Ebru Akgul Ercan

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.

Factors Associated With Increased Carotid Intima-Media Thickness and Being Nondipper in Nonobese and Normotensive Young Patients Affected by PCOS

Polycystic ovary syndrome (PCOS) is characterized by chronic unovulation, hyperandrogenism, and insulin resistance. We evaluated factors that affect “nondipper” status during 24-hour ambulatory blood pressure monitoring (ABPM) and carotid intima-media thickness (cIMT) in PCOS. Forty-two nonobese women newly diagnosed as PCOS and 32 healthy women were included. After biochemical and hormonal measurements, the ovaries were imaged by pelvic ultrasonography and cIMT was measured by B-mode ultrasonography. A 24-hour ABPM was performed thereafter. Carotid IMT and the ratio of nondippers were elevated compared with controls. Homeostasis model assessment insulin resistance index (HOMA-IR) and low-density lipoprotein cholesterol (LDL-C) were found to be related with being a nondipper in PCOS. None of the parameters evaluated were found to correlate with cIMT. In conclusion, patients with PCOS had increased nondipping ratios and cIMT when compared with controls. Insulin resistance and LDL cholesterol are factors that are related to diurnal variation in normotensive and young patients with PCOS.

Association of total serum antioxidant capacity with the Tei index in echocardiography in patients with microvascular angina.

ObjectivesCardiac syndrome X (CSX) is a condition characterized by exercise-induced chest pain that occurs considering a normal coronary angiogram. We aimed to investigate the total serum antioxidant capacity (TAC) and biventricular global functions using echocardiography in patients with CSX. Patients and methodsThe study population included 55 patients with typical anginal symptoms and a positive exercise stress test, or ischemia in myocardial perfusion scintigraphy and normal coronary arteries detected angiographically, and 49 healthy volunteers with atypical chest pain and a negative stress test. TAC was assessed from blood samples. Transthoracic echocardiography was performed for the entire study population. The Tei index was calculated using the formula IVCT+IVRT/ET. ResultsTAC was found to be significantly lower in the CSX group compared with the control group (0.70±0.37 vs. 1.5±0.30, respectively, P<0.001). The Tei index was significantly higher in patients with CSX than the control group (0.60±0.18 vs. 0.42±0.12, respectively, P<0.001).There was a significant and inverse relationship between TAC and the Tei index (r=−0.41, P<0.001). When we divided the study population according to the normal range of TAC into the decreased TAC group (<1.30 mmol/l), the normal TAC group (1.30–1.77 mmol/l), and the increased TAC group (>1.77 mmol/l), it was found that the Tei index was higher in the decreased TAC group compared with the other groups (0.66±0.18 vs. 0.49±0.10 and 0.46±0.13 mmol/l, P<0.001, respectively). ConclusionOur study suggested that TAC was significantly decreased in CSX patients and decreased antioxidant levels were related to impaired Tei index in echocardiography in patients with microvascular angina.

Impact of Admission Blood Glucose on Coronary Collateral Flow in Patients with ST-Elevation Myocardial Infarction

In patients with acute myocardial infarction, glucose metabolism is altered and acute hyperglycemia on admission is common regardless of diabetes status. The development of coronary collateral is heterogeneous among individuals with coronary artery disease. In this study, we aimed to investigate whether glucose value on admission is associated with collateral flow in ST-elevation myocardial infarction (STEMI) patients. We retrospectively evaluated 190 consecutive patients with a diagnosis of first STEMI within 12 hours of onset of chest pain. Coronary collateral development was graded according to Rentrop classification. Rentrop 0-1 was graded as poor collateral development, and Rentrop 2-3 was graded as good collateral development. Admission glucose was measured and compared between two groups. Mean admission glucose level was 173.0 ± 80.1 mg/dl in study population. Forty-five (23.7%) patients had good collateral development, and 145 (76.3%) patients had poor collateral development. There were no statistically significant differences in demographic characteristics between two groups. Three-vessel disease was more common in patients with good collateral development (p=0.026). Mean admission glucose level was higher in patients with poor collateral than good collateral (180.6 ± 84.9 mg/dl versus 148.7 ± 56.6 mg/dl, resp., p=0.008). In univariate analysis, higher admission glucose was associated with poor collateral development, but multivariate logistic regression analysis revealed a borderline result (odds ratio 0.994, 95% CI 0.989–1.000, p=0.049). Our results suggest that elevated glucose on admission may have a role in the attenuation of coronary collateral blood flow in acute myocardial infarction. Further studies are needed to validate our results.

Atipik klinik ile tespit edilen atipik yerleşimli kardiyak miksoma

Atriyal miksomalar, en sik karsilasilan benign primer kardiyak tumorlerdir. Literaturde tanimlandigi uzere bircok komplikasyona yol acmaktadir. Cogunlukla solda atriyumda olsa da atriyum ve interatriyal septuma bagli olarak, herhangi bir kardiyak boslukta ortaya cikabilir. Bu olgu raporunda 55 yasindaki bir kadin hastamizi sunduk. Kardiyoloji poliklinigine tek tarafli gecici gorme kaybi etyolojisinin arastirilmasi amaciyla danisildi. Transozofageal-ekokardiyografide kardiyak miksoma olarak suphe edilen bu kitlelenin cerrahi esnasinda sol atriyum posteriyor duvar, sol ust pulmoner ven cevresinden kaynaklandigi tespit edildi ve kitle tamamen cikartildi. Patolojik inceleme sonucunda tani kardiyak miksoma olarak dogrulandi. Gecici iskemik semptomlari olan ancak atriyal fibrilasyonu olmayan hastalarda sol atriyumda potansiyel kitle tanisini koymak icin ekokardiyografi yapilmalidir.