Gönül Açıksarı

Serum concentrations of galectin-3 in patients with cardiac syndrome X

OBJECTIVE Microvascular dysfunction has been reported in cardiac syndrome X (CSX), even though the underlying mechanisms still remain uncertain. Galectin-3 has been recently recognized as a biomarker of cardiovascular fibrosis and inflammation. We sought to investigate the role of galectin-3 in the CSX. METHODS We studied 115 consecutive CSX patients (mean age 55.43 ± 8.71 years, 36 men) and 74 healthy controls (mean age 54.53 ± 10.07 years, 31 men). Serum concentrations of galectin-3 and high-sensitive C-reactive protein (hs-CRP) were measured on the blood samples. RESULTS Galectin-3 concentrations were significantly higher in patients with CSX compared to controls (0.90 ng/ml; IQR, 0.40-1.70 ng/ml vs 0.40 ng/ml; IQR, 0.36-0.44 ng/ml, p < 0.0001). Although, the prevalence of diabetes mellitus, hypertension and family history of coronary artery disease (CAD) were significantly higher among patients with CSX, following adjustment for diabetes mellitus, hypertension, and family history of CAD, serum galectin-3 concentrations were still found significantly increased in patients with CSX. Galectin-3 concentrations correlated positively with hs-CRP (r = 0.16, p = 0.03). In addition, concentrations of galectin-3, hs-CRP, fasting glucose, uric acid and family history of CAD were determined as independent predictors of the CSX. CONCLUSION It was found that galectin-3 serum concentrations are higher in patients with CSX compared to healthy controls. Further studies on larger population are needed to confirm the relation between the fibrosis and the CSX, as well as to explore the potential role of galectin-3 in the CSX.

The Association between the Epicardial Adipose Tissue Thickness and Oxidative Stress Parameters in Isolated Metabolic Syndrome Patients: A Multimarker Approach

The risk for cardiovascular diseases and type 2 diabetes mellitus significantly increases in the patient population with metabolic syndrome (MeS). The present study aimed to investigate the association between the epicardial adipose tissue thickness (EATT) and the oxidative stress parameters in MeS patients. The study included 181 patients as a patient group of 92 consecutive patients with MeS and a control group of 89 consecutive patients with similar age and gender. EATT was evaluated by transthoracic echocardiography. Serum levels of total oxidant status (TOS), total antioxidative capacity (TAS), paraoxonase-1 (PON-1), and arylesterase activities were measured. EATT was higher in the MeS group compared to the control group (6.0 ± 2.0 mm and 4.0 ± 1.0 mm, resp.; P < 0.001). The level of TOS was higher in the MeS group compared to the control group (P < 0.001). Additionally, the TAS level was higher in the MeS group compared to the control group (P < 0.001). Furthermore, the serum levels of PON-1 and arylesterase were lower in the MeS group compared to the control group (P < 0.001). EAT may cause an increased risk of cardiovascular diseases by leading to increased oxidative stress in patients with MeS.

Drug Adherence in Patients With Nonvalvular Atrial Fibrillation Taking Non-Vitamin K Antagonist Oral Anticoagulants in Turkey: NOAC-TR:

Adherence to non-vitamin K antagonist oral anticoagulants (NOACs) is an important factor for ensuring efficacy and safety in nonvalvular atrial fibrillation (NVAF). There are controversial results regarding NOAC adherence in real-world data and there are no data about NOAC adherence in Turkish population. This study investigated the NOAC adherence based on self-report, factors affecting nonadherence, and the relation of the adherence level with efficacy and safety outcomes. This multicenter cross-sectional study included 2738 patients (59% female) using NOAC (dabigatran, apixaban, and rivaroxaban) due to NVAF for more than 3 months with >30 days of supply between September 1, 2015, and February 28, 2016. To measure the adherence level, an 8-item Morisky Medication Adherence Scale was used. The mean age of the patients was 70 ± 10 years. Of the 2738 patients, 44% were receiving dabigatran, 38% rivaroxaban, and 18% apixaban. A total of 630 (23%) patients had high medication adherence, 712 (26%) moderate adherence, and 1396 (51%) low adherence. Nonadherence had related to stroke (5.6% vs 2.5%, P < .001) and minor (21.2% vs 11.1%, P < .001) and major (6.1% vs 3.7%, P = .004) bleeding rates. The adherence to NOAC was found to be quite low in Turkey. Nonadherence is associated with bleeding and thromboembolic cardiovascular events. Age, taking NOAC twice a day, and the additional noncardiac diseases, depression, and dementia were the independent factors affecting poor medication adherence.

Elevated serum gamma-glutamyltransferase levels in patients with dilated ascending aorta

OBJECTIVE This study aimed to evaluate the serum gamma-glutamyltransferase (GGT) levels as an indirect marker of elevated oxidative stress in patients with dilated ascending aorta. METHODS The study was designed as an observational cross-sectional controlled study. One hundred consecutive patients with dilated ascending aorta and 50 consecutive controls with normal ascending aorta diameter were selected for the study by comprehensive transthoracic echocardiography (TTE). The aortic dilatation group was divided into two subgroups, according to the literature as the ectasia group (3.8-4.3 cm, 53 patients, 24 male and 29 female, mean age: 62.9±10.9 years) and the aneurysm group (≥4.4 cm, 47 patients, 18 male and 29 female, mean age: 65.5±11.1 years). The control group consisted of patients demonstrating no ascending aorta dilatation (≤3.7 cm, 50 patients, 24 male and 26 female, mean age: 62.7±9.2 years). ANOVA, Mann-Whitney U test, Pearsons correlation analysis, multivariate logistic regression analysis, and receiver-operator curve analysis were used for statistical analysis. RESULTS Regarding the comparison of laboratory parameters between the patient and control groups, serum gamma-glutamyltransferase (GGT) levels were found to be statistically significantly higher in both of the aortic dilatation subgroups than in the control group (p<0.001). In the correlation analysis between the ascending aorta diameter and GGT, a statistically significant positive correlation was found (r=0.282, p<0.001). The multivariate regression analysis revealed a significant relationship between GGT and the proximal ascending aorta diameter (β=0.131, odds ratio: 1.140, 95% CI: 1.060-1.225, p<0.001). CONCLUSION GGT as a marker of oxidative stress may play a role in the pathogenesis of aneurysm of the ascending aorta.

Endocan Levels and Endothelial Dysfunction in Patients With Sarcoidosis

A systemic inflammatory reaction is a common feature of both sarcoidosis and atherosclerosis. Endothelial-cell specific molecule 1 (endocan) is a marker of vascular pathology which also shows a correlation with inflammation, endothelial dysfunction, and atherosclerosis. The objective of this study was to evaluate the vascular involvement in sarcoidosis using serum endocan levels and brachial artery flow–mediated dilation (FMD), a marker of endothelial dysfunction. We included 53 patients with sarcoidosis without conventional cardiovascular risk factors and 40 healthy controls. Endothelial function was assessed using FMD. Endocan concentrations were measured using a commercially available enzyme-linked immunoassay. Patients with sarcoidosis had significantly higher endocan levels (306 [68] ng/mL vs 269 [73] ng/mL; P = .039) and lower FMD (2.7% [2.3%-3.2%] vs 8% [5%-13%]; P < .001) compared with the healthy group. A negative correlation was found between endocan levels and FMD in the sarcoidosis group (r = −.325, P < .007). We conclude that sarcoidosis is associated with high levels of endocan and lower FMD values, which may indicate endothelial dysfunction and an early stage of atherosclerosis.

Evaluation of drug adherence in patients with non-valvular atrial fibrillation according to geographic regions of Turkey: an analysis from NOAC-TR study -

Drug adherence to novel oral anticoagulants (NOAC) varied by countries and popuplations. As a result of NOAC-TR study, in Turkey, drug adhrence to NOACs is poor comparing to other real world studies. However it is not known whether there is a difference between geographic regions of Turkey in terms of NOAC adherence. In this study we aim to investigate the NOAC adherence in patients with non-valvular atrial fibrillation according to the geographic regions in Turkey Method: This cros-sectional study was designed as a subgroup study of NOAC-TR (Drug Adherence in patients with non valvular atrial fibrillation taking non-vitamin K antagonist oral anticoagulants in Turkey). A total of 2802 patients (59% female) taking NOAC (Dabigatran, apixaban, rivaroxaban) due to NVAF at least 3 months, were included. Morisky-8 item drug adherence scale was used. Patients were divided in 3 groups (high, moderate and low adherent) based on drug adherence Results: Of the patients 24% were adherent, 26% were moderate adhererent and 50% were low adherent to NOAC treatment. Drug adhrence was different between geographic regions (p

The Time in Therapeutic Range and Bleeding Complications of Warfarin in Different Geographic Regions of Turkey: A Subgroup Analysis of WARFARIN-TR Study

Background: The time in therapeutic range values may vary between different geographical regions of Turkey in patients vitamin K antagonist therapy. Aims: To evaluate the time in therapeutic range percentages, efficacy, safety and awareness of warfarin according to the different geographical regions in patients who participated in the WARFARIN-TR study (The Awareness, Efficacy, Safety and Time in Therapeutic Range of Warfarin in the Turkish population) in Turkey. Study Design: Cross-sectional study. Methods: The WARFARIN-TR study includes 4987 patients using warfarin and involved regular international normalized ratio monitoring between January 1, 2014 and December 31, 2014. Patients attended follow-ups for 12 months. The sample size calculations were analysed according to the density of the regional population and according to Turkish Statistical Institute data. The time in therapeutic range was calculated according to F.R. Roosendaal’s algorithm. Awareness was evaluated based on the patients’ knowledge of the effect of warfarin and food-drug interactions with simple questions developed based on a literature review. Results: The Turkey-wide time in therapeutic range was reported as 49.5%±22.9 in the WARFARIN-TR study. There were statistically significant differences between regions in terms of time in therapeutic range (p<0.001). The highest rate was reported in the Marmara region (54.99%±20.91) and the lowest was in the South-eastern Anatolia region (41.95±24.15) (p<0.001). Bleeding events were most frequently seen in Eastern Anatolia (41.6%), with major bleeding in the Aegean region (5.11%) and South-eastern Anatolia (5.36%). There were statistically significant differences between the regions in terms of awareness (p<0.001). Conclusion: Statistically significant differences were observed in terms of the efficacy, safety and awareness of warfarin therapy according to different geographical regions in Turkey.

Echocardiographic Epicardial Fat Thickness Measurement and Cardiovascular Risk Assessment in Patients with Systemic Lupus Erythematosus

received: 24.02.2016 Accepted: 06.04.2016 1Istanbul Medeniyet University, Göztepe Training and Research Hospital, Department of Cardiology 2Istanbul Medeniyet University, Göztepe Training and Research Hospital, Department of Internal Medicine 3Iskilip Atif Hoca State Hospital, Department of Cardiology Yazışma adresi: Nurşen Keleş, Istanbul Medeniyet University, Göztepe Training and Research Hospital, Department of Cardiology, Istanbul e-mail: drnursenkeles@yahoo.com.tr aBStract

Imparied retrobulbar blood flow and increased carotid IMT in patients with Crohn's disease.

Crohn’s Disease [CD] is one of the Inflammatory Bowel Diseases that are chronic relapsing inflammatory diseases. Despite the major affected organ is intestine in CD, extra intestinal organs and tissues including cardiovascular system are also affected. Several studies have demonstrated that CD patients may have a higher risk of advancing atherosclerosis. The microvascular endothelial dysfunction plays an essential role for developing coronary atherosclerosis. Microvascular structural abnormalities in the retinal circulation may predict macrovascular events such as stroke and coronary heart disease. In order to assess the the microvascular circulation of the retina; retrobulbar blood flow velocities and resisitive indices [RI] of retrobulbar arteries are measured. The carotid intima media thickness [CIMT] correlates strongly with CV risk in the future. We aimed to investigate whether calculation of RI of retrobulbar arteries can be used as novel, easy and reproducible method to define atherosclerotic risk in CD patients along with CIMT. Thirty CD patients with remission period and thirty healthy volunteers were enrolled in the study. Measurement of carotid intima-media thickness and retrobulbar blood flow velocities were obtained with ultrasound scanner and colour Doppler ultrasonography. The RI of the OA [0.77 ± 0.06 vs. 0.65 ± 0.06, p < 0.001] and CIMT 0.52 [0.50–0.60] vs. 0.40 [0.40–0.50] in patients with CD was significantly higher than the control group. Increased OARI and CIMT values may reflect an increased risk of atherosclerosis and OARI measurement may be used as a screening test for microvascular circulation evaluation in patients with CD.

Does Inflammation Have a Role in the Pathogenesis of Cardiac Syndrome X? A Genetic-Based Clinical Study With Assessment of Multiple Cytokine Levels

We compared Turkish patients with cardiac syndrome X (CSX) and controls with respect to serum pro- and anti-inflammatory cytokine levels, as well as the single-nucleotide polymorphisms located in the promoter regions of their related genes. This study included 111 consecutive patients angiographically diagnosed with CSX and 111 healthy controls with similar demographic characteristics. Serum interleukin (IL) 6, tumor necrosis factor α (TNF-α), and IL-10 levels were measured, and the genotypes of the patients and controls were determined using standard methods. Serum IL-6 and IL-10 levels were significantly higher in the CSX group than in the control group (P < .01, respectively). Serum TNF-α level was lower in the CSX group than in the control group (P < .001). On the other hand, participants with CSX and healthy controls were not significantly different with respect to the genotype distributions of IL-6, TNF-α, and IL-10 genes. As a result of our study, both pro-inflammatory and anti-inflammatory cytokines may play a role in the pathogenesis of CSX. In contrast, the studied gene polymorphisms did not influence CSX pathogenesis.