Hasan Kaya

Association between neutrophil to lymphocyte ratio and severity of coronary artery disease.

The aim of this study is to investigate the association between neutrophil to lymphocyte ratio (NLR) and severity of coronary atherosclerosis. A total of 172 patients undergoing coronary angiography were included in the study. Control group consisted of patients with normal coronary arteries. Patients with coronary stenosis were divided into 2 groups by use of Gensini scores. The NLR was higher in severe atherosclerosis group compared with mild atherosclerosis and control groups (P < .001). In correlation analysis, NLR showed significant correlation with Gensini score. A cutoff value of 2.5 for NLR predicted severe atherosclerosis with a sensitivity and specificity of 62% and 69%, respectively. After multivariate analysis, high levels of NLR were independent predictors of severe atherosclerosis together with glucose and high-density lipoprotein. Our study suggests that the NLR is a predictor of severe atherosclerosis that may be useful for cardiac risk stratification in patients with coronary artery disease.

KOUNIS SYNDROME SECONDARY TO CEFUROXIME-AXETIL USE IN AN OCTOGENARIAN

To the Editor: The concurrence of acute coronary syndromes with allergic or hypersensitivity, as well as with anaphylactic or anaphylactoid reactions, is increasingly encountered in clinical practice, and there are several reports associating mast cell activation with acute cardiovascular events in adults. Kounis first described this as ‘‘allergic angina syndrome’’ progressing to ‘‘allergic myocardial infarction.’’ The main mechanism proposed is the vasospasm of coronary arteries. We present a 90-year-old man, referred to our hospital with thoracic pain, 10 minutes after intramuscular injection of 750 mg of cefuroxime-axetil. Kounis and Zavras described the ‘‘syndrome of allergic angina’’ as the coincidental occurrence of chest pain and allergic reactions accompanied by clinical and laboratory findings of classical angina pectoris caused by inflammatory mediators released during the allergic insult. Allergic angina can progress to acute myocardial infarction, which was named ‘‘allergic myocardial infarction.’’ Causes of Kounis syndrome include medications (antibiotics, analgesics, antineoplastics, contrast media, corticosteroids, intravenous anesthetics, nonsteroidal antiinflammatory drugs, skin disinfectants, thrombolytics, anticoagulants), various conditions (angio-edema, bronchial asthma, urticaria, food allergy, exercise-induced allergy, mastocytosis, serum sickness), and environmental exposure (ant, bee, wasp, jellyfish stings; grass cutting, millet allergy; poison ivy; latex contact; shellfish eating; viper venom poisoning).

Association of neutrophil-lymphocyte ratio with the presence and severity of rheumatic mitral valve stenosis.

The aim of the study is to investigate the association between the severity of rheumatic mitral valvular disease (RMVD) and the neutrophil–lymphocyte ratio (NLR). A total of 227 patients were enrolled in the study and divided into 3 groups. Patients in group 1 had rheumatic mitral stenosis (RMS), those in group 2 had RMVD without stenosis, and those in group 3 served as the control group. Group 1 was further divided into 2 groups, severe mitral stenosis (MS) and mild to moderate MS. The NLR was significantly higher in patients with severe MS when compared to those with mild to moderate MS (P = .002) while lymphocyte count was lower (P = .034). Using a cutoff level of 2.56, the NLR predicted severe RMS with a sensitivity of 75% and specificity of 74%. In conclusion, as an inexpensive, simple, and accessible marker of inflammation, the NLR may be useful in predicting the presence and severity of MS in patients with RMVD.

The Relationship Between Serum Levels of Zn and Cu and Severity of Coronary Atherosclerosis

The essential trace elements play important roles in the maintainance of the normal structure and physiology of cells. Several research groups have demonstrated that they also play important roles in states of cardiovascular diseases. Our aim is to investigate whether there is a relationship between trace elements (Zn and Cu) and the degree of atherosclerosis. The sample consisted of 67 patients with coronary artery disease and 26 clinically healthy individuals. Ninety-three subjects were separated into four groups according to their Gensini scores, the number of diseased vessels, the presence of acute coronary syndrome, and ejection fraction. Each group was divided into three subgroups, and serum zinc and copper levels were measured for each individual. The serum levels of zinc and copper were found to be significantly lower in patients with atherosclerosis than in the control group, but there were no significant differences in the serum levels of Cu and Zn between severe atherosclerosis and mild atherosclerosis. In Spearman’s rank correlation, the zinc and copper levels were correlated with the Gensini score and the number of diseased vessels. The present study revealed a relationship between the serum levels of zinc and copper and atherosclerosis, but not between these levels and the severity of the disease.

Predictors of anticoagulant treatment in patients with nonvalvular atrial fibrillation: results from atrial fibrillation in Turkey: epidemiologic registry.

The aim of the study was to assess the factors associated with the anticoagulation treatment in patients with atrial fibrillation (AF). A total of 2242 consecutive patients who had been admitted with AF on their electrocardiogram were included in the study. After excluding valvular AF, 1745 patients with nonvalvular AF were analyzed. Mean CHA2DS2-VASc score [cardiac failure, hypertension, age ≥ 75 (doubled), diabetes, stroke (doubled), vascular disease, age 65 -74 and sex category (female)], frequency of persistent/permanent AF, hypertension, diabetes mellitus (DM), stroke history, body mass index, and left atrial diameter were significantly higher in patients receiving anticoagulant therapy. Stroke history, persistent/permanent AF, hypertension, DM, age, heart failure, and left atrial diameter were independent predictors of warfarin prescription. Labile international normalized ratio was the only independent negative predictor of effective treatment with warfarin. In this study, we demonstrated that stroke history, persistent/permanent AF, hypertension, DM, and left atrial diameter were positive predictors, whereas advanced age and heart failure were negative predictors of oral anticoagulant use in patients with nonvalvular AF.

Relationship Between Red Cell Distribution Width and the GRACE Risk Score With In-Hospital Death in Patients With Acute Coronary Syndrome.

The aim of this study was to evaluate the relationship between red cell distribution width (RDW) and Global Registry of Acute Coronary Events (GRACE) risk score in patients with unstable angina pectoris (UAP) and non-ST elevation myocardial infarction (NSTEMI). We retrospectively enrolled 193 patients with UAP/NSTEMI (mean age 63.6 ± 12.6 years; men 57%) in this study. Higher RDW values were associated with increased in-hospital mortality (P = .001). There is a significant correlation between RDW and GRACE score (P < .001). In multivariate logistic regression analysis, RDW was found to be an independent predictor of high GRACE score (odds ratio: 1.513, 95% confidence interval: 1.116-2.051, P = .008). A cutoff value of >15.74 for RDW predicted high GRACE score, with a 64% sensitivity and 65% specificity. Our study results demonstrated that high RDW was an independent predictor of high GRACE score, and it is associated with in-hospital mortality in UAP/NSTEMI.

Relation of epicardial fat thickness and brachial flow-mediated vasodilation with coronary artery disease.

OBJECTIVE The purpose of this study is to investigate the presence of a statistical association between epicardial fat thickness (EFT) and coronary artery disease (CAD) and between flow-mediated vasodilation (FMD) and CAD. METHODS We measured the EFT and FMD in 64 subjects with suspected stable angina pectoris. The patients were separated into two groups according to their coronary angiography results: 34 patients with CAD and 30 patients with normal coronary arteries (NCA). RESULTS EFT was significantly higher in the patients with CAD than the NCA group (6.43 ± 0.90 mm vs. 5.35 ± 0.75 mm, p<0.001) while FMD was significantly lower in the patients with CAD than those in the NCA group (6.41 ± 2.51% vs. 8.33 ± 3.45%, p=0.015). No significant correlation was found between EFT and FMD. After adjustment for EFT, FMD, age, sex, ejection fraction, glucose, and low-density lipoprotein cholesterol through multivariate logistic regression analysis, EFT (odds ratio: 6.325, 95% confidence interval 2.289-17.476, p<0.001) and age (odds ratio: 1.093, 95% confidence interval 1.008-1.185, p=0.032) remained significant predictors of CAD. A cut-off value of EFT≥5.8mm predicted the presence of CAD with 77% sensitivity and 70% specificity. CONCLUSION An echocardiographic EFT assessment is independently associated with the presence of CAD. Thus, EFT may be helpful in cardiometabolic risk stratification and therapeutic interventions.

Circadian Variation of Blood Pressure Is Impaired in Normotensive Pregnant Women with Gestational Diabetes Mellitus

Data about circadian blood pressure (BP) in normotensive patients with gestational diabetes mellitus (GDM) are lacking. Thus, we sought to compare dipper and nondipper circadian variation of BP profile between normotensive women complicated with GDM and normal pregnant women. Forty-two women with GDM and 33 normal uncomplicated pregnant women who met the entry criteria for the study were enrolled in the study. Twenty-four-hour noninvasive ambulatory blood pressure monitoring and echocardiography to measure the left ventricle mass index and diastolic parameters were performed. Nocturnal blood pressure dipping was calculated as follows: (awake BP – sleep BP) × 100/awake BP. Patients with a nocturnal reduction in average daytime systolic BP and diastolic BP of less than 10% were classified as nondippers. Left ventricle mass index was higher in normotensive pregnant women with GDM group than in normal pregnant subjects (101.98 ± 24 g/m2 vs. 90.67 ± 15 g/m2, P < .018). Significant nocturnal systolic and diastolic nondippings were observed in GDM groups compared with normal subjects. From diastolic variables, the mitral E velocity and isovolumetric relaxation time were compatible with diastolic dysfunction relaxation abnormalities (P = .003 and P = .015, respectively) in nondipper group. From all confounding factors, only E velocity (P = .002) and diagnosis of GDM (P < .001) were predictive of nondipper circadian variation. This study shows that (i) circadian BP is impaired in normotensive pregnant subjects with GDM, (ii) the left ventricle mass index is higher in pregnant subjects with GDM than in normal pregnant subjects who despite a 24-hour BP are within normal limits, and (iii) in nocturnal nondipper group, the tendency to having diastolic relaxation abnormalities is noted.

The Association Between the Neutrophil-to-Lymphocyte Ratio and the Presence of Ventricular Premature Contractions in Young Adults:

Inflammation has recently emerged in the pathogenesis of several cardiovascular disorders, including arrhythmias. The neutrophil–lymphocyte ratio (NLR) is a simple marker for the assessment of inflammatory status. Therefore, we aimed to investigate the relationship between the NLR and the ventricular premature contraction (VPC) existence. Patients aged between 18 and 40 years who were referred to the cardiology clinic were enrolled in the study. All patients’ complete blood counts and 24-hour Holter recordings were analyzed. The NLR was higher within the VPC group compared to the control group (P < .001). According to the NLR tertiles, VPCs were more common in the higher NLR tertile (P < .001). A cutoff point of 1.80 for the NLR had 71% sensitivity and 60% specificity in predicting VPC in apparently healthy individuals. After multivariate analysis, only the NLR remained significant predictor of presence of VPC. In conclusion, the NLR is independently and significantly associated with VPC existence.

Thrombolysis of an acute prosthetic mitral valve thrombosis presented with cardiogenic shock under the guidance of continuous transoesophageal monitoring.

Thrombotic occlusion of prosthetic valves continues to be an uncommon but serious complication. Intravenous thrombolytic treatment has been proposed as an alternative to surgical intervention. Due to the lack of a generally accepted standard regimen, various infusion protocols and thrombolytic doses were used for the management of prosthetic heart valve thrombosis. However, rapid thrombolytic infusion, especially in the presence of large thrombus, may increase the risk of embolization. Continuous transoesophageal echocardiography may provide monitoring the efficacy of thrombolysis especially in critically ill patients.