Ertugrul Kurtoglu

Endocan--a novel inflammatory indicator in newly diagnosed patients with hypertension: a pilot study.

Endothelial dysfunction is regarded as the initial lesion in the development of atherosclerosis. Endocan, previously called endothelial cell–specific molecule 1 (ESM-1), is a new candidate immunoinflammatory marker that may be associated with cardiometabolic risk factors. Therefore, we assessed serum levels of endocan in newly diagnosed patients with untreated essential hypertension (HT). A total of 18 patients with HT and 23 normotensive control participants were included in the study. Serum endocan levels, carotid intima–media thickness (cIMT), and high-sensitivity C-reactive protein (hsCRP) were measured. Serum endocan levels were significantly higher in the HT group (P < .001). In patients with HT, serum endocan levels correlated positively with cIMT and hsCRP (r = .551, P < .001 and r = .644, P < .001, respectively). Our findings suggest that circulating endocan levels represent a new marker in patients with essential HT. Endocan may be a surrogate endothelial dysfunction marker and may have a functional role in endothelium-dependent pathological disorders.

The impact of metabolic syndrome on left ventricular function: Evaluated by using the index of myocardial performance

AIM To evaluate the impact of metabolic syndrome on global left ventricular function by using the index of myocardial performance. METHODS The study population included 106 patients with metabolic syndrome (66 male, 40 female, mean age =54+/-11 years) and 106 control subjects without metabolic syndrome (71 male, 35 female, mean age=53+/-10). The diagnosis of metabolic syndrome was based on The National Cholesterol Education Program Adult Treatment Panel III criteria. All patients underwent two-dimensional and Doppler echocardiographic examination. The index of myocardial performance was determined as the sum of isovolumic relaxation time and isovolumic contraction time divided by left ventricular ejection time. RESULTS The index of myocardial performance was found to be significantly higher in patients with metabolic syndrome compared with control subjects without metabolic syndrome (0.55+/-0.06 vs 0.38+/-0.04 respectively, p<0.001). CONCLUSION In the present study, we have shown the presence of impaired global left ventricular function in patients with metabolic syndrome compared with control subjects without metabolic syndrome. This finding emphasizes the importance of early diagnosis and management of metabolic syndrome to prevent the progression of ventricular dysfunction to overt structural and symptomatic cardiac disease.

Assessment of atrial conduction time by tissue Doppler echocardiography and P-wave dispersion in patients with mitral annulus calcification.

The aim of our study was to investigate atrial conduction time in patients with mitral annulus calcification (MAC) using P-wave dispersion (PWD) and electromechanical coupling measured with the surface electrocardiogram and the tissue Doppler echocardiography. Fifty-nine patients with MAC and 43 control subjects underwent resting the surface electrocardiogram and tissue Doppler echocardiography. The difference between the maximum (Pmax) and minimum P-wave durations was calculated and defined as PWD. Interatrial and intraatrial electromechanical delays were measured with tissue Doppler echocardiography. Both Pmax and PWD were higher in patients with MAC compared with controls (111.4 +/- 15.8 vs 97.3 +/- 18.8 milliseconds; P < .0001 and 46.4 +/- 14.6 vs 31.4 +/- 13.1 milliseconds; P < .0001, respectively). Both interatrial and intraatrial conduction time were also delayed in patients with MAC compared with controls (29.8 +/- 13.3 vs 17.6 +/- 12.5 milliseconds; P < .0001; 9.4 +/- 5.1 vs 6.8 +/- 4.0 milliseconds; P < .008, respectively). Left atrial (LA) diameter was significantly higher in patients with MAC compared with controls (35.4 +/- 5.0 mm vs 32.3 +/- 4.2 mm; P < .001). The LA diameter correlated significantly with both interatrial conduction times and PWD (r = 0.56; P < .0001 and r = 0.47; P < .0001, respectively). There is a delay in both intraatrial and interatrial electromechanical coupling intervals in patients with MAC.

Neutrophil–lymphocyte ratio as an important assessment tool

was measured by dividing neutrophil count to lymphocyte count. Left atrial thrombus was detected in 32 (10.3%) of 309 patients. Mean NLR (2.2 ± 1.0 vs 2.7 ± 1.1, p = 0.026) was significantly higher among patients with LA thrombus compared to patients without LA thrombus. On multivariate analysis, NLR (odds ratio 1.59; 95% CI: 0.87–4.18; p < 0.02) was an independent risk factor for the presence of LA thrombus in patients with non-valvular AF. We concluded that NLR, an emerging marker of inflammation, was independently associated with the presence of LA thrombus in patients with non-valvular AF [2] .I

Ivabradine Improves Heart Rate Variability in Patients with Nonischemic Dilated Cardiomyopathy

Background Ivabradine is a novel specific heart rate (HR)-lowering agent that improves event-free survival in patients with heart failure (HF). Objectives We aimed to evaluate the effect of ivabradine on time domain indices of heart rate variability (HRV) in patients with HF. Methods Forty-eight patients with compensated HF of nonischemic origin were included. Ivabradine treatment was initiated according to the latest HF guidelines. For HRV analysis, 24-h Holter recording was obtained from each patient before and after 8 weeks of treatment with ivabradine. Results The mean RR interval, standard deviation of all normal to normal RR intervals (SDNN), the standard deviation of 5-min mean RR intervals (SDANN), the mean of the standard deviation of all normal-to-normal RR intervals for all 5-min segments (SDNN index), the percentage of successive normal RR intervals exceeding 50 ms (pNN50), and the square root of the mean of the squares of the differences between successive normal to normal RR intervals (RMSSD) were low at baseline before treatment with ivabradine. After 8 weeks of treatment with ivabradine, the mean HR (83.6 ± 8.0 and 64.6 ± 5.8, p < 0.0001), mean RR interval (713 ± 74 and 943 ± 101 ms, p < 0.0001), SDNN (56.2 ± 15.7 and 87.9 ± 19.4 ms, p < 0.0001), SDANN (49.5 ± 14.7 and 76.4 ± 19.5 ms, p < 0.0001), SDNN index (24.7 ± 8.8 and 38.3 ± 13.1 ms, p < 0.0001), pNN50 (2.4 ± 1.6 and 3.2 ± 2.2 %, p < 0.0001), and RMSSD (13.5 ± 4.6 and 17.8 ± 5.4 ms, p < 0.0001) substantially improved, which sustained during both when awake and while asleep. Conclusion Our findings suggest that treatment with ivabradine improves HRV in nonischemic patients with HF.

Association of Mitral Annulus Calcification with High-Sensitivity C-Reactive Protein, Which Is a Marker of Inflammation

Objectives. There are limited clinical data revealing the relationship between mitral annular calcification (MAC) and systemic inflammation. The goal of the present study was to compare high-sensitivity C-reactive protein (hs-CRP) levels in patients with and without MAC and investigate the relationship between MAC and hs-CRP. Methods. One hundred patients with MAC who underwent transthoracic echocardiography (TTE) and 100 age-matched controls without MAC who underwent TTE were included in our study. Hs-CRP levels were compared between groups. Results. Prevalence of female gender, hypertension, and coronary artery disease were significantly higher in the MAC group than in the control group (64% versus 45%, P = 0.007, 42% versus 28%, P = 0.03 and 37% versus 18%, P = 0.003, resp.). On multivariate analysis, age, gender, and coronary artery disease were the only independent predictors of MAC. The levels of hs-CRP were higher in the MAC group than in the control group (2.02 ± 0.35 versus 1.43 ± 0.47 mg/dl, P < 0.001). This increase in hs-CRP levels in the MAC group persisted in patients without hypertension, coronary artery disease, and in male patients when compared to the control group. Conclusions. Our study demonstrated that hs-CRP, which is a sensitive marker of systemic inflammation, increased in patients with MAC.

The Comparison of Cardiac Biomarkers Positivities in Hemodialysis Patients without Acute Coronary Syndrome

Aim: We aimed to compare heart-type fatty acid-binding proteins (H-FAB) and other cardiac biomarkers to determine the most reliable cardiac marker in hemodialysis (HD) patients without acute coronary syndrome (ACS). Materials and methods: Sixty HD patients without ACS were included the study. Blood samples were taken before HD session for measurement of H-FAB, troponin I, troponin T, creatine kinase-MB (CK-MB) isoforms. Results: Mean age of patients was 55 ± 15 years. Males were 55%. Mean serum level of blood urea nitrogen was 75 ± 15 mg/dL, mean serum level of creatinine was 8.3 ± 2.5 mg/dL, mean serum level of hematocrit was 33 ± 5%, mean ejection fraction was 54 ± 9%, and mean left ventricular mass index (LVMI) was 136 ± 54 g/m2. H-FAB was positive in 32%, troponin T in 20%, troponin I in 12%, and CK-MB in 5% of all patients. Three or four of all parameters were not positive together in any patient. While 5% of patients had positive troponin T with H-FAB, 3% of patients had positive troponin T with troponin I and 2% of patients had positive troponin I with H-FAB. Conclusion: Our study found that CK-MB had the lowest positivity in the HD patients without ACS. H-FAB had the highest rate of positivity in all markers. If only one marker is assessed it should be CK-MB. But using two parameters in HD patients in ACS diagnosis increases the reliability of diagnosis. If we use two biomarkers it should be CK-MB and troponin I.

The Importance of Cardiac Biomarkers on Remodelling After Myocardial Infarction

Background The purpose of this study is to evaluate the importance of tenascin-C ( TNC), N-terminal pro brain natriuretic peptide (NT-proBNP) and C-reactive protein (CRP) on LV remodelling after myocardial infarction (MI). Methods Fifty-seven stable patients with subacute anterior MI who had total or subtotal occlusion in the infarct-related left anterior desending artery in coronary angiography were enrolled the study. 18 of patients who had total occlusion received only medical theraphy, 19 of patients who had total occlusion received successful PCI+ medical theraphy and 20 of patients who had subtotal occlusion received successful PCI+ medical theraphy. Left ventricular volumes and ejection fractions (EF) were measured with echocardiography. Serum TNC, NT-proBNP and CRP levels were measured at admission and a month after treatment. Results There was significant increase in LV end-diastolic volume (LVEDV) and LV end-systolic volume (LVESV) baseline to follow-up in total-PCI group. Baseline to follow-up; a borderline significant increase was observed in LVEDV in the total-medical group. No significant difference was seen in LV volumes and EF in the subtotal-PCI group. NT-proBNP, TNC and CRP levels were decreased in all groups. The decrease in NT-proBNP and CRP values were significant in the total-medical and subtotal-PCI group but in the total-PCI group they were not significant. The decrease of TNC was significant in all groups but the lowest decrease was seen in the total-PCI group. Conclusion TNC, NT-proBNP and CRP reflect LV remodelling in accordance with echocardiography after MI. Keywords Tenascin-C; NT-pro BNP; CRP; Remodelling; Myocardial infarction

The neutrophil–lymphocyte ratio is not enough to describe inflammatory condition

We have intentionally read the article ‘‘Neutrophil–lymphocyte ratio (N/L ratio) as a new predictive and prognostic factor at the hearing loss of diabetic patients’’ by Ulu et al. [1] with interest. In that well-presented study, the authors aimed to investigate the relationship between N/L ratio levels and sensorineural hearing loss (SNHL) in diabetic patients using high-frequency audiometry (8–16 kHz) for the first time. They demonstrated that N/L ratio levels were associated with SNHL of diabetic patients. Some studies have indicated that SNHL appears to be characterized by inflammation or thrombotic events. Mean platelet volume (MPV) is one of the platelet function indices which reflects the platelet production rate and functions. The indicator for SNHL etiology remains a matter of debate because it is associated with many different disorders. MPV and platelet distribution width is significantly higher in SNHL [2]. White blood cell (WBC) count is one of the useful inflammatory biomarkers in clinical practice. N/L ratio is a readily available biomarker that conveys important information about the patient’s inflammatory activity. N/L ratio can be easily calculated from the differential WBC count, which is routinely performed on admission and is universally available. Furthermore, many epidemiological studies have highlighted that chronic low-grade inflammation measured by N/L ratio has also been linked to the traditional risk factors like diabetes mellitus, hypertension [3], metabolic syndrome [4], obesity, smoking, elevated levels of triglycerides and other lifestyle habits. Recent evidence indicated that the N/L ratio has a significant prognostic value for many conditions [5]. Psoriasis is a chronic systemic inflammatory disorder [6]. The N/L ratio has been used as a marker for systemic inflammatory status. The N/L ratio is a simple, inexpensive and easily assessable marker of systemic inflammation in patients with psoriasis [7]. N/L ratio is an emerging marker of inflammation and is higher in patients with Familial Mediterranean Fever (FMF) in attack-free periods [8]. As a conclusion, N/L ratio may be affected by many factors, the routine clinical usage of these parameters may not be reasonable yet. Because it is a ratio, N/L ratio is relatively more stable than individual leukocytic parameters that are easily altered by many simple conditions (e.g. dehydration, over-hydration, diluted blood specimens, in vitro blood specimen handling). After that, not only N/L ratio but also high-sensitivity CRP, red cell distribution width, a gamma-glutamyl transferase and uric acid are easy methods to assess in patients with ISHL [9]. These might be useful in clinical practice [10]. N/L ratio itself alone without other inflammatory markers may not give information to clinicians about the inflammatory condition of the patient [11]. So, we think that N/L ratio should be evaluated together with other serum inflammatory markers.

Association between Red Cell Distribution Width and Disease Activity in Patients with Behcet’s Disease

Aims: we aimed to investigate whether red cell distribution width (RDW) can also be used for the assessment of disease activity in Behcet’s disease (BD). Methods and results: Forty patients with active BD and seventy patients with inactive BD were included in the study. Forty-six healthy volunteers constituted the control group. Hematological parameters, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were analyzed by standard methods. All the individuals underwent comprehensive echocardiographic examination. Echocardiographic parameters of the study population were similar all groups. ESR, CRP and RDW were significantly higher in active BD patients than in inactive BD patients and controls (33.6±22 vs 15.7±9 vs 5±4.1, 23.4±21.6 vs 5.5±6.2 vs 1.2±0.5 and 17.2±2.5 vs 14.4±1.9 vs 13.2±0.5, p<0.0001 for all, respectively). Moreover, we also found that ESR, CRP and RDW were significantly higher in inactive BD patients when compared with the controls (15.7±9 vs 5±4.1, 5.5±6.2 vs 1.2±0.5 and 14.4±1.9 vs 13.2±0.5, p<0.0001 for all, respectively). There were modest positive correlations between RDW and disease duration (r=0.320, P=0.001). Conclusion: We demostrated that RDW significant increased in active and inactive BD patients without cardiac involvement. In addition, our study has established that RDW can be used to determine the disease activity state of BD.