Seckin Satilmis

Relation of red cell distribution width to contrast-induced acute kidney injury in patients undergoing a primary percutaneous coronary intervention.

Background and aimWe investigated the utility of the preprocedural red cell distribution width (RDW) for predicting contrast-induced acute kidney injury (CI-AKI) in patients with ST-segment-elevation myocardial infarction (STEMI) who underwent a primary percutaneous coronary intervention. Materials and methodsA total of 630 consecutive patients who were routinely referred to coronary angiography for STEMI were included in the present study. ResultsCI-AKI was observed in 79 patients (12.5%). The RDW, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and the mean platelet volume were significantly higher in the CI-AKI group than in the non-CI-AKI group (P<0.001, P=032, P=0.025, and P=0.039, respectively). Serum total bilirubin and direct bilirubin levels were not different among the study groups. Using multivariate logistic regression analysis, we found that left ventricular ejection fraction [odds ratio (OR)=0.972, 95% confidence interval (CI) 0.945–0.998, P=0.033], estimated glomerular filtration rate (OR=0.970, 95% CI 0.959–0.981, P<0.001), contrast volume (OR=1.007, 95% CI 1.002–1.012, P=0.009), and RDW (OR=1.406, 95% CI 1.120–1.792, P=0.005) were independent predictors of CI-AKI. ConclusionRed blood cell distribution width, an inexpensive and easily measurable laboratory variable, is associated independently with the development of CI-AKI. Our data suggest that RDW may be a useful marker in CI-AKI risk stratification.

The effect of rosuvastatin and atorvastatin on erectile dysfunction in hypercholesterolaemic patients

BACKGROUND AND AIM The aim of this study was to evaluate the effect of atorvastatin and rosuvastatin on erectile dysfunction in hypercholesterolaemic patients. METHODS Ninety consecutive male hypercholesterolaemic patients (mean age 50.4 ± 7.9 years) who were otherwise healthy were included into the study prospectively. None of the patients had any cardiovascular risk factors except hypercholesterolaemia.The patients were divided into two groups. One group received atorvastatin while the other group was given rosuvastatin. All patients were followed for six months and International Index of Erectile Function-5 (IIEF-5) score and blood samples were re-evaluated. RESULTS Patients were in similar ages in both groups. There were also no statistical differences in terms of blood glucose levels, total cholesterol, low density lipoprotein, high density lipoprotein, triglyceride and mean IIEF score in both groups at the beginning. After six months, no IIEF score changes were observed in the rosuvastatin group after the medication. However, the IIEF score was significantly lower in the atorvastatin group (p = 0.019). CONCLUSIONS Rosuvastatin showed no effect on erectile dysfunction, while we observed increased erectile dysfunction with atorvastatin. Our study reveals that different statin types may have different effects on erectile dysfunction.

The Relationship Between Gamma-Glutamyl Transferase Levels and Coronary Plaque Burdens and Plaque Structures in Young Adults With Coronary Atherosclerosis

Elevated gamma‐glutamyl transferase (GGT) levels have been demonstrated to be associated with poor prognoses in patients with coronary artery disease. Coronary computed tomography angiography (CCTA) is a noninvasive imaging modality that may differentiate the structure of coronary plaques. Elevated plaque burdens and noncalcified plaques, detected by CCTA, are important predictors of atherosclerosis in young adults.

Association between serum vitamin D levels and subclinical coronary atherosclerosis and plaque burden/composition in young adult population

Evidence suggests that low 25-OH vitamin D 25(OH)D concentrations may increase the risk of several cardiovascular diseases such as hypertension, peripheral vascular disease, diabetes mellitus, obesity, myocardial infarction, heart failure and cardiovascular mortality. Recent studies suggested a possible relationship between vitamin D deficiency and increased carotid intima-media wall thickness and vascular calcification. We hypothesized that low 25(OH)D may be associated with coronary atherosclerosis and coronary plaque burden and composition, and investigated the relationship between serum vitamin D levels and coronary atherosclerosis, plaque burden or structure, in young adult patients by using dual-source 128x2 slice coronary computed tomography angiography (CCTA). We included 98 patients with coronary atherosclerosis and 110, age and gender matched, subjects with normal findings on CCTA examinations. Patients with subclinical atherosclerosis had significantly higher serum total cholesterol, triglycerides, hs-CRP, uric acid, HbA1c and creatinine levels and lower serum 25(OH)D levels in comparison with controls. There was no significant correlation between 25(OH)D and plaque morphology. There was also a positive relationship between 25(OH)D and plaque burden of coronary atherosclerosis. In multivariate analysis, coronary atherosclerosis was associated high hs-CRP (adjusted OR: 2.832), uric acid (adjusted OR: 3.671) and low 25(OH)D (adjusted OR: 0.689). Low levels of 25(OH)D were associated with coronary atherosclerosis and plaque burden, but there was no significant correlation between 25(OH)D and plaque morphology.

Evaluation of lipoprotein-associated phosholipase A2 and plaque burden/composition in young adults.

ObjectiveThe total burden of subclinical coronary atherosclerosis is significant in young adults. Serum lipoprotein-associated phospholipase A2 (Lp-PLA2) is an established predictor of morbidity and mortality because of cardiovascular disease. The aim of the present investigation was to evaluate the relationship between subclinical coronary atherosclerosis and serum Lp-PLA2 concentrations in a population of young adults. Patients and methodsA total of 261 individuals younger than 45 years of age who had undergone coronary computed tomography angiography were evaluated. The study group included 101 patients in whom coronary computed tomography angiography detected subclinical coronary atherosclerosis; the control group included 160 sex-matched and age-matched healthy control patients. ResultsSerum Lp-PLA2 levels were increased significantly in the study group patients compared with the control patients (15.42±11.88 vs. 8.06±4.32 ng/ml, P<0.001). Furthermore, a positive correlation was identified between the Lp-PLA2 levels and the total number of plaques and diseased arteries (r=0.495, P<0.001, and r=0.621, P<0.001, respectively). The presence of mixed plaque composition was also correlated with the Lp-PLA2 levels (r=0.657, P<0.001). Multivariate regression analysis identified four independently significant predictors of subclinical coronary atherosclerosis: high-sensitivity C-reactive protein levels, tobacco use, uric acid levels, and serum Lp-PLA2 levels. ConclusionThe presence of subclinical coronary atherosclerosis is associated independently with Lp-PLA2, and it has potential utility as a novel indicator of cardiovascular disease risk in the young adult population.

Relationship of fibroblast growth factor 23 and fetuin-A to coronary atherosclerosis

BACKGROUND Serum fibroblast growth factor 23 (FGF-23) and fetuin-A are established predictors of morbidity and mortality due to cardiovascular disease. The objective of the present study is to evaluate the relationship between coronary artery disease (CAD) and serum concentrations of FGF-23 and fetuin-A. METHODS A total of 383 subjects who underwent coronary computed tomography angiography (CCTA) were included in the study. CCTA detected CAD in 208 patients; the rest of the patients had no detectable CAD. RESULTS Serum FGF-23 and fetuin-A levels were significantly increased in CAD patients compared to non-CAD patients (26.6±21.1pg/mL vs. 17.9±16.1pg/mL, p=0.001 and 826±350mg/L vs. 595±300mg/L, p<0.001, respectively). Serum FGF-23, fetuin-A, low-density lipoprotein (LDL)-cholesterol, and uric acid values were elevated in non-diabetic patients with CAD when compared to those without CAD. FGF-23, and fetuin-A were not significantly different in diabetic patients with CAD when compared to those without CAD. Using multivariate logistic regression analysis, we found that age, hypertension, LDL-Cholesterol, high-density lipoprotein (HDL)-Cholesterol, hs-CRP, uric acid, FGF-23 and fetuin-A levels were independently associated with the presence of CAD. CONCLUSION FGF-23 and fetuin-A were positively correlated with coronary atherosclerosis Similar trends were seen among diabetic patients, but this did not reach statistical significance. FGF-23 and fetuin-A could be used as novel risk markers of cardiovascular disease.

Impact of clopidogrel resistance on ST-segment resolution and no-reflow in acute myocardial infarction with ST-elevation patients treated with a primary percutaneous coronary intervention.

IntroductionA rapid restoration of epicardial coronary flow in acute myocardial infarction is crucial for saving jeopardized myocardium. The no-reflow phenomenon is one of the major problems in a primary percutaneous coronary intervention (PCI) and may be defined as an outcome of different pathological pathways. Our aim was to evaluate clopidogrel resistance in patients who underwent primary PCI and the relationship with the no-reflow phenomenon. Materials and methodsA total of 127 patients (mean age 54.0±11.4 years, 83.7% men) were assessed for this purpose. No-reflow was defined as less than 50% ST-segment resolution on ECG. ResultNo-reflow was significantly frequent in patients with clopidogrel resistance (25.3 vs. 57.1%, P=0.006). Univariate analysis and multivariate analysis showed that clopidogrel resistance and anterior myocardial infarction were only independent predictors of no-reflow phenomenon in patients treated with a primary PCI during acute myocardial infarction. ConclusionOur study showed that clopidogrel resistance may be one of the responsible mechanisms for the no-reflow phenomenon. Assessment of simple ECG after a primary PCI may help clinicians to determine patients with a poor prognosis.

Relation of platelet indices to severity of coronary artery disease in patients undergoing primary percutaneous coronary intervention.

Aim: We investigated the association between platelet indices and the severity of coronary artery disease (CAD) in patients with ST-segment–elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PPCI). Methods: A total of 484 consecutive patients who were routinely referred to coronary angiography for STEMI and 81 age- and gender-matched patients with normal coronary arteries were included in the present study. We analyzed the relation between the platelet distribution width (PDW) and the angiographic severity of CAD. The SYNTAX score was used for assessing the severity of coronary atherosclerosis. Results: The mean platelet volume (MPV), the plateletcrit (PCT) and the neutrophil levels were significantly higher in the STEMI group than in the control group. Patients with an elevated SYNTAX score (>32) had higher PDW values. The levels of plateletcrit and the estimated glomerular filtration rate (eGFR) were lower in the high SYNTAX score group compared to the moderate-to-low SYNTAX score group. The PDW was positively correlated with age (r = 0.128, p=0.004) and SYNTAX score (r = 0.209, p<0.001). There was a mild, significant inverse association between the PDW level and the eGFR (r = -0.101, p=0.049), the mean platelet volume (MPV) (r = −290, p<0.001) and the PCT (r = −345, p<001). Using multivariate logistic regression analysis, we found that age (OR = 1.046, 95% CI 1.013–1.079, p=0.005), diabetes (OR = 4.779, 95% CI 2.339-9.767, p<0.001) and PDW (OR = 1.229, 95% CI 1.072–1409, p=0.003) were independent correlates of high SYNTAX score. Conclusion: Platelet distribution width, an inexpensive and easily measurable laboratory variable, is independently associated with high SYNTAX score.

Impact of serum alkaline phosphatase level on coronary collateral circulation

BACKGROUND Serum alkaline phosphatase (ALP) level has been shown to be a prognostic factor for myocardial infarction and stroke via its promotion of vascular calcification. AIM To investigate for the first time the correlation between serum ALP level and coronary collateral circulation (CCC) development. METHODS A total of 356 patients with stable angina pectoris were evaluated retrospectively. Patients were classified according to ALP level and CCC grade. Rentrop 0-1 flow was defined as impaired CCC. Serum ALP > 129 mg/dL in men and > 104 mg/dL in women was defined as elevated ALP. All groups were compared statistically according to clinical, laboratory and demographic features. RESULTS Impaired CCC was observed in 53.7% of the patients. The mean ALP level was 102.8 ± 57.9 mg/dL, and elevated ALP levels were obtained in 19.4% of cases. There was a significant correlation between ALP and CCC grade, and impaired CCC was associated with relatively higher ALP values (65.2% vs. 50.9%, p = 0.03). Multivariate regression analysis also showed a significant correlation between elevated ALP level and impaired CCC (OR 1.85, with a 95% CI 1.056-3.264; p = 0.03). CONCLUSIONS Serum ALP is a widely avaliable unfavourable prognostic parameter in coronary heart disease. Elevated ALP levels were associated with inadequate CCC, which supports the previously reported literature concerning the negative prognostic value of ALP levels in cardiovascular settings.

PREDICTORS OF IN-HOSPITAL AND LONG TERM MORTALITY IN PATIENTS WITH ACUTE PULMONARY EMBOLISM

Results: Mean age of patients was 61.6±17.5 years and 55.4% were female. In the univariate analysis in-hospital mortality was related to cyanosis, syncope, lower systolic blood pressure, increased respiratory rate, hypoxia, hypocarbia, acidosis, echocardiogaphic McConnell sign, inotropic infusion, elevated heart rate, elevated Troponin-I and brain natriuretic peptide levels. In multivariate analysis, McConnell sign (p=0.026), inotropic infusion (p=0.007) and acidosis (p<0.0001) were only independent predictors of in-hospital mortality. In univariate analysis, patients with total mortality tended to have older age, cyanosis, syncope, history of cancer, lower systolic blood pressure, shock, inotropic infusion, hypoxia, hypocarbia, acidosis and increased brain natriuretic peptide levels. In multivariate analysis, older age (p=0.031) and history of cancer (p=0.018) are only independent predictors of total mortality.