Emrullah Kiziltunc

A novel oxidative stress marker in acute myocardial infarction; thiol/disulphide homeostasis.

BACKGROUND The aim of this study was to investigate a novel oxidative stress marker (thiol/disulphide homeostasis) in patients with acute myocardial infarction (AMI) and compare the results with healthy controls for the first time in literature. METHODS A total of 450 participants including 300 patients with AMI and 150 healthy individuals were included in the study. Left ventricular ejection fraction, body mass index, peak troponin I levels, triglyceride, total cholesterol, low-density lipoprotein, high-density lipoprotein (HDL), native thiol, total thiol, and disulphide as well as disulphide/native thiol and disulphide/total thiol ratios were compared between the groups. RESULTS There were significant differences between AMI patients and the controls for left ventricular ejection fraction and troponin, HDL, native thiol, total thiol, and disulphide levels as well as disulphide/native thiol and disulphide/total thiol ratios (P < .05). Stepwise logistic regression model indicated that HDL (odds ratio [OR] = 0.923, P < .001) and disulphide levels (OR = 0.548, P < .001) and disulphide/total thiol ratio (OR = 0.356, P < .001) were significantly and independently related to AMI. The cutoff value of disulphide/total thiol ratio percentage on admission to predict AMI in all population was 4.3, with a sensitivity of 70% and a specificity of 69%. CONCLUSION Thiol/disulphide homeostasis may be used as a novel oxidative stress marker in patients with AMI because it is readily available, easily calculated, and relatively cheap. Further studies are needed to confirm the pathophysiologic role of thiol/disulphide homeostasis in AMI.

Association of thiol/disulfide ratio with syntax score in patients with NSTEMI

Abstract Objective. The aim of this study was to investigate the relation between native thiol/disulfide ratio (TDR) and severity of coronary atherosclerosis as assessed by the Syntax score (SXscore) in patients with non-ST elevation myocardial infarction (NSTEMI) who underwent coronary angiography. Material and Methods. A total of 290 patients with NSTEMI who underwent coronary angiography, were included in the study between January and August 2014. Baseline coronary angiography determined the SXscore. The patients were divided into two groups: one with low SXscores (< 23) and the other with high SXscores (≥ 23). Results. TDR was significantly lower in patients with high SXscores (p < 0.001). In-hospital mortality was higher in the group with low TDR and high SXscores. The cut-off value of TDR on admission that predicted a high SXscore in the groups combined was 14, with a sensitivity of 73% and a specificity of 68%. Conclusion. TDR can be determined by an easy, inexpensive, automated, or optionally manual spectrophotometric assay, and correlates inversely with SXscore in patients with NSTEMI.

Relation Between Monocyte to High-Density Lipoprotein Cholesterol Ratio With Presence and Severity of Isolated Coronary Artery Ectasia

The aim of this study was to investigate an easily available inflammatory and oxidative stress marker and monocyte to high-density lipoprotein cholesterol ratio (MHR) in patients with coronary artery ectasia (CAE). The study population included 405 patients of which 135 patients had isolated CAE, 135 patients had obstructive coronary artery disease (CAD), and 135 patients had normal coronary angiograms (NCAs). The severity of isolated CAE was determined according to the Markis classification. The MHR was significantly greater in patients with isolated CAE than those with obstructive CAD and NCAs: 14.8 (11.6 to 19.8), 11.4 (9.6 to 13.5), 9.8 (7.5 to 11.9), respectively. Linear regression analyses showed that MHR and C-reactive protein were significantly related with the severity of isolated CAE. In conclusion, the MHR is significantly greater in patients with CAE compared to controls with obstructive CAD and NCAs, and MHR is associated with the severity of CAE.

The relation between platelet-to-lymphocyte ratio and Pulmonary Embolism Severity Index in acute pulmonary embolism.

PURPOSE In this study, we aimed to investigate the value of the platelet-to-lymphocyte ratio (PLR) for predicting disease severity based on simplified Pulmonary Embolism Severity Index (sPESI), as well as in-hospital mortality in patients with acute pulmonary embolism (APE). MATERIALS AND METHODS Our hospitals electronic patient database was searched for the patients with ICD-9 code I26, and eligible 646 patients were included in the study. RESULTS Univariate logistic regression analysis showed that PLR, pulmonary artery systolic pressure, right ventricular dysfunction, D-dimer level, and white blood cell, lymphocyte, platelet and neutrophil counts were significantly correlated with a high sPESI score in patients with APE. CONCLUSIONS To the best of our knowledge, this is the first study in the literature showing that a high PLR is independently associated with a high risk of mortality in patients with APE.

The reliability of fractional flow reserve measurement in patients with diabetes mellitus.

BackgroundFractional flow reserve (FFR) is an invasive method to assess the functional significance of coronary stenoses. The value of FFR in diabetic patients is controversial because of microvascular dysfunction. The aim of this study is to investigate the effect of diabetes mellitus (DM) on FFR measurements. MethodsOne hundred and twenty-one patients with an intermediate lesion who had undergone FFR measurement were included in the study. Lesion severity was determined by quantitative coronary angiography. The patients were divided into groups according to the presence (group 1) or absence (group 2) of DM. The patients were further categorized according to the degree of luminal narrowing caused by the lesion (40–50, 51–60, and >60%) and reference vessel diameter (≥2.8 and <2.8 mm). FFR measurements were compared in each category. ResultsThere was no difference between the FFR values of diabetic and nondiabetic patients who had coronary lesions with similar degree of luminal narrowing (0.87±0.08 vs. 0. 0.85±0.07; 0.81±0.08 vs. 0.82±0.10; 0.81±0.10 vs. 0.83±0.09, P = 0.957). In the analysis comparing FFR measurements in the categories set according to reference vessel diameter, we did not find a difference either (0.82±0.09 vs. 0.83±0.09; 0.84±0.09 vs. 0.82±0.09, P = 0.878). The ΔFFR value, which is the difference between FFR values before and after adenosine administration, was also similar in diabetic and nondiabetic patients (8.4±6.0 vs. 8.4±5.5, P = 0.997). ConclusionThe presence of DM does not have a significant impact on FFR values in coronary stenoses of intermediate severity.

Admission Endocan Level may be a Useful Predictor for In-Hospital Mortality and Coronary Severity Index in Patients With ST-Segment Elevation Myocardial Infarction.

We assessed the prognostic role of serum endocan level in patients with ST-segment elevation myocardial infarction (STEMI) and compared the results with a normal coronary angiography group. A total of 133 patients were included in the study (88 patients with STEMI and 45 patients with normal coronary arteries). The SYNTAX score was determined based on the baseline coronary angiogram. Multivariate logistic regression analysis indicated that endocan independently correlated with the presence of STEMI. Moreover, high-sensitivity C-reactive protein (hsCRP), peak troponin I, and left ventricular ejection fraction (LVEF) were found to be independently associated with STEMI. Endocan level correlated significantly with hsCRP and SYNTAX score. We analyzed the discriminatory capability of endocan level for the presence of STEMI using a receiver–operating characteristics curve. A cutoff endocan level of 1.7 (ng/mL) predicted the presence of STEMI with a sensitivity of 76.1% and specificity of 73.6%. In conclusion, a high endocan level on hospital admission is an independent predictor of a worse cardiovascular outcome and a high SYNTAX score in patients with STEMI.

Relationship between serum vitamin D levels and angiographic severity and extent of coronary artery disease

Vitamin D is known for its effect in calcium and bone homeostasis. There is an increasing evidence for health benefits accomplished by activated vitamin D that go beyond these classical functions. Previous studies have suggested that lower vitamin D levels are associated with increased cardiovascular disease risk. Therefore, we aimed to evaluate relationship between vitamin D levels and extent and severity of coronary artery disease.

Neutrophil gelatinase-associated lipocalin levels in isolated coronary artery ectasia.

BACKGROUND The pathophysiology of coronary artery ectasia (CAE) is still unknown. Inflammation and degradation of connective tissue may have a role in the development of coronary ectasia. In the present study, the authors examined neutrophil gelatinase-associated lipocalin (NGAL) levels in isolated CAE patients. METHODS Thirty-five patients with isolated CAE (25 males; mean age, 59±10 years) and 35 age- and sex-matched healty volunteers (22 males; mean age, 57±11 years) who had been shown to have normal coronary arteries were included in the study. Basal characteristics were recorded. Serum NGAL levels were determined with an enzyme-linked immunosorbent assay kit. RESULTS NGAL levels were significantly higher in the isolated CAE group than in the control group (65.1±13 vs 53.7±19 ng/mL; P=0.006). There were also significant difference in NGAL levels according to the number of ectatic coronary arteries (58.1±13, 70.9±9, and 71.1±11 ng/mL for 1, 2, and 3 arteries, respectively; P=0.015). Level of NGAL was lowest in patients who have only 1 ectatic coronary artery. CONCLUSION Serum NGAL levels increased in patients with isolated CAE, and NGAL may play a crucial role in the development and/or progression of coronary artery ectasia.

The Relationship Between Serum Endocan Levels With the Presence of Slow Coronary Flow: A Cross-Sectional Study.

Background: The aim of this study was to investigate the relationship between endocan levels with the presence of slow coronary flow (SCF). Methods: In this cross-sectional study, a total of 88 patients, who admitted to our hospital, were included in this study. Of these, 53 patients with SCF and 35 patients with normal coronary flow were included in the final analysis. Coronary flow rates of all patients were determined by the Timi Frame Count (TFC) method. Results: In correlation analysis, endocan levels revealed a significantly positive correlation with high sensitive C-reactive protein and corrected TFC. In multivariate logistic regression analysis, the endocan levels were found as independently associated with the presence of SCF. Finally, using a cutoff level of 2.3, endocan level predicted the presence of SCF with a sensitivity of 77.2% and specificity of 75.2%. Conclusion: In conclusion, our study showed that higher endocan levels were significantly and independently related to the presence of SCF.

Relationship between platelet-to-lymphocyte ratio and the presence and severity of coronary artery ectasia

Objective: The aim of this study was to investigate the relationship between platelet-to-lymphocyte ratio (PLR), an easily available inflammatory marker, and coronary artery ectasia (CAE). Methods: After applying the exclusion criteria, the retrospective study population consisted of 330 patients, including 110 patients with isolated CAE, 110 with obstructive coronary artery disease (CAD), and 110 with normal coronary artery angiograms (NCA). The severity of isolated CAE was determined according to the Markis classification. SPSS 22.0 statistical package program was used for data analysis. Results: PLR was significantly higher in patients with isolated CAE than in those with NCA and obstructive CAD [123 (113–156), 100 (86–138), and 110 (102–141), respectively]. Logistic regression analysis showed that PLR and C-reactive protein level were significantly correlated with the severity of isolated CAE. Conclusion: To the best of our knowledge, this study showed for the first time that PLR was significantly associated with CAE.