Gulacan Tekin

Aortic valve calcification: association with bone mineral density and cardiovascular risk factors

BackgroundCardiovascular risk factors are reported to increase the incidence of aortic valve calcification. Among older women, low bone mineral density appears to be associated with increased prevalence of aortic calcification. We aimed to assess and compare cardiovascular risk factors and bone mineral density of patients with and without aortic valve calcification. Materials and methodsCardiovascular risk factors and bone mineral density measurements have been assessed in 49 patients with aortic valve calcification and in 65 patients without aortic valve calcification. All patients were subsequently referred to the nuclear medicine department to measure bone mineral density after echocardiographic evaluation. ResultsNo statistically significant differences were observed between the two groups with respect to sex, body mass index, history of coronary artery disease, diabetes mellitus, hypercholesterolemia, and smoking status. Although height and weight of the patients with aortic valve calcification were significantly lower than those of patients without aortic valve calcification, they were not independent risk factors. Age and hypertension were found to be independent positive risk factors for aortic valve calcification, whereas T score was found to be negatively associated with aortic valve calcification. ConclusionWe have shown that aortic valve calcification is positively associated with age and hypertension, whereas bone mineral density is negatively associated with aortic valve calcification. The mechanism underlying the association between decreased bone mineral density and aortic valve calcification remains to be clarified in further studies.

Evaluation of cardiovascular risk factors and bone mineral density in post menopausal women undergoing coronary angiography

BACKGROUND The underlying mechanism by which osteoporosis and cardiovascular disease may be linked is not fully understood. However studies mainly focused on the association between bone mineral density (BMD) and cardiovascular risk factors or atherosclerosis itself by only assessing the presence of vascular calcification. In this study we aimed to evaluate both cardiovascular risk factors, and presence of coronary artery disease (CAD) in post-menopausal women patients with and without low BMD. MATERIALS AND METHODS Study population consisted of post menopausal women who were scheduled to coronary angiography. Two hundred and twenty seven consecutive female patients were included in the study and evaluated for the presence of cardiovascular risk factors and CAD. Bone mineral density was measured in all patients either the day before or the day after coronary angiography. Low BMD was defined as T score<-1 and normal BMD was defined as T score > or = -1. For statistical analysis patients were divided into two groups: patients with low BMD and patients with normal BMD. RESULTS There were not statistically significant differences between two groups in respect to body mass index, presence of diabetes mellitus, hypercholesterolemia, and smoking status. Age and presence of CAD was found to be statistically different between two groups being higher in patients with low BMD. Logistic regression analysis revealed that age was positively and independently associated with low BMD in post menopausal female patients (Odds ratio=1.072 CI: 1.036-1.11, p=0.001). CONCLUSION Age is found to be an independent predictor of decreased BMD in our study population recruited from the coronary angiography laboratory. However, neither cardiovascular risk factors, nor coronary artery disease itself has been found to be associated with low BMD.

Statins decrease mean platelet volume irrespective of cholesterol lowering effect

BACKGROUND Recent clinical observations have demonstrated that the beneficial effects of statins are not limited to LDL lowering effect. They have also favourable effects on platelet activation, endothelial function, inflammation, and coagulation cascade. AIM To investigate the effects of statins on mean platelet volume (MPV) which is a simple measure of platelet activation volume in patients who have been prescribed statins. Atorvastatin and rosuvastatin were also compared in respect to effects on MPV. METHODS One hundred and forty five patients were retrospectively included in the study from the outpatient cardiology clinic. Patients who had been given statin treatment were recruited based on the records. Baseline and 4-8 weeks biochemical analysis and haematological measurements and cardiovascular risk factors were recorded. RESULTS Both statins significantly decreased the MPV. MPV of patients did not show any significant correlation with lipid parameters. Linear regression analysis revealed that there were no statistically significant associations of ∆ MPV with the ∆LDL-cholesterol (beta coefficient = 0.13; p = 0.24), ∆DL-cholesterol (beta coefficient = 0.17; p = 0.18) or ∆triglyceride (beta coefficient = -0.11; p = 0.21) after statin treatment. Both statins had comparable effects on lipid parameters at the end of the one month follow up period. CONCLUSION Statins significantly reduce MPV irrespective of cholesterol levels, and atorvastatin and rosuvastatin have comparable effects in this regard.

Serum uric acid levels are associated with atrial fibrillation in patients with ischemic heart failure.

We evaluated the association between serum uric acid (SUA) and atrial fibrillation (AF) in patients with chronic heart failure (HF). Totally, 363 patients with chronic HF were included in the study. Of all, 78 patients had AF and 285 patients were in normal sinus rhythm. Serum uric acid was significantly increased in patients with AF compared with patients in normal sinus rhythm (P < .05). Comparing patients with AF and normal sinus rhythm, we found that age was significantly higher in patients group with AF. Echocardiographic parameters including ejection fraction, left atrial diameter, left ventricle end-diastolic diameter, and left ventricle end-diastolic volume were also significantly higher in patients with AF compared with patients in normal sinus rhythm. We have shown that patients with AF have significantly higher SUA and this was independently associated with AF in patients with ischemic HF.

Mean platelet volume in patients with nonvalvular atrial fibrillation.

The procoagulant and prothrombotic states in patients with chronic atrial fibrillation are higher than those in patients with normal sinus rhythm. Mean platelet volume (MPV) which is a marker of platelet function and activation can reflect changes either in the level of platelet stimulation or the rate of platelet production. In this study, we aimed to assess and compare the hematologic parameters of routine complete blood count analysis in elderly patients with nonvalvular atrial fibrillation and control individuals with normal sinus rhythm. One hundred and seven consecutive patients with nonvalvular chronic atrial fibrillation and 112 age and sex-matched control individuals with normal sinus rhythm were retrospectively included in the study from the outpatient cardiology clinic. Hematological variables, including MPV, platelet count, red blood cell and white blood cell count were measured in all patients and control individuals. Presence of coronary artery disease, hypertension, sex, hyperlipidemia, diabetes mellitus, smoking status, hematocrit and platelet count were comparable between two groups (P > 0.05 for all). However, MPV and white blood cell count were significantly higher in patients with atrial fibrillation compared to those without atrial fibrillation. Logistic regression analysis revealed that white blood cell count and MPV significantly and independently associated with atrial fibrillation. We have shown that MPV and white blood cell count is independently associated with chronic nonvalvular atrial fibrillation. To improve the clinical utility of MPV and role of inflammation in the pathogenesis of atrial fibrillation, further studies are needed to be carried out.

Increased plasma levels of cystatin C and transforming growth factor-??1 in patients with coronary artery ectasia: can there be a potential interaction between cystatin C and transforming growth factor-??1

Cystatin C, known as an inhibitor of the cathepsin family of cysteine proteases, has been evaluated in several cardiovascular disorders such as atherosclerosis and acute myocardial infarction. The potential interaction between transforming growth factor-&bgr;1 and cystatin C has also been demonstrated in some cell types. Accordingly, we aimed to compare the plasma levels of cystatin C and transforming growth factor-&bgr;1 in patients with coronary artery ectasia coexisting with coronary artery disease and those with coronary artery disease alone. Thirty-nine patients with coronary artery ectasia and coronary artery disease and 35 age and sex-matched patients with coronary artery disease alone were prospectively enrolled in the study. Blood samples of all patients and control participants for measuring plasma cystatin C and transforming growth factor-&bgr;1 levels were drawn ≥24 h after the coronary angiography. Cystatin C concentrations in plasma were measured by latex-enhanced reagent on a Behring Nephelometer II. Plasma levels of transforming growth factor-&bgr;1 were measured by using transforming growth factor-&bgr;1 enzyme-linked immunosorbent assay kit (BioSource International, Inc., Camarillo, California, USA). Plasma level of cystatin C was significantly higher in patients with coronary artery ectasia+coronary artery disease than in patients with coronary artery disease alone (1.05±0.30 mg/dl vs. 0.92±0.18 mg/mdl, P=0.025, respectively). Transforming growth factor-&bgr;1 was also found to be significantly higher in patients with coronary artery ectasia+coronary artery disease compared with those with coronary artery disease (2.47±0.43 vs. 2.22±0.43 pg/ml, P=0.02, respectively). The plasma level of cystatin C was significantly but weakly correlated with that of transforming growth factor-&bgr;1 (r=0.217 P=0.02). We conclude that plasma levels of cystatin C and transforming growth factor-&bgr;1 are significantly higher in patients with combined coronary artery ectasia and coronary artery disease than in those with coronary artery disease. Correlation between transforming growth factor-&bgr;1 and cystatin C may also suggest that pathogenesis of coronary artery ectasia might have some different pathways from atherosclerosis with respect to the regulation of extracellular matrix remodeling. Therefore, the role of cystatin in the pathogenesis of coronary artery ectasia and its potential interaction with transforming growth factor-&bgr;1 should be evaluated in further studies.

Anticoagulation in Patients With Left Ventricular Systolic Dysfunction and Sinus Rhythm When

Left ventricular (LV) systolic dysfunction and chronic systolic heart failure (HF) predispose to intraventricular thrombus formation and embolization resulting in stroke. Current guideline recommends the use of oral anticoagulants in patients with atrial fibrillation and history of previous thromboembolism. However, anticoagulant treatment in patients with LV systolic dysfunction with sinus rhythm and without history of previous thromboembolism is still on debate. Recent epidemiologic date has reported increased stroke rate in patients with systolic HF shortly after diagnosis. This review focuses on the possible causes of increased stroke rate shortly after the diagnosis of HF and subsequently suggests a rationale for the use of oral anticoagulant in these patient groups.

A rare localization of muscular bridge causing myocardial ischemia.

The coronary arteries are normally localized subepicardially and are visible on the surface of the heart. Myocardial bridge is a most common congenital abnormality of coronary arteries. A segment of coronary artery travelling trough myocardial tissue, which is called tunneled artery, exhibits compression during systole. Generally, it is a benign condition and often asymptomatic, but it may also be accompanied by chest pain, dyspnea, myocardial infarction, ventricular arrhythmias and/or sudden death. We report a rare localization of myocardial bridge in the right coronary artery, which caused myocardial ischemia. A 51-year-old male patient was admitted to our clinic with the complaint of chest pain on exertion for one month. His physical examination revealed blood pressure of 120/70 mmHg, pulse rate of 70 per minute and system examinations were normal. On the electrocardiogram, there was no abnormality. Transthoracic echocardiography revealed infero-posterior wall hypokinesia. Exercise stress testing was performed and it revealed horizontal ST segment depression of 1 to 2 mm in leads II, III, aVF and V5-6. Upon this, coronary angiography was done. Coronary angiography showed stenoses of the mid left anterior descending artery-30%, 1st diagonal artery-50%, distal circumflex artery 50%, and the typical ‘milking effect’ for myocardial bridge in right coronary artery (RCA), causing 70% stenosis at systole (Video 1. See corresponding video/movie images at www.anakarder.com). Ventriculography was normal. In our case, myocardial bridge was observed in RCA that has been reported in the literature rarely.

Headache response to nitrate in patients with coronary artery disease and systolic heart failure

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Mean platelet volume in patients with dilated cardiomyopathy: does it have a role in left ventricular thrombus formation?

We assessed the clinical echocardiograhic, hematological, and biochemical parameters in patients with dilated cardiomyopathy (DCMP) and control individuals mainly focusing on the mean platelet volume (MPV) in terms of DCMP and left ventricle (LV) thrombus formation. Consecutive patients (n = 251) with DCMP and 266 patients without DCMP were studied. Mean platelet volume was significantly greater in patients with DCMP than in control patients (P < .05 for all comparisons). Comparing DCMP patients with LV thrombus (19 patients, 8%) and without LV thrombus (232 patients, 92%) showed that the prevalence of smokers was significantly higher and ejection fraction was significantly lower in patients with LV thrombus. We have shown that patients with DCMP have significantly higher MPV suggesting more platelet activation and the MPV of patients with DCMP and LV thrombus is comparable to those of patients without LV thrombus.