Mehmet Dogan

Decreased plasma concentrations of adiponectin in patients with slow coronary flow

Adiponectin has multiple protective effects on vascular endothelium through anti-inflammatory and anti-atherogenic properties. Recent data suggested that endothelial activation and inflammation may contribute to the pathogenesis of slow coronary flow (SCF). Therefore, we investigated whether adiponectin plasma concentrations were decreased in patients with SCF compared to subjects with normal coronary flow. The study population consisted of 35 patients with angiographically documented SCF in all three coronary arteries and 35 sex- and age-matched cases with normal coronary flow. Coronary flow rates of all participants were determined by Thrombolysis in Myocardial Infarction (TIMI) frame count. Plasma adiponectin concentrations were measured by an enzyme-linked immunosorbent assay method using commercially available adiponectin kits. There were no statistically significant differences between the patients with SCF and the subjects with normal coronary flow in terms of demographic characteristics and cardiovascular risk factors (P > 0.05). Plasma adiponectin concentrations of patients with SCF were found to be significantly lower than those with normal coronary flow (4.77 ± 3.86 mg/ml vs 10.8 ± 6.60 mg/ml, P = 0.001, respectively). Plasma adiponectin levels were correlated significantly and inversely with mean TIMI frame count in patients with SCF (r = −0.441, P = 0.008). Furthermore, the Receiver Operator Characteristics curve of adiponectin concentrations showed that an adiponectin <4.6 mg/ml is associated with SCF with a sensitivity of 68.6%, specificity of 82.9%, positive predictive value of 80.0%, and negative predictive value of 72.5%. Our findings suggest that endothelial inflammation may play a role in the pathogenesis of SCF phenomenon.

Impact of plasma adiponectin levels to the presence and severity of coronary artery disease in patients with metabolic syndrome.

ObjectivesAdiponectin is thought to serve a protective function for the coronary endothelium by inhibiting many of the crucial steps in atherosclerotic process. Previous research has indicated an increased risk of coronary artery disease (CAD) in patients with metabolic syndrome (MetS). The objective of this study was to investigate whether plasma adiponectin concentrations were associated with the presence and severity of CAD in patients with MetS undergoing coronary angiography. MethodsWe measured plasma adiponectin levels in 167 consecutive patients with MetS undergoing coronary angiography. The severity of coronary atherosclerosis was defined by using Gensini score system. ResultsCAD was found in 70.1% of the patients. Patients with significant CAD had lower plasma adiponectin concentrations than those without CAD (4.14±3.83 vs. 8.94±6.63 μg/ml, P<0.001). Multiple regression analysis demonstrated that plasma adiponectin level was independently associated with CAD (odds ratio: 0.86; 95% confidence interval: 0.78–0.94; P=0.001). Plasma adiponectin levels were inversely related to the Gensini score (ρ: −0.480, P<0.001) and predicted the severity of coronary atherosclerosis independent of other risk factors (&bgr;: −0.054; 95% confidence interval: −0.074–−0.034; P<0.001). ConclusionsThese findings suggest that hypoadiponectinemia may play a role in the development of coronary atherosclerosis and the observation of adiponectin levels may be indicative of the presence of significant CAD in patients with MetS.

Neutrophil–Lymphocyte Ratio May Predict Left Atrial Thrombus in Patients With Nonvalvular Atrial Fibrillation

Objective: Neutrophil–lymphocyte ratio (NLR) has been associated with poor outcomes in patients with cardiovascular diseases. We aimed to compare NLRs among patients with nonvalvular atrial fibrillation (AF) with or without left atrial (LA) thrombus. Methods: A total of 309 (70.1 ± 9.8 years, 49% male) patients with nonvalvular AF have undergone transoesophageal echocardiography (TEE) to assess the presence of LA thrombus. Baseline NLR was measured by dividing neutrophil count to lymphocyte count. Results: Left atrial thrombus was detected in 32 (10.3%) of 309 patients. Mean NLR (2.2 ± 1.0 vs 2.7 ± 1.1, P = .026) was significantly higher among patients with LA thrombus compared to patients without LA thrombus. On multivariate analysis, NLR (odds ratio 1.59, 95% confidence interval 0.87-4.18; P < .02) was an independent risk factor for the presence of LA thrombus in patients with nonvalvular AF. Conclusion: Neutrophil–lymphocyte ratio, an emerging marker of inflammation, was independently associated with the presence of LA thrombus in patients with nonvalvular AF.

P-Wave dispersion increases in prehypertension

Background. Prolongation of P‐wave durations and increased P‐wave dispersion are independent predictors of atrial fibrillation (AF). AF is the most common arrhythmia of the general population. Prehypertension, including those with systolic blood pressure ranging from 120–139 mmHg or diastolic blood pressure ranging from 80–89 mmHg was described by JNC7. Prehypertension is the predictor of development of hypertension in the future. Prehypertension is associated with excess cardiovascular morbidity and mortality. In this study, we evaluated relationship between prehypertension and P‐wave dispersion. Methods. Seventy‐eight prehypertensive patients (group 1: mean age 44.6±11.2 years; 45 male) and 78 normotensive patients (group 2: mean age 43.3±7.0 years; 43 male) were enrolled in this study. Standard 12‐lead ECGs were recorded in all patients using a paper speed of 50 mm/s. In all patients, transthoracic echocardiographic examination was performed. Results. Pmax and P‐wave dispersion were significantly higher in group 1 compared with group 2 (103.59±19.8 ms vs 93.59±13.4 ms, p<0.001; 50.51±18.6 ms vs 39.85±10.6 ms, p<0.001, respectively). Conclusion. Pmax and P‐wave dispersion increase in prehypertensive patients compared with normotensive patients. This data might show increased risk of AF in prehypertension.

Platelet to Lymphocyte Ratio Can be a Predictor of Infarct-Related Artery Patency in Patients With ST-Segment Elevation Myocardial Infarction.

Patency of infarct-related artery (IRA) in patients with ST-segment elevation myocardial infarction (STEMI) before primary percutaneous coronary intervention (pPCI) is associated with lower mortality and better clinical outcome. However, there were little data regarding the predictors of IRA patency before pPCI in the setting of STEMI. We aimed to assess the association of platelet to lymphocyte ratio (PLR) with IRA patency in STEMI. A total of 452 patients were enrolled and categorized as occluded or patent IRA. Patency IRA was assessed by the thrombolysis in myocardial infarction (TIMI) flow grade. Blood samples were obtained on admission to calculate PLR. Of all patients, 92 (20.4%) patients revealed pre-pPCI TIMI 3 flow in IRA. The PLR was significantly higher in occluded IRA group (138.4 ± 51.4 vs 95.4 ± 43.5, P < .001). Glucose, troponin I, and neutrophil to lymphocyte ratio (NLR) levels were also higher in occluded IRA group (P < .05). Multivariate regression analysis demonstrated the PLR (odds ratio [OR]: 0.987; 95% confidence interval [CI]: 0.978-0.995, P = .002) and NLR (OR: 0.758; 95% CI: 0.584-0.985, P = .038) on admission as independent predictors of IRA patency. In conclusion, a higher PLR is a powerful and independent predictor of IRA patency in patients with STEMI before pPCI.

Coronary embolism causing non-ST elevation myocardial infarction in a patient with paroxysmal atrial fibrillation: Treatment with thrombus aspiration catheter

Coronary embolism is an uncommon cause of acute coronary syndromes and there is no standard recommended therapeutic algorithm for this rare entity. Herein, we present a 69-year-old female patient diagnosed with non-ST elevation myocardial infarction due to coronary embolism secondary to paroxysmal atrial fibrillation. Considering the clinical characteristics of the patient and also no evidence of atherosclerotic basis for the lesion on the coronary angiogram, thrombus aspiration was decided to be the optimal treatment for this case. She underwent a successful thrombus aspiration procedure and followed by long-term oral anticoagulant therapy with warfarin.

Association Between Platelet to Lymphocyte Ratio and Saphenous Vein Graft Disease

Atherosclerosis plays an important role in saphenous vein graft disease (SVGD). Previous trials showed that inflammatory blood cells play a role in this process. The platelet to lymphocyte ratio (PLR) has been proposed as a novel predictor for cardiovascular risk and indicator of atherosclerosis. The aim of this study was to assess the relationship between SVGD and PLR. A total of 220 patients with SVG were enrolled (n = 87 with SVGD and n = 133 with patent SVG). A ≥50% stenosis within the SVG was defined as clinically significant. Median PLR (P < .001) and mean platelet volume (MPV; P = .043) were significantly higher in patients with SVGD. Also, PLR showed significantly positive correlation with age of SVG (P < .05). Median age of SVGs was also higher in the SVGD group (P = .025). In multivariate logistic regression analyses, the PLR and MPV were independent predictors of SVGD. Using a cutoff level of 106.3, the PLR predicted SVGD with a sensitivity of 87.4% and a specificity of 80.3%. To the best of our knowledge, this study showed, for the first time, that PLR was independently associated with SVGD. Both PLR and MPV might predict SVGD.

Relationship Between Neutrophil-to-Lymphocyte Ratio and Saphenous Vein Graft Disease in Patients With Coronary Bypass

Purpose: In this study, we aimed to investigate the relationship between saphenous vein graft disease (SVGD) and neutrophil-to-lympocyte ratio (NLR) with other possible confounding factors. Methods: A total of 120 patients were enrolled into the present study. Of all participants, 40 patients were with SVGD and 80 of them were with patent SVG. Results: The NLR, white blood cell (WBC) count, age of SVG, red cell distribution width (RDW), and mean platelet volume were significantly higher in the SVGD group. In regression analysis, NLR, WBC, RDW, and age of SVG remained as independent predictors of SVGD. Conclusion: To our knowledge, we showed for the first time that NLR is independently associated with SVGD. It can be easily used in this era, because it is easily available, widely used, and relatively cheap. Besides NLR, WBC count, SVG age, and RDW can also be used to predict SVGD.

Can Admission Neutrophil to Lymphocyte Ratio Predict Infarct-Related Artery Patency in ST-Segment Elevation Myocardial Infarction.

Objectives: In this study, we aimed to investigate the relationship between neutrophil to lymphocyte ratio (NLR) and infarct-related artery (IRA) patency in patients with ST-segment elevation myocardial infarction (STEMI). Methods: A total of 349 patients with STEMI were recruited to this retrospective study. Baseline characteristics were reviewed. Patency of IRA was evaluated by thrombolysis in myocardial infarction flow grade. Results: Of all patients, 293 patients formed the occluded IRA group and 56 patients formed the patent IRA group. The NLR was significantly higher in occluded IRA group (4.4 ± 4.1 vs 1.9 ± 1.1, P < .001). Glucose levels were also higher in occluded IRA group (171.3 ± 78.0 vs 144.7 ± 49.7, P = .022). Regression analysis demonstrated admission NLR and plasma glucose levels as independent predictors of IRA patency. Conclusion: In this study, we found that admission NLR and glucose levels were higher in patients with occluded IRA than in patients with STEMI. We also found that NLR and glucose levels were independent predictors of IRA patency. Because hemogram is a cheap, fast, and widely available test, it can be used in daily practice as a predictor of IRA patency.

Relationship between neutrophil to lymphocyte ratio and slow coronary flow.

Objectives: We evaluated the relationship between neutrophil to lymphocyte ratio (NLR) and slow coronary flow (SCF). Methods: A total of 180 participants were recruited to the present study. Of all the participants, 82 patients were with SCF and 98 participants were with normal coronary arteries. Basal characteristics were recorded. Coronary flow was quantified by thrombolysis in myocardial infarction frame count. Results: Basal characteristics were similar between the 2 groups. The NLR was significantly higher in the SCF group when compared to the control group (2.3 ± 0.8 and 1.5 ± 0.4 respectively, P < .001). In multiple logistic regression analysis, NLR remained as the independent predictor of SCF (P < 0.001). Conclusions: Our findings showed that NLR was significantly higher in the SCF group when compared to the control group with normal coronary arteries. We also showed that NLR was related to the presence of SCF rather than the extent of SCF. Besides these findings, we also showed the NLR as an independent predictor of SCF.