Gülten Taçoy

Effect of transradial coronary angiography procedure on vascular diameter and vasodilator functions in the access site.

The present study aimed to investigate the long-term effects of transradial procedures on the radial artery diameter and vasodilator properties. The study included a total of 35 patients (28 males and 7 females) who underwent left transradial coronary angiography with an appropriate indication. The radial artery diameters were measured before and after flow-mediated vasodilation (FMD) and nitrate-mediated vasodilation (NMD). The nonintervened right radial artery served as the control. A marked narrowing in the diameter of the intervened radial artery and impaired FMD response indicating endothelial dysfunction were observed at a mean of 9 months after transradial intervention. Structural and functional changes should be taken into consideration if previously intervened radial artery would be used for interventions, such as arterial bypass graft or dialysis fistula.

Relationship between total and differential leukocyte counts and isolated coronary artery ectasia.

BackgroundCoronary artery ectasia (CAE) is a clinical entity characterized by localized or diffuse dilatation of more than or equal to 1.5 times that of the normal adjacent segments of vessels. Although the etiopathogenesis is not clearly understood, some studies have shown that CAE may be a form of atherosclerosis and has more potent inflammatory properties. Leukocytes have a crucial role in the development of inflammatory processes. We aimed to investigate a possible relationship between leukocytes and the coronary ectatic process without coronary artery disease (CAD) and to compare it with the inflammatory atherosclerotic process related to leukocytes. Methods and resultsThe study population consisted of 371 patients. We divided the patients into three groups: 42 patients with isolated CAE as group I, 279 patients with CAD as group II, and 50 control participants with normal coronary arteries (NCA) as group III. The counts of total leukocytes (7348±1898, 7569±1619, and 6770±1748 cells/mm3, P=0.002), neutrophils (4260±2169, 4529±1380, and 4040±1649 cells/mm3, P=0.037) and monocytes (630±216, 583±198, and 480±140 cells/mm3, P<0.001) were significantly different among the CAE, CAD, and NCA groups, respectively. The CAE group also had significantly higher leukocyte and subtype counts than the nonobstructive CAD subgroup and NCA group. ConclusionThis study demonstrates that total and differential leukocyte counts, which play an important role in inflammation, are increased in patients with isolated CAE. In conclusion, this studys findings show that leukocytes may play an important role in the development of CAE independently of the atherosclerotic process.

Plasma osteopontin levels in prediction of prognosis in acute myocardial infarction.

Objective We sought to explain the clinical importance of the osteopontin (OPN) in the setting of acute ST-elevation myocardial infarction (STEMI). Methods Eighty consecutive patients (55 ± 11 years, 12 women and 68 men) and sixty healthy control subjects were included in the study. In all patients, plasma OPN levels were assessed on admission and on the third day (peak value). Creatinine kinase (CK)/CK-myocardial band (MB), troponin I and N-terminal pro-brain natriuretic factor levels and echocardiographic fi ndings were also recorded. Patients were classifi ed into high and low OPN groups according to the median OPN value, and monitored for the occurrence of major adverse cardiovascular events (MACE). Results Patients with STEMI had higher OPN levels (23.8 [16.7-41.3] ng/ml) on admission than the control subjects (18.0 [11.3-31.5] ng/ml, P= 0.004). The third day value of OPN was signifi cantly higher (39.2 [27.2-56.0] ng/ml) than the OPN level on admission (23.8 [16.7-41.3] ng/ml, P < 0.001). Admission and peak OPN levels were not correlated with CK/CK-MB, white blood cell counts, troponin I and the N-terminal pro-brain natriuretic factor. The plasma OPN levels were not correlated with left ventricular wall motion score index either. In the subgroups of infarct localization and reperfusion strategy, plasma OPN levels were similar. When the patients were compared according to the median OPN values, there were no diff erences in the occurrence of MACE between the high and low OPN groups. Conclusion This study suggests, for the fi rst time, that the plasma OPN level increases in the fi rst hours of the acute STEMI; however, it could not be used as a prognostic biomarker of STEMI.

The relationship of visfatin levels to inflammatory cytokines and left ventricular hypertrophy in hemodialysis and continuous ambulatory peritoneal dialysis patients.

Visfatin was recently defined as an adipocytokine; however, the pathophysiological role of visfatin is not completely understood. A few studies suggest that visfatin may be a new proinflammatory adipocytokine. The aim of the present study was to compare serum visfatin levels between hemodialysis and continuous ambulatory peritoneal dialysis (CAPD) patients and evaluate the relationship between visfatin levels to IL-6, TNF-α, and left ventricular hypertrophy. Serum visfatin, IL-6, and TNF-α levels were measured by using the ELISA method, and echocardiographic evaluations were performed in 31 hemodialysis patients, 30 CAPD patients, and 21 healthy volunteers. Serum visfatin levels were higher in the CAPD group (265.27 ± 387.86 ng/mL) than hemodialysis (97.68 ± 244.96 ng/mL,) and control (41.33 ± 48.87 ng/mL) groups (p = 0.04, p = 0.01, respectively). No significant difference was observed between the hemodialysis and control groups. In univariate analysis, visfatin levels were positively correlated with IL-6 (r = 0.24, p = 0.03), TNF-α (r = 0.34, p = 0.002), and BMI (r = 0.26, p = 0.03) and negatively correlated with some left ventricular diastolic parameters [Em and Em/Am (r = −0.305, p = 0.01), (r = −0.251, p = 0.03), respectively]. No relationship was found between visfatin and left ventricular mass index. In the linear regression analysis, visfatin levels independently related with TNF-( (β = 0.369, p = 0.001) and IL-6 (β = 0.284, p = 0.015). This study has found significantly higher levels of serum visfatin in CAPD patients when compared to healthy individuals. Increased visfatin levels seem to associate with proinflammatory cytokines such as IL-6 or TNF-α. As for the effects of on left ventricular structure and functions, visfatin might have negative effects on left ventricular diastolic function parameters but have no effects on left ventricular mass index.

Is there a relationship between obesity, heart rate variability and inflammatory parameters in heart failure?

Background To investigate the effect of body mass index (BMI) on heart rate variability (HRV) and inflammatory parameters in patients with heart failure. Methods We analyzed 55 consecutive patients (mean age, 63.5 ± 12.8 years; male/female, 39/16) with symptomatic left ventricular systolic (ejection fraction <45%) heart failure. The participants were classified into three categories according to BMI: lean (BMI < 25 kg/m2), overweight (BMI = 25–29.9 kg/m2) and obese (BMI ≥ 30 kg/m2). The cause of heart failure was mainly ischemic heart disease (75%) with mean ejection fraction 30 ± 7%. Plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) and C-reactive protein levels were measured, and time-domain HRV indices were determined on Holter electrocardiogram. The relationship between HRV indices and laboratory, inflammatory and echocardiographic parameters was investigated with correlation analysis. Results Age, sex, clinical characteristics (hypertension, diabetes mellitus, dyslipidemia, family history, smoking) were similar between groups. BMI was inversely correlated with NT-pro BNP levels (P = 0.001). HRV indices did not differ between groups. Correlation analysis demonstrated the relationship between HRV indices and fasting blood glucose (SDNN, SDANN, SDNNI, root mean square successive differences, VTI), C-reactive protein (SDANN, SDNNI, VTI), pulmonary artery pressure (SDNN, SDANN, VTI) levels. Conclusion In systolic heart failure patients a higher BMI is associated with decreased NT-proBNP levels. Although HRV indices were not different between groups, inflammatory parameters, fasting blood glucose and pulmonary artery pressure were correlated with them.

Gemcitabine-Induced Acute Coronary Syndrome: A Case Report

Objectives: To report a case of metastatic leiomyosarcoma, in which a patient developed chest pain accompanied by acute left bundle-branch block (LBBB) after gemcitabine infusion. Clinical Presentation and Intervention: A 59-year-old woman admitted with bilateral pulmonary nodules had classic risk factors for coronary heart disease and coronary stenosis as demonstrated by previous coronary angiography. She was treated with gemcitabine infusion, and 30 min later she experienced severe chest pain accompanied by acute LBBB confirmed by ECG. We suspected gemcitabine-induced coronary vasospasm exacerbated by the preexisting coronary artery disease as the cause of the acute coronary syndrome. The patient was subsequently treated with antianginal therapy and percutaneous coronary intervention. Her chest pain resolved and LBBB disappeared. She was discharged 2 days later without any further cardiac events. No additional cancer therapy was given and she died 5 months later, due to disease progression. Conclusion: This case showed that chemotherapeutic agents must be administered with intensive cardiac monitoring especially in patients with cardiac disease and well-known risk factors to prevent the development of cardiac complications, despite an agent not being known to be ‘cardiotoxic’.

The Relationship among Asymmetric Dimethylarginine (ADMA) Levels, Residual Renal Function, and Left Ventricular Hypertrophy in Continuous Ambulatory Peritoneal Dialysis Patients

Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of endothelial-based nitric oxide synthase. Its level is increased by end stage renal disease. However, most studies showing an increase in ADMA in dialysis patients have focused on hemodialysis. Results with peritoneal dialysis patients have been more inconclusive. Recent studies suggest that ADMA may be a new cardiovascular risk factor. The aim of the present study was to evaluate the relationship between ADMA levels, residual renal function, and left ventricular hypertrophy in peritoneal dialysis patients. Serum ADMA measurements and echocardiographic evaluations were performed in 54 peritoneal dialysis patients and 26 healthy volunteers. Residual renal function was measured in peritoneal dialysis patients by urea clearance from a urine collection. Thirty-two of the 54 peritoneal dialysis patients had residual renal function. ADMA levels of the peritoneal dialysis group were found to be significantly higher than those of healthy individuals (p = 0.03). Within the peritoneal dialysis group, ADMA levels of patients with residual renal function were significantly lower than those without residual renal function (p = 0.01), though they were still higher than the ADMA levels of the control group (p = 0.04). Serum levels of ADMA were positively correlated with left ventricular mass index (r = 0.29, p = 0.01) and negatively correlated with early mitral inflow velocity (Em) (r = −0.28, p = 0.01), Em/Late mitral inflow velocity (Am) (r = −0,32, p = 0.00), and isovolumetric relaxation time (r = −0.30, p = 0.01). In conclusion, increased ADMA levels seem to be associated with left ventricular hypertrophy in peritoneal dialysis patients, and residual renal function may lead to a reduction of serum ADMA levels.

Traditional Risk Factors Are Predictive on Segmental Localization of Coronary Artery Disease

The aim of this study was to investigate the relationship between established risk factors and segmental localization of coronary artery disease. A total of 2760 patients who underwent coronary angiography were enrolled into the study. Coronary angiographic segmental evaluation was performed according to the scheme of American Heart Association. Patients were classified into 2 groups (group 1: normal coronary artery segments, group 2: coronary artery segments with coronary artery disease). Smoking was highly related with left main coronary artery disease (odds ratio = 7.5; P = .005). Diabetes mellitus and male sex increased the risk of atherosclerosis in all coronary vasculature (odds ratio = 2.7-2.2; P < .001-P < .001). Hypertension was correlated with distal coronary artery (odds ratio = 1.4; P < .001) and family history with distal circumflex lesions (odds ratio = 4.5; P = .005) High triglyceride levels were associated with right coronary artery lesions (odds ratio = 1.00; P =.03). The effect of advanced age was small (odds ratio = 1.08; P < .001). Risk factors may be predictive for segmental localization.

Assessment of left ventricular systolic and diastolic function by tissue Doppler analysis in patients with hypertension with or without hyperuricemia.

ObjectiveHyperuricemia (HU) is a well-recognized risk factor for cardiovascular diseases. The independence of this association from other confounding factors has remained controversial. The possible contributory effect of HU to myocardial impairment produced by hypertension (HT), however, has not been clarified yet. The study was designed to assess the left ventricular (LV) systolic and diastolic function in patients with HT with or without HU. Tissue Doppler imaging (TDI) was used for detailed analysis as this method was superior to other conventional echocardiographic techniques. MethodsThe study participants consisted of 27 patients (men 56%, mean age±SD; 55±10 years) with HT without HU, and 27 patients with HT with HU (men 62%, mean age±SD; 56±9 years), and 27 age-matched healthy control participants (men 57%, mean age±SD; 53±11 years). Cardiac functions were determined using echocardiography, comprising standard two-dimensional and conventional Doppler and TDI. Peak systolic myocardial velocity at mitral annulus (Sm), mitral inflow velocities and early diastolic mitral annular velocity (Em), late diastolic mitral annular velocity (Am), peak systolic mitral annular velocity, Em/Am, and myocardial performance index were calculated by TDI. ResultsMitral inflow velocities and tissue Doppler-derived mitral annular diastolic velocities were significantly different in the patient groups (HT without HU and HT with HU) compared with the control cases. Tissue Doppler-derived myocardial performance index (LV-MPI) was significantly impaired in the patient groups compared with those of the controls (0.48±0.09, 0.53±0.07, and 0.39±0.07, respectively, P<0.001). Significant differences were also observed between the patients who had HT without HU and the patients who had HT with HU regarding LV-MPI. Significant correlations were observed between the serum uric acid levels and LV function parameters.

Dramatic response of a patient with pregnancy induced idiopathic pulmonary arterial hypertension to sildenafil treatment

Idiopathic pulmonary arterial hypertension (IPAH) is characterized by a progressive increase in pulmonary vascular resistance, which may lead to right ventricular failure and death. Major cardiovascular and pulmonary alterations occur during pregnancy and therefore worsen or increase the complications of pulmonary arterial hypertension (PAH). A patient diagnosed with IPAH after a successful full‐term pregnancy and cesarean section with epidural anesthesia is presented. The postoperative course was complicated by progressive dyspnea, and lower limb edema. The outcome of treatment with sildenafil during puerperium was favorable in this patient. The clinical course was complicated by an unexpected spontaneous pregnancy after primary infertility.