Hasan Güngör

Serum resistin level: as a predictor of atrial fibrillation after coronary artery bypass graft surgery.

AimAtrial fibrillation (AF) is the most common arrhythmia with an incidence of 25–40%, after coronary artery bypass grafting (CABG). Resistin is a newly identified adipocyte-secreted hormone belonging to a cysteine-rich protein family. This study examined the relation of preoperative and postoperative early serum resistin level, which can play an important role as an inflammatory marker to predict AF after CABG. MethodsWe prospectively analyzed 40 consecutive patients (mean age, 59.2+10.3 years; 31 men and nine women) who were undergoing CABG between September and November 2009 at our department. Blood samples were taken to examine quantities of resistin level, the day before surgery and on the 24th hour in the intensive care unit. ResultsThe incidence of AF was 25% (n=10, 2.2+1.1 days, 1.2+0.4 episodes). Preoperative resistin level was higher in the AF group (10.6+3.3 vs. 9.1+4.5 ng/ml, P=0.33), but it was not statistically significant. Postoperative resistin level was significantly higher in the AF group (27.4+8.4 vs. 17.9+9.1 ng/ml, P=0.012) compared with the sinus rhythm group. Resistin levels significantly increased after the surgery in both groups [9.1+4.5 vs. 17.9+9.1 ng/ml, P<0.001 (sinus rhythm group) and 10.6+3.3 vs. 27.4+8.4 ng/ml, P<0.001 (AF group)]. ConclusionPatients with an elevated postoperative resistin level may have high risk for AF after CABG. This intervention targeting inflammation might help reduce the incidence of AF.

Predictors of early death in patients with acute pulmonary embolism

AIM We aimed to determine the predictors of early death in the course of acute pulmonary embolism (APE). MATERIALS AND METHODS We included 206 patients who had been admitted to our hospital between January 2011 and April 2013 with the diagnosis of APE. We derived a new model including corrected QT interval dispersion (QTcd) and P wave dispersion (Pd), echocardiographic findings, laboratory markers, and blood cell count indices to predict early death in patients with APE. RESULTS Thirty patients (14.5%) died; 176 patients (85.5%) lived after diagnosis of APE. Logistic regression (LR) analysis found that troponin I (odds ratio [OR], 1.084 [95% confidence interval {CI}, 1.009-1.165]), creatinine (OR, 4.153 [95% CI, 1.375-12.541]), mean platelet volume (OR, 1.991 [95% CI, 1.230-3.223]), neutrophil to lymphocyte ratio (NLR) (OR, 1.079 [95% CI, 1.005-1.160]), QTcd (OR, 1.084 [95% CI, 1.043-1.127]), Pd (OR, 1.049 [95% CI, 1.004-1.096]) were associated with early death in APE. New LR model (area under the curve [AUC], 0.970) performed better than the simplified pulmonary embolism severity index (sPESI) score (AUC, 0.859) in predicting early death in APE (P=.021). The predictivity of the sPESI score significantly improved after its single combination with creatinine, QTcd, or troponin I. When the combined model was constructed together with these 6 independent variables and sPESI score, stepwise LR model automatically excluded Pd and NLR, and the AUC from the rest of the combined model was 0.976, which is significantly different from the AUC of sPESI (0.859) (P=.0031). CONCLUSIONS Creatinine, troponin I, and QTcd significantly improves sPESI score. A new model with troponin I, creatinine, mean platelet volume, NLR, QTcd, and Pd seems to have greater prognostic power than the sPESI scoring system.

Digoxin intoxication: An old enemy in modern era.

Objectives Although development of new treatment modalities limited digoxin usage, digoxin intoxication is still an important issue which could be easily overlooked. In this report, we analyzed a case series definitively diagnosed as digoxin intoxication in the modern era. Methods We analyzed 71 patients hospitalized with digoxin intoxication confirmed by history, complaints, clinical and electrocardiograph (ECG) findings, and serum digoxin levels > 2.0 ng/mL, during a five year period. The demographic and clinical data, indications for digoxin use, digoxin dosage, concurrent medications, laboratory data, hospital monitoring, and ECG findings were obtained from all patients. Results Thirty-eight of 71 patients (53.5%) had symptoms of heart failure during admission or later. Sixty-four percent of patients were older than 75 years. The percentage of females was 67%. Atrial fibrillation, hypertension and gastrointestinal complaints were more frequent in the females (64% in females, 30% in males, P = 0.007; 81% in female, 52% in males, P = 0.01; 50% in female, 17.3% in males, P = 0.008, respectively). The mortality rate during the hospital course was 7%. Conclusions This report demonstrated the reduced mortality rates in patients with digoxin intoxication over the study period. Gastrointestinal complaints are the most common symptoms in this population.

Circadian and Infradian Rhythms of Vasovagal Syncope in Young and Middle‐Aged Subjects

Background: The most cardiovascular physiological and pathophysiological events show a circadian rhythm. It is thought that the autonomic nervous system and biologic factors play a key role in the pathogenesis of vasovagal syncope (VVS). In this study, we investigated the circadian and infradian variation of VVS.

Nebivolol to attenuate the effects of hyper-homocysteinaemia in rats

OBJECTIVE This study investigated the prophylactic effect of nebivolol against hyper-homocysteinaemia (hHcy) induced oxidative stress in brain, heart, liver and kidney tissues and histomorphometric changes in the thoracic aorta. METHODS Twenty-four adult male Wistar rats were divided into a control, nebivolol, hHcy and nebivolol+hHcy group. hHcy was induced by oral administration of L-methionine (1 g/kg/day) for 28 days. 10 mg/kg/day nebivolol was administered orally for 28 days. Malondialdehyde (MDA) and glutathione (GSH) levels and catalase (CAT) and superoxide dismutase (SOD) activities in the tissues were determined. The total cross-sectional area (TCSA), luminal cross-sectional area (LCSA) and intima-media thickness (IMT) were measured in the thoracic aorta. RESULTS Homocysteine (Hcy) levels were lower in the nebivolol+hHcy group than in the hHcy group. Nebivolol treatment significantly decreased high MDA levels in the brain, heart and liver tissues. The level of GSH was higher in the brain, heart and kidney tissues of the nebivolol+hHcy group (P<0.001). The activity of CAT increased only in the kidney tissue of the nebivolol+hHcy group (P<0.01), and the activity of SOD was significantly increased in all the tissues in this group. Increased TCSA and IMT in the nebivolol+hHcy group were significantly decreased after nebivolol administration. The LCSA was significantly higher in the hHcy group than the control group, probably due to outward vascular remodelling. CONCLUSION Nebivolol treatment may be useful in different clinical scenarios where hHcy affects physiopathological pathways.

Evaluation of left ventricular systolic and diastolic functions in patients with coronary slow flow phenomenon

OBJECTIVES In this study, systolic and diastolic function parameters were measured with conventional and tissue Doppler echocardiography in coronary slow flow phenomenon (CSFP) patients and compared to those of a control group. STUDY DESIGN Sixty patients (49 male; mean age 52.4±12.1) in whom CSFP was detected during coronary angiography study and 30 volunteers with normal coronary arteries (21 males; mean age 50.2±12.1) were included in this study. CSFP was determined using the TIMI frame count (TFC) method. TIMI frame count was calculated in each coronary artery using the TFC method. Left ventricular systolic and diastolic function was assessed by conventional echocardiography and tissue Doppler imaging. TFC correlation between diastolic function parameters was measured. RESULTS Baseline demographic and laboratory results did not differ significantly between the groups. TIMI frame counts were greater in the CSFP group compared to controls (p<0.001). Left ventricular ejection fraction (65.93±8.06% vs 66.63±5.96%), E/A ratio (1.11±0.36 vs 1.22±0.33), and isovolumetric relaxation time (IVRT) (85±17 cm/s vs 84±13 cm/s) measured with conventional echocardiography showed no significant difference between the two groups. Em (7.0±2.1 cm/s vs 7.4±1.7 cm/s), Am (7.4±2.0 cm/s vs 7.0±1.4 cm/s) and E/Em (10±3 vs 10±1) measured with tissue Doppler echocardiography showed no significant difference between the two groups. Corrected TIMI frame count for the left descending coronary artery (cLAD) and mean TFC were not correlated with the E/A ratio, deceleration time (DT), IVRT, or E/Em ratio. CONCLUSION Left ventricular systolic and diastolic functions were preserved in CSFP.

Ozone preconditioning attenuates contrast-induced nephropathy in rats.

BACKGROUND Contrast-induced nephropathy (CIN) is an important complication of vascular interventions. Ozone therapy can induce tolerance to ischemic insults, a phenomenon known as ozone oxidative preconditioning (OOP). The aim of this study was to investigate the effects of OOP on CIN. MATERIALS AND METHODS Thirty-two Wistar rats were randomized into four groups (n = 8). The control group had intravenous saline injection. The contrast media (CM) group had intravenous meglumine/sodium diatrizoate injection to form CIN. The ozone (O3) group received intraperitoneal ozone for 5 d before the induction of CIN. The oxygen (O2) group was given an equal amount of oxygen for 5 d before the induction of CIN. The animals were sacrificed 48 h after the administration of contrast agent or saline. Kidneys were harvested, and blood samples were obtained. Renal function tests, serum and renal tissue malondialdehyde (MDA), and nitric oxide (NO) levels and renal oxidant system parameters were determined. Histologic examination was performed for renal injury. RESULTS Serum blood urea nitrogen (BUN), creatinine, and serum and renal MDA were increased after contrast exposure. Renal NO was decreased, and there was prominent tubular necrosis in the CM group. Serum BUN, creatinine, serum and renal MDA, and grade of tubular necrosis were decreased in the O3 group as compared with those in the CM group. The levels of serum and renal NO and renal total antioxidant system in O3 group were higher than the levels in the CM group. CONCLUSIONS OOP attenuates experimental CIN. This effect is suggested to be mediated by reinforcement of renal antioxidant defenses and maintenance of renal NO levels.

Comparison of heart transplantation patients with ischemic and idiopathic dilated cardiomyopathy.

OBJECTIVE We retrospectively analyzed our data to compare preoperative demographic, laboratory, echocardiographic, hemodynamic findings mortality and survival rates of heart transplantation patients with ischemic (ICM) and idiopathic dilated (IDCM) cardiomyopathy. METHODS The data of 144 patients transplanted from February 1998 to January 2011 were analyzed. 38 patients with ischemic ICM and 86 patients with IDCM were compared. RESULTS Recipient age, preoperative creatinine, recipient body mass index, intraoperative cross-clamp time, donor male sex ratio, recipient male sex ratio, hyperlipidemia ratio, and previous nitrate use were significantly higher and left ventricular end systolic diameter significantly lower in patients with ICM. Major causes of death after heart transplantation were infections (31.9%), right ventricle failure (14.8%), and sudden cardiac death (14.8%). Causes of death were not different between the groups. Overall mortality in the entire population was 37.9% (47/124), and it was not different between the groups (39.5% vs 37.2%; P=.48). Early mortality (<30 days) rate was 11.2% (14/124), late mortality rate was 26.6% (33/124), and no statistically significant difference was observed between the groups. Survival analysis showed that ICM patients were not associated with worse survival compared with IDCM (71.1% vs 81.1% after 1 year, 68.1% vs 73.0% at 2 years, and 54.2% vs 62.3% at 5 years; log rank=0.57). Multivariate analysis showed that the only predictor of mortality was preoperative urea level and that heart failure etiology was not a predictor of this end point. CONCLUSIONS Patients with ICM had similar survival and mortality rate compared with IDCM.

The usefulness of carvedilol and nebivolol in preventing contrast nephropathy in rats

Abstract Background: Oxidative stress and vasoconstriction appear to be important components of contrast nephropathy (CN) pathogenesis, and both carvedilol and nebivolol are known to have vasodilatory and antioxidant effects. Aims: This study aimed to investigate whether carvedilol and nebivolol play preventive roles against developing CN and to compare the effects of each. Materials and methods: Wistar albino rats were divided into control (C, n = 6), contrast material (CM, n = 6), carvedilol (CV, n = 7), carvedilol + contrast material (CV + CM, n = 7), nebivolol (N, n = 7), and nebivolol + contrast (N + CM, n = 7) groups. Following 3 days of dehydration, 6 mL/kg diatrizoate was administered to each rat. Carvedilol was given at a dose of 2 mg/kg and nebivolol at a dose of 1 mg/kg by way of oral gavage. After scarification, total antioxidant capacity (TAC), malondialdehyde (MDA), and superoxide dismutase (SOD) were studied in renal tissue. Histopathological findings were graded as mild (+), moderate (++), and severe (+++). Results and discussion: Most of the histopathological findings and MDA levels were significantly higher in the CM group than that in the C, CVCM, and NVCM groups, whereas there was no significant difference between the C, CVCM and NVCM groups. TAC level in the CM group was significantly lower than in all other groups. There was no difference in SOD among groups. Conclusions: Carvedilol and nebivolol both prevent development of nephropathy related to CMs by decreasing oxidative stress. Neither is superior to the other.

Association between hematologic parameters and in-hospital mortality in patients with infective endocarditis

Early and accurate risk prediction is an important clinical demand in patients with infective endocarditis (IE). The platelet‐to‐lymphocyte ratio (PLR) is an independent predictor of worse prognosis in various cardiovascular diseases. The aim of this study was to determine the value of PLR in the prediction of in‐hospital mortality among IE patients. We retrospectively analyzed the clinical, laboratory, and echocardiographic data of 59 adult patients with definite IE and in 40 adult controls. In‐hospital mortality occurred in 16 (27%) patients. Vegetation size, levels of high‐sensitive C‐reactive protein and procalcitonin, neutrophil‐to‐lymphocyte ratio, and PLR were significantly higher in the in‐hospital‐mortality‐positive group than in the in‐hospital‐mortality‐negative group (p = 0.004, p = 0.009, p = 0.030, p = 0.001, and p = 0.008, respectively). Lymphocyte count was, however, significantly lower in the in‐hospital‐mortality‐positive group (p = 0.004). In the receiver‐operating characteristic analysis, PLRs over 191.01 predicted in‐hospital mortality with 56.3% sensitivity and 81.4% specificity [area under the curve 0.725, 95% confidence interval (CI) 0.594–0.833; p = 0.0027]. In the multivariate analysis, PLR was found to be an independent predictor of in‐hospital mortality in patients with IE (odds ratio 1.022, 95% CI 1.003–1.042; p = 0.021). In conclusion, higher PLR may predict in‐hospital mortality in patients with IE.