Şeref Alpsoy

Relationship between red cell distribution width and contrast-induced nephropathy in patients who underwent primary percutaneous coronary intervention.

OBJECTIVE This study evaluated the relationship between contrast-induced nephropathy (CIN) and red cell distribution width (RDW) in patients who underwent primary percutaneous coronary intervention (PCI). METHODS A total of 359 patients with ST elevation myocardial infarction (STEMI) who had undergone primary PCI were included in the study. An increase of 25% in serum creatinine value after 48 h, or an increase of >0.5 mg/dL in the basal value was defined as CIN. RESULTS Of the patients included in the study, 49 (13.8%) developed CIN. Compared to the CIN-negative group, CIN-positive patients had increased RDW values (16.9 ± 2.00 and 14.8 ± 2.14 respectively, p<0.001). The latter were also older patients, and had increased age rates of diabetes mellitus, baseline creatinine, ∆-creatinine and amount of contrast media were higher and left ventricular ejection fraction and baseline glomerular filtration rate (GFR) were lower in the CIN-positive group than in the CIN-negative group. A statistically weak correlation was found between RDW and change in creatinine levels (∆-creatinine) (r=0.250, p=0.002). Diabetes mellitus (odds ratio [OR]: 3.252, 95% CI=1.184-8.951, p=0.022), high RDW (OR: 1.716, 95% CI=1.363-2.157, p<0.001), baseline low GFR (OR: 0.941, 95% CI=0.925-0.971, p<0.001), ∆-creatinine (OR: 1.197, 95% CI=1.061-2.986, p=0.006) and increased amount of contrast media (OR: 1.187, 95% CI=1.048-3.02, p=0.001) used were observed as independent predictors of CIN. CONCLUSION The study found diabetes mellitus, high RDW, basal low GFR, ∆-creatinine and increased contrast amount used to be the independent predictors of CIN in STEMI patients who underwent PCI.

Role of sympathetic cotransmitter galanin on autonomic balance in heart failure: an active player or a bystander?

Objective: Galanin, a cotransmitter similar to neuropeptide Y (NPY), aggravates autonomic imbalance in systolic heart failure (HF) by attenuating vagal tonus after burst sympathetic activity. In animal HF models, galanin antagonists have improved cardiac function. To determine whether galanin is a promising therapeutic target in HF, we studied its concentrations in HF patients and evaluated its correlation with NPY, markers of humoral activity such as pro-BNP and copeptin, and echocardiographic parameters of HF severity. Methods: After recording demographic and echocardiographic characteristics of 87 individuals (57 HF patients and 30 control subjects), fasting serum concentrations of galanin, NPY, copeptin, and pro-BNP were determined. Results: Unlike pro-BNP, copeptin, and NPY, which were significantly elevated in HF patients (p<0.001, p<0.001, and p=0.001, respectively), galanin was similar in HF patients and control subjects (p=0.9). NPY correlated with the echocardiographic parameters of HF severity (r=–0.22, p=0.03 for EF; r=0.3, p=0.005 for Tei index of RV; r=–0.23, p=0.03 for TAPSE; and r=0.24, p=0.024 for E/e¢) and pro-BNP (r=0.22, p=0.046). NPY levels were also associated with beta blocker (BB) use, wherein BB significantly decreased NPY in both HF patients and control subjects. Galanin correlated with humoral biomarkers, pro-BNP and copeptin (r=0.39, p<0.001 and r=0.41, p<0.001, respectively). Although current smoking, BB therapy, pro-BNP, copeptin, and body mass index were associated with galanin in univariate analyses, the multiple linear regression model revealed that pro-BNP was the only significant determinant of galanin levels in HF patients. Conclusion: Our findings confirmed the role of NPY in autonomic balance and suggest that galanin is associated with the proadrenergic state, but its role in HF in humans remains unclear.

Tools to improve the diagnostic accuracy of exercise electrocardiograms in patients with atypical angina pectoris

OBJECTIVE Although frequently utilized, an exercise electrocardiogram (ECG) provides limited diagnostic accuracy in patients with atypical angina pectoris. The purpose of this study was to determine the possible incremental value of pretest probability (PTP) scores and exercise parameters in discriminating coronary artery disease (CAD) and to identify PTP cutoff values. METHODS In a retrospective cohort of 207 patients with atypical angina (76 women, 131 men; mean age: 57.6±8.2 years) who underwent coronary angiography (CAG) after a positive exercise ECG, the PTP was calculated according to the CAD Consortium basic and clinical models along with exercise parameters of blood pressure (BP), heart rate (HR), exercise duration, maximal metabolic equivalents (METs), HR reserve, HR recovery, chronotropic index, BP reserve, BP recovery, and ST/HR ratio. Patients were categorized into true positive (TP) or false positive (FP) groups, depending on the ultimate determination of a presence of obstructive CAD. RESULTS A TP result was associated with older age, male gender, hypertension, diabetes, hyperlipidemia, and higher basic and clinical PTP, as well as higher maximal BP, maximal ST deviation and ST/HR, but lower maximal METs, chronotropic index, and HR recovery. The basic and clinical PTP, and the chronotropic index could predict a TP test result irrespective of gender. Logistic regression analysis revealed that clinical PTP was the only independent predictor of TP results. A cutoff score of 18 for the basic and 21 for the clinical PTP were determined to discriminate CAD. CONCLUSION This study has shown that, among various electrocardiographic and hemodynamic parameters, the clinical PTP and the chronotropic index are the most helpful tools to discriminate patients with CAD among patients with atypical angina.

Sağ Sinüs Valsalva’dan Çıkan Sol Ana Koroner Arter Anomalisi

Sag sinus Valsalva’dan cikan sol ana koroner arter anomalisi, oldukca nadir gorulen bir konjenital anomalidir. Tamamen semptomsuz olabildigi gibi, egzersiz ile olusan gogus agrisi ve bayilma, miyokart enfarktusu ve ani olum gibi ciddi klinik tablolar ile de ortaya cikabilir. Yazimizda, sol ana koroner arterin sag sinus Valsalva’dan cikis anomalisi sunulmaktadir.

Endothelial dysfunction in children with low birth weight, born at term -

The aim of our study was to assess whether endothelial function of the brachial artery is normal or impaired in children born at term with low birth weight (LBW) compared with their normal birth weight (NBW) peers, because there are still few data on this subject in children born at term with LBW. We compared brachial artery flow mediated dilatation (FMD) in children with LBW (n= 55, 30 male) and NBW (n= 45, 24 male) who were born at term. Age, gender, weight, height, waist and hip circumference, body mass index, body mass Z score, fasting glucose, total cholesterol, triglycerides, low density lipoprotein-cholesterol, high density lipoproteincholesterol, calcium, C-reactive protein, hemoglobin, serum insulin concentration, homeostatic model assessment index, creatinine values, brachial artery baseline diameter and brachial artery post dilatation diameter were similar in both groups (all p values >0.05). Compared with the NBW group, the LBW group had lower FMD (%) (6.68 ± 2.1 vs. 7.8 ± 1.9, p = 0.004). Brachial artery FMD was negatively correlated with waist circumferences (r = 0.521, p < 0.001). A general linear analysis model, FMD as the dependent variable revealed significant effect of waist circumference (β ± SE:0.07±0.02, p<0.001) and LBW controlling for age (β ± SE: -0.028±0.01, p = 0.004). LBW closely affects to FMD. Therefore, the children with LBW born at term may be potentially at risk for early atherosclerosis compared with their peers.

Yalancı Çift Çıkışlı Sağ Koroner Arter: Yüksek Çıkışlı Gelişmiş Sağ Ventrikül Dalı Olgusu

Double right coronary artery (RCA) is a very rare coronary artery anomaly. Double RCAvariations are incidentally discovered, because they are asymptomatic. The differentiation oftrue double RCA and high take off of a large right ventricular branch (RVB) in coronaryangiograms is a condition that requires quite remarkable attention. Here, we reported a casewith acute inferior myocard infarction in whom high take off of a large RVB originated fromproximal RCA, mimicking a double RCA. If this type variation is not well-defined along withcoronary artery narrowness, it may lead to mistaken distal anastomose during coronary arterybypass surgery

The Effect of Respiratory Functions and Pulmonary Artery Pressure on Right and Left Ventricular Diastolic Function

Which Method used for the Assessment of Left Ventricule Ejection Fraction is more Correlated with the Left Ventricule Global Strain? Süleyman Karakoyun, Mustafa Ozan Gürsoy, Kamuran Kalkan, Zakir Lazo glu, Halil _ Ibrahim Tanbo ga, Tayyar Gökdeniz Doç. Dr.Yaşar Eryılmaz Do gubeyazıt State Hospital, Department of Cardiology, A gri, I gdır State Hospital, Department of Cardiology, I gdır, Ataturk University, Medical School, Heart Center, Department of Cardiology, Erzurum, Kafkas University, Medical School, Department of Cardiology, Kars