Burcu Uludag

microRNA -143 and -223 in obesity

BACKGROUND Obesity alters endocrine and metabolic functions of adipose tissue and has been recognized as a chronic inflammatory disease, which in turn may contribute to the development of insulin resistance, type 2 diabetes, obesity-associated vasculopathy and cardiovascular disease. The pathogenesis of obesity involves many regulatory pathways including transcriptional regulatory networks, including microRNAs. METHODS A total of 83 patients were included in the study. Patients were recruited from a cardiology outpatient clinic and were allocated into 3 age- and sex-matched groups according to their body mass index. Group 1 included 23 morbidly obese, group 2 30 obese, and group 3 30 normal or overweight subjects. RESULTS In our study, we showed that miR-143 and miR-223 levels were significantly lower in groups 1 and 2 than the control group (normal BMI or overweight). CONCLUSIONS Obesity leads to alterations in miRNA expressions and miRNA-143 and -223s can be used as biomarkers for the metabolic changes in obesity.

Increased red blood cell deformability and decreased aggregation as potential adaptive mechanisms in the slow coronary flow phenomenon.

ObjectiveAt present, the precise pathophysiology of the slow coronary flow phenomenon (SCFP) is still unknown and there is no consensus as to how it should be treated. The rheological factors affect the clinical course of various cardiovascular diseases. We studied the intrinsic properties of blood in the SCFP. Materials and methodsTwenty-six SCFP patients who had angiographically confirmed SCFP, and had otherwise normal epicardial coronary arteries, were included in our study, as were 30 healthy individuals with normal results from arteriography. Red blood cell (RBC) deformability, aggregation, whole-blood viscosity at both native and standard (40%) hematocrit, and plasma viscosity were determined in each individual. The results were analyzed using a Mann–Whitney U-test, an unpaired t-test, and a &khgr;2-test, where appropriate. ResultsThe mean thrombolysis in myocardial infarction frame count was significantly higher in SCFP patients than in the controls. RBC deformability measured at five different shear rates was significantly higher in SCFP patients than in the controls. The RBC aggregation index was lower in SCFP patients. There were no statistically significant differences in RBC aggregation half-time (t1/2) and aggregation amplitude, whole-blood viscosity, and plasma viscosity between the two groups. ConclusionThe SCFP is associated with increased RBC deformability and decreased RBC aggregation. These hemorheological alterations, possibly also contributing factors in limiting the pathogenesis, can especially serve as beneficial adaptive mechanisms in the SCFP.

Severity of coronary atherosclerosis in patients with COPD.

Chronic obstructive pulmonary disease (COPD) has many comorbidities such as coronary artery disease (CAD) and stroke. Chronic low‐grade systemic inflammation and oxidative stress play a significant role in CAD and COPD. We analysed that impact of COPD on intensity and severity of coronary artery lesions on the angiogram in the groups of patients with COPD according to the Global Initiative for Obstructive Lung Disease (GOLD) grades updated in 2015.

Impaired systolic blood pressure recovery and heart rate recovery after graded exercise in patients with metabolic syndrome.

Abstract The aim of this study was to evaluate and compare systolic blood pressure recovery and heart rate recovery (HRR) values obtained at various time intervals after maximal graded exercise treadmill testing between patients with metabolic syndrome (MS) and the controls without MS. To our knowledge, this is the first study indicating systolic blood pressure recovery (SBPR) impairment and its relations to HRR and other variables in this group of patients. The study population included 110 patients with MS (67 men, 43 women; mean age: 46 ± 9 years) and 110 control subjects who did not meet the criteria for MS (58 men, 52 women; mean age: 44 ± 10 years). All patients were selected from nonobese, apparently healthy sedentary individuals who had the ability to perform maximum exercise testing. SBPR was assessed by calculating the ratio of systolic blood pressure (SBP) obtained in the third minute of the recovery period to either the peak-exercise SBP or the SBP in the first minute of the recovery period after graded exercise testing. HRR values were calculated by subtracting the HR at the first, second, third, fourth, and fifth minutes of the recovery period from the HR reached at peak exercise. There was no significant difference found between the 2 groups with respect to age and sex distribution. As expected, patients with MS had higher waist circumference, fasting plasma glucose and serum triglyceride, and lower high-density lipoprotein cholesterol compared with control subjects. All HRR values calculated in the first, second, third, fourth, and fifth minutes were significantly detected lower in the MS group compared with the control group (HRR 1st: 32 ± 10 vs 36 ± 11; P = 0.009; HRR 2nd: 47 ± 10 vs 51 ± 11; P = 0.02; HRR 3rd: 53 ± 11 vs 58 ± 12; P = 0.001; HRR 4th: 57 ± 11 vs 64 ± 12; P < 0.001; HRR 5th: 60 ± 16 vs 69 ± 15; P < 0.001). In addition, calculated mean values for SBPR1 and SBPR2 were >1 in patients with MS (1.01 ± 0.2 vs 0.91 ± 0.1 and 1.01 ± 0.1 vs 0.94 ± 0.1) and these were statistically significant compared with the control group (P < 0.001 and P = 0.002, respectively). The existence of MS was found to be the only parameter that was independently and positively related to SBPR values in the study population. Our findings suggest that only the existence of MS itself, not the presence of any MS components, is independently associated with SBPRs. We are of the opinion that significantly impaired SBPR values, in addition to the decreased HRR values observed in this group of patients, such as those with MS, may especially help identify patients with potentially increased cardiovascular risk despite normal exercise stress testing findings.

Atrial tachycardia treated by coil embolization of a giant coronary artery fistula

Coronary artery fistulas are the second most frequently seen coronary anomaly following abnormalities of coronary artery origin and distribution. A coronary fistula is defined as a direct communication between a coronary artery and any cardiac chamber or vessel. Treatment options include percutaneous embolization and surgical intervention. Herein, we present a case of a giant coronary artery fistula and right atrial tachycardia that was induced during a diagnostic electrophysiologic study but was not inducible after the successful treatment of the fistula. This is the first case indicating this association.

The association between coronary flow rate and impaired heart rate recovery in patients with metabolic syndrome: A preliminary report

BACKGROUND The aim of this study is to evaluate heart rate recovery (HRR) and association between coronary flow rate and HRR in patients with metabolic syndrome (MS) who had morphologically normal coronary angiogram. METHODS Study population included 43 patients with MS and 37 control subjects without MS. All patients were selected from individuals who had recently undergone coronary angiography in our hospital and were diagnosed as having angiographically normal coronary arteries. Exercise stress test results obtained prior to coronary angiography were evaluated for calculating HRR and other parameters. In addition, coronary flow was objectively evaluated for each major coronary artery in each subject using TIMI frame count method. RESULTS All HRR values calculated were detected significantly lower in MS group compared to controls (HRR first: 32 ± 9 vs. 37 ± 10; p = 0.01, second: 46 ± 11 vs. 52 ± 11; p = 0.03, third: 51 ± 12 vs. 59 ± 12; p = 0.00, fourth: 54 ± 13 vs. 61 ± 2; p = 0.02). TIMI frame counts for each major epicardial coronary artery and mean TIMI frame count were also found to be significantly higher in MS group compared to controls (left anterior descending artery:51 ± 24 vs. 39 ± 15; p = 0.009, left circumflex artery: 32 ± 11 vs. 24 ± 7; p = 0.001, right coronary artery: 33 ± 14 vs. 24 ± 10; p = 0.003, mean TIMI frame count: 38 ± 15 vs. 29 ± 9;p = 0.002). Additionally, significant negative correlations were also detected between HRR first minute and coronary TIMI frame count values in patients with MS. None of MS parameters did not affect HRR values, however mean TIMI frame count independently associated with HRR first minute (p = 0.04) in patients with MS. CONCLUSIONS Impaired coronary blood flow occurring in MS might be a clue of autonomic dysfunction in addition to previously known endothelial dysfunction.

Vitamin D and PTH Levels in Acute Coronary Syndromes

PP-077 Vitamin D and PTH (Parathyroid hormone) are considered important primarily for calcium and phosporus homeostasis. However, in the recent years, vitamin D and PTH levels have been linked to cardiovascular disease and mortality. One hundred patients were included in the study. Patient group

Successful management of a proximally migrated stent in a middle-aged woman with unnoticed native aortic coarctation☆

Endovascular stent placement for adults with a newly diagnosed native discrete post-subclavian aortic coarctation (AC) became widely acceptedas an alternative to surgery,despite thatthe efficacyand long term safety of the technique have not yet been well established [1]. Placement of stent can be technically challenging and has been associated with serious complications, such as acute aortic rupture (rare), aortic dissection, femoral artery trauma, subacute stent thrombosis, recurrent coarctation, and aneurysm formation [2]. There is a paucity of data regarding stent migration, its causes; and its management has not been well defined. Proximal migration of a (covered) stent is a very rare occurrence [3]. To our knowledge, no previous reports of a proximally migrated covered stent and its successful repositioning using a peripheral balloon catheter during transcatheter management of AC in an adult have been published. We report a woman with a native AC whose treatment was complicated by stent migration proximally, which was then successfully repositioned at the expected site by transcatheter technique. A 45-year-old woman was referred for catheterization after her diagnostic work-up for resistant hypertension suggested renal artery stenosis. Her past medical history was notable for a 10-year history of hypertension. She had no other history of cardiovascular disease. She had hadtwo prior pregnancies,with ahistoryof hypertension requiring no drug therapy. Her medical regimen included nebivolol, lercanidipine, irbesartan, hydrochlorothiazide, and atorvastatin at the time of presentation. A thorough physical examination was performed, revealing the blood pressure difference between the right arm and leg of 30 mm Hg in the presence of systemic hypertension, a radial–femoral pulse delay with weak lower limb pulses, and faint mid-systolic murmur over the chest and back. Her electrocardiogram was normal with no evidence of left ventricular hypertrophy or ischemia. Echocardiography demonstrated left atrial dilatation, moderate mitral regurgitation, with an estimated left ventricular ejection fraction of 65%. However, gradient measurement by continuous wave Doppler was not obtainable. No other associated abnormalities were detected.

Ventricular tachycardia-based long QT without hypocalcaemia after use of ibandronic acid : online article - case report

Many drugs are known to cause lengthening of the QT interval. Ibandronic acid is a frequently used agent in the treatment of osteoporosis and is known to cause prolongation of the QT interval due to hypocalcaemia. However, no cases of long QT syndrome associated with ventricular tachycardia (VT) with a serum calcium level within the normal limits have been reported in the literature. We report on a case of a VT-based long QT syndrome associated with the use of ibandronic acid.