Erdal Akturk

Increased Platelet Distribution Width Is Associated With ST-Segment Elevation Myocardial Infarction and Thrombolysis Failure

We investigated 2 hypotheses: (1) a relationship between platelet indices and stable coronary artery disease (CAD) and acute ST-segment elevation myocardial infarction (STEMI) and (2) a relationship between platelet indices on admission and thrombolysis outcomes in patients with STEMI. A total of 260 patients were enrolled. The white blood cell (WBC) and platelet distribution width (PDW) were found to be increased in patients with STEMI (P for both < .001). White blood cell and PDW were independent predictors of acute STEMI. Mean platelet volume (MPV) and PDW were significantly higher in the thrombolysis failure group than in the thrombolysis success group (9.9 ± 1.8 vs 9.2 ± 1.5 fL, P = .021 and 17.7 ± 1.0 vs 16.4 ± 2.1 fL, P < .001, respectively). Mean platelet volume and PDW were independent predictors of thrombolysis failure. Patients with acute STEMI had higher PDW than did patients with stable CAD. In addition, higher PDW and MPV seem to correlate with thrombolysis failure in patients with STEMI.

Prediction of Coronary Artery Disease Severity Using CHADS2 and CHA2DS2-VASc Scores and a Newly Defined CHA2DS2-VASc-HS Score

As the CHADS2 and CHA2DS2-VASc scores include similar risk factors for the development of coronary artery disease (CAD), they may provide crucial information regarding the severity of coronary artery lesions and the risk of thromboembolism. To increase the likelihood of determining CAD severity, we formulated the CHA2DS2-VASc-HS score comprising hyperlipidemia and smoking in addition to the components of the CHA2DS2-VASc score and male instead of female gender. We aimed to investigate whether these 3 risk scores can be used to predict CAD severity. A total of 407 consecutive patients who underwent coronary angiography were enrolled in the study. Presence of >50% stenosis in a coronary artery was assessed as significant CAD. Of the patients, 87 had normal coronary angiograms and served as group 1. The remaining 320 patients with coronary stenosis were further classified into 2 groups according to CAD with stenosis of <50% or ≥50%: 123 patients with mild CAD as group 2 and 197 patients with severe CAD as group 3. The CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-HS scores were significantly different among the 3 groups. The CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-HS scores correlated significantly with the number of diseased vessels (r = 0.406, p <0.001; r = 0.308, p <0.001; and r = 0.533, p <0.001, respectively) and the Gensini score (r = 0.383, p <0.001; r = 0.300, p <0.001; and r = 0.500, p <0.001, respectively). The CHA2DS2-VASc-HS score was found to be the best scoring scheme to predict CAD severity in the area under the curve comparison of these scoring systems. For prediction of severe CAD, the cut-off value of CHA2DS2-VASc-HS score was >2 with a sensitivity of 85.2% and a specificity of 57.5% (area under the curve 0.802, 95% confidence interval 0.760 to 0.839, p <0.001). In conclusion, our findings suggest that the CHADS2, CHA2DS2-VASc, and especially CHA2DS2-VASc-HS scores could be considered predictive of the risk of severe CAD.

Predictors of thrombus burden and no-reflow of infarct-related artery in patients with ST-segment elevation myocardial infarction: importance of platelet indices.

Preprocedural high-thrombus burden (HTB) of infarct-related artery (IRA) is a harbinger of procedural complications following primary percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI). The HTB of IRA can lead to poor outcomes by various mechanisms, including no-reflow phenomenon, increased myocardial necrosis and with subsequent reduced survival benefit at follow-up. In this study, we investigated the relationship between all platelet indices on admission and thrombus burden and the no-reflow phenomenon after primary PCI of IRA in patients with STEMI. We retrospectively enrolled 475 patients with STEMI undergoing primary PCI. Study population was divided into two groups according to the thrombolysis in myocardial infarction thrombus grade of IRA as low-thrombus burden or HTB. There were no statistically significant differences in platelet indices, including platelet count, platelet-large cell ratio (P-LCR), mean platelet volume (MPV) and platelet distribution with (PDW) among the groups. However, in the subgroup analysis, P-LCR, MPV and PDW were significantly higher in the no-reflow patients than reflow patients despite similar platelet count (P for allu200a<u200a0.001). The cutoff value of P-LCR for predicting no-reflow was 26.5% with a sensitivity of 67.0% and a specificity of 62% (area under the curve, 0.689; 95% confidence interval, 0.614–0.765; Pu200a<u200a0.001). Furthermore, P-LCR, MPV and PDW had similar AUC (0.689, Pu200a<u200a0.001; 0.688, Pu200a<u200a0.001; and 0.677, Pu200a<u200a0.001; respectively) for predicting no-reflow phenomenon after primary PCI. As a result, all of the platelet indices have no effect on thrombus load of IRA, however, these parameters seem to impair epicardial perfusion after primary PCI.

Effect of Masked Hypertension on Aortic Elastic Properties

Aortic stiffness is increased in patients with sustained hypertension (SH). The aim of this study was to investigate the relationship between aortic elastic properties and masked hypertension (MH). We evaluated aortic elastic properties in 35 individuals with MH, 35 patients with SH, and 35 normotensive healthy volunteers using transthoracic Doppler echocardiography. All aortic distensibility values were carried out at the same time or immediately after the blood pressure (BP) measurement. Baseline clinical and demographic characteristics of the patients were similar in all three groups. Aortic stiffness index and elastic modulus values were higher in MH group compared to SH group and control group (8.9 ± 6.3 vs. 5.4 ± 2.2 vs. 4.2 ± 2.5, P < .001 and 9.0 ± 6.3 vs. 6.4 ± 2.5 vs. 4.1 ± 2.4, P < .001, respectively). Aortic strain values were lower in MH group compared to SH group and control group (7.4 ± 5.3 vs. 9.5 ± 4.1 vs. 14.6 ± 7.1, P < .001, respectively). Aortic distensibility values were lower in MH and SH groups compared to controls (3.1 ± 1.9 vs. 3.7 ± 1.6 vs. 6.4 ± 3.4, P < .001, respectively). Furthermore, diastolic aortic diameter, left ventricular mass index, interventricular septum, and posterior wall thickness were higher in MH and SH groups when compared to controls. This study shows that masked hypertensive patients are at higher risk of “aortic” stiffness, a risk factor for cardiovascular morbidity and mortality, than normotensive and sustained hypertensive patients.

Left atrial volume and function in patients with Behcet's disease assessed by real-time three-dimensional echocardiography.

AIMSnBehçets disease (BD), a multisystemic inflammatory disorder, has been associated with a number of cardiovascular dysfunctions, including endomyocardial fibrosis of the right heart, atrial fibrillation, ventricular arrhythmias and sudden cardiac death. The incidence and nature of cardiac involvement in BD are not yet clearly documented. Our aim was to evaluate left atrial (LA) volume and functions using real-time three-dimensional echocardiography (RT3DE) in Behcets patients without any cardiac symptom.nnnMETHODS AND RESULTSnThe study included 40 BD (16 females, 24 males and mean age of 33±7 years) and 30 healthy (11 females, 19 males and mean age of 35±6 years) subjects. All the patients demographic parameters such as age, gender, and duration of BD were recorded. All the individuals underwent comprehensive 2D echocardiography examination, and RT3DE was performed to assess LA volumes and mechanical functions. LA maximum volume (Vmax) and before atrial contraction volume (Vpre A), LA active stroke volume and total stroke volumes (TSV), total emptying and active emptying fractions and expansion index were significantly higher in Behcets disease patients when compared with the controls (P<0.0001 for all). LA passive emptying fraction was significantly lower in the patients with BD than in the controls (41±7 vs. 44±5, P=0.039). There were positive correlations between TSV and high-sensitive C-reactive protein level (r=0.413, P=0.008), TSV, and disease duration (r=0.417, P<0.007).nnnCONCLUSIONnOur study has shown that LA mechanical functions and volumes are impaired in BD. These results may be an early form of subclinical cardiac involvement in patients with BD who have no clinical evidence for cardiovascular disease.

Negative Effects of Acute Sleep Deprivation on Left Ventricular Functions and Cardiac Repolarization in Healthy Young Adults

Sleep deprivation (SD) is associated with an increased incidence of adverse cardiovascular events, we aimed to determine the impact of acute SD on structural and functional alterations of the left ventricle (LV) and on electrocardiogram (ECG) markers including T wave peak‐to‐end interval (TpTe), QT interval, and TpTe/QT ratio in healthy subjects after a night of SD.

Endothelial nitric oxide synthase levels and their response to exercise in patients with slow coronary flow

Summary Background Endothelial dysfunction plays a key role in the aetiopathogenesis of slow coronary flow (SCF) even if there is no obstructive epicardial lesion. Reduced plasma levels of endothelial nitric oxide synthase (eNOS) are an important indicator of endothelial dysfunction. We aimed to determine plasma levels of eNOS and their relationship with exercise in patients with SCF. Methods Twenty-two patients with SCF in at least one coronary artery and 17 healthy individuals were included in this study. The TIMI frame count method was used to determine SCF. Plasma levels of eNOS before and after effort were determined in the patient and control groups. Results Basal eNOS levels in the patient group were lower than in the control group (p = 0.040), and plasma eNOS levels after exercise decreased more significantly in the patient group compared to the control group (p = 0.002). Median decreases of eNOS in response to exercise were higher in the SCF group than in the control group (p < 0.001), and the decrease observed in the control group was not statistically significant (p = 0.35). There were significantly negative correlations between TIMI frame count and plasma levels of eNOS at baseline and after exercise (r = –0.51, p = 0.015, r = –0.58, p = 0.005, respectively). Moreover, there was also a positive correlation between the rate–pressure product and plasma levels of eNOS after exercise in patients with SCF (r = 0.494, p = 0.019). Conclusion Our findings indicate an important pathophysiological relationship between the severity of SCF in which endothelial dysfunction plays a role in its pathogenesis and the level of circulating plasma levels of eNOS.

The association of serum albumin with coronary slow flow

SummaryBackgroundA number of inflammatory markers such as high-sensitivity C-reactive protein (Hs-CRP), interleukin-6 (IL-6), and fibrinogen have been shown to be associated with coronary slow flow (CSF). Our aim was to investigate the relationship between albumin, a long-acting negative acute-phase protein, and CSF.MethodsA total of 106 patients with angiographically proven slow coronary flow and 57 control subjects with normal coronary flow were included in the study. Serum levels of Hs-CRP and albumin were measured. CSF was defined by Thrombolysis In Myocardial Infarction (TIMI) frame count (TFC) method.ResultsSerum albumin (s-albumin) was significantly lower in the CSF group (3.79u2009±u20090.3 vs 4.17u2009±u20090.3, pu2009<u20090.001), whereas Hs-CRP level was significantly higher in the CSF group compared with the controls (1.22u2009±u20090.79 vs 0.76u2009±u20090.44, pu2009<u20090.001). S-albumin and Hs-CRP were correlated with the mean TFC in the whole study population (r=u2009−u20090.574, pu2009<u20090.001; ru2009=u20090.376, pu2009<u20090.001, respectively). Hs-CRP and low s-albumin were found to be significant predictors of CSF in the multivariate analysis. The comparison of receiver-operating characteristics curves for s-albumin and Hs-CRP demonstrated that s-albumin was the strongest predictor of CSF.ConclusionsWe found that s-albumin levels decreased and Hs-CRP levels increased in patients with CSF. S-albumin was also found to have superior predictive value than Hs-CRP for diagnosing CSF. S-albumin, an inexpensive and easily measurable laboratory variable, may be a useful predictor of CSF, especially when other reasons which alter its serum levels were excluded.ZusammenfassungGrundlagenVon mehreren Entzündungsmarkern, wie hochsensitivem C-reaktiven Protein (hs-CRP), Interleukin-6 (IL-6) und Fibrinogen konnte gezeigt werden, dass sie mit langsamem koronarem Durchfluss („coronary slow flow“, CSF) vergesellschaftet sind. Ziel unserer Studie war es, zu prüfen, ob ein Zusammenhang zwischen Albumin, einem lang-wirksamen negativen Akutphasenprotein und CSF besteht.MethodikInsgesamt wurden 106 Patienten mit angiographisch nachgewiesenem CSF und 57 Kontrollen mit normalem Koronarfluss in die Studie aufgenommen. Die Serumkonzentrationen von hs-CRP und Albumin wurden gemessen. CSF wurde durch die TIMI (Thrombolysis In Myocardial Infarction) Frame Count (TFC) Methode erhoben.ErgebnisseDas Serum Albumin war in der Gruppe mit CSF im Vergleich zur Kontrolle signifikant erniedrigt (3,79u2009±u20090,3 vs 4,17u2009±u20090,3, pu2009<u20090,001) – die hs-CRP Konzentrationen dahingegen signifikant erhöht (1,22u2009±u20090,79 vs 0,76u2009±u20090,44, pu2009<u20090,001). Serum Albumin und hs-CRP waren in der Gesamtpopulation mit dem mittleren TFC korrelieret (r=u2009−u20090,574, pu2009<u20090,001; ru2009= 0,376, pu2009<u20090,001, respektive). In der Multivarianzanalyse zeigte sich, dass hs-CRP und niedriges Serum Albumin signifikante Prädiktoren eines CSF sind. Der Vergleich der ROC Analysen für hs CRP und Serum Albumin ergab, dass das Serum Albumin der stärkste Prädiktor eines CSF war.SchlussfolgerungenBei unseren Patienten mit CSF waren die Serum Albumin-Konzentrationen erniedrigt und die hs-CRP Werte erhöht. Das Serum Albumin war in unseren Händen der bessere Prädiktor als das hs-CRP für einen CSF. Serum Albumin ist ein billiger und leicht messbarer Laborparameter, der – nach Ausschluss anderer Albumin beeinflussender Faktoren - ein nützlicher Prädiktor für einen CSF sein kann.

Comparision of Effects of Rosuvastatin Versus Atorvastatin Treatment on Plasma Levels of Asymmetric Dimethylarginine in Patients With Hyperlipidemia Having Coronary Artery Disease

Elevated plasma levels of asymmetric dimethylarginine (ADMA) are prevalent in patients with hypercholesterolemia and coronary artery disease. A total of 83 patients with hypercholesterolemia and angiographically documented mild coronary artery stenosis were randomized to rosuvastatin treatment (20 mg) or atorvastatin treatment (40 mg) once daily for 6 weeks after a 4-week dietary lead-in phase. Both statins decreased total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and triglyceride levels effectively. Only rosuvastatin increased high-density lipoprotein cholesterol (HDL-C) levels. Both rosuvastatin and atorvastatin decreased plasma ADMA levels; rosuvastatin had a significantly greater effect. The reduction in ADMA levels were correlated with the reduction in TC and LDL-C levels as well as LDL-C–HDL-C ratio. Treatment with rosuvastatin or atorvastatin in patients with hyperlipidemia with mild coronary artery stenosis may lead to a decrease in ADMA levels, which may contribute to improved endothelial function.

Assessment of atrial conduction time by tissue Doppler echocardiography and P-wave dispersion in smokers.

IntroductionThe aim of this study was to evaluate the relationship between cigarette smoking and atrial rhythm disorders with the use of noninvasive methods.MethodsThe study population consisted of 50 healthy volunteer smokers and 40 healthy volunteer non-smokers who had normal echocardiographic parameters and similar sex and age profiles. P-wave dispersion (PWD) was calculated from the 12-lead surface ECG. Left ventricle (LV) end-systolic and end-diastolic diameters, LV ejection fraction, and interatrial and intraatrial electromechanical delay were measured by tissue Doppler imaging and conventional echocardiography.ResultsIsovolumetric relaxation time and deceleration time were significantly higher (91.5u2009±u200911 vs. 82.35u2009±u20098.6, pu2009<u20090.0001; 215.7u2009±u200937.1 vs. 175.3u2009±u200917.7, pu2009<u20090.0001, respectively), and HDL cholesterol was significantly lower in smokers (39.34u2009±u20097.5 vs.44.3u2009±u20098.07, pu2009=u20090.003). There were no significant differences between the groups with respect to Sm and Em values, Am value, and E/A and E/Em ratios. However, the Em/Am ratio was significantly lower in smokers (1.28u2009±u20090.21 vs. 1.44u2009±u20090.33, pu2009<u20090.006). Inter- and intraatrial electromechanical delay were significantly higher in smokers when compared with non-smokers (51.11u2009±u20091.54 vs. 27.30u2009±u20093.36, pu2009<u20090.0001, and 30.63u2009±u20093.2 vs. 12.24u2009±u20093.26, pu2009<u20090.0001, respectively). The amount of smoking was strongly correlated with interatrial electromechanical delay (ru2009=u20090.567, pu2009<u20090.0001), and a significant correlation was detected between PWD and interatrial electromechanical delay (ru2009=u20090.653, pu2009=u20090.001).ConclusionWe have demonstrated the relationship between inter- and intraatrial electromechanical delay and PWD. These parameters may be useful predictive markers for the development of AF in the asymptomatic period before cardiac rhythm disturbances occur. This finding may indicate that smokers have an increased risk of developing atrial rhythm disturbances.