İsmail Türkay Özcan

Plasma homocysteine is associated with ischemic findings without organic stenosis in patients with slow coronary flow

AIM To investigate the plasma concentrations of homocysteine (Hcy) in slow coronary flow (SCF) patients before and at the end of the exercise test and compare with the values of healthy controls. METHODS Study population consisted of 41 patients with SCF [68% men, aged 49 ± 8 years], and 41 subjects with normal epicardial coronary arteries [56% men, aged 50 ± 9 years]. Exercise test was performed in all study participants. Blood samples were drawn at rest and immediately at the end of exercise testing after 12h of overnight fasting. RESULTS The baseline Hcy value of the SCF patients was higher than that of the control subjects (p<0.0001), and this difference continued after exercise test between the groups (p<0.0001). Median post-exercise increases in Hcy levels were higher in the SCF group than in the control group, without a significant difference (p=0.088). In the SCF group after exercise, Hcy levels in 17 patients with angina and 18 patients with ST depression were higher than those without angina and ST depression (p<0.0001 and p<0.0001, respectively). In addition, Hcy values in patients with both angina and ST depression were greater than those with either angina (p<0.05) or ST depression (p<0.05). CONCLUSION The results of this study show that there is an important pathophysiologic link between the increased levels of plasma Hcy, the degree of ischemic findings, and the severity of slow flow in SCF patients.

Usefulness of admission hematologic parameters as diagnostic tools in acute pulmonary embolism

The purpose of this study was to determine the role of red cell distribution width (RDW), neutrophil–lymphocyte ratio (NLR), and platelet–lymphocyte ratio (PLR) in the diagnostic phase of acute pulmonary embolism (PE). We screened 248 consecutive patients who were admitted to the emergency service with PE foremost in the differential diagnosis. Based on spiral computed chest tomography, the patients were divided into two groups. There were 112 confirmed cases of acute PE and 138 patients without PE. Blood samples were obtained within 2 hours of presentation and before starting any medication. There were no significant differences between the PE and the non‐PE groups with respect to sex, age, frequency of disease, serum creatinine, sodium, and potassium (p > 0.05 for all). NLR, RDW, and PLR were higher in patients with PE than those without PE. High‐sensitivity C‐reactive protein, d‐dimer, and troponin levels were also higher in patients with PE. RDW values were positively correlated with troponin levels (r = 0.147, p = 0.021). There were no correlations between RDW and NLR, PLR, or d‐dimer. NLR had a highly positive correlation with PLR (r = 0.488, p < 0.001). In multivariate logistic regression analysis, troponin I, d‐dimer, high‐sensitivity C‐reactive protein, and RDW were found to be independent predictors of PE [odds ratio (95% confidence interval) respectively: 5.208 (2.534–10.704), 1.242 (1.094–1.409), 1.005 (1.000–1.010), 1.175 (1.052–1.312)]. In receiver operating characteristic analysis of the patients in the study, RDW >18.9 predicted acute PE with a sensitivity of 20.7% and a specificity of 93.4%. In conclusion, RDW can be considered useful as a diagnostic measure for patients with suspected acute PE.

NT-Pro-BNP levels and their response to exercise in patients with slow coronary flow.

BACKGROUND Natriuretic peptides are released by the heart in response to wall stress. OBJECTIVE The NT-Pro-BNP concentrations in slow coronary flow (SCF) patients were assessed before and after the exercise test and compared with the values of healthy controls. METHODS The study population was 34 patients with SCF [22 males (64.7%), aged 51.0 ± 6.2 years], and 34 normal subjects with normal coronary arteries [21 males (61.8%), aged 53.2 ± 6.6 years]. Coronary flow rates of all patients and control subjects were documented as Thrombolysis in Myocardial Infarction (TIMI) frame count. Blood samples were drawn at rest and after the exercise testing. RESULTS The baseline NT-Pro-BNP concentrations of the SCF patients were higher than those of the control subjects (NT-Pro-BNP: 49.7 ± 14.2 pg/mL vs. 25.3 ± 4.6 pg/mL p<0.0001, respectively), and this difference increased after exercise test between the groups (NT-Pro-BNP: 69.5 ± 18.6 pg/mL vs. 30.9 ± 6.4 pg/mL p<0.0001). In SCF group after exercise, NT-Pro-BNP concentration in 15 patients with angina was higher than those without angina (76.8 ± 17.8 pg/mL vs. 63.8 ± 17.5 pg/mL p=0.041). NT-Pro-BNP concentration in 11 patients with ST depression was also higher than those without ST depression (82.4 ± 17.3 pg/mL vs. 63.3 ± 16.1 pg/mL p=0.004). Median post-exercise increases in NT-Pro-BNP (Δ NT-Pro-BNP) were higher in the SCF group than in the control group (Δ NT-Pro-BNP: 19.8 ± 7.7 pg/mL vs. 5.7 ± 4.5 pg/mL p<0.0001). CONCLUSION The results of this study suggest that there may be an important pathophysiologic link between the severity of SCF (microvascular or epicardial coronary artery dysfunction) and the level of circulating NT-Pro-BNP in SCF patients.

Stabil angina pektoris ile başvuran hastalarda ciddi kroner arter darlığı ile fragmente QRS arasındaki ilişkinin araştırılması

Amac: Gogus agrisi, koroner arter hastaliklarinin (KAH) en sik semptomudur. Bununla birlikte koroner arter hastaligi disinda gogus agrisina sebep olabilen bircok neden bulunmaktadir. Gogus agrisi ayirici tanisinin yapilmasinda elektrokardiyografinin (EKG) oldukca onemli bir yeri vardir. Fragmante QRS (fQRS) ventrikul depolarizasyonunun sonucu olarak EKG de QRS kompleksinde centiklenme olmasidir. Bizim calismamizin amaci gogus agrisi ile poliklinige basvuran hastalarda fQRS varligi ile koroner arterlerde ciddi darlik olmasi arasindaki iliskinin incelenmesidir. Yontem: Kardiyoloji poliklinigine gogus agrisi sikâyeti ile basvuran 256 hasta calismaya dâhil edildi. Hastalar koroner anjiyografi (KAG) sonucunda koroner arterlerde ciddi darlik olup olmamasina gore iki gruba ayrildi. Hastalarin EKG’leri incelenerek fQRS olup olmadigi kayit edildi ve fQRS varligi ile koroner arterlerde ciddi darlik olmasi arasindaki iliski incelendi. Bulgular: Stabil anjina pektoris sikayeti bulunan 256 hastanin 78’ine (%30.4) KAG uygulandi ve bu hastalarin 49’unda (%62.8) KAH tespit edildi. KAH olan gruptaki hastalarin ve olmayan gruptaki hastalarin EKG’sinde fQRS bulunma oranlari sirasi ile %36 ve %20.4 (p:0.019) olarak bulundu. Sonuc: fQRS’in koroner arterlerdeki sinirda darliklari olan hastalardaki lezyonlarin ciddiyetini tespit etmede, Akut Kroner Sendrom (AKS) tanisini koymada ve AKS sonrasi takiplerde mortaliteyi ongormede basarili oldugu daha once yapilan calismalarda gosterilmistir. Bizim calismamizda kardiyoloji poliklinigine gogus agrisi sikâyeti ile basvuran hastalardan koroner arterlerde ciddi darlik tespit edilenlerde fQRS bulunma orani anlamli olarak yuksek bulunmustur.

Awareness of Pleiotropic and Cardioprotective Effect of Statins in Patients with Coronary Artery Disease

Background Statins are commonly used in the secondary prevention of coronary artery disease. Studies have shown that the rate of statin use is low among patients with coronary artery disease. In this study, we aimed to investigate the reasons for poor patient compliance with statin treatment. Methods A total of 504 patients diagnosed with coronary heart disease were included in the study. Patients were asked 5 questions to assess their level of knowledge about statin therapy. Results Among the patients not using statins, 42% stated they did not take the medication because their cholesterol was not high or they did not know they should renew their prescription when they ran out and 35% because they were influenced by news reports in the media suggesting that cholesterol-lowering drugs were harmful. When patients who were aware of the pleiotropic/cardioprotective effects of statins were compared with patients who were not, the more knowledgeable patients had lower noncompliance rate and mean LDL-C level and a higher rate of LDL-C level optimization. Conclusion We found that patients who are aware of the pleiotropic effects of statins were more compliant with treatment. We believe that spending more time explaining and emphasizing the mechanisms of action, reason for prescribing, and necessary treatment duration of drugs that patients must use will result in greater compliance and improve patient care. In this way, patients may be less influenced by misinformation presented by the media.

Ventriculer fibrillation due to Prinzmetal angina in a pregnant patient

Variant angina, which is also referred to as prinzmetal or coronary vasospastic angina, is a clinical entity characterized by episodes of angina pectoris, usually at rest and often between midnight and early morning, in association with ST-segment elevation on the electrocardiogram. Angina is usually caused by focal spasm of a major coronary artery resulting in a high-grade obstruction, and myocardial infarction may develop in some cases. We report a prinzmetal angina which caused ventricular fibrillation and cardiac arrest in an 18-week pregnant woman.