Ibrahim Basarici

Determination of subclinical atherosclerosis in plaque type psoriasis patients without traditional risk factors for atherosclerosis.

OBJECTIVES Systemic inflammation plays an important role in the pathogenesis of atherosclerosis in psoriasis patients. Therefore, persistent skin inflammation in psoriasis patients may contribute to the development of premature atherosclerosis, as it occurs in rheumatoid arthritis and systemic lupus erythematosus. We aimed to evaluate the relationship between subclinical atherosclerosis and psoriasis by using pulse wave velocity (PWV) and the measurement of carotid intima media thickness (CIMT) in psoriatic patients. STUDY DESIGN Fifty-seven plaque-type psoriasis patients (31 males, 26 females; mean age 41±10.8 years) and 60 healthy individuals (32 males, 28 females; mean age 40±9.4 years) were included. Atherosclerotic risk factors were excluded in both of the groups. Demographic, bio-chemical data, psoriasis area and severity index (PASI) score of the psoriasis group, and disease duration were recorded. Carotid-femoral artery PWV and CIMT values were compared. RESULTS PWV, and the maximum and average CIMT values of psoriasis patients were higher than those of the healthy group (PWV: 7.04±1.1 m/sn vs. 6.03±0.61 m/sn, p<0.001; maximum CIMT: 0.86±0.09 mm vs. 0.77±0.06 mm, p<0.001; mean CIMT: 0.73±0.09 mm vs. 0.66±0.06 mm p<0.001, respectively). Although there was no difference in the lipid levels of the groups, total/HDL cholesterol (4.40±1.26 vs. 3.88±1.18, p=0.02, respectively), and LDL/HDL cholesterol ratios (2.78±0.98 vs. 2.32±0.92, p=0.01, respectively) of the psoriasis group were higher than those of the healthy group. A positive correlation was observed between PASI and the PWV (r=0.417, p=0.001). CONCLUSION Despite the nonexistence of atherosclerotic risk factors, the risk of development of atherosclerosis is higher in psoriasis patients compared to healthy individuals. In addition to damage of the artery wall caused by systemic inflammation, lipid metabolism disorders may contribute to the development of atherosclerosis in these patients.

Associations of isoprostanes-related oxidative stress with surrogate subclinical indices and angiographic measures of atherosclerosis.

ObjectivesCardiovascular diseases are the most common cause of death in the world. Oxidative stress has been proved to play a role in atherosclerotic diseases and 8-isoprostane is one of the most valid markers of in-vivo oxidative stress. We aimed to investigate the 8-isoprostane levels in relation to surrogate and direct angiographic indexes of atherosclerosis. MethodsUrinary 8-isoprostane levels were measured and a B-mode carotid ultrasound examination was performed in 100 consecutive patients scheduled for coronary angiography. ResultsIn patients with angiographic coronary artery disease (CAD) urinary 8-isoprostane levels were significantly (P<0.001) higher than in patients without CAD (68.75±5.5 vs. 38.27±3.7 pg/ml). Moreover, 8-isoprostane levels of patients with increased carotid intima media thickness (CIMT) were higher (P<0.001) than in patients with normal CIMT values (75.12±6.4 vs. 38.72±2.7 pg/ml). Moreover log(8-isoprostane) levels were significantly correlated with maximum and mean CIMT values (P<0.001) and across univessel and multivessel CAD groups levels of log(8-isoprostane) showed a significantly (P<0.001) increasing trend. Logistic regression analysis revealed that 8-isoprostane levels were an independent predictor for both intima-media thickening and angiographic CAD. ConclusionThese findings indicate that elevated urinary levels of 8-isoprostane are associated with both subclinical atherosclerosis and manifest CAD. The results therefore support the hypothesis that isoprostanes-related oxidative stress is involved in the whole atherosclerotic process.

Urinary 8-isoprostane levels can indicate the presence, severity and extent of angiographic coronary artery disease.

Background — Atherosclerotic coronary artery disease is the leading cause of death worldwide. Oxidative stress is one of the key elements in the pathogenesis of atherosclerosis. Isoprostanes are established markers of oxidative stress. The aim of this study was to investigate the association of urinary 8-isoprostane levels with the presence and severity of coronary artery disease (CAD) assessed by a validated scoring system. Method — Urinary 8-isoprostane levels were measured in 100 consecutive patients scheduled for coronary angiography. Extent and severity of CAD were assessed by modified Gensini scores. Results — In patients with CAD, 8-isoprostane levels were higher (P < 0.001) than in patients without CAD (68.75 ± 5.5 vs. 38.27 ± 3.7 pg/ml). The levels of 8-isoprostane correlated with the number of risk factors (P < 0.001) and significantly increased in relation with the number of diseased vessels (P < 0.001). A significant (P < 0.001) correlation was found between 8-isoprostane levels and Gensini scores (r = 0.496), and a stepwise elevation in 8-isoprostane levels was observed across the increasing tertiles of the Gensini scores (P < 0.001). The multivariate logistic regression analysis revealed that 8-isoprostane was an independent predictor (odds ratio: 7.19 and P = 0.007) associated with angiographic CAD. Conclusion — These results confirm the role of oxidative stress in the atherosclerotic process. Urinary 8-isoprostane levels reflect the extent and severity of CAD and they may provide additional information for risk assessment in patients with suspected CAD.

Successful management of osteal perforation of left anterior descending artery with coated stent

Coronary perforation is a rare complication of percutaneous coronary intervention. We report a case of left anterior descending artery osteal perforation that led to acute cardiac tamponade during excimer laser angioplasty. Perforation was successfully covered with a PTFE-coated stent with preserved distal coronary flow.

The Value of Procalcitonin, a Novel Inflammatory Marker, in the Diagnosis of Myocardial Infarction and Evaluation of Acute Coronary Syndrome Patients

BACKGROUND Procalcitonin is a calcitonin precursor that is used as an inflammatory biomarker in the plasma of patients with sepsis. OBJECTIVE The aim of this study was to determine the diagnostic accuracy of emergency department (ED) point-of-care blood procalcitonin testing in identifying myocardial infarction (MI) in patients with chest pain of presumed ischemic origin. METHODS Patients over 18 years of age who presented to the ED with MI-typical chest pain of presumed ischemic origin were included in the study. An initial point-of-care blood sample was drawn from each study patient for testing procalcitonin, troponin T, myoglobin, and creatine kinase-MB levels. A second sample was taken 4h after admission for a procalcitonin test. Finally, a 6-h post-admission blood sample was taken to measure troponin T, myoglobin, and creatine kinase-MB levels in each study patient who had an initial negative cardiac marker test. RESULTS A total of 1008 patients with chest pain were admitted to the ED during the study period, and a total of 141 patients met study criteria and were entered into the study. ED point-of-care blood procalcitonin testing to identify myocardial infarction in patients with chest pain of presumed ischemic origin had a sensitivity of 38.3% (95% confidence interval [CI] 28.8-47.3%) and a specificity of 77.8% (95% CI 70.0-84.4%), a positive likelihood ratio (LR+) of 1.725 and a negative likelihood ratio (LR-) of 0.792. The 4th hour diagnostic values (sensitivity, specificity, LR+ and LR-) of procalcitonin semi-quantitative (PCT-Q) testing were 90% (95% CI 80.9-95.7%), 59.3% (95% CI 52.5-63.5%), 2.2, and 0.16, respectively. CONCLUSION ED point-of-care testing for procalcitonin had poor diagnostic accuracy for predicting myocardial infarction.

Tricuspid valve thrombus: A case report associated with gonadotropin-releasing hormone analogue therapy and review of the literature

A 35-year-old woman with a previously repaired atrial septal defect was referred for preoperative evaluation before laparoscopic surgery. The patient was asymptomatic, and a transesophageal echocardiographic examination revealed a probable thrombus attached to the tricuspid valve. The patients history included therapy with a gonadotropin-releasing hormone analogue and deep venous thrombosis five months earlier. The tricuspid valve thrombus disappeared after anticoagulant therapy. Warfarin was initiated for prophylaxis. During the follow-up, the patient was event-free during laparoscopic surgery and pregnancy (when warfarin was switched to acetylsalicylic acid) and gave birth to a healthy term baby. Because etiological investigations revealed no reason for the tricuspid valve thrombus, it was considered to be related to the procoagulant state induced by hormonal treatment. The patient was scheduled for close follow-up.

Imminent pulmonary embolism: a fatal mobile right atrial thrombus.

Right sided heart thrombi are infrequent and if they are mobile they may cause serious morbidity and mortality due to massive pulmonary embolism or paradoxical embolism. Malignancies are one of the important etiological factors for right heart thrombi. A patient with operated but recurrent ovarian carcinoma, presented with symptoms of heart failure was admitted to oncology department. Rapidly progressing dyspnea and a pre-syncope attack required consultation of a cardiologist and echocardiography revealed a mobile thrombus in the right atrium. Urgent open heart surgery was decided but imminent massive pulmonary embolism complicated the case leading to irreversible cardiogenic shock. By means of the presented case this paper overviews etiological factors and treatment options for right sided heart thrombi.

Ischemia modified albumin levels cannot predict stress induced ischemia shown by myocardial perfusion scintigraphy

PURPOSE Ischemia modified albumin (IMA) is a new marker of ischemia which is used in especially emergency room. Aim of this study is showing the association of IMA with stress induced ischemia on Tc-99m 2-methoxyisobutyl-nitrate (MIBI) myocardial perfusion scintigraphy (MPS). METHODS 56 patients (23 F, 33 M; 56.04 ± 8.45 years old) were included in our study. Stress-rest two days protocol Tc-99m MIBI MPS single photon emission tomography (SPECT) was performed to all patients. IMA levels from the blood samples which were taken before and after the treadmill test were measured. Thirty patients additionally underwent coronary angiography. RESULTS The difference of IMA levels of ischemia between positive and negative groups was not statistically significant. Also, there was not statistically significant difference between IMA levels of patients who have narrowing in the coronary arteries and not. CONCLUSION Although IMA is an important marker of ischemia, probably because of other ischemic process during stress; it cannot reflect stress induced ischemic changes on MPS.

Aorta-right atrial tunnel leading to heart failure

Congential aorta-right atrial tunnel (ARAT) is a rare anomaly. Many patients are asymptomatic and diagnosis can be made during investigation of systolic and diastolic continuous murmur heard on cardiac oscultation. In some patients, symptoms such as palpitation, dyspnea, and fatigue on exertion can be seen. With transthoracic and transesophageal echocardiography diagnosis can usually be made, but more definite diagnosis is possible with coronary angiography, aortography, and computerized tomography. Herein with the data from current literature we will discuss a case who was admitted to our clinic with symptoms of heart failure and diagnosed with ARAT.

Evaluation of cardiac autonomic functions in myasthenia gravis

Abstract Objective: We aimed to comprehensively evaluate cardiac autonomic function in patients with MG and to investigate the relationship between this disorder and disease duration, thymoma and acetylcholine receptor antibody positivity in cases of cardiac autonomic disorder. Methods: The study included 30 patients with MG and 30 age-matched healthy control subjects. Haemodynamic parameters (heart rate, systolic and diastolic blood pressure) and autonomic parameters (low frequency [LF], high-frequency [HF], sympathovagal balance [LF/HF], baroreceptor reflex sensitivity [BRS]) of the patients were automatically measured at rest and in a tilted position with the Task Force Monitor. Results: The mean systolic and diastolic blood pressure measurements obtained at rest and during the tilt test were higher in patients with MG. Sympathovagal balance has been disturbed in favour of sympathetic tone, and parasympathetic insufficiency has become more prominent. When baroreceptor sensitivity was used as the second parameter to evaluate autonomic heart functions, BRS at rest and during the tilt test was lower in the MG group compared with the control group. Discussion: These results suggest that sympathovagal balance has been disturbed in favour of sympathetic tone and that parasympathetic insufficiency has become more prominent. The current findings support the presence of cardiac autonomic involvement in patients with MG. The determination of cardiac autonomic function via noninvasive methods among patients with MG has high predictive value. The identification of autonomic dysfunction at an early stage and the early treatment of cardiovascular diseases can reduce morbidity and mortality.