Ömer Çağlar Yılmaz

Association between gamma-glutamyltransferase and coronary artery calcification

BACKGROUNDnThe exact mechanisms behind the association between atherosclerosis and gamma-glutamyltransferase (GGT) are unclear. Coronary artery calcification (CAC) detected by computerized tomography is an important marker of atherosclerosis and its severity correlates with coronary plaque burden. The aim of this study was to investigate if serum GGT levels are associated with CAC in patients without known coronary heart disease (CHD) who had low-intermediate risk for CHD.nnnMETHODSnTwo hundred and seventy two patients who had low-intermediate risk for coronary artery disease were included in the study. Serum GGT levels were measured spectrophotometrically. CACS (Agatston method) were performed using a 64-slice computerized tomography scanner. The patients were grouped according to their GGT values in four quartiles.nnnRESULTSnPatients in higher GGT quartiles had elevated CAC score (P<0.001). Patients in higher GGT quartiles were predominantly males (P<0.001) and were more likely to be smoking (P=0.004), and have elevated uric acid (P<0.001), fasting blood glucose (P<0.001), CRP levels (P=0.003) and 10-year total cardiovascular risk (P=0.007) and low HDL levels (P<0.001). Positive correlations were found between log GGT and CAC (r=0.233, P<0.001). In the multivariate analysis GGT, age, smoking and serum uric acid levels appeared as independent factors predictive of presence of CAC.nnnCONCLUSIONSnWe demonstrated a significant correlation between serum GGT levels and CAC and CHD risk factors. Serum GGT level was an independent marker of CAC.

Serum uric acid level is an independent risk factor for presence of calcium in coronary arteries: an observational case-controlled study.

OBJECTIVEnA link between uric acid levels and cardiovascular diseases has been previously reported. Coronary artery calcium score (CACS) is a marker of atherosclerotic disease and a predictor of cardiovascular events. We sought to determine if serum uric acid level is an independent risk factor for the presence of calcium in coronary arteries.nnnMETHODSnFour hundred and forty-two patients who were evaluated in the cardiology outpatient clinic for suspected coronary heart disease with a low-moderate risk for coronary artery disease were included in this observational case-controlled study. Serum uric acid levels were measured with colorimetric methods. CACS were performed using a 64-slice CT scanner. Patients were divided to 3 groups according to their CACS value (Group 1: CACS=0, Group 2: CACS 1-100, Group 3: CACS>100).nnnRESULTSnThe demographical characteristics and laboratory findings of 3 groups were similar, except age, fasting glucose levels and serum uric acid levels. Serum uric acid levels were found to increase significantly with increasing CACS (p=0.001). Patients were grouped according to presence CAC (CACS=0 and CACS≥1) and in the multiple regression analysis, age (OR, 1.11, 95% CI, 1.07-1.16), smoking (OR, 3.83, 95% CI, 2.06-7.09), serum uric acid levels (OR, 1.26, 95% CI, 1.04-1.54) and average 10-year total risk of Framingham risk score (OR, 1.13, 95% CI, 1.04-1.09) appeared as independent factors predictive of presence of CAC (p<0.05).nnnCONCLUSIONnSerum uric acid level is an independent risk factor for presence of coronary calcium. Moreover, increasing levels of serum uric acid are associated with increasing CACS.

Epicardial adipose tissue and pericoronary fat thickness measured with 64-multidetector computed tomography: potential predictors of the severity of coronary artery disease

OBJECTIVE: The aim of the present study was to investigate the relationship between pericoronary fat and the severity and extent of atherosclerosis, quantified using 64-multidetector computed tomography, in patients with suspected coronary artery disease. METHODS: The study population consisted of 131 patients who were clinically referred for noninvasive multislice computed tomography coronary angiography for the evaluation of coronary artery disease. Patients were classified as follows: no atherosclerosis, Group 1; nonobstructive atherosclerosis (luminal narrowing <50% in diameter), Group 2; and obstructive atherosclerosis (luminal narrowing ≥50%) in a single vessel or obstructive atherosclerosis in the left main coronary artery and/or multiple vessels, Group 3. Epicardial adipose tissue was defined as the adipose tissue between the surface of the heart and the visceral layer of the pericardium (visceral epicardium). Epicardial adipose tissue thickness (mm) was determined in the right ventricular anterior free wall. The mean thickness of the pericoronary fat surrounding the three coronary arteries was used for the analyses. RESULTS: The average thickness over all three regions was 13.2 ± 2.1 mm. The pericoronary fat thickness was significantly increased in Group 3 compared with Groups 2 and 1. The epicardial adipose tissue thickness was significantly increased in Group 3 compared with Groups 2 and 1. A receiver operating characteristic curve for obstructive coronary artery disease was assessed to verify the optimum cut-off point for pericoronary fat thickness, which was 13.8 mm. A receiver operating characteristic curve for obstructive coronary artery disease was also assessed to verify the optimum cut-off point for epicardial adipose tissue, which was 6.8 cm. CONCLUSION: We showed that the epicardial adipose tissue and pericoronary fat thickness scores were higher in patients with obstructive coronary artery diseases.

Association between Red Blood Cell Distribution Width and Coronary Artery Calcification in Patients Undergoing 64-Multidetector Computed Tomography

Background and Objectives The red blood cell distribution width (RDW) has been found to be associated with cardiovascular morbidity and mortality. The objective of this study was to determine whether the RDW measures are associated with the coronary artery calcification score (CACS) in patients who did not present with obvious coronary heart disease (CHD). Subjects and Methods A total of 527 consecutive patients with a low to intermediate risk for CHD but without obvious disease were enrolled in this study. The study subjects underwent coronary computerized tomography angiography and CACS was calculated. The patients were divided into two groups based on CACS: Group I (CACS≤100) and Group II (CACS>100). The two groups were compared in terms of classic CHD risk factors and haematological parameters, particularly the RDW. Results Group I patients were younger than Group II patients. The Framingham risk score (FRS) in patients of Group II was significantly higher than that in patients of Group I. Group II patients had significantly elevated levels of haemoglobin, RDW, neutrophil count, and neutrophil/lymphocyte ratio compared with Group I patients. CACS was correlated with age, RDW, and ejection fraction. In the multivariate analysis, age, RDW, and FRS were independent predictors of CACS. Using the receiver-operating characteristic curve analysis, a RDW value of 13.05% was identified as the best cut-off for predicting the severity of CACS (>100) (area under the curve=0.706). Conclusion We found that the RDW is an independent predictor of the CACS, suggesting that it might be a useful marker for predicting CAD.

Cardiac flow parameters with conventional and pulsed tissue Doppler echocardiography imaging in patients with polycystic ovary syndrome

Background.u2003Polycystic ovary syndrome (PCOS) is independently associated with the major cardiovascular risk factors. The aim of this study was to examine the echocardiographic profiles of patients with PCOS using conventional echocardiographic methods and tissue Doppler imaging. Methods.u2003For this study, we have registered 48 women with PCOS and 21 healthy control subjects who were mathced with respect to age and body mass index. Standard two-dimensional and M-mode measurement, transmitral valve flows and tissue Doppler imaging of mitral and tricuspid anulus were recorded. Results.u2003In PCOS and control groups, left ventricular and atrium diameters, ejection fraction, mitral E/A ratio, deceleration time and isovolumic relaxation time were similar. There were no significant differences between patients with PCOS and control subjects with respect to tissue Doppler profiles. Conclusion.u2003Patients with PCOS execute echocardiographic measures of cardiac function that are similar to those of healthy women.

Double right coronary artery: a report of two cases

Coronary artery anomalies are usually incidentally diagnosed at the time of coronary angiography or autopsy. In a large series of 70,850 patients undergoing coronary angiography, the incidence of coronary anomalies was found to be 0.24–1.3%. The majority of these were reported to be anomalies of origin or distribution, with separate ostia of the left anterior descending artery and left circumflex artery being the most common.1 Although many of the primary congenital coronary anomalies are hemodynamically insignificant, it is important to know the anatomic variants in patients with coronary artery disease who are undergoing either surgical myocardial revascularization or coronary angioplasty.2 Double right coronary artery is a very rare coronary abnormality that is generally considered benign. n nIn this report, we present two cases of double right coronary artery (RCA). n nCase Report 1 nA 40-year-old woman was admitted to our center with dyspnea. She had been experiencing shortness of breath and dyspnea on exertion for two months. Her risk factors for coronary artery disease included a history of diabetes mellitus and a family history of premature atherosclerotic heart disease. Her physical examination was unremarkable; cardiac and lung auscultations were normal. Her blood pressure was 125/80 mmHg and pulse was 64 beats/min. The chest X-ray was normal. Routine blood and biochemical laboratory tests were nonspecific and nondiagnostic. n nThe electrocardiogram showed a sinus rhythm with clearly negative T waves in D2–D3 and aVF. An exercise stress test showed ST-segment depression in the inferior leads at peak exercise, which was asymptomatic. The patient underwent selective left and right coronary artery angiography. The left coronary angiography revealed a normal origin and course of the left main artery (LM), the left circumflex artery (LCx) and the left anterior descending (LAD) arteries. The LCx and LAD arteries were normal. The right coronary angiography revealed two different right coronary arteries arising from a common ostium in the right coronary sinus. Both coursed along the atrioventricular groove and terminated via individual posterior descending arteries (PDA) (Figure 1). Both arteries were free of any angiographically identifiable atherosclerotic lesion. n n n nFigure 1 n nLeft anterior oblique view showing a double right coronary artery. n n n n nCase Report 2 nA 66-year-old woman was admitted to our center with chest pain. She was complaining of angina and dyspnea on exertion lasting one week. Her risk factors for coronary artery disease included a history of diabetes mellitus and hypertension. The physical examination was completely normal. Cardiac enzymes and troponin–T were also found to be normal. n nThe patient underwent selective left and right coronary artery angiography. The left coronary arteries were of normal origin and distribution. The right coronary angiography revealed two separate RCAs originating from a single ostium in the right sinus of Valsalva. Both RCAs gave off branches with typical courses and in parallel distribution (Figure 2). Both arteries were free of any angiographically identifiable atherosclerotic lesion. n n n nFigure 2 n nSelective right coronary angiography (left anterior oblique projection). n n n n n nDISCUSSION nCoronary anomalies are incidentally detected during routine coronary angiography. Congenital coronary anomalies are seen in approximately 1% of adult patients.3 Double RCA is a very rare type of coronary abnormality. There was no mention of this anomaly in a series of 126,595 patients who underwent coronary angiography.3 n nThe first report about double RCA anomaly in the literature was by Barthe et al.4 They observed double RCA originated from one ostium. The vessels were within the right atrioventricular groove. After the origin of a conus artery and a ventricular branch, the most anterior RCA descended toward the acute margin of the heart and terminated in a small posterior descending artery. The second RCA terminated in a small posterior descending and posterolateral branches. In our cases, both right coronary arteries were almost identical in size and both gave rise to a PDA. n nThe correct diagnosis of double RCA is not easily made based on conventional coronary angiography because it is difficult to distinguish this variation from that of a high takeoff of a large right ventricular branch. This alternative diagnostic possibility creates uncertainty in making the correct diagnosis of double RCA.5 n nThough double RCA is a relatively rare entity, it is not necessarily benign, as it has been associated with atherosclerosis, life-threatening arrhythmia and myocardial infarction.6,7,8 However, our patients’ coronary arteries were free of atherosclerotic lesions. In the absence of atherosclerotic stenosis, ischemia can be a result of anatomical malformations, including an acute takeoff angle of the anomalous vessel, myocardial squeezing, vasospasm and a small artery.1 n nIn these cases, double RCAs were identified as isolated coronary anomalies. Two previous studies have reported double RCA in combination with other anomalies.9,10 Double RCA has been reported 18 studies and in 20 cases.11 Interestingly, 12 of these cases were identified in the Turkish population. This suggests that certain coronary artery anomalies may be associated with a particular genetic background. The double RCA anomaly is seen mostly in males, as are other congenital coronary anomalies, though our patients were both female.12 n nIn conclusion, although double right coronary artery is a rare anomaly, every operator should be familiar with it in order to perform an adequate examination.

Effects of Helicobacter pylori eradication on proteinuria: a prospective study

SummaryBackgroundHelicobacter pylori is one of the most common bacterial infections, seen in humans worldwide and its possible relationship to different diseases is a focus of attention nowadays. The aim of this study was to analyse the effects ofH. Pylori eradication on proteinuria.MethodsNinety-nine patients suffering from dyspeptic complaints were recruited in this prospective study. The patients were divided into two groups according to the presence ofH. pylori infection. Thus, a total of 67xa0H. pylori positive and 32xa0H. pylori negative patients were studied. TheH. pylori positive patients’ group was divided into two groups according to response toH. pylori eradication treatment. A total of three groups were formed, viz; group 1 comprises of patients who areH. pylori positive and responds positively toH. pylori eradication therapy, group 2 comprises of patients who areH. pylori positive and responds negatively toH. pylori eradication therapy and group 3 is the control group and comprises of patients that areH. pylori negative. Urine samples to obtain the protein/creatinine ratio were collected initially and at the end of the study from all patients.ResultsMean difference levels (pre- and post-treatment difference) of urine protein/creatinine ratio was 0.055u2009±u20090.13 in group 1. The ratio was −u20090.0007u2009±u20090.0067 in group 2 and −u20090.0022u2009±u20090.008 in group 3. A statistically significant difference was found in group 1 compared to the other groups in terms of mean difference levels of protein/creatinine ratios (pu2009<u20090.001).ConclusionAs a result of our study, treatment ofH. pylori eradication significantly reduced the proteinuria within the normal limits.ZusammenfassungHintergrundHelicobacter pylori ist weltweit eine der häufigsten bakteriellen Infektionen beim Menschen. Immer mehr Aufmerksamkeit wird heutzutage einem möglichen Zusammenhang mit verschiedenen anderen Erkrankungen gewidmet. Ziel der vorliegenden Studie war es, die Wirkung einer HP Eradikation auf die Proteinurie zu analysieren.Methodik99 Patienten mit dyspeptischen Beschwerden wurden für diese Studie rekrutiert. Die Patienten wurden in 2 Gruppen je nach Nachweis eines HP geteilt. So wurden 67 HP positive und 32 HP negative Patienten untersucht. Die HP positiven Patienten wurden entsprechend dem Ansprechen auf die Eradikationstherapie unterteilt. Insgesamt wurden somit 3 Gruppen gebildet: Gruppe 1: HP positive Patienten, die auf die Therapie ansprachen; Gruppe 2: HP positive Patienten, die nicht ansprachen, und Gruppe 3: HP negative Patienten (die als Kontrolle dienten). Harnproben zur Analyse des Protein/Kreatinin Quotienten (P/K Qu) wurden initial und am Ende der Studie von allen Patienten gesammelt.ErgebnisseDie P/K Qu Werte der mittleren Differenz vor und nach Therapie lagen bei 0.055u2009±u20090.13 in Gruppe 1. Der Quotient war bei −u20090.0007u2009±u20090.0067 in Gruppe 2 und bei −u20090.0022u2009±u20090.008 in Gruppe 3. Ein statistisch signifikanter Unterschied wurde bezüglich der mittleren Differenzen der P/K Qu in Gruppe 1 im Vergleich zu den anderen Gruppen gefunden (pu2009<u20090,001).SchlussfolgerungEine erfolgreiche Eradikation von HP reduziert die Eiweißausscheidung innerhalb des Normalbereichs signifikant.

Response letter to 'Uric acid: A crucial marker of coronary artery calcium score?'

The letter by Yildiz [1] addresses an important issue regarding the relation between serum uric acid levels and coronary artery calcification (CAC). We are grateful for the enlightening and inspiring comments on our manuscript [2]. In our study [2] we showed that, GGT, age, smoking and serum uric acid levels appeared as independent factors predictive of the presence of coronary artery calcium score (CACS) in patients without known coronary heart disease (CHD) who had low-intermediate risk for CHD. The relation between CHD and uric acid is well known and recently a meta-analysis showed that hyperuricemia may increase the risk of CHD events, independently of traditional CHD risk factors [3] as pointed by Yildiz et al. [1]. There are contradicting data about the relation between CACS and serum uric acid levels. Previously some studies demonstrated a relation between CACS and serum uric acid levels [4–6] but one large scale study did not support these findings [7] as pointed by Yildiz et al. [1]. In another study, we demonstrated that serum uric acid level, age, smoking and Framingham risk score are independent risk factors for the presence of CAC in patients with a low-intermediate risk for coronary artery disease (unpublished data). We found a linear relationship between serum uric acid levels and CACS. The mechanisms behind the association between uric acid and CAC are still not fully explained. However, we think that, uric acid should be considered as an additional risk factor beyond traditional risk factors for coronary artery disease.

Frequency of sublingual nitroglycerin prescription in patients with coronary artery disease and angina and awareness of patients about the shelf life of the drug

OBJECTIVESnACC/AHA/ESC guidelines recommend sublingual nitroglycerin (SNG) in patients with stable angina pectoris and coronary artery disease (CAD). However, the shelf life of SNG following first use is six months for SNG tablets and two years for SNG sprays. We investigated the frequency of prescription of SNG tablets/sprays in patients having anginal symptoms and documented CAD and the awareness levels of patients about appropriate use of SNG.nnnSTUDY DESIGNnThree hundred patients (201 men, 99 women; mean age 61.7±10.8 years) with documented CAD and angina were enrolled into this study. Angina pectoris was categorized according to the functional classification system of the Canadian Cardiovascular Society. Data on cardiovascular past histories, risk factors, medications, and the use of SNG were recorded.nnnRESULTSnAt least one risk factor was present in 96% of the patients. Only 46% of the patients had a prescription for SNG. Of those with a prescription of SNG tablet and spray, 91.8% and 84.4% did not know the shelf life of the product, respectively. Of those who were routinely carrying SNG, 35.6% had an expired product. Of those with a prescription of SNG, only 65.9% were informed by the physician on the proper use of SNG.nnnCONCLUSIONnOur results show that, despite recommendations of the guidelines, SNG is not prescribed to a substantial percentage of patients with CAD and angina, a considerable fraction of patients carry an expired product, and that patients are not adequately informed by the physicians on the use of SNG. These problems will certainly affect the optimal medical management of CAD and its efficacy.