Fatih Altunkaş

The relationship between inflammation and slow coronary flow: increased red cell distribution width and serum uric acid levels

OBJECTIVES The underlying mechanism of slow coronary flow (SCF) has yet to be elucidated. Increased red cell distribution width (RDW) and uric acid level may be indicative of an underlying inflammatory state. We aimed to investigate RDW and serum uric acid levels in patients with normal coronary arteries and SCF without stenosis. STUDY DESIGN The study included 46 consecutive patients (25 males, 21 females; mean age 54 ± 11 years) with angiographically normal coronary arteries but having SCF in all three coronary arteries. The control group consisted of 40 patients (18 males, 22 females; mean age 54 ± 9 years) with angiographically normal coronary arteries without SCF. In both groups, RDW and serum uric acid levels were measured and compared. RESULTS In the SCF group, TIMI frame counts measured in the left anterior descending coronary artery, left circumflex coronary artery, and right coronary artery were significantly higher compared to the control group (p<0.05). Patients with SCF exhibited significantly higher RDW (13.4 ± 1.6% vs. 12.6 ± 1.2%, p=0.01) and serum uric acid levels (5.3 ± 1.6 mg/dl vs. 4.7 ± 1.3 mg/dl, p=0.01) compared to controls. In logistic regression analysis, uric acid [Exp(B)=1.612, 95% CI 0.206-5.35, p=0.021] and RDW [Exp(B)=1.496, 95% CI 0.403-4.72, p=0.030] were found as independent predictors of SCF. CONCLUSION Our findings show that patients with SCF have significantly increased RDW and serum uric acid levels. This may help throw more light on the pathophysiological basis of SCF.

Coronary Ectasia Is Associated with Impaired Left Ventricular Myocardial Performance in Patients without Significant Coronary Artery Stenosis

Objectives: To determine both ventricular functions and tissue Doppler echocardiography (TDE)-derived myocardial performance index (MPI) in patients with coronary artery ectasia (CAE). Subjects and Methods: Twenty-five patients with CAE (13 men; mean age 57 ± 9 years) and 25 age- and sex-matched controls without CAE (8 men; mean age 54 ± 10 years) were enrolled in the study. Left and right ventricular functions were detected using conventional echocardiography and TDE. Results: Left ventricle-lateral wall (0.61 ± 0.17; 0.50 ± 0.10, p = 0.02), interventricular septum (0.66 ± 0.17; 0.52 ± 0.10, p = 0.007) and mean MPI (0.63 ± 0.15; 0.51 ± 0.09, p = 0.004) were increased in the CAE group compared to the control group. Right ventricular MPI was similar in both the CAE and control groups (0.58 ± 0.18; 0.52 ± 0.19, p > 0.05). Conclusion: The findings show that left ventricular MPI is different in CAE patients without obstructive coronary artery disease compared to the normal control group. Also in these patients, right ventricular MPI was similar to the control group.

Sodium Bicarbonate Versus Isotonic Saline for the Prevention of Contrast-Induced Nephropathy in Patients With Diabetes Mellitus Undergoing Coronary Angiography and/or Intervention: A Multicenter Prospective Randomized Study

Introduction Contrast-induced nephropathy (CIN) is a leading cause of acute renal failure and affects mortality and morbidity. Although the incidence of CIN is quite low in the general population, CIN incidence is significantly increased in patients with diabetes mellitus (DM). Objectives We compared the efficacy of prophylactic use consisting of a saline infusion or a sodium bicarbonate infusion for the prevention of CIN in patients with DM. Materials and Methods A total of 195 DM patients who had unselected renal function were randomized into 2 groups: 101 patients were assigned to saline infusion, and 94 patients were assigned to bicarbonate infusion. The primary end point was the maximum increase in the serum creatinine (SCr) level, whereas the secondary end point was the development of CIN after the procedure. Results The maximum increase in SCr levels was significantly lower in the saline group than in the bicarbonate group: −0.03 mg/dL (IQR, −0.09 to 0.10 mg/dL) versus 0.02 mg/dL (IQR, −0.09 to 0.13 mg/dL) (P = 0.014). The rate of CIN was significantly lower in the saline group than in the bicarbonate group (5.9% vs 16%, P = 0.024). In the subset of study participants with a baseline creatinine clearance of less than 60 mL/min, the maximum increase in SCr levels was significantly lower, −0.08 mg/dL (IQR, −0.13 to −0.04 mg/dL), in the saline group than in the bicarbonate group, 0.03 mg/dL (IQR, −0.13 to 0.12 mg/dL) (P = 0.004). Conclusions The use of prophylactic hydration with isotonic saline before coronary procedures may decrease SCr levels and reduce the incidence of CIN in patients with DM with unselected renal functions to a greater extent than sodium bicarbonate can.

Antioxidant status and levels of antioxidant vitamins in coronary artery ectasia.

BackgroundCoronary artery ectasia (CAE) is a rare coronary artery anomaly. In this study, we investigated superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and &ggr;-glutamyltransferase (GGT) activities, and antioxidant vitamin levels (vitamins A and E) in patients with CAE. MethodsForty-five patients who were diagnosed with CAE using coronary angiography were included in the study (26 men; mean age, 57±9 years). The control group consisted of 35 participants who had normal coronary arteries as shown by coronary angiography (14 men; mean age, 54±7 years). The plasma activity of SOD, GSH-Px, GGT, and levels of vitamins A and E were measured. ResultsThe plasma SOD activity was significantly lower in the CAE group compared with the control group (0.70±0.64 vs. 1.52±0.85 U/ml; P=0.001). The serum GGT activity was higher in the CAE group compared with the control group (34±20 vs. 26±13 U/ml; P=0.04). There were no significant differences in the plasma GSH-Px activity and vitamin A and E levels. There was a positive correlation between SOD activity and low-density lipoprotein cholesterol levels (r=0.418; P=0.01). There was also a positive correlation between vitamin E and low-density lipoprotein cholesterol (r=0.410; P=0.01) and triglyceride levels (r=0.310; P=0.04) in patients with CAE. ConclusionIn this study, patients with CAE had a decreased SOD plasma activity and an increased GGT activity compared with normal controls. These results suggest that oxidative stress and antioxidant status may have an important role in the pathogenesis of CAE.

The Effect of Slow Coronary Flow on Right and Left Ventricular Performance

Objective: To evaluate left and right ventricular functions using tissue Doppler echocardiography (TDE) and myocardial performance index (MPI) methods in patients with slow coronary flow (SCF) and to determine the relationship between these parameters and thrombolysis in myocardial infarction frame count in SCF patients. Subjects and Methods: Thirty-five patients (20 males and 15 females) with SCF who underwent coronary angiography and 35 age- and sex-matched controls (14 males and 21 females) without SCF who underwent elective coronary angiography were enrolled in the study. Left ventricular (LV) and right ventricular (RV) functions were examined using conventional echocardiography and TDE. Results: LV systolic myocardial velocity (Sm), early myocardial velocity (Em), late myocardial velocity (Am), and Em/Am ratio were similar in both the SCF and control groups; however, isovolumetric relaxation time (IRT) was higher in the SCF group compared to the control group (IRT: 99 ± 17 vs. 88 ± 20; p = 0.01). In patients with SCF, LV MPI was higher than in the control group, but this was not statistically significant (0.61 ± 0.11 vs. 0.56 ± 0.12; p = 0.07). The RV tricuspid annular velocities and MPI were similar in the SCF and control groups. Conclusion: This study showed that SCF affected LV functions echocardiographically and could cause partially reduced LV performance. In addition, SCF did not affect RV functions echocardiographically.

The protective effect of single dose tadalafil in contrast-induced nephropathy: an experimental study.

Objective: Contrast-induced nephropathy (CIN) is one of the most common causes of acute renal failure in hospitalized patients. The direct toxic effect of contrast media; ischemic damage caused by reactive oxygen species; increased perivascular hydrostatic pressure; high viscosity and changes in the activity of vasoactive substances play important roles in the pathogenesis. Tadalafil inhibits the phosphodiesterase enzyme which destroys nitric oxide. Nitric oxide causes renal vasodilatation, increases renal medullar blood flow and mediates the removal of free oxygen radicals. Drugs that increase levels of nitric oxide are expected to reduce the development of contrast nephropathy due to contrast media. We aimed to test the hypothesis that tadalafil reduces the development of contrast nephropathy due to contrast toxicity. Methods: A total of 24 female Wistar albino rats, three groups of eight, were included in the study. After 48 hours of dehydration, contrast media (meglumine diatrozoate, 6 mL/kg) was administered to the first group, and contrast media with tadalafil (10 mg/kg) was administered to the second group. The third group served as the control group. Blood and tissue samples were taken 48 hours after this procedure. Results: Serum cystatin C, serum creatinine and blood urea nitrogen (BUN) values were significantly lower in the contrast with tadalafil group compared to the group given only contrast. Serum and tissue malondialdehyde (MDA) levels were significantly lower in the contrast with tadalafil group than in the contrast only group. Conclusion: These results demonstrate the protective effect of tadalafil in the prevention of CIN in rats.

Ischemia-modified albumin and total antioxidant status in patients with slow coronary flow: a pilot observational study.

OBJECTIVE Slow coronary flow (SCF) is defined as late opacification in the epicardial coronary arteries without significant stenosis. The underlying mechanism of SCF is similar to coronary atherosclerosis. Free radical damage may be responsible for the pathology. In this study, we aimed to investigate ischemia-modified albumin (IMA) levels and differences with regard to total antioxidant status (TAS) between patients with normal coronary arteries and patients with SCF without significant stenosis. METHODS Thirty patients who were diagnosed with SCF using coronary angiography were included in this cross-sectional observational study (13 male; mean age, 56±10 years). The control group consisted of 30 patients who had normal coronary arteries as shown by coronary angiography (13 male; mean age, 53±11 years). In this study, we assessed serum IMA levels, albumin-adjusted IMA and TAS. The Student t-test was used to compare serum IMA levels and TAS between the two groups. Pearsons correlation test was used to explore the relationship between TAS and serum IMA levels. RESULTS Serum IMA levels and albumin-adjusted IMA were similar in both groups (p=0.432, p=0.349). The mean value of TAS was significantly lower in the SCF group compared to control group (p=0.011). The TAS was negatively correlated with the levels of IMA and albumin-adjusted IMA in the SCF group (r=-0.457, p=0.011; r=-0.509, p=0.004). CONCLUSION This study shows that serum IMA levels and albumin-adjusted IMA were similar between the groups, however the mean value of TAS was significantly lower in the SCF group compared to control group and negatively correlated with IMA. These results are important in terms of understanding the pathophysiological basis of SCF.

Is there any relationship between RDW levels and atrial fibrillation in hypertensive patient

BACKGROUND Atrial fibrillation (AF) is the most common cardiac arrhythmia and increases the risk of stroke and death. Patients with hypertensive have an increased risk of developing atrial fibrillation. RDW (Red blood cell distribution width) levels are elevated in cardiovascular disorders including heart failure, stable coronary disease, acute coronary syndrome, slow coronary flow and stroke. OBJECTIVE We aimed to investigate the relation between RDW and AF in patients with hypertensive. METHOD We retrospectively examined 126 consecutive hypertensive patients (63 hypertensive patients with AF and 63 hypertensive patients without AF matched with age and sex. RESULTS The mean age of the study population was 71,09± 8,50 (af group) and 70,97±8,24 (non-af group) years. RDW level was different among patients with atrial fibrillation and without atrial fibrillation.(15,13±1,58 and 14,05±1,15 p<001) . Logistic regression analysis showed that RDW and left atrial dimension were only independently risk factory associated with atrial fibrillation. (Rdw odds ratio:1,846 CI; 1,221-2,793 p<0,05). Roc curve analyses were applied to determine the cut-off point. Cut-off point was at 14,195 and Sensitive, specificity was %71,4, %56 respectively. CONCLUSION RDW levels were higher in hypertensive patients with atrial fibrillation. An increased RDW level in the patient with hypertension may alert physician on developing or presence of atrial fibrillation.

Effect of Weight Loss Induced by Intragastric Balloon Therapy on Cardiac Function in Morbidly Obese Individuals: A Pilot Study

Objective: The aim of the study was to investigate the effect of intragastric balloon therapy on left ventricular function and left ventricular mass in a cohort of morbidly obese patients. Subjects and Methods: A prospective trial was performed in a cohort of 17 class II and class III morbidly obese individuals. The intragastric balloon was retained in the stomach for an average of 6 months. Conventional and tissue Doppler echocardiography were performed in all patients before and after the procedure. Results: The mean age of the study participants was 36 ± 10 years (range: 18-55). The mean body mass index was significantly decreased following the intragastric balloon insertion procedure (44 ± 8 vs. 38 ± 5, p < 0.001). The left ventricular mass index and left atrial volume index were significantly decreased following the procedure (112 ± 21 vs. 93 ± 17, p = 0.001 and 20 ± 6 vs. 14 ± 5, p = 0.02, respectfully). In addition, the ratio of mitral peak early diastolic velocity to tissue Doppler-derived peak diastolic velocity and tissue Doppler echocardiography-derived left ventricular myocardial performance index were decreased significantly following the procedure (9.5 ± 1.9 vs. 7.7 ± 1.5, p = 0.002 and 0.57 ± 0.11 vs. 0.46 ± 0.06, p = 0.001, respectively). Conclusions: Intragastric balloon therapy resulted in significant weight reduction in morbidly obese patients. This weight reduction was associated with improved left ventricular function.

Detection of atrial electrical and mechanical dysfunction in non-dipper pre-hypertensive subjects.

Abstract Introduction: A relationship between atrial conduction time and hypertension was shown in previous studies. Increased atrial electromechanical intervals used to predict atrial fibrillation by measured tissue Doppler imaging (TDI). So we aimed to search if there was any association between the non-dipping status and atrial electromechanical intervals in pre-hypertensive patients. Methods: Forty-one non-dipper and 33 dipper pre-hypertensive subjects enrolled in the study. Systolic and diastolic blood pressures were measured with a mercury sphygmomanometer. Twenty-four hours blood pressure was measured with cuff-oscillometric method. All patients were evaluated by transthoracic echocardiography. Using tissue Doppler imaging (TDI), atrial electromechanical coupling (PA) was measured from the lateral mitral annulus (PA lateral), septal mitral annulus (PA septum) and right ventricular tricuspid annulus (PA tricuspid). Results: Systolic and diastolic blood pressures were significantly higher in subjects with non-dipper phenomenon than dipper ones at night. Twenty-four hours average systolic and diastolic blood pressures were higher in non-dipper pre-hypertensive subjects, but this elevation was not significant. Left and right intraatrial (PA lateral-PA septum and PA septum-PA tricuspid) and interatrial (PA lateral-PA tricuspid) electromechanical coupling intervals were measured significantly higher in non-dipper pre-hypertensive patients (31.3 ± 3.9 versus 24.1 ± 2.3, p = 0.001; 19.5 ± 4.3 versus 13.8 ± 2.1, p = 0.001; and 11.4 ± 2.8 versus 8.8 ± 1.5, p = 0.001). Also, interatrial electromechanical delay was negatively correlated with dipping levels. Conclusion: This study showed that prolonged atrial electromechanical intervals were related non-dipper pattern in pre-hypertensive patients. Prolonged electromechanical intervals may be an early sign of subclinical atrial dysfunction and arrhythmias’ in non-dipper pre-hypertensive patients.