Göksel Kahraman

Relation between proinflammatory to anti-inflammatory cytokine ratios and long-term prognosis in patients with non-ST elevation acute coronary syndrome

Objective: To investigate the relation between serum high sensitivity (hs) C reactive protein (CRP), proinflammatory cytokine concentrations, proinflammatory to anti-inflammatory cytokine ratios and long-term prognosis in patients with non-ST elevation acute coronary syndrome (NSTEACS). Design: Prospective follow-up study for the first six months and then for the first year after admission to hospital. Setting: Tertiary referral centre. Patients: 80 patients (60 men, 20 women, mean age 60 (SD 10) years) with NSTEACS and moderate to high TIMI (Thrombolysis In Myocardial Infarction) risk scores. Interventions: Blood samples from patients with NSTEACS were obtained at the time of admission. Serum concentrations of hs-CRP, (hs) pro-inflammatory (interleukin (IL) -1β, IL-6, tumour necrosis factor α) and (hs) anti-inflammatory (IL-10) cytokines were analysed and proinflammatory to anti-inflammatory cytokine ratios were calculated by dividing proinflammatory cytokine concentrations by anti-inflammatory cytokine IL-10. Main outcome measure: The primary end point of the study was new coronary events (NCE) defined as the combination of cardiac death, non-fatal myocardial infarction and recurrent rest angina that required hospitalisation within 12 months of follow up. Results: During the one-year follow-up period, 23 patients (29%) met the NCE criteria. Concentrations of hs-CRP, IL-1β and IL-6 and ratios of IL-1β:IL-10 and IL-6:IL-10 were significantly higher in patients with NCE than in patients without NCE. In the logistic regression analysis, IL-6:IL-10 ratio was the most important predictor for NCE (p  =  0.006) with an odds ratio of 2.24 (95% CI 1.26 to 3.97). Conclusions: Cytokine concentrations and proinflammatory to anti-inflammatory cytokine ratios may be useful markers for predicting vascular risk in patients with NSTEACS.

Relation between free triiodothyronine/free thyroxine ratio, echocardiographic parameters and mortality in dilated cardiomyopathy

Abnormalities in thyroid function are frequent in patients with heart failure and are associated with increased mortality. However, the relation between thyroid hormone levels and echocardiographic parameters has not been investigated sufficiently.

Long-term prognosis of non-interventionally followed patients with isolated myocardial bridge and severe systolic compression of the left anterior descending coronary artery.

The aim of this study was to investigate the long‐term prognosis of non‐interventionally followed patients with myocardial bridge and angiographic milking of the left anterior descending (LAD) coronary artery.

Evaluation of post-stress left ventricular dysfunction and its relationship with perfusion abnormalities using gated SPECT in patients with cardiac syndrome X.

ObjectiveCardiac syndrome X defines patients with typical angina, a positive exercise ECG stress test and angiographically documented normal coronary arteries. In previous studies, post-stress prolonged left ventricular dysfunction (PLVD) using gated SPECT (G-SPECT) had been well correlated with myocardial perfusion abnormalities and degree of stenotic vessels in CAG in patients with coronary artery disease. However, evaluation of left ventricular myocardial perfusion, wall motion and left ventricular ejection fraction (LVEF) in patients with cardiac syndrome X, using G–SPECT had not been studied yet. Thus, the aim of this study was to analyse PLVD using 99mTc-MIBI GSPECT in patients with cardiac syndrome X. MethodsOf the patients in whom G-SPECT was performed in our institution between 2004 and 2006, 17 patients with anginal chest pain, positive exercise ECG stress test and normal coronary angiograms were retrospectively included to the study (group I). Fifteen patients with normal myocardial perfusion and another 15 patients with ischaemia on G-SPECT were selected as control groups (groups II and III). 99mTc-MIBI G-SPECT was performed for all patients according to 2 day (stress–rest) protocol. Stress and rest LVEF were derived automatically (SLVEF and RLVEF). Difference LVEF (DLVEF) (stress–rest) was calculated. Semiquantitative analyses were made both for myocardial perfusion and wall motion (WM), using a 20-segment model and a 5-point scoring system. DLVEF, perfusion and WM scores of all groups were compared among three groups and relationship between DLVEF, perfusion and WM scores were evaluated. ResultsAbnormal perfusion were detected in eight (47.1%) of patients, while the remaining nine (52.9%) had normal myocardial perfusion, in group I. Six of 17 (35.3%) patients in group I had post-stress WM abnormalities. Mean of DLVEF values were −3.1±3.0%, 4.4±2.0% and −6.0±5.1% in groups I, II and III, respectively (P<0.05 for group II vs. group I and group III; P>0.05 for group I vs. group III). LVEF response impairment (≤5% increase from rest to post-stress images) was found in 17 (100%), seven (46.6%), 14 (93.3%) of patients in groups I, II and III, respectively. ConclusionAbnormal myocardial perfusion, concordant transient segmental WM abnormalities and LVEF response impairment are not uncommon in patients with cardiac syndrome X of this cohort of the study population. Therefore, post-stress prolonged stunning may be attributed to these findings in some of cardiac syndrome X patients as in true ischaemic patients. However, further studies with larger number of subjects and long-term follow-up are necessary to support these findings.

Effect of cardiac resynchronization therapy on left ventricular diastolic filling pattern in responder and nonresponder patients.

Background: The aim of this study was to investigate the short‐ and long‐term effects of cardiac resynchronization therapy (CRT) on left ventricular (LV) diastolic filling pattern and the relation between the diastolic filling pattern and the response to CRT.

Impact of the metabolic syndrome on high-sensitivity C reactive protein levels in patients with acute coronary syndrome

OBJECTIVE Underlying predisposition for a heightened inflammatory response is postulated as one of the mechanisms for elevated high-sensitivity C reactive protein (hs-CRP) levels in patients with acute coronary syndrome (ACS). It is unclear whether metabolic syndrome (MetS) may cause a predisposition for heightened hs-CRP response in patients with ACS. The aim of this study is to investigate the interaction between hs-CRP levels and presence of MetS in patients with and without ACS. METHODS Two hundred and seventy-three consecutive patients presenting with a first ACS event and 261 MetS patients without any ACS event were included to the study. The study participants were divided into three groups as MetS (+) ACS (-) [n=261], MetS (-) ACS (+) [n=110], and MetS (+) ACS (+) [n=163]. Median levels of hs-CRP were compared between and within the three groups. RESULTS Hs-CRP levels were lowest in MetS (+) ACS (-) subjects and highest in MetS (+) ACS (+) patients. Factors associated with hs-CRP levels were troponin elevation, presence of ACS, body mass index (BMI), and presence of MetS (R(2)=0.26, p<0.01). Predictors of elevated hs-CRP levels (>0.3mg/dl) were the presence of ACS (OR=3.6, 95% CI=1.9-6.5, p<0.01), presence of MetS (OR=2.1, 95% CI=1.0-4.0, p=0.02), troponin elevation (OR=5.7, 95% CI=2.8-11.5, p<0.01) and BMI (OR=1.1, 95% CI=1.0-1.1, p<0.01). CONCLUSIONS The presence of MetS had an impact on the increase in hs-CRP levels observed with an ACS event in the study population. These findings suggested that a heightened baseline inflammatory status of MetS may predispose ACS patients to an augmented hs-CRP response.

Effect of Cardiac Resynchronization Therapy on Libido and Erectile Dysfunction

Chronic heart failure (HF) is a common, complex clinical syndrome characterized by dyspnea, fatigue and exercise intolerance. HF patients experience decreased libido and erectile dysfunction (ED). The effects of cardiac resynchronization therapy (CRT) on libido and erectile function have not been previously evaluated. We aimed to investigate the effects of CRT on libido and ED.

Two cases with similar pseudoaneurysms but different outcomes.

The pseudoaneurysm is a rare cardiac pathology, in which the left ventricular free wall ruptures and the pericardium surrounds the rupture in combination with thrombus and inflammation and thus prevents the development of a hemopericardium. Left ventricular pseudoaneurysm may remain silent unless it gives rise to cardiac tamponade, collapse, and finally sudden death. In this case report, we present two cases with left ventricular pseudoaneurysms in the same area. One of them had a stable outcome and the other had a fatal outcome. Copyright

Could decreased vitamin D levels be related with impaired cardiac autonomic functions in patients with chronic heart failure: an observational study.

OBJECTIVE Vitamin D status has been implicated in the pathophysiology of heart failure (HF). The aim of this study was to investigate the association between vitamin D levels with heart rate variability and heart rate turbulence in patients with heart failure whom had ischemic and non-ischemic dilated cardiomyopathy. METHODS Study designed as an observational cross-sectional study. Seventy-one patients [36 non-ischemic dilated cardiomyopathy (NIDCM), 35 ischemic dilated cardiomyopathy (IDCM)] with chronic heart failure and 25 control subject were included. It was evaluated the association between 25 hydroxyvitamin D [25(OH)D] and calcitriol levels with heart rate variability time domain (SDNN, SDANN, RMSSD) and heart rate turbulence [turbulence onset (TO), turbulence slope (TS)] parameters. Statistical analysis was performed using Kruskal-Wallis test and ANOVA. RESULTS Calcitriol levels in NIDCM patients with abnormal TO and TS were significantly lower than NIDCM patients with normal TO (17.1 ± 11.3 vs. 27.6 ± 15.5 pg/mL, p=0.05) and TS (16.6 ± 9.1 vs. 29.4 ± 16.9 pg/mL, p=.018). There was a positive correlation between 25 (OH) D with heart rate variability parameters SDNN (r=0.368, p=0.027) and SDANN (r=0.360, p=0.031). It was not found any association between vitamin D and parameters of heart rate variability and heart rate turbulence in IDCM patients. CONCLUSION Insufficiency of vitamin D may have deleterious effects on cardiac autonomic functions which were showed with heart rate turbulence and heart rate variability in patients with NIDCM. Vitamin D levels might be a predictor to determine the sudden cardiac death in patients with non-ischemic etiology.

The Effect of Nebivolol on Endothelial Function in Newly Diagnosed Hypertensive Patients with and without Diastolic Dysfunction

AbstractObjective: Hypertension is associated with endothelial dysfunction and reduced nitric oxide (NO) activity. Recent observations have shown a significant correlation between endothelial and diastolic dysfunction in cardiovascular disease. The aim of this study was to assess the effect of nebivolol, a β-blocker with NO-mediated vasodilatation properties, on endothelial function in newly diagnosed, previously untreated, hypertensive patients with and without diastolic dysfunction. Methods: Eighty-eight patients were enrolled, 46 of whom had diastolic dysfunction (early/atrial peak wave velocity [E/A] ratio <1 or deceleration time (DT) >240ms in patients aged <55 years, or E/A ratio <0.8 and DT >240ms in patients aged ≥55 years). After a 2-week run-in period, patients received nebivolol 5mg once daily for 3 months. Endothelium-dependent and -independent vasodilation was assessed with brachial artery ultrasound at the end of the run-in and treatment periods. Results: After treatment with nebivolol, flow-mediated dilation increased significantly in both patients with diastolic dysfunction (from 10.32 ± 1.32% to 12.82 ± 1.20%, p < 0.001) and those without diastolic dysfunction (from 11.09 ± 1.12% to 12.72 ± 1.06%, p < 0.001) so that there was no statistically significant difference between the two groups. Nebivolol was well tolerated, with no adverse events reported during the treatment period. Conclusion: Nebivolol can improve endothelial-dependent vasodilation in hypertensive patients with and without diastolic dysfunction, and suggests that endothelial and diastolic dysfunction are early manifestations of hypertension.