistic regression analysis, migraine duration was shown to be an independent predictor of diastolic dysfunction (odds ratio 1.130, 95% confidence interval, P = 0.044). CONCLUSIONS Cardiac diastolic dysfunction is associated with migraine. A long history of migraine is an independent predictor of diastolic dysfunction.

Successful Management of Coronary Artery Rupture with Stent-Graft: A Case Report

Perforation of coronary arteries is a relatively rare yet life-threatening complication of percutaneus coronary interventions and is encountered in approximately 0.5% of these procedures. According to the type of coronary perforation, various methods of correction are employed, ranging from conservative approach to emergency cardiac surgery. Coronary stent-grafts are composed of two metal stents and a polytetrafluoroethylene layer between them. Advent of such stents enabled efficient endovascular repair of coronary artery perforation. We present a case of coronary artery perforation which had occurred during stent implantation for the treatment of a bridged segment in the distal portion of the left anterior descending artery. This perforation was successfully managed by implanting a stent-graft.

Do pre-procedural laboratory parameters predict drug-eluting stent restenosis?

OBJECTIVE Drug-eluting stents (DES) have considerably reduced the rates of in-stent restenosis (ISR). Several studies reported pre-procedural C-reactive protein (CRP), neutrophil to lymphocyte (N/L) ratio, red cell distribution width (RDW), serum uric acid (UA), and mean platelet volume (MPV) as independent predictors of ISR using bare metal stents. This study investigates whether any laboratory parameter obtained before the coronary stenting procedure is associated with ISR using DES in stable coronary artery disease. METHODS Three hundred fifteen stents were retrospectively analysed in 285 patients who had undergone coronary stenting and a control coronary angiography within one year of stenting, between January 2012 and April 2014. Pre-procedural complete blood count, biochemistry, and CRP were recorded. Off-line quantitative coronary angiography analysis was performed. RESULTS Overall restenosis rate was 10.2%. When the stents were analysed with respect to the presence of ISR, the number of diabetics and smokers was higher in the ISR group. CRP levels were significantly higher in the ISR group, but there were no differences in N/L, monocytes, eosinophils, RDW, MPV, UA, and total bilirubin levels. In the univariate regression analysis, DM, CRP, stent length, stent diameter, pre-procedural diameter stenosis, pre-procedural minimal lumen diameter (MLD), post-procedural residual diameter stenosis, post-procedural reference vessel diameter, and post-procedural MLD were predictors of ISR. However, multivariate regression analysis identified only DM and post-procedural residual stenosis as independent predictors of ISR. CONCLUSION Pre-procedural blood parameters do not independently predict ISR in DES, which is mainly determined by the presence of diabetes and post-procedural residual stenosis.

Thickening of the epicardial adipose tissue can be alleviated by thyroid hormone replacement therapy in patients with subclinical hypothyroidism

BACKGROUND Subclinical hypothyroidism (SCH) is a common disorder which has adverse cardiovascular effects. Epicardial adipose tissue (EAT), a novel marker of cardiovascular risk, is increased in SCH. AIM We aimed to investigate whether L-thyroxine treatment can reverse the thickening of EAT in SCH. METHODS Forty-four patients with SCH and 42 euthyroid control subjects were included. EAT thickness was measured using transthoracic echocardiography at baseline and after restoration of the euthyroid status with 3 months of L-thyroxine treatment. RESULTS At baseline, mean EAT thickness was significantly greater in the SCH group when compared to the control group (6.3 ± 1.7 mm vs. 4.1 ± 0.9 mm, respectively, p < 0.001). There was a significant positive correlation between baseline serum thyroid stimulating hormone (TSH) level and EAT thickness in the SCH group. There was a significant reduction in mean EAT thickness in response to L-thyroxine treatment (6.3 ± 1.7 mm vs. 5.1 ± 1.4 mm, p < 0.001). The decrease in EAT thickness after L-thyroxine treatment when compared to baseline (DEAT) significantly correlated to the difference in TSH levels before and after treatment (DTSH; r = 0.323; p = 0.032). CONCLUSIONS Epicardial adipose tissue thickness is increased in patients with SCH. This thickening was alleviated with restoration of the euthyroid status with L-thyroxine treatment in our study population of predominantly male, relatively old subjects with greater baseline EAT thickness.

Shone's complex with dextrocardia and situs inversus totalis: a case report.

Parachute mitral valve complex is an unusual congenital anomaly that has been described by Shone et al. It is characterized by a parachute deformity of the mitral valve associated with additional forms of left heart anomalies, such as aortic valvular stenosis and coarctation of the aorta. A 21-year-old female who was referred to our department because of progressive dyspnea on effort and at rest and minimal cyanosis is presented in this case report. On cardiac auscultation, the patient had a grade III/VI pansystolic murmur best heard at the lower left sternal border. The chest X-ray demonstrated dextrocardia and mild cardiomegaly. Echocardiographic evaluation revealed Shones complex, including parachute mitral valve anomaly.