Fatma Nihan Turhan Caglar

Hypertension as a Risk Factor for Aspirin and Clopidogrel Resistance in Patients With Stable Coronary Artery Disease

Background: Platelets play an important role in the pathogenesis of coronary artery disease (CAD). The importance of dual antiplatelet therapy to prevent recurrent ischemic events in patients who have acute coronary syndrome and who will undergo percutaneous coronary intervention (PCI) is well known and widely accepted as a gold standard. However, despite this apparently effective therapy, incidence of adverse ischemic events could not be decreased enough. Resistance to aspirin/clopidogrel is an important risk factor for adverse ischemic clinical events. Up-to-date studies revealed many risk factors for antiplatelet resistance, one of which is hypertension (HT). Currently, there is no sufficient number of studies evaluating the association between HT and antiplatelet resistance, which is the aim of this study. Methods: We enrolled 145 consecutive patients (19 female [13.1%], 126 male [86.9%], mean age 55 ± 10) with stable CAD receiving regular antiplatelet therapy composed of 100 mg/d aspirin and 75 mg/d clopidogrel. All patients had been implanted nondrug-eluting coronary stent and/or stents at least 1 month ago. The HT was diagnosed by 24-hour blood pressure (BP) monitoring. Clopidogrel and aspirin resistance was measured by impedance aggregometry method. Results: We included 49 patients with HT and 96 nonhypertensive patients with stable CAD. Aspirin resistance was detected in 22 (16.4%) of 134 patients who received aspirin. Clopidogrel resistance was detected in 55 (37.9%) of 145 patients who received clopidogrel. Prevalance of aspirin and clopidogrel resistance was significantly higher in the hypertensive group than in the nonhypertensive group (P = .030 and P = .007, respectively). Correlation analysis revealed weak but significantly positive correlation between clopidogrel resistance and serum uric acid levels, mean platelet volume, platelet count, and 24-hour mean systolic BP (r = −.180, P = .030; r = .189, P = .016; r = .226, P = .006; and r = .200, P = .016, respectively). Conclusion: We demonstrated higher incidence of antiplatelet resistance in patients with HT. Upon this finding, which is emerged from an actual group of patients with HT, cardioprotective effect of antiplatelet therapy in patients with HT should be argued.

Aspirin: from a Historical Perspective

Aspirin is one of the oldest medicines. Due to its wide range usage in different fields of medicine, we aimed to present the history, effects and different uses of aspirin in this review. Furthermore, recent patents of novel pharmaceutical interventions in the field of acetylsalicylic acid, expanding treatment options are presented. Literature search was performed in order to reach data and present information about aspirin from a historical perspective. Since its first use as a pain killer, aspirin has found a broad range of use in general medicine, cardiovascular medicine, neurology, obstetrics and gynecology, dentistry, gastroenterology, oncology with its different effects. Aspirin, a painkilling gift of history to mankind, with a history dating back to BC and various healing effects, promises to be of greater use in different fields of medicine with the light of recent studies, inspiring more research and gaining more popularity.

Electrocardiography changes in bipolar patients during long-term lithium monotherapy

OBJECTIVE Cardiovascular side effects of lithium have been reported to occur mainly at higher-than-therapeutic serum levels. We aimed to investigate the impact of the long-term lithium use on electrocardiogram (ECG) parameters in association with the serum levels in patients with bipolar disorder (BD) and in healthy controls (HCs) serving as the reference group. METHODS The study sample consisted of 53 euthymic BD type I patients on lithium monotherapy at therapeutic serum levels (M = 0.76, S.D. = 0.14, range = 0.41-1.09 mmol/l) for at least 12 months and 45 HCs. A 12-lead surface ECG was obtained from all participants at resting state for at least half an hour for 5-min recording. Heart-rate, Pmax, Pmin, QRS interval, QT dispersion, QT dispersion ratio (QTdR) and Tpeak-to-end interval (TpTe) were measured. RESULTS Regression analyses revealed that QTdR (B = 14.17, P = .001), TpTe (B = 18.38, P < .001), Pmax (B = 17.84, P<.001) and Pmin (B = 25.10, P < .001) were increased in BD patients who were on chronic lithium treatment than in HCs after controlling for age, sex and strict Bonferroni correction for multiple testing. There were no associations between serum lithium levels and ECG parameters. CONCLUSION Our findings suggest that the use of lithium is associated with both atrial and ventricular electrical instability, even when lithium levels are in the therapeutic range.

Kounis Syndrome together with Myocardial Bridging Leading to Acute Myocardial Infarction at Young Age.

Kounis syndrome, also named as “allergic angina syndrome,” is a diagnosis in which exposure to an allergen causes mostly coronary spasm and rarely plaque rupture, resulting in ischemic myocardial events. Myocardial bridging is defined as an intramural segment of a coronary artery and its systolic compression by overlying fibers. Myocardial bridging generally has a benign prognosis and mostly affects the mid portion of left anterior descending coronary artery. However, some cases with myocardial ischemia, infarction, and sudden death have also been reported. A 17-year-old boy presented to the clinic with acute anterolateral myocardial infarction after having first dose of clindamycin and diagnosed as Kounis syndrome. Further diagnostic workup of the patient showed myocardial bridging at the mid left anterior descending artery. In this report, we present the combination of Kounis syndrome and myocardial bridging leading to myocardial infarction at young age.

Presepsin (sCD14-ST): could it be a novel marker for the diagnosis of ST elevation myocardial infarction?

Introduction Acute myocardial infarction (AMI) could be considered to be a state of inflammation. Many inflammatory markers have been evaluated in the AMI setting so far. Presepsin (PSP) is a novel biomarker for diagnosis and prognosis of systemic inflammation that has not been studied in the AMI setting to date. In this study, we aimed to examine serum PSP levels in patients with acute ST elevation myocardial infarction (STEMI). Material and methods Forty-eight patients with STEMI and fifty healthy controls without coronary artery disease, verified by coronary angiography, were included in the study. Together with routine laboratory tests needed for STEMI, plasma concentrations of PSP were measured in peripheral venous blood samples of the participants. Results Plasma PSP and troponin levels were significantly higher in patients with STEMI than controls (1988.89 ±3101.55 vs. 914.22 ±911.35 pg/ml, p = 0.001 and 3.46 ±3.39 vs. 0.08 ±0.43 ng/ml, p = 0.001, respectively). The cut-off value for PSP of 447 pg/ml was found to detect STEMI with 87.5% sensitivity, 44% specificity, 60% positive predictive value and 78.5% negative predictive value. Conclusions In this study, PSP levels were found to be significantly elevated in patients with STEMI together with high-sensitivity troponins. The PSP may be a new marker for AMI detection. Large scale studies are needed to reveal the importance of PSP in the diagnosis and prognosis of AMI.

Association between soluble lectin-like oxidized low-density lipoprotein receptor 1 levels and coronary slow flow phenomenon

Introduction The coronary slow flow phenomenon (CSFP) has been associated with myocardial ischemia, myocardial infarction, life-threatening arrhythmias, sudden cardiac death and increased cardiovascular mortality similar to coronary artery disease (CAD). Possible underlying mechanisms of CSFP are endothelial dysfunction, chronic inflammation, microvascular dysfunction and diffuse atherosclerosis. Soluble lectin-like oxidized low-density lipoprotein receptor-1 (sLOX-1) seems to play an important role in the pathogenesis of atherosclerosis. We hypothesized that sLOX-1 might be associated with CSFP, and aimed to research the relationship between sLOX-1 and CSFP. Material and methods Forty patients with angiographically proven CSFP and 43 patients with a normal coronary flow pattern (NCFP) were included in this study. Coronary blood flow was measured according to the Thrombolysis In Myocardial Infarction (TIMI) frame count method. sLOX-1 levels were measured in all study subjects. Results Serum levels of sLOX-1 were significantly higher in the CSFP group than the NCFP group (1061.80 ±422.20 ng/ml vs. 500.043 ±282.97 ng/ml, p < 0.001, respectively). Multivariate logistic regression analysis including sLOX-1, MPV, GGT and uric acid levels revealed a significant association between sLOX-1 levels and CSFP (Exp (B)/OR: 1.006, 95% CI: 1.002–1.010, p = 0.001). Conclusions The present study demonstrated that serum sLOX-1 levels were significantly higher in patients with CSFP and there was a strong association between high sLOX-1 levels and CSFP. High serum sLOX-1 levels may have an important role in the pathogenesis of CSFP. Future studies are needed to confirm these results.

Contrast layering: late clearance of contrast dye--a novel angiographic phenomenon of early atherosclerosis.

Patients with angiographically normal coronary arteries sometimes exhibit delayed clearance of contrast medium. This contrast layering (CL) was tested with intravascular ultrasound (IVUS) and markers of endothelial dysfunction and oxidative stress. The study group (n = 26) consisted of patients with CL and the control group (n = 32) comprised patients with normal coronary arteries despite angina symptoms. The CL was observed in 36 coronary arteries of 26 patients in the study group. Total antioxidant status and nitric oxide levels were significantly lower; total oxidant status, malondialdehyde plasma levels, and oxidative stress index were significantly higher in patients with CL than in controls. The IVUS studies revealed that atherosclerotic plaque burden, fibrous tissue, dense calcific tissue, and necrotic core ratios were significantly higher in the coronary segments with CL compared with adjacent normal segments. These results support the concept of CL as a new angiographic appearance of early atherosclerosis.

Serum Presepsin Levels Are Not Elevated in Patients with Controlled Hypertension

Introduction Hypertension (HT) is a common serious condition associated with cardiovascular morbidity and mortality. The pathogenesis of HT is multifactorial and has been widely investigated. Besides the vascular, hormonal, and neurological factors, inflammation plays a crucial role in HT. Many inflammatory markers such as C-reactive protein, cytokines, and adhesion molecules have been studied in HT, which supported the role of inflammation in the pathogenesis of HT. Presepsin (PSP) is a novel biomarker of inflammation. Therefore, the potential relationship between PSP and HT was investigated in this study. Methods Forty-eight patients with controlled HT and 48 controls without HT were included in our study. Besides routine clinical and laboratory data, PSP levels were measured in peripheral venous blood samples from all the participants. Results PSP levels were significantly lower in patients with HT than in controls (144.98 ± 75.98 versus 176.67 ± 48.12 pg/mL, p = 0.011). PSP levels were positively correlated with hsCRP among both the patient and the control groups (p = 0.015 and p = 0.009, resp.). However, PSP levels were not correlated with WBC among both groups (p = 0.09 and p = 0.67, resp.). Conclusions PSP levels are not elevated in patients with well-controlled HT compared to controls. This result may be associated with anti-inflammatory effects of antihypertensive medicines.

Correlations between hematological indicators and other known markers in acute coronary syndromes

Introduction: Recently, many hematologic markers have identified as prognostic and diagnostic indicators in different acute coronary syndrome (ACS) patients. In particular, neutrophil / lymphocyte ratio (NLR) and platelet / lymphocyte ratio (PLR) are recognized as markers in the diagnosis and prognosis of ACS. In this study, our aim was to investigate the correlation between the diagnostic yield of PLR and NLR values and other markers such as troponin in all ACS patients. Material and methods: 319 patients admitted to our hospital with ACS and 283 control patients were included in the study. Leukocyte, neutrophil, platelet, lymphocyte counts, PLR, NLR and high sensitive troponin I (HsTnI) measurements were taken. Results: Leukocyte, neutrophil and platelet counts were significantly higher in the ACS group than the controls (p

Primary cardiac involvement of anti-phospholipid syndrome misdiagnosed as infective endocarditis

Corresponding author: Ismail Biyik Department of Cardiology Usak University Education and Research Hospital 64100 Usak, Turkey Fax: +90 5424173209 E-mail: ismailbiyikmd@ yahoo.com 1 Department of Cardiology, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey 2 Department of Cardiology, Usak University Education and Research Hospital, Usak, Turkey 3 Department of Biochemistry, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey