Nurcan Basar

The neutrophil to lymphocyte ratio was associated with impaired myocardial perfusion and long term adverse outcome in patients with ST-elevated myocardial infarction undergoing primary coronary intervention

OBJECTIVES In the present study we aimed to reveal any probable correlation between neutrophil-to-lymphocyte ratio (N/L ratio) and the occurrence of no-reflow, along with assessment of the prognostic value of N/L ratio in patients with ST-segment elevation myocardial infarction (STEMI). BACKGROUND The N/L ratio stands practically for the balance between neutrophil and lymphocyte counts in the body, which can also be utilized as an index for systemic inflammatory status. METHODS In our study, we included 204 consecutive patients suffering from STEMI who underwent primary percutaneous coronary intervention (PCI). Patients with STEMI were assigned into distinct tertiles based on their N/L ratios on admission. No-reflow encountered following PCI was evaluated through both angiography [Thrombolysis in Myocardial Infarction (TIMI) flow and myocardial blush grade (MBG)] and electrocardiography (as ST-segment resolution). RESULTS Patients featured with no ST-resolution were documented to have displayed significantly higher N/L ratio on admission compared to those with intermediate or complete ST-segment resolution. The number of the patients characterized with no-reflow, evident both angiographically (TIMI flow ≤ 2 or TIMI flow 3 with final myocardial bush grade ≤ 2 after PCI) and electrocardiographically (ST-resolution <30%), was encountered to depict increments throughout successive N/L ratio tertiles. Moreover, the same also held true for three-year mortality rates across the tertile groups (9% vs. 15% vs. 35%, p < 0.01). Multivariable logistic regression analysis disclosed that N/L ratio on admission stood for a significant indicator for long-term mortality in patients with no-reflow phenomenon detected with MBG. Elevated N/L ratio on admission was also found to be a significant indicator for three-year mortality and major adverse cardiac events. CONCLUSIONS In patients with STEMI who underwent primary PCI, elevated N/L ratios on admission were revealed to be correlated with both no-reflow phenomenon and long-term prognosis.

Mean platelet volume could be possible biomarker in early diagnosis and monitoring of gastric cancer.

Abstract Gastric cancer is the fourth most frequent cancer and the second cause of cancer-related deaths worldwide. The early diagnosis of gastric cancer is fundamental in decreasing the mortality rates. It has been shown that MPV level is a sign of inflammation in hepatocellular carcinoma and pancreatic adenocarcinoma. The aim of this study is to examine whether MPV would be a useful inflammatory marker for differentiating gastric cancer patients from healthy controls. Thirty-one gastric cancer patients and 31 age-sexes matched healthy subjects included into the study. Patients with hypertension, hematological and renal disease, heart failure, chronic infection, hepatic disorder and other cancer were excluded from the study. MPV level was significantly higher in pre-operative gastric cancer patients compared to healthy subjects (8.31 fL vs. 7.85; p: 0.007). ROC analysis suggested 8.25 fL as the cut-off value for MPV (AUC: 0.717, sensitivity: 61%, specificity: 81%). Surgical tumor resection resulted in a significant decrease in MPV level (8.31 fL vs. 7.55 fL; p: 0.001). No significant difference was found in MPV level between the post-operative group and control subjects. We did not find statistically significant difference between MPV and TNM stages. In conclusion, changes in MPV values may be used as an easily available biomarker for monitoring the healthy patients for GC risk and may prompt physicians to make an early diagnosis of GC.

Increased mean platelet volume in patients with slow coronary flow

Mean platelet volume (MPV) is an indicator of platelet activation, a central process in the pathophysiology of coronary heart disease (CAD). The importance of slow coronary flow (SCF) phenomenon results from its association with angina pectoris, acute myocardial infarction, hypertension and sudden cardiac death. The aim of this study is to evaluate the values of MPV in patients with SCF. MPV was measured in 84 consecutive patients with SCF and 88 patients with CAD and 84 control subjects. The association between thrombolysis in myocardial infarction (TIMI) frame count (TFC) and MPV level and other clinical and laboratory parameters were evaluated. There were no statistically significant differences in MPV between SCF group and CAD group. MPV was significantly higher in patients in the both SCF and CAD groups, compared with control group. The TFC for all the epicardial coronary arteries and the mean TFC were significantly higher in the SCF group than the both CAD group and control group. The mean TFC was positively and moderately correlated with MPV in the whole study population. To determine the independent predictors of mean TFC, a stepwise linear regression analysis was performed by including the parameters that were correlated with the mean TFC in the bivariate analysis. MPV level was the only independent predictor of the mean TFC (b = 0.312, p < 0.001). These findings have shown that MPV level is significantly associated with coronary blood flow and that elevated MPV level might be an independent predictor for the presence of SCF. We believe that further studies are needed to clarify the role of MPV in SCF complicatedCAD, especially in relation to angiographic and clinical parameters, before we conclude that MPV to be used as a follow-up marker during the management of relevant patients.

Elevated Serum Uric Acid Predicts Angiographic Impaired Reperfusion and 1-Year Mortality in ST-Segment Elevation Myocardial Infarction Patients Undergoing Percutaneous Coronary Intervention

Background Serum uric acid (SUA) is associated with microvascular disease that could alter coronary blood flow and prognosis. We evaluated the effects of admission SUA levels on coronary blood flow and prognosis in 185 consecutive patients with ST-segment elevation myocardial infarction (STEMI) who underwent acute primary percutaneous coronary intervention (PCI). Methods Patients undergoing PCI for an acute STEMI were stratified into elevated SUA (>6.5 mg/dL) and normal SUA group (≤6.5 mg/dL). Primary end points were post-PCI myocardial blood flow and in-hospital and 1-year mortality. Results Serum uric acid level was high in 45 patients (24%) on admission. Subjects with elevated SUA had a higher prevalence of hypertension, previous myocardial infarction, multivessel disease, and Killip functional class III or higher. Corrected thrombolysis in myocardial infarction (TIMI) frame count was longer, and mean TIMI myocardial perfusion grade was higher in patients with elevated uric acid compared with controls. Patients with elevated SUA levels had higher in-hospital (6.6% vs 2.8%, P < 0.01) and 1-year mortality (11.1% vs 5.7%, P < 0.01). Major adverse cardiac events were higher in patients with elevated SUA levels both in-hospital (11.1% vs 5.7%, P < 0.01) and at 1 year (17.7% vs 10%, P < 0.05). An elevated admission SUA level also independently predicted both 1-year mortality (odds ratio, 1.41; 95% confidence interval, 1.24-2.69) and abnormal myocardial perfusion detected by TIMI myocardial perfusion grade in STEMI patients undergoing primary PCI (odds ratio, 2.14; 95% confidence interval, 1.17-4.19, respectively). Conclusions Elevated SUA level on admission independently predicts impaired myocardial flow and poor prognosis in STEMI patients undergoing primary PCI.

Increased epicardial fat thickness is associated with low grade systemic inflammation in metabolic syndrome

OBJECTIVES Epicardial fat tissue is a type of visceral adipose tissue that functions as a metabolically active endocrine organ. Most components of metabolic syndrome (MetS), especially visceral obesity, are associated with a low-grade systemic inflammatory state. In this study, we aimed to assess the relationship between echocardiographic epicardial fat thickness (EFT), MetS, the components of MetS, and high sensitivity C-reactive protein (hs-CRP) levels in patients with MetS. STUDY DESIGN Forty-six patients (25 males, mean age 47.3±6.5 years) with the diagnosis of MetS (according to the Adult Treatment Panel III update criteria) but without clinical coronary artery disease, and 44 age and gender matched healthy volunteers (18 males, mean age 46.0±6.1 years) were included in the study. EFT, which was measured by transthoracic echocardiography, as well as clinical and biochemical parameters were compared between the two groups. RESULTS Waist circumference, total and LDL-cholesterol, fasting glucose, triglycerides, systolic and diastolic blood pressure levels, hs-CRP, and uric acid levels were significantly higher in patients with MetS. EFT was also significantly increased in patients with MetS (8.7±0.2 mm vs. 4.8±0.1 mm, p<0.001). Multiple regression analysis determined that MetS itself (ß=0.929, p<0.001) and hs-CRP (r=-0.181, p=0.007) are independent predictors of increased EFT. CONCLUSION This study demonstrates that EFT is higher in patients with MetS, and that MetS and hsCRP are independent predictors of this increased EFT. Increased EFT, which is associated with low-grade systemic inflammation, may play a role in the pathogenesis of atherosclerosis in MetS patients.

Pseudoaneurysm of the mitral-aortic intervalvular fibrosa in a patient with Takayasu's arteritis

An asymptomatic 35-year-old woman with Takayasu’s arteritis, moderate aortic regurgitation, left ventricular (LV) hypertrophy and hypertension was referred to the echocardiography laboratory at the Yuksek Ihtisas Hospital (Ankara, Turkey) for a routine clinical follow-up. Transthoracic echocardiography revealed a suspected aneurysm in the subaortic region adjacent to the left sinus of Valsalva (Figure 1A). Subsequent three-dimensional real-time transthoracic echocardiography clearly demonstrated a pseudoaneurysm in the mitral-aortic intervalvular fibrosa (MAIVF) (Figure 1B). Specific echocardiographic features identified the lesion as a pseudoaneurysm: expansion in systole and collapse in diastole (Figure 1C), and communication between the sac and the LV outflow tract (Figure 1B). Figure 1) A Transthoracic echocardiography showing suspected aneurysm in the subaortic region adjacent to the left sinus of Valsalva (arrowhead). B Three-dimensional, real-time transthoracic echocardiography showing a pseudoaneurysm in the mitral-aortic intervalvular ... The MAIVF is the fibrous junction between the noncoronary and left coronary cusps of the aortic valve and the anterior mitral leaflet (1). Most pseudoaneurysms of the MAIVF form as complications of aortic valve endocarditis or aortic root surgery (2). The prognosis is grave because of the high risks of rupture, peripheral embolization and destruction of the aortic or mitral valves (1–3). Of note, the patient had not undergone cardiac surgery, and tests showed no evidence of infective endocarditis. It is known that a pronounced shear effect on tissues near MAIVF can lead to pseudoaneurysm formation (3). In Takayasu’s arteritis, the MAIVF is exposed to high LV intracavitary pressure due to elevated central aortic pressure. Pseudoaneurysm of the MAIVF is unusual in the setting of Takayasu’s arteritis. Surgical correction is life-saving, so clinicians should keep in mind that such lesions can occur in this patient group. Three-dimensional real-time transthoracic echocardiography is an excellent, noninvasive way to accurately diagnose pseudoaneurysms of the MAIVF.

Lower fetuin-A predicts angiographic impaired reperfusion and mortality in ST-elevation myocardial infarction.

Aims Fetuin-A is an anti-inflammatory negative acute-phase glycoprotein, synthesized by the liver. In this study, we aimed to investigate the effects of admission fetuin-A levels on coronary and myocardial blood flow and short- and long-term prognosis in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention. Methods and Results One hundred eighty consecutive patients admitted with diagnosis of STEMI and 55 healthy age- and sex-matched volunteer controls were enrolled in the study. Patients with STEMI were divided into 2 groups in respect to thrombolysis in myocardial infarction myocardial perfusion grade after primary PCI: with thrombolysis in myocardial infarction myocardial perfusion grade 0-1-2 and thrombolysis in myocardial infarction myocardial perfusion grade 3. Serum levels of fetuin-A were lower in patients with STEMI than in the healthy group subjects. In-hospital and 1-year deaths were significantly higher in patients from the abnormal perfusion group. In-hospital major adverse cardiac event (MACE) and 1-year follow-up MACE also were significantly higher in patients from the abnormal perfusion group. The receiver-operating characteristic analysis indicated an optimal cut point of less than 200 μg/mL, which detects 1-year mortality with a negative predictive value of 95%. The 1-year mortality rate and 1-year MACE were significantly higher in patients with low fetuin-A level as compared with those with high fetuin-A level. Conclusions Because low-admission fetuin-A levels are associated with impaired coronary flow in STEMI patients undergoing primary percutaneous coronary intervention, admission fetuin-A level detection may be helpful in identifying the patients at a greater risk of poor coronary blood flow and worse short- and long-term prognosis.

Impaired coronary flow reserve evaluated by echocardiography is associated with increased aortic stiffness in patients with metabolic syndrome: an observational study.

OBJECTIVE Metabolic syndrome (MetS) is a strong predictor of cardiovascular events and coronary flow reserve (CFR), an indicator of microvascular function, has been found to be impaired in MetS. Aortic stiffness (AS) is a simple and effective method for assessing arterial elasticity. The aim of this study was to evaluate whether there is an independent association of impaired coronary flow and aortic elasticity in patients with MetS. METHODS Forty-six patients (mean age 47.3 ± 6.6 years) with the diagnosis of MetS according to the ATP III update criteria and 44 age and gender matched controls (mean age 46.0 ± 6.1 years) were included into the cross-sectional observational study. Peak diastolic coronary flow velocities were measured in left anterior descending artery by pulsed wave Doppler at baseline and after adenosine infusion, and CFR was calculated as the ratio of hyperemic to baseline velocities. Aortic strain, distensibility and stiffness were calculated by M-mode echocardiography. Statistical analysis was performed by using Student t-test, Chi-square test, Pearson correlation and linear regression analyses. RESULTS CFR was significantly lower in patients with MetS than in controls (2.3 ± 0.2 vs 2.7 ± 0.2, p<0.001). In the MetS group, aortic distensibility (10.4 ± 3.5 cm².dyn⁻¹.10⁻⁶ vs. 12.7 ± 3.4 cm2.dyn⁻¹.10⁻⁶, p=0.002) was decreased and AS was significantly increased (6.5 ± 2.0 vs. 3.2 ± 0.8, p<0.001). In multivariate linear regression analysis, AS (β=-0.217, p=0.047), systolic blood pressure (β=-0.215, p=0.050) and waist circumference (β=-0.272, p=0.012) had an independent relationship with impaired CFR. CONCLUSION This study demonstrated that coronary flow reserve is impaired in patients with MetS and there is an independent relationship between impaired CFR and increased aortic stiffness, systolic blood pressure or waist circumference.

Serum gamma-glutamyl transferase activity increased in patients with coronary artery ectasia.

BackgroundSerum &ggr;-glutamyl transferase (GGT) activity, an enzyme responsible for the extracellular catabolism of antioxidant glutathione, may directly take part in atherogenesis and evolve as a potential biochemical risk indicator of cardiovascular morbidity and mortality. An important characteristic of coronary artery ectasia (CAE) is the fact that in 85% of the cases, atherosclerotic coronary disease accompanies it. The relation between CAE and serum GGT activity has not been studied so far. Hence, we decided to investigate the serum GGT level in patients with CAE. MethodsWe measured serum GGT activity in 88 consecutive patients (48 males) with isolated CAE and 86 patients with coronary artery disease (CAD) and 84 controls. CAE was defined as being without any stenotic lesions with a visual assessment of the coronary arteries showing a luminal dilatation 1.5-fold or more of the adjacent normal coronary segments. Four subgroups were created in accordance with the CAE extension in coronary arteries. ResultsThere were no statistically significant differences in serum GGT activity among CAE and CAD groups. Serum GGT activity was found significantly increased in patients in both CAE and CAD groups, compared with those in control group (P<0.001, P<0.001, respectively). According to the CAE severity, there were no statistically significant differences in CAE among these subgroups. ConclusionWe have shown for the first time that patients with CAE have higher serum GGT activity compared with controls with normal coronary angiograms. Hence, serum GGT activity can be used as a follow-up marker in patients with CAE.

Bronchogenic cyst of interatrial septum.

Bronchogenic cyst, also known as inclusion cyst, is a type of congenital endodermal heterotropia derived from an abnormal development of the ventral diverticulum of the foregut or the tracheobronchial tree during embryogenesis. Its interatrial localization is extremely rare and making a final diagnosis without surgery challenges the clinician. Herein, we report a 58-year-old male patient who had an interatrial bronchogenic cyst related to transient ischemic attack.