Faruk Akturk

Comparison of different strategies of ivabradine premedication for heart rate reduction before coronary computed tomography angiography

OBJECTIVE The aim of this study was to assess the effectiveness and safety of different strategies of ivabradine therapy by comparing the effects on heart rate (HR), blood pressure (BP), and image quality of coronary CT angiography (CTA). METHODS A total of 192 consecutive patients were randomly assigned to 3 groups of oral premedication with ivabradine 15 mg (single dose), 10 mg (single dose), and 5 mg twice daily for 5 days, prospectively. Patients using HR-lowering drugs and patients with β-blockade contraindication were excluded. The target HR was 65 beats/min. In addition 5 to 10 mg of intravenous metoprolol was administered to the patients at the CT unit, if required. The systolic and diastolic blood BP values and the HRs were recorded. Image quality was assessed for 8 of 15 coronary segments with a 4-point grading scale. Results were compared with the Kruskal-Wallis test, one-way ANOVA, and χ2 test. RESULTS Reductions in mean HR after the treatment were 18 ± 6, 14 ± 4, and 17 ± 7 beats/min for groups 1, 2, and 3, respectively. With the total additional therapies, 81.3%, 67.2%, and 84.3% of the patients achieved HR < 65 beats/min in groups 1, 2, and 3, respectively. The mean BP values before coronary CTA were not significantly changed except for patients in group 2. Unacceptable (score 0) image quality was obtained in only 4.5%, 10.2%, and 4.2% of all the coronary segments, in groups 1, 2, and 3, respectively. CONCLUSIONS Our study indicates that coronary CTA with premedication with oral ivabradine in all 3 strategies is safe and effective in reducing HR, in particular with a β-blockade combination. All 3 ivabradine regimes may be an alternative strategy for HR lowering in patients undergoing coronary CTA. Ivabradine 15 mg (single dose) and ivabradine 5 mg twice daily for 5 days are superior to the ivabradine 10-mg single-dose regime for HR lowering without adjunctive intravenous β-blocker usage.

The relationship between γ-glutamyl transferase levels and the clinical outcomes in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.

ObjectivesSerum &ggr;-glutamyl transferase (GGT) activity has been shown to be related to the development of atherosclerosis and cardiovascular events. The aim of this study was to evaluate the prognostic value of GGT in patients with ST-segment elevation myocardial infarction (STEMI) undergoing a primary percutaneous coronary intervention (PCI). Patients and methodsA total of 683 consecutive patients with STEMI who underwent primary PCI were evaluated. The study population was divided into tertiles on the basis of admission GGT values. A high GGT (n=221) was defined as a value in the upper third tertile (GGT>37) and a low GGT (n=462) was defined as any value in the lower two tertiles (GGT⩽37). The mean follow-up time was 29 months. ResultsThe in-hospital mortality rate was significantly higher in patients in the high GGT group (7.2 vs. 1.7%, P<0.001), as was the rate of adverse outcomes in patients with high GGT levels. In multivariate analyses, a significant association was found between high GGT levels and adjusted risk of in-hospital cardiovascular mortality (odds ratio=8.6, 95% confidence interval: 2.3–32.4, P=0.001). In a receiver operating characteristic curve analysis, a GGT value greater than 37 was identified as an effective cutoff point in STEMI for in-hospital cardiovascular mortality (area under curve=0.71, 95% confidence interval: 0.59–0.82, P<0.001). There were no differences in the long-term adverse outcome rates between the two groups. ConclusionGGT is a readily available clinical laboratory value associated with in-hospital adverse outcomes in patients with STEMI who undergo primary PCI. However, there was no association with long-term mortality.

A comparative analysis of leukocyte and leukocyte subtype counts among isolated systolic hypertensive, systo-diastolic hypertensive, and non-hypertensive patients

BACKGROUND Isolated systolic hypertension (ISHT) is a subtype of hypertension (HT) that often exhibits wide pulse pressure, and pulse pressure has a strong predictive value for future adverse cardiovascular events. Previous studies have shown the effects of leukocyte count on the prognosis of ischaemic heart disease and HT. AIM Thus, in this cross-sectional study, we analysed the relationship between leukocyte counts and subtypes in HT and non-HT groups. METHODS The study population consisted of 960 consecutive patients who were admitted to the outpatient clinic of our hospital. After ambulatory blood pressure values were assessed, the participants were divided into three groups: ISHT (n = 98), systo-diastolic hypertensives (SDHT, n = 405), and non-hypertensives (non-HT, n = 457). RESULTS The subjects in the ISHT group were older than those in the SDHT and non-HT groups (64 ± 10, 53 ± 12, and 52 ± 13, respectively; p < 0.001). The leukocyte and neutrophil counts and neutrophil/lymphocyte (NL) ratios were significantly different in all groups. In subgroup analysis, the leukocyte count, neutrophil count, and N/L ratio were higher in the ISHT and SDHT groups than in the non-HT group (p < 0.001 for all). The leukocyte count, neutrophil count, and N/L ratio were significantly higher in the ISHT group than in the SDHT group (p = 0.023, p = 0.007, p = 0.010, respectively). Neutrophil count (p = 0.012; OR = 1.229, 95% CI 1.046-1.444) was an independent risk factor for ISHT in multivariate logistic regression analysis. CONCLUSIONS The leukocyte and neutrophil counts and N/L ratios were higher in the ISHT group than in the SDHT and non-HT groups. High neutrophil count was an independent predictor of ISHT.

Evaluation of lipoprotein-associated phosholipase A2 and plaque burden/composition in young adults.

ObjectiveThe total burden of subclinical coronary atherosclerosis is significant in young adults. Serum lipoprotein-associated phospholipase A2 (Lp-PLA2) is an established predictor of morbidity and mortality because of cardiovascular disease. The aim of the present investigation was to evaluate the relationship between subclinical coronary atherosclerosis and serum Lp-PLA2 concentrations in a population of young adults. Patients and methodsA total of 261 individuals younger than 45 years of age who had undergone coronary computed tomography angiography were evaluated. The study group included 101 patients in whom coronary computed tomography angiography detected subclinical coronary atherosclerosis; the control group included 160 sex-matched and age-matched healthy control patients. ResultsSerum Lp-PLA2 levels were increased significantly in the study group patients compared with the control patients (15.42±11.88 vs. 8.06±4.32 ng/ml, P<0.001). Furthermore, a positive correlation was identified between the Lp-PLA2 levels and the total number of plaques and diseased arteries (r=0.495, P<0.001, and r=0.621, P<0.001, respectively). The presence of mixed plaque composition was also correlated with the Lp-PLA2 levels (r=0.657, P<0.001). Multivariate regression analysis identified four independently significant predictors of subclinical coronary atherosclerosis: high-sensitivity C-reactive protein levels, tobacco use, uric acid levels, and serum Lp-PLA2 levels. ConclusionThe presence of subclinical coronary atherosclerosis is associated independently with Lp-PLA2, and it has potential utility as a novel indicator of cardiovascular disease risk in the young adult population.

Valvular and Supravalvular Aortic Stenosis Secondary to Familial Hyperlipidemia

Familial hypercholesterolemia (FH) is an autosomal dominant disorder characterized by high levels of low density lipoprotein (LDL) and premature coronary artery disease. Mutations in low density lipoprotein (LDL) receptors induce pathologic mechanisms resulting in this disorder. Hypercholesterolemia also affects aortic valve and aortic root together with coronary arteries [1,2]. Herein we present a 46 year old female patient with heterogenous familial hyperlipidemia leading to valvular and supravalvular aortic stenosis.