Cagdas Yuksel

The comparative effects of metoprolol and perindopril on aortic elasticity in young patients with prehypertension.

ObjectivesIt has been recently demonstrated that aortic elasticity is impaired in young patients with prehypertension compared with healthy controls. Accordingly, the purpose of the current study was to analyze the comparative effects of metoprolol and perindopril on aortic elasticity in young patients with prehypertension after 6 months of therapy. Material and methodsFifty newly diagnosed patients with hypertension, who were in the prehypertension category according to the Joint National Committee seventh report, were enrolled in this blind, randomized, prospective study. After baseline clinical assessment, patients were randomly assigned to 4 mg daily dose of perindopril (group I, n=27, 18 male, median age=35 years) or 100 mg daily dose of metoprolol succinate (group II, n=28, 16 male, median age=33 years) for 6 months. Aortic strain, distensibility, and stiffness indexes were calculated from aortic diameters measured by echocardiography and blood pressures simultaneously measured by sphygmomanometry before and after treatment. ResultsWhen the median aortic distensibility and strain indexes after 6 months of therapy were analyzed, aortic distensibility and strain indexes of both treatment arms were found to be significantly higher than those of the pretreatment period. In contrast, the posttreatment aortic stiffness indexes of both groups were significantly lower compared with those of pretreatment period. No statistical difference was found between pretreatment and posttreatment aortic elasticity parameters of both groups. Importantly, no statistically significant difference was found between the percentage change from baseline of metoprolol and perindopril groups regarding aortic elasticity parameters (aortic distensibility: 38.1 vs. 37.9%, respectively, P=0.86; aortic strain: 37.7 vs. 37.9%, respectively, P=0.44; stiffness index: −20.0 vs. −23.9%). ConclusionThe current study revealed that early pharmacological intervention had strong beneficial effects on aortic elasticity in patients with prehypertension despite the fact that neither metoprolol nor perindopril was superior to the other.

Impact of admission glomerular filtration rate on the development of poor myocardial perfusion after primary percutaneous intervention in patients with acute myocardial infarction.

AimsWe aimed to investigate the impact of admission estimated glomerular filtration rates (eGFR) on the development of poor myocardial perfusion after primary percutaneous coronary intervention (pPCI) in patients presenting with acute ST-segment-elevation myocardial infarction (STEMI). Materials and methodsStudy population consisted of 80 patients with STEMI (64 men, mean age=67.5±6.6 years) undergoing pPCI. Myocardial perfusion was evaluated by using thrombolysis in myocardial infarction (TIMI) myocardial perfusion grade (TMPG). Patients were divided into two groups according to TMPG after pPCI. Group 1 and 2 consisted of 40 patients with TMPGs 0–1 and 40 patients with TMPGs 2–3, respectively. GFR was calculated based on the abbreviated Modification of Diet in Renal Disease study equation. ResultsAdmission serum creatine kinase-MB isoenzyme (CKMB) levels and the percentage of lower eGFR (<60 ml/min/1.73 m2) values of the patients with TMPGs 0–1 were significantly higher than those of the patients with TMPGs 2–3 after primary PCI (P=0.007, P<0.001, respectively). Univariate analysis identified pain-to-balloon time, eGFR lower than 60 ml/min/1.73 m2, peak CKMB, and TIMI flow grade 0/1 as the predictors of poor myocardial perfusion. In multivariate analysis peak CKMB, left ventricular ejection fraction less than 35%, admission TIMI flow grade 0/1, lower eGFR and pain-to-balloon time continued to have statistically significant independent association with poor myocardial perfusion in the model. Adjusted odds ratios were calculated as 12.05 for low eGFR [P=0.005; confidence interval (CI): 2.11–68.70], 8.10 for admission TIMI grade 0/1 (P=0.04; CI: 1.37–47.91), 7.04 for pain-to-balloon time (P<0.001; CI: 2.37–20.90), 6.76 for low left ventricular ejection fraction (P=0.03; CI: 1.12–40.61), and 1.02 for CKMB (P=0.01; CI: 1.00–1.04). ConclusionDecreased GFR on admission in patients with STEMI is independently associated with the risk of poor myocardial perfusion following after primary PCI.

Alpha tocopherol use in the management of diabetic cardiomyopathy: lessons learned from randomized clinical trials

Although animal studies suggested that there may be a role for antioxidants (especially alpha-tocopherol) as therapy for heart failure (HF), the results obtained from human trials are disappointing. The variability in the response to antioxidant therapy may be due to genetic polymorphisms in enzymes involved in oxidative stress. We strongly believe that we do not have enough data supporting the use of antioxidant treatment in the management of HF patients, including a diabetic subset.

Stent fracture: A new villain of the village

Stent strut fracture (SSF) may be an important complication after drug-eluting stent (DES) implantation particularly in patients undergoing sirolimus-eluting stent (SES) implantation. The occurrence of SSF at 6 to 9 months after the SES implantation, which was relatively common, resulted in a higher rate of focal in-stent restenosis. Although this angiographic unfavorable outcome did not lead to an increased risk of adverse cardiac events in the current study, we believe that large-scale prospective studies are needed to elucidate the exact pathophysiology and clinical sequela of the stent strut fracture, including bare metal stents.

The beneficial effects of angiotensin-converting enzyme inhibitors on serum asymmetric dimethylarginine levels in the patients with cardiovascular disease

ACEI and AT1 receptor antagonists are the drugs most consistently shown to reduce ADMA level in humans. Unfortunately, most of the human studies addressing the effect of pharmacotherapy on ADMA metabolism were accomplished on small patient subgroups and were relatively shortlasting. Besides, L-arginine was rarely measured in most studies, whereas L-arginine/ADMA ratio may be more important for NO synthase function than ADMA itself, and arginine concentration may be either increased or decreased by pharmacotherapy. We strongly believe that agents affecting ADMA more specifically (protein arginine methyltransferases inhibitors or dimethylarginine dimethylaminohydrolase inducers) deserve further investigation.

Coronary artery disease associated with radiation therapy

Recent advancements in curative-intent therapies have led to dramatic improvements in breast cancer-specific mortality but at the direct expense of increased risk of cardiovascular-related mortality. The use of radiation therapy has led to significant improvements in survival for patients treated for breast cancer. However, as patients live longer, the potentially serious adverse effects of radiation on the heart have raised concerns. Coronary artery disease following irradiation is encountered rarely but is one of the most devastating treatable complications.In this article we review the cardiac complications associated with radiation therapy.

The prognostic significance of coronary collaterals in patients with ischemic heart disease: An essential response to ischemia

point like a fulcrum shaft. Stent strut fracture was an overlooked phenomenon in the era of BMSs because ISR rate due to proliferation of neointima was high; however, restenosis rate has become very low in the era of SESs, and SSF is thought to be one of potential the risk factors of ISR. On the other hand, ISR due to SSF of conventional BMS has also been reported [6,7]. It is interesting that many reported cases of restenosis due to stent fracture have been cases of stent implantation in the right coronary artery (RCA), which has a strongly curved course and large motion during cardiac systole and diastole, and cases of a vein graft in the large intrathoracic space. It has been suggested that mechanical fatigue occurs due to HM in regions of twists and curves, where the motion of the vessel during cardiac diastole and systole exerts strong forces at certain locations, which thus become vulnerable to strut fracture [8]. In conclusion, SSF may be an important complication after DES implantation particularly in patients undergoing SES implantation. The occurrence of SSF at 6 to 9 months after the SES implantation, which was relatively common, resulted in a higher rate of focal in-stent restenosis. Although this angiographic unfavorable outcome did not lead to an increased risk of adverse cardiac events in the current study, we believe that large-scale prospective studies are needed to elucidate the exact pathophysiology and clinical sequela of the stent strut fracture, including BMSs. Acknowledgement

Increased Platelet Activation in Young Patients with Prehypertension

Mean platelet volume (MPV) and sP-selectin levels are considered as indicators of platelet activation. In this study, we assessed platelet activation in prehypertensive patients by comparing MPV and sP-selectin levels of these patients with healthy conrols. The study population consisted of 25 newly diagnosed prehypertensive individuals (18 men, mean age = 34 ± 6 y) and 25 healthy control subjects (16 men, mean age = 33 ± 6 y) eligible for the current study. Blood pressure (BP) , lipid profile, plasma glucose, HOMA-IR values, sP-selectin levels, platelet counts, and MPV were measured in both groups. Other than systolic blood pressure (SBP) and diastolic blood pressure (DBP), baseline demographic characteristics of both groups were similar. No significant difference was found between the platelet counts of the two groups. Despite comparable platelet counts, platelet activation parameters were found significantly higher in the prehypertensives. Prehypertensives had larger a MPV value compared to that of the control group (8.24 ± 0.46 fl vs. 7.70 ± 0.64 fl; P = 0.001) and plasma sP-selectin levels were also significantly higher in the prehypertensive patients (163.60 ± 41.21 ng/ml vs. 132.80 ± 36.46; P = 0.007). Spearman correlation analysis revealed moderate positive correlation between SBP and platelet activation parameters (for SBP and MPV, r = 0.60, p = 0.001; for SBP and sP-selectin r = 0.51, p = 0.009). Prehypertension causes platelet activation as evidenced by increased MPV and plasma sP-selectin levels. Increased platelet activation might be related to increased vascular thrombotic risk in those patients.

The clinical presentation of restenosis after bare metal stent implantation: Behind a facade of benignity

Contrary to common belief, bare metal in-stent restenosis (ISR) seems to be not a benign clinical entity. Thus,we believed that continued efforts are warranted to prevent bare metal ISR, including aggressive use of drug-eluting stent (DES) to decrease the incidence of acute coronary syndromes. However, despite improved outcomes with DES, bare metal stent (BMS) will continue to play a role for both clinical and economic reasons and we feel that there is still a future for BMS.