Bugra Ozkan

Mean platelet volume and extent and complexity of coronary artery disease in diabetic and nondiabetic patients with ST elevation myocardial infarction.

We investigated whether the mean platelet volume (MPV) is associated with the extent and complexity of coronary artery disease in patients with ST elevation myocardial infarction (STEMI). We prospectively included 912 STEMI patients (663 male and 249 female; mean age 58.7 ± 12.4 years) who underwent primary percutaneous coronary intervention. The patients were divided into 3 groups according to MPV tertiles. Highest SYNTAX score (SS) was observed in MPVhigh group compared with MPVmid and MPVlow groups (P < .001 for all). The SS of MPVmid group was higher than MPVlow group (P = .036). The MPV in diabetic STEMI patients was higher than in nondiabetic STEMI patients (P < .001). Multivariate linear regression analysis showed that the MPV was associated with diabetes (β = .115, P = .001), troponin level (β = .131, P = .001), platelet count (β = −.241, P < .001), and SS (β = .216, P < .001). The relation between MPV and SS in diabetic STEMI patients was stronger than for nondiabetic STEMI patients (r = .473, P < .001 vs r = .129, P = .001).

Relationship between mean platelet volume and atherosclerosis in young patients with ST elevation myocardial infarction.

Increased mean platelet volume (MPV) is associated with poor clinical outcome in patients with acute coronary syndrome. We evaluated the predictive role of MPV in young patients with acute myocardial infarction (AMI). This study includes 373 patients who presented to our hospital with AMI (group 1: 134 young patients, males aged <45 years and females aged <55 years; group 2: 239 older patients) and 141 adults with normal coronary angiography as a control group (group 3). In group 1, the levels of MPV and hemoglobin were higher than that in groups 2 and 3. In group 1, blood urea nitrogen levels were lower than that in groups 2 and 3 and creatinine levels were lower than that in group 2. After multivariate analysis, MPV and age were independent predictors of AMI in young patients.

Association Between Uric Acid and Coronary Collateral Circulation in Patients With Stable Coronary Artery Disease

Serum uric acid (SUA) levels have been proposed as a biomarker of coronary artery disease (CAD) and coronary collateral circulation (CCC). We investigated the association between SUA levels and development of CCC in patients with stable CAD. Consecutive patients (n = 480) with stable CAD who underwent coronary angiography and documented total occlusion in 1 of the major coronary arteries were included in this study. Levels of fasting blood glucose, white blood cell (WBC), creatinine, platelet count, and SUA were significantly higher in patients with poor CCC than in those with good CCC. After multivariate analysis, high levels of SUA were an independent predictor of CCC together with levels of fasting blood glucose and WBC. The receiver–operating characteristic analysis provided a cutoff value of 5.65 mg/dL for SUA to predict poor CCC with 60% sensitivity and 66% specificity. High levels of SUA may be associated with poor CCC in patients with stable CAD.

Red cell distribution width is associated with acute myocardial infarction in young patients

BACKGROUND There are few studies about predictors of ST elevation myocardial infarction (STEMI) in young patients. High red cell distribution width (RDW) levels were associated with adverse outcomes in patients with STEMI. We aimed to investigate the relationship between RDW and STEMI in young patients. METHODS This study included 370 patients who presented to our hospital with acute myocardial infarction (Group 1: 198 young patients, 〈 45 ages for male, 〈 55 ages for female, Group 2: 172 elderly patients) and 156 adults with normal coronary angiography as a control group (Group 3: 91 young patients, 〈 45 ages for male, 〈 55 ages for female, Group 4: 65 elderly patients). RESULTS Compared with Group 3, Group 1 had a significantly higher value of RDW (Group 1 RDW 14.1 ± 1.1%, Group 3 RDW 13.4 ± 0.9, p1 〈 0.01). Value of RDW was similar both of Group 2 and 4 (Group 2 RDW 13.7 ± 1.2, Group 4 RDW 13.5 ± 0.9, p2 = 0.1). After multivariate analysis, high levels of RDW were independent predictors of STEMI in young patients (OR: 0.337, p 〈 0.01) together with gender (OR: 3.725, p 〈 0.01), history of hyperlipidemia (OR: 25.172, p 〈 0.01) and high density lipoprotein cholesterol (OR: 1.088, p 〈 0.01). CONCLUSIONS High levels of RDW were associated with STEMI in young patients. We think that RDW is a widely available marker with no additional costs, in contrast to other novel markers of cardiovascular risk.

Relationship between platelet indices and international normalized ratio in patients with non-valvular atrial fibrillation

Abstract Atrial fibrillation (AF) is the most common sustained arrhythmia and associated with adverse outcomes and increased risk for thromboembolic events. Warfarin is still the most extensively prescribed oral anticoagulant in AF to prevent ischemic complications. We aimed to determine the differences at platelet indices with warfarin usage layered by International Normalized Ratio (INR). A total of 250 patients with permanent non-valvular AF (mean age 70.2 ± 9.1; 153 female) were divided into two groups. Group 1 included 125 patients whose INR is between 2.0 and 3.0 (called as “effective”) and Group 2 included 125 patients whose INR is <2.0 (called as “ineffective”). Also 123 age- and sex-matched individuals in sinus rhythm enrolled as control group (Group 3). After physical and echocardiographic examination, complete blood counts and INR were studied. There was no statistically significant difference in age, sex, co-morbidities and medications, also hemoglobin, white blood cell and platelet counts among the groups. The CHA2DS2-VASc scores were similar between Groups 1 and 2. The mean platelet volume (MPV), platelet distribution width (PDW) and plateletcrit (PCT) were significantly higher in Group 2 than Groups 1 and 3 and similar between Groups 1 and 3. MPV was positively correlated with PDW and PCT and also inversely correlated with INR value and platelet count. On multivariate logistic regression analysis, MPV, PDW and PCT were independent predictors of ineffectiveness of INR. The results of this study showed that MPV, PDW and PCT are increased in patients with non-valvular AF without effective warfarin treatment. Warfarin usage adjusted by INR is associated with lower values of these platelet indices, even lower as the values of subjects in sinus rhythm. MPV, PDW and PCT are independent predictors of INR ineffectiveness and seem to be useful parameters for monitoring the effectiveness of warfarin treatment.

The relationship between neutrophil-to-lymphocyte ratio and coronary collateral circulation.

Neutrophil/lymphocyte ratio (NLR) has been proposed as a prognostic marker to determine systemic inflammatory response and atherosclerosis. Our aim was to determine the relationship between NLR and development of coronary collateral circulation (CCC) in patients with stable coronary artery disease (CAD). A total of 521 consecutive patients with stable CAD who underwent coronary angiography and documented total occlusion in one of those major coronary arteries were included in this study. Levels of fasting blood glucose, white blood cell, and NLR were significantly higher in patients with poor collateral than in those with good collateral. After multivariate analysis, high level of NLR was an independent predictor of CCC together with levels of fasting blood glucose. The receiver–operating characteristic analysis provided a cutoff value of 2.75 for NLR to predict poor CCC with 65% sensitivity and 68% specificity. We demonstrated an independent association between levels of NLR and development of CCC in patients with stable CAD.

Association of mean platelet volume and pre- and postinterventional flow with infarct-related artery in ST-segment elevation myocardial infarction.

Platelets play a role in the pathogenesis of ST-segment elevation myocardial infarction (STEMI). We assessed the relationship between mean platelet volume (MPV) on admission and pre- and postinterventional flow with the infarct-related artery (IRA) in patients with STEMI. We prospectively included 840 patients with STEMI who underwent primary percutaneous coronary intervention (PCI). The patients were divided into 3 groups according to MPV tertiles. Pre- and post-PCI Thrombolysis In Myocardial Infarction (TIMI) flow grade was determined. Initial TIMI flow grade 3 was accepted as patent IRA. After the primary PCI, normal flow was defined as post-PCI TIMI flow 3. When the MPV was increased, the incidence of pre-PCI patent IRA (P = .004) and post-PCI normal TIMI flow (P < .001) was significantly decreased. Multivariate analysis showed that MPV was independently associated with post-PCI TIMI flow grade.

Mean platelet volume is related with ischemic stroke in patients with sinus rhythm.

Stroke is the leading cause of disability worldwide. It is known that atrial fibrillation and left atrial enlargement contribute ischemic stroke, and mean platelet volume (MPV) increases in patients with ischemic stroke and atrial fibrillation. We aimed to determine whether higher MPV is associated with ischemic stroke in patients with sinus rhythm. We evaluated 74 patients in sinus rhythm and with ischemic stroke (Group 1) and 90 age-matched and sex-matched healthy individuals as control group (Group 2). After physical and echocardiographic examination, 24–48 h Holter monitoring and complete blood counts were studied. There were no statistically significant differences in age, sex rates, and comorbidities between groups. Left atrial diameter was higher in Group 1 than Group 2 (P = 0.001), but both were in normal range. MPV was significantly higher in Group 1 (P < 0.001) and was an independent determinant [odds ratio (OR): 1.840; P < 0.001; 95% confidence interval (CI) 1.330–2.545] of ischemic stroke with left atrial (OR: 1.138; P = 0.006; 95% CI 1.037–1.248). In conclusion, higher MPV is associated with acute ischemic stroke in patients with sinus rhythm and without heart failure or left atrial enlargement. MPV and left atrial diameter are independent predictors of ischemic stroke in this patient population.

Asymptomatic accessory mitral valve tissue diagnosed by echocardiography.

A 19-year-old male patient was presented with a complaint of palpitation. His physical examination and 12-lead electrocardiogram were normal. Transthoracic echocardiography revealed a mobile, chord-like structure, attached to the anterior papillary muscle and ventricular surface of the anterior mitral leaflet moving in the systole into the left ventricular outflow tract (arrow) (Fig. 1). There was no mitral regurgitation. Doppler examination showed a maximal 20 mm Hg gradient in the left ventricular outflow tract area. Transoesophageal echocardiography revealed an accessory mitral valve tissue (arrow), which adheres to the anterior mitral valve leaflet, and ballooning into the left ventricular outflow tract during the systole (Fig. 2). The patient was followed-up with periodical echocardiographic examinations, and without any surgical intervention. Accessory mitral valve tissue is a rare anomaly of embryologic development of the endocardial cushion. It may be associated with complex cardiac congenital malformations, can cause the left ventricle outflow tract obstruction and valve insufficiency.1),2) In patients with accessory mitral valve tissue, surgery is mandatory if there is significant obstruction in the left ventricular outflow tract, severe valvular regurgitation or any complication associated with this accessory tissue.3) Fig. 1 Fig. 2

PAI-1 4G/5G gene polymorphism is associated with angiographic patency in ST-elevation myocardial infarction patients treated with thrombolytic therapy.

BackgroundIn this study, we examined the relationship between PAI-1 4G/5G polymorphism and patency of the infarct-related artery after thrombolysis in patients with ST-elevation myocardial infarction (STEMI). MethodsAcute STEMI patients who received thrombolytic therapy within first 12 h were included in our study. The PAI-1 4G/5G promoter region insertion/deletion polymorphism was studied from venous blood samples. Patients with the PAI-1 4G/5G gene polymorphism were included in group 1 and the others were included in group 2. Coronary angiography was performed in all patients in the first 24 h after receiving thrombolytic therapy. Thrombolysis in myocardial infarction (TIMI) 0–1 flow in the infarct-related artery was considered as ‘no flow’, TIMI 2 flow as ‘slow flow’, and TIMI 3 flow as ‘normal flow’. ResultsA total of 61 patients were included in our study. Thirty patients (49.2%) were positive for the PAI-1 4G/5G gene polymorphism, whereas 31 of them (50.8%) were in the control group. There were significantly more patients with ‘no flow’ (14 vs. 6; P=0.02) and less patients with ‘normal flow’ (8 vs. 19; P=0.02) in group 1. In addition, time to thrombolytic therapy (TTT) was maximum in the ‘no flow’ group and minimum in the ‘normal flow’ group (P=0.005). In the logistic regression analysis, TTT (odds ratio: 0.9898; 95% confidence interval: 0.982–0.997; P=0.004) and the PAI-1 4G/5G gene polymorphism (odds ratio: 4.621; 95% confidence interval: 1.399–15.268; P<0.01) were found to be independently associated with post-thrombolytic ‘no flow’. ConclusionThe PAI-1 4G/5G gene polymorphism and TTT are associated independently with ‘no flow’ after thrombolysis in patients with STEMI.