İsa Sincer

Increased prevalence of varicocele in patients with coronary artery ectasia.

BackgroundCoronary artery ectasia (CAE) is defined as localized or diffuse non-obstructive lesions of the epicardial coronary arteries with a luminal dilation exceeding the 1.5-fold of normal adjacent segment or vessel diameter. Varicocele is the dilatation of the pampiniform plexus. Recently increased prevalence of peripheral varicose veins has been shown in patients with CAE. In this study we aimed to assess the prevalence of varicocele, which is dilatation of another venous system, in patients with CAE. Materials and methodsThirty-five male consecutive patients with coronary artery ectasia in combination with or without coronary artery disease (CAD) and 63 male, age-matched patients with coronary artery disease were included in the study. All patients were evaluated for the presence of varicocele. ResultsTwenty-one patients with CAE were found to have varicocele (62% of group I patients). In patients with CAD, 24 patients (38%) were found to have varicocele. The difference between the two groups in respect to presence of varicocele was statistically significant (P=0.02; odds ratio=1.57; 95% confidence interval 1.05– 2.3). ConclusionWe have shown that patients with coronary artery ectasia have an increased prevalence of varicocele compared to those with coronary artery disease. The mechanism underlying coronary artery ectasia might further increase the prevalence of varicocele in susceptible patients.

Mean platelet volume: an important predictor of coronary collateral development.

Collaterals, which develop in response to ischemic stimuli derived from coronary artery disease (CAD), contribute to reduction of infarct size, left ventricular dysfunction, and mortality. However, there is considerable variation among patients with coronary heart disease regarding the extent of coronary collateral development (CCD). In this study, we aimed to investigate the association of the degree of platelet activation via mean platelet volume (MPV) with coronary collateral circulation. Therefore, 210 patients who underwent coronary angiography and had coronary stenosis ≥50 % in at least one coronary artery were included in the study. Clinical information and analyses of blood samples were obtained from a review of the patients’ chart. Blood samples for MPV were analyzed by K3 EDTA and collateral vessels were graded according to the Rentrop classification. In the study group, 150 of the 210 patients were found to have inadequate CCD. Although there was no difference between the two groups with regard to platelet count, MPV levels were significantly higher in the patients who had inadequate CCD (11.3 ± 1.0 fl vs. 9.5 ± 1.5 fl, p < 0.001). Furthermore, the Gensini score was significantly lower in patients who had inadequate CCD (45 ± 46 vs. 91 ± 35, p < 0.001). MPV, Gensini score, age, female gender, total cholesterol, red cell distribution width, triglyceride, and fasting glucose levels were found to have univariate association with poor CCD. In multivariate logistic regression model, MPV (OR = 2.45, p < 0.001) and Gensini score (OR = 0.98, p < 0.001) were found to be the independent predictors of impaired CCD. In receiver operator characteristic curve analysis, optimal cut-off value of MPV to predict inadequate CCD was found as >9.6 fl, with 96% sensitivity and 84.7% positive predictive value. In conclusion, we can say that MPV is an important, simple, effortless, and cost effective tool and can be useful in predicting the CCD in patients with significant CAD.

Elevated plasma homocysteine levels in patients with isolated coronary artery ectasia.

ObjectiveCoronary artery ectasia is a variant of coronary atherosclerosis. Hyperhomocysteinemia has emerged as a major, independent risk factor for cardiovascular diseases. The purposes of this study were to determine plasma hyperhomocysteine levels in patients with coronary artery ectasia, and to compare patients with coronary artery ectasia, coronary artery disease, and controls with normal coronary angiogram. MethodThe study population included 37 patients with coronary artery ectasia and 36 patients with coronary artery disease. The control group consisted of 32 patients with angiographically proven normal coronary arteries. Plasma hyperhomocysteine levels were measured in all study patients with an enzyme-linked immunosorbent assay. ResultsPlasma homocysteine levels were significantly higher in patients with both coronary artery ectasia and coronary artery disease than in the controls (14.8±1.1 and 15.9±0.8 vs. 2.5±0.6 μmol/l; P<0.001 and P<0.001, respectively). No significant differences in plasma homocysteine levels were found among CAE and CAD groups (P>0.05). ConclusionsWe have demonstrated that patients with coronary artery ectasia and coronary artery disease have increased plasma hyperhomocysteine levels compared with the controls. These findings suggest that hyperhomocysteinemia may play an important role in the pathogenesis of coronary artery ectasia as in coronary artery disease.

Sonographic evaluation for predicting the presence and severity of coronary artery disease.

Purpose The aim of our study was to investigate the relationship between age, sex, obesity, nonalcoholic fatty liver disease (NAFLD), carotid intima-media thickness (CIMT), and both the presence and severity of coronary artery disease (CAD) and their predictive value for the presence and severity of CAD. Methods Our study population consisted of 136 patients who underwent coronary angiography for various reasons. Gensini scoring was used to determine the severity of coronary atherosclerosis. Carotid intima-media thickness was estimated by carotid duplex ultrasound. Nonalcoholic fatty liver disease was diagnosed by abdominal ultrasonography. Body mass index (BMI) was calculated as kilograms divided by meters squared. Results Coronary artery disease was detected in 74 patients (54%). In the whole group, patients with CAD had significantly higher CIMT measurements compared with those without CAD (0.93 [SD, 0.14] and 0.72 [SD, 0.12] mm, respectively, P < 0.001). Carotid intima-media thickness was correlated with BMI (P < 0.001, r = 0.453), age (P = 0.001, r = 0.389), and grade 2–3 NAFLD (P < 0.001, r = 0.356). In the multiple logistic regression model, CIMT (odds ratio, 1.189; 95% confidence interval, 1.122–1.261; P < 0.001) was the only independent predictor of the presence of CAD. In receiver operating characteristic curve analysis, optimal cutoff value of CIMT to predict the presence of CAD was found as greater than 0.75 mm with 93.2% sensitivity and 71% specificity. In CAD group patients, Gensini score was correlated with CIMT (P < 0.001, r = 0.604), grade 2–3 NAFLD (P < 0.001, r = 0.534), BMI (P < 0.001, r = 0.498), and age (P = 0.001, r = 0.385). In the multiple stepwise linear regression model, CIMT (&bgr; = 0.444, P < 0.001) and grade 2–3 NAFLD (&bgr; = 0.353, P < 0.001) were associated with severity of CAD. Conclusions Our data suggest that CIMT is a strong independent predictor for the presence and severity of CAD. Furthermore, moderate to severe hepatosteatosis is also significantly associated with the severity of CAD. Therefore, detection of CIMT and NAFLD by ultrasonography, which is a very cheap, safe, and noninvasive radiological modality, can be used to improve CAD risk prediction.

Association between Red Cell Distribution Width and Disease Activity in Patients with Behcet’s Disease

Aims: we aimed to investigate whether red cell distribution width (RDW) can also be used for the assessment of disease activity in Behcet’s disease (BD). Methods and results: Forty patients with active BD and seventy patients with inactive BD were included in the study. Forty-six healthy volunteers constituted the control group. Hematological parameters, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were analyzed by standard methods. All the individuals underwent comprehensive echocardiographic examination. Echocardiographic parameters of the study population were similar all groups. ESR, CRP and RDW were significantly higher in active BD patients than in inactive BD patients and controls (33.6±22 vs 15.7±9 vs 5±4.1, 23.4±21.6 vs 5.5±6.2 vs 1.2±0.5 and 17.2±2.5 vs 14.4±1.9 vs 13.2±0.5, p<0.0001 for all, respectively). Moreover, we also found that ESR, CRP and RDW were significantly higher in inactive BD patients when compared with the controls (15.7±9 vs 5±4.1, 5.5±6.2 vs 1.2±0.5 and 14.4±1.9 vs 13.2±0.5, p<0.0001 for all, respectively). There were modest positive correlations between RDW and disease duration (r=0.320, P=0.001). Conclusion: We demostrated that RDW significant increased in active and inactive BD patients without cardiac involvement. In addition, our study has established that RDW can be used to determine the disease activity state of BD.

Increased aortic stiffness in patients with coronary artery ectasia.

ObjectiveAlterations in aortic stiffness may reflect the elastic properties of the larger arteries. In many diseases, aortic elastic properties have been investigated to show whether the larger arteries are involved. The elastic properties of aorta in patients with coronary artery ectasia, however, have not been studied yet. We aimed to investigate aortic stiffness parameters in patients with coronary artery ectasia and to compare patients with coronary artery ectasia and coronary artery disease with the control group. MethodThirty-three patients with coronary artery ectasia, 31 patients with coronary artery disease and 30 patients with angiographically normal coronary arteries were included in this study. Aortic diameters were measured on the M-mode tracing obtained at a level 3 cm beyond the aortic valve at parasternal long-axis view. Aortic diameter change, aortic strain, aortic distensibility and stiffness parameters were measured as aortic stiffness parameters. ResultsAortic diameter changes were fewer in the coronary artery ectasia and coronary artery disease group than in the control group (0.4±0.1 and 0.3±0.1 vs. 0.8±0.2; P<0.001). Aortic distensibility and aortic strain were significantly lower in patients with coronary artery ectasia and coronary artery disease than in the controls (for aortic distensibility P<0.001 and for aortic strain P<0.001, <0.001, respectively). In contrast, a significantly higher aortic stiffness index was observed in patients with coronary artery ectasia and coronary artery disease than in the control group (14.2±2.6 and 18.1±2.9 vs. 5.9±1.8; P<0.001, respectively). ConclusionsThe impairment in aortic elastic properties in patients with coronary artery ectasia indicates that this disease is a generalized disease rather than a localized disease of the coronary arteries.

Association between serum total antioxidant status and flow-mediated dilation in patients with systemic lupus erythematosus: an observational study.

Objective: Endothelial dysfunction (ED) is a condition that involves increased oxidative stress and decreased total antioxidant status (TAS) levels. Systemic lupus erythematosus (SLE) is also associated with ED. We aimed to determine the association between serum TAS and ED as assessed by flow-mediated dilation (FMD) in patients with SLE. Methods: Thirty-four patients with stable SLE who were not undergoing any treatment and 39 healthy volunteers without any overt cardiovascular disease were included in this cross-sectional study. Doppler ultrasound was used to measure FMD to assess ED in the study groups. Serum TAS levels were measured using a TAS kit. High-sensitivity C-reactive protein (hs-CRP) and anticardiolipin antibody (aCLA) levels were also measured to assess the inflammatory state. The SLE group further was divided into 2 groups according to presence or absence of aCLA. SLE disease activity was assessed using the SLE disease activity index (SLEDAI). Regression analysis was used to define independent predictors. Results: The mean TAS levels were significantly lower in patients with SLE than in controls (1.60±0.11 versus 1.73±0.15 mmol/L, p<0.001). hs-CRP levels were significantly higher in patients with SLE than in controls (8.2±6.0 vs. 2.9±4.0 mg/L; p<0.001), particularly in SLE patients with positive aCLA when compared with SLE patients with negative aCLA (13.8±4.3 vs. 5.6±4.8 mg/L, p<0.001). The FMD percent was significantly lower in patients with SLE than in controls (8.1±4.9 vs. 10.6±4.7, p=0.04). There was a significant positive correlation between FMD and TAS in the SLE group (r=0.448, p=0.008) and the control group (r=0.367, p=0.03) and a significant negative correlation between FMD and serum hs-CRP (r=-0.368, p=0.04) in only the SLE group. In multiple linear regression analysis, TAS, hs-CRP and SLEDAI were independently correlated with FMD (ß=0.50, p=0.003; ß=-0.33, p=0.03; and ß=-0.36, p=0.03; respectively). Conclusion: Patients with SLE who have no overt cardiovascular disease are at increased risk for ED and this may be associated with underlying inflammation and impairment of TAS.

Comparision of Effects of Rosuvastatin Versus Atorvastatin Treatment on Plasma Levels of Asymmetric Dimethylarginine in Patients With Hyperlipidemia Having Coronary Artery Disease

Elevated plasma levels of asymmetric dimethylarginine (ADMA) are prevalent in patients with hypercholesterolemia and coronary artery disease. A total of 83 patients with hypercholesterolemia and angiographically documented mild coronary artery stenosis were randomized to rosuvastatin treatment (20 mg) or atorvastatin treatment (40 mg) once daily for 6 weeks after a 4-week dietary lead-in phase. Both statins decreased total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and triglyceride levels effectively. Only rosuvastatin increased high-density lipoprotein cholesterol (HDL-C) levels. Both rosuvastatin and atorvastatin decreased plasma ADMA levels; rosuvastatin had a significantly greater effect. The reduction in ADMA levels were correlated with the reduction in TC and LDL-C levels as well as LDL-C–HDL-C ratio. Treatment with rosuvastatin or atorvastatin in patients with hyperlipidemia with mild coronary artery stenosis may lead to a decrease in ADMA levels, which may contribute to improved endothelial function.

Significant correlation between uric acid levels and flow-mediated dilatation in patients with masked hypertension

Abstract Background: Serum uric acid (UA) level is associated with prognosis in cardiovascular disorders such as sustained hypertension, diabetes mellitus and chronic kidney diseases. Increased UA levels in sustained hypertension may reflect early renal vascular alterations. However, it remains unclear if serum UA is associated with endothelial dysfunction in masked hypertensive patients. Methods: A total of 100 individuals (57% men and 43% women; mean 45 ± 8 years) with masked hypertension were included in the present study. The clinical and laboratory data were collected. Endothelial function was estimated by flow-mediated dilatation (FMD) of the brachial artery and expressed as percentage change relative to baseline diameter. Results: Univariate regression analysis showed that the FMD was significantly negative correlated with uric acid (r = −0.300, p = 0.002), ambulatory 24-h systolic blood pressure (SBP) (r = −0.275, p = 0.008), hs-CRP (r = −0.222, p = 0.033) and diastolic aortic diameter (r = −0.243, p = 0.019). In multivariate linear regression analysis, only uric acid levels and ambulatory 24-h SBP were significantly associated with FMD. Conclusion: There was an independent correlation between UA and FMD, and a higher UA level was related to worse endothelial function which may contribute to hypertension and cardiovascular morbidity.

Emergency endovascular treatment of peripheral arterial injuries occurring during the Syrian civil war: Gaziantep Dr. Ersin Arslan Education and Research Hospital Experience.

As we are working in Gaziantep Dr. Ersin Arslan Education and Research Hospital that is approximately 50 km away from Turkish–Syrian border, we frequently encounter peripheral arterial injuries in terms of emergency endovascular interventions. Therefore, we would like to share our single-center experience of these patients with you and our colleagues. Extremity injuries involving a major artery that are not promptly diagnosed and treated can lead to death or loss of the extremity. Arterial injury can cause distal ischemia because of hemorrhage, hematoma, laceration, or thrombosis, and the complications of the injury can lead to pseudoaneurysm or arteriovenous fistula (1). Endovascular therapy is a continuously developing alternative to surgical therapy in selected patients. Between July 2012 and May 2014, 21 patients were evaluated by digital subtraction angiography in our catheterization laboratory. Twelve of them were operated and nine patients underwent emergency endovascular interventions in our cath lab. Lesion types were hemorrhagic laceration fistulazing to the skin, arteriovenous fistula, pseudoaneurysm, and distal ischemia due to postoperative occlusion. Patients had internal carotid artery, axillary artery, brachial artery, superficial femoral artery, and popliteal artery injuries. The conventional treatment for perforation, aneurysm, pseudoaneurysm, and arteriovenous fistula caused by penetrating arterial trauma is surgery; however, the deteriorated anatomy and hematoma around the lesion as well as the risks of performing the surgery again can make surgical option a challenging procedure (2). Endovascular interventions also have their own risks and complications such as stent occlusion, stent fracture, restenosis, and loss of collaterals during stent placement (3). The most often traumatized vessel is the femoropopliteal artery, the same as in our series. Direct penetrating injuries caused by deep stabs, gunshots, or high-kinetic energy weapons can cause pseudoaneurysm or arteriovenous fistulas. The graft stent implantation in femoral interventions provides a patency rate of 88% in one year. Less thrombogenic heparin-bonded stents are being implanted for arteries running through joints. These stents are resistant to fracture and have high radial strength (4). As this is a case series of nine patients treated with covered stents in one center, we could say surgery should be the first-line treatment for these kinds of lesions (5). However, because of reoperation and anatomical challenges, reluctance of the vascular surgical team to redo the procedure, and patient preferences, endovascular treatment of these kinds of lesions could be another option.