Fatih Kahraman

Increased plasma monocyte chemoattractant protein-1 levels in patients with isolated low high-density lipoprotein cholesterol

Abstract Background. High-density lipoprotein cholesterol (HDL-C) inhibits inflammation associated with the development of atherosclerotic plaques. Monocyte chemoattractant protein-1 (MCP-1) contributes to the pathogenesis of atherosclerosis. The aim of this study was to evaluate the relationship between plasma MCP-1 levels and low HDL-C levels in patients without cardiovascular disease (CVD). Methods. This study included 55 patients with low HDL-C (≤ 35 mg/dL) and 33 age- and sex-matched control subjects with normal HDL-C (˃ 35 mg/dL). In addition to MCP-1 levels, laboratory parameters associated with inflammation such as neutrophil-lymphocyte ratio (NLR), uric acid and high sensitivity C-reactive protein (hs-CRP) were also evaluated. Results. HDL-C levels was significantly lower in study group compared to that of the control group (p < 0.001). MCP-1 were prominently higher in the low HDL-C group compared with those of the control group (p < 0.01). NLR, uric acid and hs-CRP levels were also higher in patients with low HDL-C than controls. Conclusion. These findings suggest that elevated plasma MCP-1 levels and inflammation status might be associated with the increased cardiovascular risk in patients with low HDL-C.

Acute stent thrombosis and/or atrial fibrillation occurring after bee sting.

Acute stent thrombosis may result from many causes. Bee sting is a very rare cause of this situation. As bee venom activates some inflammatory and vascular events resulting in occlusion in vessels or diseases in electrical system of heart, it may cause myocardial infarction or atrial fibrillation. This problem may be temporary or fatal. Because of its pathologic effects, to be able to catch on and treat them shortly is very important.

Nebivolol versus Carvedilol or Metoprolol in Patients Presenting with Acute Myocardial Infarction Complicated by Left Ventricular Dysfunction.

Objective: The aim of this study was to evaluate the efficacy of nebivolol, carvedilol or metoprolol succinate on the outcome of patients presenting with acute myocardial infarction (AMI) complicated by left ventricular dysfunction. Subjects and Methods: Patients (n = 172, aged 28-87 years) with AMI and left ventricular ejection fraction ≤0.45 were randomized to the nebivolol (n = 55), carvedilol (n = 60) and metoprolol succinate (n = 57) groups. Baseline demographic and clinical characteristics and composite event rates of nonfatal MI, cardiovascular mortality, hospitalization due to unstable angina pectoris or heart failure, stroke or revascularization during the 12-month follow-up were compared among the groups using the χ2 test, t test or log-rank test as appropriate. Results: Baseline demographic and clinical characteristics were similar in the three groups. The composite end point during follow-up was lower in the patients treated with nebivolol than those treated with metoprolol (14.5 vs. 31.5%; p = 0.03). However, event rates were similar between the patients treated with carvedilol and those treated with the metoprolol (20.3 vs. 31.5%, p > 0.05) and between the patients treated with nebivolol and carvedilol (14.5 vs. 20.3%, p > 0.05). Conclusion: The patients treated with nebivolol experienced 12-month cardiovascular events at a lower rate than those treated with metoprolol succinate. However, event rates were similar between the carvedilol and the metoprolol succinate groups and between the nebivolol and the carvedilol groups.

Low high-density lipoprotein cholesterol is characterized by elevated oxidative stress.

High-density lipoprotein cholesterol (HDL-C) is an independent risk factor for premature atherosclerosis and cardiovascular disease. Plasma HDL exerts potent antioxidant activity. We evaluated parameters associated with oxidative stress in participants with low HDL-C. This study included 32 patients with low HDL-C (≤35 mg/dL) and 33 age- and sex-matched control patients with normal HDL-C (>35 mg/dL). We evaluated clinical and laboratory parameters that are associated with oxidative stress. The oxidative stress index (OSI) levels were significantly higher in the low HDL-C group (3.32 [0.01-13.3] vs 0.74 [0.17-3.55] AU; P < .01) and negatively correlated with HDL-C levels. We suggest that change in OSI and uric acid levels in the study group might indicate increased oxidative status in patients with low HDL-C. This may be associated with increased cardiovascular risk.

Predictors of neurologically favorable survival among patients with out-of-hospital cardiac arrest: A tertiary referral hospital experience

bodies in sera of patients with idiopathic dilated cardiomyopathy by two-dimensional gel electrophoresis and protein sequencing. Am J Cardiol 1997;80:1040–5. 10. Nopp A, Johansson SG, Lundberg M, Oman H. Simultaneous exposure of several allergens has an additive effect on multisensitized basophils. Allergy 2006;61:1366–8. 11. Kounis NG, Mazarakis A, Almpanis G, Gkouias K, Kounis GN, Tsigkas G. The more allergens an atopic patient is exposed to, the easier and quicker anaphylactic shock and Kounis syndrome appear: Clinical and therapeutic paradoxes. J Nat Sci Biol Med 2014;5:240–4.

Serum nitric oxide level in patients with coronary artery ectasia

We read the article entitled ”Serum nitric oxide levels in patients with coronary artery ectasia” written by Gürlek et al. (1) and published in Anatol J Cardiol 2016;16:947-52 with great interest. Though prevalence of coronary artery ectasia (CAE) has increased with use of advanced imaging techniques in cardiology practice, the main etiological factor and mechanism is still uncertain. While atherosclerosis is the main etiological factor in adults, Kawasaki disease is the most common cause in children and young adults. Many trials have been performed, both prospectively and retrospectively, to understand the underlying mechanism and related conditions of CAE. Prospective studies are always more valuable and significant. Prospective study is a longitudinal study that follows over time a group of similar individuals who differ with respect to certain factors under study to determine how these factors affect rates of a certain outcome (2). In prospective studies, results are collected at regular time intervals moving forward, so recall error is minimized. In retrospective studies, selection and information bias can negatively impact the veracity of the study (3). In this trial, the authors stated in the methods section that it was designed as a prospective protocol. But in the second paragraph, they explained that they had evaluated the coronary angiograms (CA) and selected patients retrospectively. We think this discrepancy will create questions for readers. If serum nitric oxide (NO) level detection was done long after CA, the results of the study will be affected, since risk factors for coronary artery disease (CAD) such as diabetes mellitus, hypertension, and smoking alone may increase NO levels in CAE patients. In addition, CAE, which is attributed to atherosclerosis in 50% of cases (4), may progress to CAD over time, and CAD can also increase NO level. Follow-up angiograms are needed to demonstrate absence of CAD in both groups, and most particularly in CAE patients. Authors should explain if blood samples were taken just after CA or later. In either case, this trial can be accepted as a cross-sectional study but not a prospective study. A second issue is control group selection. We wonder if they were selected consecutively, like the CAE patients, or randomly assigned. If the authors would share the power analysis status with us it would be valuable and informative for readers. Meanwhile, we are grateful to the authors. They performed a great study that helps to clarify an uncertain issue.

Aortic propagation velocity does not correlate with classical aortic stiffness parameters in healthy individuals

Objective: Aortic stiffness is an important cardiovascular risk marker, which can be determined using different noninvasive techniques. Aortic propagation velocity (APV) has recently been established as a novel echocardiographic parameter of aortic stiffness. This study aimed to investigate the association between APV and the classical echocardiography-derived aortic stiffness parameters, aortic distensibility (AD) and aortic strain (AS), in a group of otherwise healthy individuals. Methods: In total, 97 consecutive healthy subjects were recruited in this observational study. APV was measured using color M-mode echocardiography from the suprasternal window in the descending aorta. AS and AD were calculated using clinical blood pressure and the M-mode echocardiography-derived aortic diameters. Correlation analyses were performed between cardiovascular risk factors related to increased aortic stiffness (age, obesity, and blood pressure) and measured stiffness parameters (APV, AS, and AD). Correlation analyses were also performed among the measured stiffness parameters. Results: Good correlation of age, blood pressure, and BMI with AS and AD was observed. One-on-one correlation of age, blood pressure, and BMI with APV was not observed. No correlation was observed between APV and AS (r=–0.05, p=0.6) or between APV and AD (r=–0.17, p=0.8). Conclusion: Although APV has been proposed as a novel and practical echocardiographic parameter of aortic stiffness, especially in patients with coronary artery disease, correlations between classical stiffness parameters (AS and AD) and APV were absent in healthy individuals at low–intermediate risk. The clinical and research applicability of APV should be further evaluated.

Evaluation of heart rate recovery index in heavy smokers

I read the article entitled “Evaluation of heart rate recovery index in heavy smokers” by Erat et al. (1), which has been recently published in Anatolian Journal of Cardiology 2016; 16: 667-72, with great interest. The authors have successfully manifested a statistically significant relationship between smoking and the heart rate recovery index (HRRI) even though the study population was small in number. HRRI, which is indicator of the autonomic nervous system (ANS), is not routinely evaluated in daily clinical practice even though it is an independent risk factor for cardiovascular (CV) diseases. Several studies have shown that HRRI plays an important role in all-cause mortality and CV events (2, 3). The authors have done a good job by investigating the relationship between HRRI and smoking because the potential harmful effects of smoking on the autonomic nervous system apart from those on the vascular biology needed to be proved. HRRI calculation is a simple and beneficial way to evaluate autonomic nervous system function. Therefore, this trial will help us understand the harmful effects of smoking on ANS using HRRI. To our knowledge, HRRI is calculated by extracting the heart rate during the 1st, 2nd, 3rd, and 5th minutes after finalizing the test from the patient’s maximum heart rate during exercise. However, the authors have described HRRI in the “Introduction” section as being calculated by extracting the maximum heart rate from the heart rate in the 1st, 2nd, 3rd, and 5th minutes in the post-exercise period. In case of this type calculation, the study results will change, and it will forward us wrongly. I wonder if it was miswritten or miscalculated in this article. I wanted to emphasize on the importance of right usage of medical formulas.

Late perforation of anterior mitral leaflet after surgical resection of the subaortic membrane

A 54-year-old woman who underwent surgical resection of the subaortic membrane 10 years earlier presented with new onset dyspnea. Cardiovascular examination revealed 3-4/6 pansystolic murmur at the apex. She was found to have severe mitral regurgitation (MR) with transthoracic echocardiography; 2D and real-time-3D transesophageal echocardiography demonstrated severe MR through anterior mitral leaflet perforation with precise localization. The patient was treated with surgery in which the perforated segment was closed by direct suture technique and discharged on postoperative 5th day. <Learning objective: Late anterior mitral leaflet perforation after surgical or interventional procedures has rarely been reported. We present this case to emphasize the role of traumatic injury to weak endothelial surfaces such as a valve leaflet in the development of late leaflet perforation after surgical or interventional procedures.>.

Low atrial rhythm mimics myocardial infarction.

Answer: 683 A 55-year-old male patient was admitted to an emergency department of a secondary care hospital with left forearm pain and numbness of fingers lasting for 6 h. He did not state any kind of chest pain and has not had any cardiac disease history and risk factors except smoking for 30 years. Electrocardiography (ECG) demonstrated negative P waves and ST-segment elevation in inferior leads and minimal ST-segment depression in D1 and aVL, and heart rate was 101 bpm (Fig. 1). His cardiac examination and vital signs were normal. He was transported to our hospital for primary percutaneous coronary intervention with the diagnosis of inferior myocardial infarction (MI). Which of the following is not included in your first differential diagnosis in light of the clinical and electrocardiographic findings?