Jale Cordan

Evaluation of diastolic dysfunction and repolarization dispersion in Behcet’s disease

Behcets disease is a generalized chronic inflammatory disease characterized by genital, ocular, and cardiovascular involvement. Recently, left ventricular diastolic dysfunction, ventricular arrhythmia and sudden cardiac death have been documented in Behcets disease. From January 1996 to May 1998, we investigated left ventricular systolic and diastolic function, valvular heart disease, ischemic heart disease and repolarization dispersion in 71 cases, 40 men and 31 women (mean age, 36.8+/-10.3 years) with Behcets disease. All of the results were compared with the control group of 33 men and 22 women (mean age, 37.9+/-9.6 years). Exercise stress test or myocardial perfusion scintigraphy was performed for the documentation of ischemia. All the patients and the controls were recorded by M-mode, 2-D and Doppler echocardiography. Ventricular wall thickness, valvular apparatus, left ventricular systolic and diastolic parameters were evaluated. Repolarization dispersion parameters were calculated as the difference between maximal and minimal values of QT from 12-lead electrocardiogram recording at baseline, immediate and end of recovery from the exercise stress tests. The measured parameters were compared with the control group by using statistical methods. In the Behcets group of 22 patients (31%) E/A ratio was <1. In the control group of five cases (10%) E/A ratio was <1 (P=0.003). In the Behcets group isovolumic relaxation time (IRT) and mitral deceleration time (MDT) were longer than the control group (P=0.002, P=0.041, respectively). A mean QT of 368+/-30 ms and mean QT dispersion of 73+/-14 ms in the patient group compared with a mean QT of 395+/-39 ms and mean QT dispersion of 38+/-12 ms in the controls. There was no statistical difference between the mean QT values of the patient and control groups however, ventricular dispersion parameters in the Behcets patients were longer than in the controls (P<0.001). There was also statistical significance for the QT dispersion between the Behcets patients with and without diastolic dysfunction (P<0.01). In conclusion, the study reveals that the patients with Behcets disease have a high incidence of increased diastolic dysfunction and repolarization dispersion. A positive correlation may exist between diastolic dysfunction and QT dispersion.

Effect of N-acetylcysteine on oxidative stress and ventricular function in patients with myocardial infarction.

Recent evidence suggests that postischemic myocardial dysfunction (“stunning”) may be mediated by oxygen free radicals. Various studies have reported the beneficial effects of antioxidants in ischemia–reperfusion injury. The aim of this study was to assess the effect of N-acetylcysteine (NAC) treatment on oxidative stress, infarct size, and left ventricular (LV) function, as adjunct therapy in myocardial infarction (MI). Patients with acute MI received either 15 g NAC infused over 24 h (n = 15) or no NAC (n = 15), combined with streptokinase. Peripheral venous blood was serially sampled to measure creatine kinase (CK)-MB levels. Plasma malondialdehyde (MDA) level was measured at admission and after 4 and 24 h. Echocardiography was performed within 3 days of MI and after 3 months. At admission, plasma MDA levels were not different between the groups. In the NAC-treated patients plasma MDA levels decreased, whereas in the nontreated NAC patients MDA levels increased at 4 and 24 h (P < 0.01 and P < 0.001, respectively). Left ventricular ejection fraction was higher (P < 0.05) and LV end-systolic and end-diastolic diameters were lower (P < 0.001 and P < 0.001) in patients receiving NAC on day 3. Left ventricular wall motion score index was significantly lower in patients treated with NAC on day 3 (P < 0.05). Left ventricular diastolic parameters were not different whether patients were treated with NAC or not. No difference in reduction of infarct size was detected between the groups according to CK-MB levels. It was thus demonstrated that administration of NAC in combination with streptokinase significantly diminished oxidative stress and improved LV function in patients with acute MI. These encouraging results would justify the performance of a larger controlled study.

Procalcitonin in patients with acute coronary syndrome: correlation with high-sensitive C-reactive protein, prognosis and severity of coronary artery disease.

Objectives — The aim of this study is to determine the relation of high-sensitive serum C-reactive protein (hsCRP) and procalcitonin with presence and severity of coronary artery disease and early prognosis in patients with acute coronary syndrome (ACS). Methods and results — Procalcitonin and hsCRP levels were measured at admission and after 48 hours in 50patients (41men, 9 women) with ACS. The patients were assigned to three groups according to their clinical diagnosis: unstable angina pectoris (UAP) (Braunwald III-B), non-ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI). Incidences of adverse cardiac events were recorded in a 3-month follow-up. Coronary angiography was performed to evaluate presence and severity of coronary artery disease. In the groups of STEMI, NSTEMI and UAP, procalcitonin (P=0.013, P=0.045 and P=0.0001, respectively) and hsCRP (P=0.0001, P=0.01 and P=0.001, respectively) levels were significantly increased. No significant correlation was found between these markers and the presence and severity of coronary artery disease.There was no correlation between procalcitonin and hsCRP levels at admission and after 48hours and primary end points after 3months except in the group of UAP with revascularization procedure. In the group of UAP, hsCRP levels at 48hours were found higher in the patients with a revascularization procedure (P=0.04). Conclusions — In conclusion, levels of hsCRP and procalcitonin are increased in patients with ACS but failed to correlate with severity of coronary disease and early prognosis.

The effect of orlistat-induced weight loss on interleukin-6 and C-reactive protein levels in obese subjects.

Objective — Inflammation plays a major role in the pathogenesis of atherosclerosis. Obesity is an independent risk factor for cardiovascular disease, which may be mediated by increased secretion of proinflammatory cytokines by adipose tissue. The aim of this study is to investigate changes in the inflammatory markers interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hs-CRP) during weight reduction with orlistat treatment in obese patients. Methods and results — Thirty-six obese (BMI: 36.1 ± 3.4 kg/m2) and 11 non-obese (BMI: 22.9 ± 1.7 kg/m2) subjects were studied. IL-6 and hs-CRP levels were evaluated at baseline. In obese subjects after treatment of orlistat 120 mg three times daily for 6 months, IL-6 and hs-CRP levels were repeated. Levels of circulating IL-6 (p < 0.05) and hs-CRP (p < 0.01) were significantly higher in the obese group than in the non-obese group. Plasma IL-6 (r = 0.29 and p < 0.05) and CRP (r = 0.35 and p < 0.05) concentrations correlated positively with the level of obesity assessed by BMI at baseline. After 6 months of orlistat treatment in obese subjects, the mean weight of the patients decreased by 6.8 kg, the BMI by 3.2 kg/m2. Compared with baseline, weight loss was associated with significant reductions of IL-6 (p < 0.001) and hs-CRP (p < 0.001) levels. Conclusion — In summary plasma IL-6 and hs-CRP levels were increased in obese patients. Orlistatinduced weight reduction was associated with decreasing levels of both IL-6 and hs-CRP in obese subjects. Because inflammatory mediators may be directly involved in atherogenesis, this would suggest that interventions to reduce IL-6 and CRP levels could be cardioprotective.

A Comparison of Safety and Efficacy of Sublingual Captopril with Sublingual Nifedipine in Hypertensive Crisis.

Sublingual nifedipine is commonly used in hypertensive crisis, however, it may result in several adverse effects such as reflex tachycardia, headache, and flushing. Research is continuing to find a new drug that has the same efficiency and fewer side effects. Sublingual captopril, a new preparation of angiotensin-converting enzyme inhibitor, lowers blood pressure. It is not known whether it is effective in these emergent clinical settings. Therefore we designed a randomized, double-blind study to compare the efficacy and safety of those two drugs in hypertensive crisis. Eighty patients (32 male and 48 female) with hypertensive crisis were included in the study; their mean age was 43.4 ± 7.9 years. Nifedipine 10 mg was given sublingually to 34 and captopril 25 mg to 46 patients randomly. There was no difference between the two drugs with respect to their antihypertensive effect. Heart rate significantly dropped (p<0.01 andp<0.001) in the patients taking captopril, but no changes were observed in the patients taking nifedipine. Twenty-three of 34 patients taking nifedipine encountered adverse effects. Adverse effects were observed in only three patients taking captopril (p<0.001). Sublingual captopril is as effective as and has less side effects than sublingual nifedipine. Because sublingual captopril has fewer side effects, it may be safer than nifedipine in the treatment of hypertensive crisis.

Effects of Origanum onites on Endothelial Function and Serum Biochemical Markers in Hyperlipidaemic Patients

The effects of Origanum onites on endothelial function and antioxidative status were investigated in 48 patients with mild hyperlipidaemia who required no drug therapy. All participants were given lifestyle and low-fat dietary advice, however 32 of the patients (study group) were also prescribed 25 ml of aqueous distillate of Origanum onites to be taken after each meal for 3 months. The remaining 16 patients were the control group. Various biochemical markers and endothelial function parameters were measured at baseline and after 3 months. A significantly greater increase in high density lipoprotein-cholesterol and significantly greater decreases in low density lipoprotein-cholesterol, apolipo-protein B, lipoprotein(a) and high-sensitivity C-reactive protein occurred in the study group compared with the control group over the 3-month study period. Paraoxonase and arylesterase activities, and flow- and nitroglycerine-mediated dilatation of the brachial artery showed significantly greater increases in the study group compared with the changes in the control group. In conclusion, consumption of Origanum onites distillate had beneficial effects on lipid profiles, antioxidant status and endothelial function in patients with mild hyperlipidaemia.

The relationship of serum ferritin with malondialdehyde concentration in patients with coronary artery disease: Ferritin and oxidative stress in CAD

It has been suggested that the risk of coronary heart disease increased with increasing body iron stores. Free iron catalyzes the generation of free radicals and free radicals promote the oxidation of lipids. The aim of this study was to determine the association of serum ferritin levels with coronary artery disease (CAD) and to establish the relation of ferritin to the lipid peroxidation product malondialdehyde (MDA). The study included 188 patients. Thirty-eight patients (mean age: 55±9 years) had angiographically normal coronary arteries and 150 patients (mean age: 54±10 years) had significant stenosis at least in one coronary artery. Serum ferritin, total iron binding capacity (TIBC), MDA levels, lipoprotein variables and CAD risk factors were determined in all patients. Serum ferritin levels were significantly higher in patients with CAD compared with control groups (105±65 ng/ml versus 83±71 ng/ml) (p<0.01). TIBC was lower in patients with CAD (333±62 µg/dl) versus 348±48 µg/dl), (p<0.05). In patients with CAD, serum MDA levels were significantly higher when compared with control groups (8.1±2 nmol/ml versus 5.9±1.8 nmol/ml), (p<0.001). There were positive correlation between ferritin and MDA levels (r=0.20, p=0.02) and negative correlation between TIBC and MDA levels (r=0.22, p=0.001). These findings support the concept that iron, being an important transition metal, might contribute to atherogenesis, along with the classic risk factors. The results are also in agreement with the concept that iron overload would elevate the risk of CAD by promoting the lipid peroxidation.

Cardiac metastasis in a laryngeal carcinoma and associated electrocardiographic changes.

In patients with cancer, metastases to the heart are rare and usually difficult to diagnose unless they cause symptoms. Cardiac metastasis of laryngeal carcinoma is also rarely reported in the literature. This report deals with a 63-year-old male patient with carcinoma of the larynx that involved the heart. The patient presented with chest pain, and the electrocardiogram revealed new ST segment elevation in the precordial leads. The cardiac markers were negative, and the electrocardiogram showed no changes during the course in the cardiology clinic. Although the patient was stable, he had massive hemorrhage at his tracheotomy site and died on the sixth day of hospitalization. A necropsy of the myocardium showed metastasis of squamous cell carcinoma to the heart. We conclude that the electrocardiographic changes in cancer patients during the course of the disease may provide a clue for detection of cardiac involvement. Heart metastasis in cancer patients is rare. When this rare events occurs, diagnoses are usually based on postmortem examinations. However, electrocardiographic changes may serve as a clue for detection of involvement of the myocardium. Here we present a male patient, aged 63 years, with laryngeal carcinoma with heart metastasis, a rare condition reported 3 decades ago by Harrer et al. A male patient aged 63 years was admitted to the emergency clinic because of dull sternal pain, nausea, and diaphoresis that had been present for the preceding 5 hours. His general condition was poor. His blood pressure and pulse rate were 130/80 mm Hg and 90/min, respectively. The presence of tracheotomy and coarse crackles in the lower right lung were remarkable in his lung exam. The patient had completed chemotherapy for squamous cell carcinoma

Effects of fosinopril treatment on blood pressure during physical and mental stress test in essential hypertension.

In this study the effects of once daily administration of 10 mg fosinopril on blood pressure response to mental and physical stress were evaluated in mild to moderate essential hypertension. A total of 25 patients (14 women, 9 men) with mild to moderate essential hypertension were enrolled in this study. Before the treatment and after 10 mg/day fosinopril treatment for 2 months, systolic and diastolic blood pressure and heart rate were recorded at rest and while performing a mental arithmetic test. In addition, exercise stress testing with Bruce protocol were performed before and after the treatment and systolic and diastolic blood pressure and heart rate were recorded at rest and during peak exercise. Statistical analysis were done by using the paired t-test. During the mental arithmetic test, systolic and diastolic blood pressure were significantly reduced (p < 0.005 and p < 0.001, respectively) after 2 months fosinopril treatment. Systolic and diastolic blood pressure were also significantly reduced during the exercise stress test (p < 0.005 and p < 0.05) after the treatment. Heart rate did not change during either the mental arithmetic or the exercise test. As a result, once daily 10 mg fosinopril may be effective in reducing blood pressure, not only at rest, but also during stressful situations.