Ertan Vuruşkan

Association between serum total antioxidant status and flow-mediated dilation in patients with systemic lupus erythematosus: an observational study.

Objective: Endothelial dysfunction (ED) is a condition that involves increased oxidative stress and decreased total antioxidant status (TAS) levels. Systemic lupus erythematosus (SLE) is also associated with ED. We aimed to determine the association between serum TAS and ED as assessed by flow-mediated dilation (FMD) in patients with SLE. Methods: Thirty-four patients with stable SLE who were not undergoing any treatment and 39 healthy volunteers without any overt cardiovascular disease were included in this cross-sectional study. Doppler ultrasound was used to measure FMD to assess ED in the study groups. Serum TAS levels were measured using a TAS kit. High-sensitivity C-reactive protein (hs-CRP) and anticardiolipin antibody (aCLA) levels were also measured to assess the inflammatory state. The SLE group further was divided into 2 groups according to presence or absence of aCLA. SLE disease activity was assessed using the SLE disease activity index (SLEDAI). Regression analysis was used to define independent predictors. Results: The mean TAS levels were significantly lower in patients with SLE than in controls (1.60±0.11 versus 1.73±0.15 mmol/L, p<0.001). hs-CRP levels were significantly higher in patients with SLE than in controls (8.2±6.0 vs. 2.9±4.0 mg/L; p<0.001), particularly in SLE patients with positive aCLA when compared with SLE patients with negative aCLA (13.8±4.3 vs. 5.6±4.8 mg/L, p<0.001). The FMD percent was significantly lower in patients with SLE than in controls (8.1±4.9 vs. 10.6±4.7, p=0.04). There was a significant positive correlation between FMD and TAS in the SLE group (r=0.448, p=0.008) and the control group (r=0.367, p=0.03) and a significant negative correlation between FMD and serum hs-CRP (r=-0.368, p=0.04) in only the SLE group. In multiple linear regression analysis, TAS, hs-CRP and SLEDAI were independently correlated with FMD (ß=0.50, p=0.003; ß=-0.33, p=0.03; and ß=-0.36, p=0.03; respectively). Conclusion: Patients with SLE who have no overt cardiovascular disease are at increased risk for ED and this may be associated with underlying inflammation and impairment of TAS.

Carotid artery stenting with double cerebral embolic protection in asymptomatic patients – a diffusion-weighted MRI controlled study

BACKGROUND The aim of this study was to compare the simultaneous double-protection method (proximal balloon plus distal filter) with distal-filter protection or proximal-balloon protection alone in asymptomatic patients during carotid artery stenting. PATIENTS AND METHODS 119 consecutive patients were investigated for carotid artery stentings in the extracranial internal carotid artery with the use of distal filters (n = 41, 34.4 %), proximal balloon (MoMa) protection (n = 40, 33.6 %) or double protection (n = 38, 31.9 %). Magnetic resonance imaging (MRI) was performed on all patients before the procedure, and control diffusion-weighted MRI (DW-MRI) was obtained within 24-48 h after the procedure. Procedural data, complications, success rate, major adverse cardiovascular events, and MRI findings were collected. RESULTS New cerebral high-intensity (HI) lesions were observed in 47 (39.4 %) patients. HI lesions were observed in 22 (53.6 %), 15 (37.5 %), and 10 (26.3 %) of the patients with distal filters, proximal protection, and double protection, respectively (p = 0.004). The average number of HI lesions on DW-MRI was 1.80 in the distal-filter group, 0.90 in the proximal-balloon group, and 0.55 in the double-protection group (p < 0.001). Procedure and fluoroscopy times were slightly longer in the double-protection group compared to the distal- or proximal-protection groups (p = 0.001). CONCLUSIONS The double (proximal plus distal) cerebral embolic protection technique is safe and effective for minimizing the risk of cerebral embolization, even in patients with asymptomatic carotid artery stenosis, despite slightly longer procedure and fluoroscopy times.
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Leukocyte TRP channel gene expressions in patients with non-valvular atrial fibrillation

Atrial fibrillation (AF) is the most common arrhythmia in clinical practice and is a major cause of morbidity and mortality. The upregulation of TRP channels is believed to mediate the progression of electrical remodelling and the arrhythmogenesis of the diseased heart. However, there is limited data about the contribution of the TRP channels to development of AF. The aim of this study was to investigate leukocyte TRP channels gene expressions in non-valvular atrial fibrillation (NVAF) patients. The study included 47 NVAF patients and 47 sex and age matched controls. mRNA was extracted from blood samples, and real-time polymerase chain reaction was performed for gene expressions by using a dynamic array system. Low levels of TRP channel expressions in the controls were markedly potentiated in NVAF group. We observed marked increases in MCOLN1 (TRPML1), MCOLN2 (TRPML2), MCOLN3 (TRPML3), TRPA1, TRPM1, TRPM2, TRPM3, TRPM4, TRPM5, TRPM6, TRPM7, TRPM8, TRPC1, TRPC2, TRPC3, TRPC4, TRPC5, TRPC6, TRPC7, TRPV1, TRPV2, TRPV3, TRPV4, TRPV5, TRPV6, and PKD2 (TRPP2) gene expressions in NVAF patients (P < 0.05). However, there was no change in PKD1 (TRPP1) gene expression. This is the first study to provide evidence that elevated gene expressions of TRP channels are associated with the pathogenesis of NVAF.

Determinants of Chronic Total Occlusion in Patients With Peripheral Arterial Occlusive Disease.

Chronic total occlusion (CTO) is a common finding in 40% of the patients with peripheral arterial disease (PAD). The aim of this study was to investigate the determinants of CTO in patients with PAD. The study included a total of 211 nonanemic patients with PAD. All patients were categorized according to the Fontaine classification. In lower extremity angiography cohorts, CTO− patients were designated as group 1 and CTO+ patients were designated as group 2. Patients with CTO had significantly higher red cell distribution width (RDW), neutrophil–lymphocyte ratio, uric acid, and high-sensitivity C-reactive protein compared to patients without CTO (P ≤ .001, P = .036, P ≤ .001, and P = .015, respectively). Albumin, total bilirubin, and direct bilirubin were significantly lower in the patients with CTO compared to patients without CTO (P = .023, P ≤ .001, and P = .049, respectively). Multivariate logistic regression analysis showed that RDW, uric acid, and total bilirubin were independent predictors of CTO in patients with PAD. We demonstrated that increased RDW and uric acid levels and lower total bilirubin values were independently associated with CTO in patients with PAD.

Bilirubin Levels are Associated With Contrast-Induced Nephropathy in Peripheral Artery Disease:

The relationship between contrast-induced nephropathy (CIN) and oxidative mechanisms is well documented. Our aim was to demonstrate the possible relationship between CIN and serum bilirubin as an antioxidant molecule. This retrospective study included 359 patients with peripheral artery disease (PAD) who underwent peripheral diagnostic angiography; 179 developed CIN after the intervention and another 180 were the control group, matched for age, gender, and cardiovascular risk factors. Baseline, 48- to 72-hour, and 30-day laboratory values, major adverse cardiovascular events, and dialysis requirements were recorded. Patients with CIN had significantly higher levels of uric acid, red cell distribution width, and neutrophil-to-lymphocyte ratio (NLR) but lower total bilirubin compared to the control patients (P < .05). Multivariate logistic regression analysis showed that diabetes mellitus, left ventricular ejection fraction, uric acid, NLR, and total bilirubin levels were independent predictors of CIN development (P = .01, P = .001, P = .001, P = .01, and P = .001, respectively). This study demonstrated that decreased total bilirubin was associated with CIN development after the administration of radiocontrast agents in patients with PAD.

Serum Bilirubin Levels and the Presence and Progression of Abdominal Aortic Aneurysms.

The relationship between bilirubin levels and peripheral artery disease has been documented. Our aim was to demonstrate the possible relationship between serum bilirubin levels and abdominal aortic aneurysms (AAAs). The study included 219 patients, 110 had a previous diagnosis of AAA and 109 patients were normal controls. Only patients with AAAs which had a size of 40 to 54 mm were included in the study. Baseline laboratory values and 2 computerized tomographic measurements 12 months apart were recorded. Patients with AAA had significantly higher white blood cell (WBC) counts and neutrophil–lymphocyte ratio (NLR) but lower total and direct bilirubin levels compared with the control patients (P < .05). Multivariate logistic regression analysis showed that WBC, NLR, and total and direct bilirubin levels were independent predictors of the presence of an AAA (P = .03, P = .001, P = .001, and P = .001, respectively). White blood cells and total bilirubin level were independent predictors of a rapidly enlarging AAA (>10 mm/y, P = .002 and P < .001, respectively). This study demonstrated that increased WBC and decreased total bilirubin levels were independent predictors of an AAA, especially the subgroup in which the AAA was rapidly expanding.

Emergency endovascular treatment of peripheral arterial injuries occurring during the Syrian civil war: Gaziantep Dr. Ersin Arslan Education and Research Hospital Experience.

As we are working in Gaziantep Dr. Ersin Arslan Education and Research Hospital that is approximately 50 km away from Turkish–Syrian border, we frequently encounter peripheral arterial injuries in terms of emergency endovascular interventions. Therefore, we would like to share our single-center experience of these patients with you and our colleagues. Extremity injuries involving a major artery that are not promptly diagnosed and treated can lead to death or loss of the extremity. Arterial injury can cause distal ischemia because of hemorrhage, hematoma, laceration, or thrombosis, and the complications of the injury can lead to pseudoaneurysm or arteriovenous fistula (1). Endovascular therapy is a continuously developing alternative to surgical therapy in selected patients. Between July 2012 and May 2014, 21 patients were evaluated by digital subtraction angiography in our catheterization laboratory. Twelve of them were operated and nine patients underwent emergency endovascular interventions in our cath lab. Lesion types were hemorrhagic laceration fistulazing to the skin, arteriovenous fistula, pseudoaneurysm, and distal ischemia due to postoperative occlusion. Patients had internal carotid artery, axillary artery, brachial artery, superficial femoral artery, and popliteal artery injuries. The conventional treatment for perforation, aneurysm, pseudoaneurysm, and arteriovenous fistula caused by penetrating arterial trauma is surgery; however, the deteriorated anatomy and hematoma around the lesion as well as the risks of performing the surgery again can make surgical option a challenging procedure (2). Endovascular interventions also have their own risks and complications such as stent occlusion, stent fracture, restenosis, and loss of collaterals during stent placement (3). The most often traumatized vessel is the femoropopliteal artery, the same as in our series. Direct penetrating injuries caused by deep stabs, gunshots, or high-kinetic energy weapons can cause pseudoaneurysm or arteriovenous fistulas. The graft stent implantation in femoral interventions provides a patency rate of 88% in one year. Less thrombogenic heparin-bonded stents are being implanted for arteries running through joints. These stents are resistant to fracture and have high radial strength (4). As this is a case series of nine patients treated with covered stents in one center, we could say surgery should be the first-line treatment for these kinds of lesions (5). However, because of reoperation and anatomical challenges, reluctance of the vascular surgical team to redo the procedure, and patient preferences, endovascular treatment of these kinds of lesions could be another option.

Evaluation of ventricular repolarization features with Tp-e, Tp-e/QTc, JTc and JTd during electroconvulsive therapy

OBJECTIVE The purpose of this study was to investigate the influence of electrical stimulation transmitted through the body during electroconvulsive therapy on traditional and relatively new ventricular repolarization parameters (Rate corrected QT interval (QTc), QT dispersion (QTd), rate corrected JT interval (JTc), JT dispersion (JTd), T-peak to T-end interval (Tp-e) and Tp-e/QTc ratio) under propofol anaesthesia. METHODS Twenty-two patients (aged 18-50 years) who were each scheduled for ECT for major depression, bipolar disorder or schizophrenia enrolled to the study. Electrocardiography (ECG) recordings were obtained before anaesthesia and within 3-5 min after electrical stimulus of ECT for measurements. QTc, QTd, JTc, JTd, Tp-e and Tp-e/QTc were measured as repolarization indices. RESULTS The study included twenty-two patients, 9(40.9%) females and 13(59.1%) males, and the mean age accounted for 33.57 ± 9.95 years. The comparison of the measured parameters before and after ECT, which were not statistically different, were as follows: QTc (416.52 ± 46.64 vs 430.00 ± 34.00msn; p = 0.18), JTc (308.09 ± 25.09 vs 315.47 ± 26.89msn; p = 0.30), QTd (22.27 ± 11.51 vs 20.45 ± 9.9msn; p = 0.52) and JTd (22.72 ± 11.2 vs 17.72 ± 10.20msn; p = 0.06). Also, no significant difference was detected at the following parameters Tp-e (80.0 ± 13.45 vs 78.63 ± 15.21msn; p = 0.65) and Tp-e/QTc ratio (0.19 ± 0.03 vs 0.18 ± 0.07; p = 0.08). On the other hand, HR showed a significant increase after ECT at 88.13 ± 13.74 vs 93.0 ± 15.2 bpm; p = 0.03. CONCLUSION QTc, QTd, JTc, JTd, Tp-e interval and Tp-e/QTc ratio, which are thought to be potential repolarisation markers for ventricular arrhythmias, did not demonstrate significant change within 3-5 min of electrical stimulation during ECT.

Effects of Dust Storms and Climatological Factors on Mortality and Morbidity of Cardiovascular Diseases Admitted to ED

Objective This study was designed to investigate the effects of Desert Dust Storms and Climatological Factors on Mortality and Morbidity of Cardiovascular Diseases admitted to emergency department in Gaziantep. Method Hospital records, obtained between September 01, 2009 and January 31, 2014, from four state hospitals in Gaziantep, Turkey, were compared to meteorological and climatological data. Statistical analysis was performed by Statistical Package for the Social Science (SPSS) for windows version 24.0. Results 168,467 patients were included in this study. 83% of the patients had chest pain and 17% of patients had cardiac failure (CF). An increase in inpatient hospitalization due to CF was observed and corresponded to the duration of dust storms measured by number of days. However, there was no significant increase in emergency department (ED) presentations. There was no significant association of cardiac related mortality and coinciding presence of a dust storm or higher recorded temperature. The association of increases in temperature levels and the presence of dust storms with “acute coronary syndrome- (ACS-) related emergency service presentations, inpatient hospitalization, and mortality” were statistically significant. The relationship between the increase in PM10 levels due to causes unrelated to dust storms and the outpatient application, admission, and mortality due to heart failure was not significant. The increase in particle matter 10 (PM) levels due to causes outside the dust storm caused a significant increase in outpatient application, hospitalization, and mortality originated from ACS. Conclusion Increased number of dust storms resulted in a higher prevalence of mortality due to ACS while mortality due to heart failure remained unchanged. Admission, hospitalization, and mortality due to chest pain both dependent and independent of ACS were increased by the presence of dust storms, PM10 elevation, and maximum temperature.

Prediction of subtle left ventricular systolic dysfunction in homozygous and heterozygous familial hypercholesterolemia: Genetic analyses and speckle tracking echocardiography study

Few studies have shown the direct effect of familial hypercholesterolemia (FH) on myocardial systolic function. Studies focused on heterozygote FH patients but not homozygote ones, and they did not perform genetic analyses. We aimed to evaluate all types of patients with FH using the potentially more sensitive speckle tracking echocardiography (STE) technique to identify early left ventricular (LV) dysfunction.