Fatih Poyraz

Carotid intima–media thickness in patients with cardiac syndrome X and its association with high circulating levels of asymmetric dimethylarginine

BACKGROUND The cause of myocardial ischemia and chest pain in patients with cardiac syndrome X (CSX) has been explained by mechanisms including endothelial dysfunction. CSX patients have higher levels of asymmetric dimethylarginine (ADMA) and increased mean common carotid intima-media thickness (C-IMT). Accordingly, this study was designed to examine C-IMT with its association serum endothelial function parameters in patients with CSX. METHODS The study population consisted of 30 enrolled consecutive patients with diagnosis of CSX. As a control group, 30 individuals with the complaint of anginal chest pain without any ischemia on myocardial perfusion scintigraphy and with normal coronary angiographies were selected. C-IMT was measured by recording ultrasonographic images of both the left and the right common carotid artery. Plasma levels of L-arginine, ADMA, and nitrate/nitrite (NO(x)) were measured from blood samples. RESULTS Both C-IMT (mm) and carotid atherosclerotic plaques were significantly higher in patients with CSX than in control group. Also, the plasma level of NO(x), L-arginine, and L-arginine/ADMA ratio were lower in patients with CSX than they were in the control group subjects. Plasma ADMA level increased in the CSX patients group. Correlation analysis showed significant positive correlation with C-IMT and plasma ADMA levels and showed significant negative correlation with plasma NO(x) and L-arginine levels. L-arginine/ADMA ratio and C-IMT was also showed significant negative correlation with the same analysis. CONCLUSIONS CSX patients had higher plasma ADMA levels and C-IMT values than the controls, reflecting the presence of subclinical atherosclerosis. These findings suggest that, besides endothelial dysfunction, presence of atherosclerosis may also contribute to the etiopathogenesis of the CSX phenomenon.

The effect of nebivolol treatment on oxidative stress and antioxidant status in patients with cardiac syndrome-x

BackgroundFree radical-mediated oxidative stress has been implicated in the etiopathogenesis of several disorders. The aim of this study was to elucidate the effect of treatment with nebivolol on the metabolic state of oxidative stress, and antioxidant status markers in patients with cardiac syndrome-X (CSX), additionally, to compare with the effect of metoprolol treatment. MethodsThirty patients, 17 female and 13 male, with CSX were enrolled in the study. Nebivolol (5 mg/day) or metoprolol (50 mg/day) was administrated for 12 weeks. Twelve hour fasting blood samples, taken at the initiation and on the third month of therapy, were analyzed for the levels of malondialdehyde (MDA), nitrite+nitrate (NOx), and the activity of myeloperoxidase (MPO), superoxide dismutase (SOD). No patient presented additional risk factors for increased reactive oxygen species levels. ResultsCompared with sixteen control participants, patients with CSX had significantly higher activity of MPO and levels of MDA, but significantly lower SOD activity and levels of NOx before treatment. After treatment, MPO activity and MDA levels were significantly reduced; SOD activity and NOx levels were significantly increased with nebivolol but remained unchanged with metoprolol. ConclusionWe have shown that patients with CSX who taken nebivolol have lower serum MPO activity, levels of MDA and higher serum SOD activity, NOx levels when compared with metoprolol treatment. Exercise stress test parameters were also ameliorated in patients who had taken nebivolol in contrast to metoprolol. Nebivolol treatment may be a novel treatment strategy in cases with CSX in the future.

Incremental effects of serum uric acid levels, autonomic dysfunction, and low-grade inflammation on nocturnal blood pressure in untreated hypertensive patients and normotensive individuals.

OBJECTIVES We aimed to evaluate the associations between nocturnal blood pressure (BP) and serum uric acid (SUA) level, low-grade inflammation, and cardiac autonomic function in untreated dipper and nondipper hypertensive patients and normotensive individuals. STUDY DESIGN The study included 92 consecutive patients (44 men, 48 women; mean age 51.6 ± 9.7 years) who presented for initial evaluation of hypertension. All patients underwent 24-hour Holter monitoring to assess heart rate variability (HRV) and ambulatory BP. Serum high-sensitivity C-reactive protein (hs-CRP) and SUA levels were measured. Due to the non-normal distribution of hs-CRP and microalbuminuria (MAU), they were normalized by logarithmic transformation. RESULTS Of the study group, 60 patients (65.2%) were diagnosed as hypertensive (50% nondippers). In univariate correlation analysis, log(MAU) showed a significant correlation with nocturnal BP (r=0.560, p<0.001). Among HRV parameters, SDNN, SDANN, and triangular index were inversely correlated with log(hs-CRP) (r=-0.356, p=0.001; r=-0.350, p=0.001; r=-0.314, p=0.002, respectively) and nighttime BP (r=-0.286, p=0.006; r=-0.251, p=0.02; r=-0.294, p=0.004, respectively). Log(hs-CRP) was positively correlated with nighttime BP (r=0.302, p=0.003). Serum UA levels were correlated with only nocturnal BP; i.e., nocturnal mean (r=0.260, p=0.01), systolic (r=0.249, p=0.016), and diastolic BP (r=0.249, p=0.017). In multiple linear regression analysis, log(hs-CRP) and age were independent predictors of cardiac autonomic dysfunction, and log(hs-CRP), SUA, and HRV parameters were independent predictors of nocturnal BP measurements. CONCLUSION Our findings suggest the role of low-grade inflammation, uric acid levels, and autonomic dysfunction even in the early stages of hypertension.

Dialysis Type May Predict Carotid Intima Media Thickness and Plaque Presence in End-Stage Renal Disease Patients

IntroductionCarotid intima media thickness (CIMT) and carotid plaques (CP) were shown to be independent predictors of mortality in end-stage renal disease (ESRD) patients. In this study, the authors aimed to compare the two dialysis modalities for CIMT and CP presence (CPP).MethodsESRD patients who had been on the same renal replacement therapy for at least 24 months were selected. CIMT, CPP, known risk factors, and laboratory parameters for atherosclerosis were determined for each patient.ResultsA total of 77 hemodialysis (HD) patients (68% male, 47.6 ± 17.0 years), 61 continuous ambulatory peritoneal dialysis (CAPD) patients (51% male, 45.3 ± 13.9 years), and 36 age- and sex-matched controls (61% male, 43.3 ± 10.6 years) were included. The mean CIMT (m-CIMT) were 0.99 ± 0.24, 0.86 ± 0.22, and 0.60 ± 0.13 mm in the HD, CAPD, and control groups, respectively (HD vs. CAPD, P = 0.001; HD vs. control, P < 0.001; and CAPD vs. control, P < 0.001). The CPP occurred more frequently in the HD group compared to the CAPD group (64% vs. 39%, respectively, P = 0.004). The backward linear and logistic regression analysis of potential confounders revealed that both m-CIMT and CPP was independently associated with dialysis type (beta = 0.249, P = 0.008; and odds ratio [OR] = 4.11, 95% CI, 1.72 to 6.73, P = 0.015, respectively).ConclusionThe authors have shown that dialysis type may be an independent predictor of m-CIMT and CPP in long-term ESRD patients.

Rectus sheath hematoma due to inappropriate warfarin usage.

Laboratory findings were white blood cell count, 11200 /mm; hemoglobin level, 6.4 g/dL; platelet count, 162 000/mm; prothrombin time, 88.6 seconds; and international normalized ratio (INR), 7.2. The electrocardiogram revealed atrial fibrillation. Left ventricular and prosthetic mitral valve functions were normal in transthoracic echocardiography. Bedside abdominal ultrasonography and abdominal computed tomography (CT) scans revealed a 9-cm × 13-cm × 12-cm intra-abdominal organized hematoma extending from the umbilicus to the pelvic region and a massive, free intra-abdominal hemorrhage (Figure 1). The patient was given 16 units of fresh frozen plasma and 14 units of erythrocyte suspension during To the editor, Rectus sheath hematoma is a rare but potentially life-threatening clinical condition generally seen in patients under subcutaneous low-molecularweight heparin therapy. A 75-year-old woman complaining of abdominal pain was admitted to the emergency department. She was being treated with warfarin because of mitral valve replacement 6 years earlier. In her physical examination, her general status was dismal. Her arterial blood pressure was 95/60 mm Hg, her pulse was 102 beats/min and arrhythmic, and her body temperature was 36.3°C. She had an obvious umbilical hernia and a tender mass at the paraumbilical area. Clinical and Applied Thrombosis/Hemostasis Volume 14 Number 1 January 2008 116-117

Plasma Levels and Distribution of Gene Polymorphisms of Factor VII in Turkish Population

Three factor VII (FVII) promoter haplotypes are associated with stratified plasma FVII levels. To our knowledge, this is the first study examining the distribution of FVII gene polymorphism and levels in Turkish population. The study population was classified into 3 groups according to the absence of coronary arterial disease and presence or absence of a history of myocardial infarction. It was found that the levels of FVII coagulant activity (FVIIc) were higher in the event group than that of the other groups. Participants with high FVIIc levels were found to have 2-fold increased risk for myocardial infarction. The alleles at the FVII loci in all cases are similar. In conclusion, our results indicate that FVIIc levels have an important predictive role in cardiovascular events. The distribution of FVII gene polymorphisms in the Turkish population shows significant differences when compared with European populations.

Depresyon Hastalarında Endotel Fonksiyonları, Ekokardiyografik Parametreler ve Damar Sertliğine Antidepresan Tedavinin Etkisi

Giderek artan bilgiler depresyonun bagimsiz bir kardiyovaskuler hastalik (KVH) risk faktoru oldugunu ortaya koymaktadir. Bu calismamizda seratonin geri alim inhibitorleri (SSRI) ile tedavinin kalbin sistolik ve diyastolik fonksiyonlari ve kardiyovaskuler hastalik gelisimi icin bagimsiz ongorduruculer olan aortik sertlik ve endotel fonksiyon parametreleri uzerine etkisini arastirdik. Calismaya 16-65 yas arasi bilinen KVH oykusu olmayan ve major depresyon nedeni ile ilk defa SSRI tedavisi baslanan 41 hasta dâhil edildi. Tedavi baslangicinda ve 8 haftalik tedavi sonunda hastalarin ekokardiyografik olarak sistolik ve diyastolik fonksiyon parametreleri, miyokard performans indeksi (MPI) ve aortikgerilim (Ao strain) degerlendirildi. Otomatik analizor ile parmaktan pletismografik yontemle yapilan nabiz dalga analizi ile belirlenen nabiz ilerleme zamani (PPT), sertlik indeksi (SI) ve Refleksiyon indeksi (RI) hesaplandi. Endotel fonksiyonlari akima bagli dilatasyon yontemi ile degerlendirildi. Sekiz haftalik tedavi sonunda 19 hasta kontrole geldi (%46,3) ve nihai degerlendirmeye bu hastalarin sonuclari dâhil edildi. Analiz yapilan hastalarin tedavi oncesine gore tedavi sonunda sol ventrikul ejeksiyon fraksiyonunun (%64,83±4,54 vs %66,80±3,3, p=0,020) ve fraksiyonel kisalmasinin arttigi (%35,39±3,53 vs %37,11±2,49, p=0,013), MPI degerinin dustugu gozlendi (0,60±0,21 vs 0,45±0,15, p=0,004). Bunun disinda diyastolik fonksiyon parametreleri,aortik strain, endotel fonksiyon ve aortik sertlik parametreleri acisindan tedavi sonrasinda anlamli farklilik izlenmedi. Calismamiz yeni tani konmus depresyonlu hastalarin SSRI inhibitoru ile kisa donem tedavilerinin sol ventrikul sistolik fonksiyonlarini olumlu yonde etkileyebilecegini, diyastolik fonksiyonlarda, endotel fonksiyonlarinda ve buyuk arter sertliginde ise degisiklik yapmadigini gosterdi.