Sinan Albayrak

Correlation of Plasma B-Type Natriuretic Peptide with Shunt Severity in Patients with Atrial or Ventricular Septal Defect

The goal of this study was to test the utility of bedside plasma concentration of B-type natriuretic peptide (BNP) assay as a screen for large shunts in pediatric patients with atrial septal defects (ASDs) and ventricular septal defects (VSDs). Thirty-five children at a mean age of 70 ± 129 weeks with ASD or VSD were included in the study. Nine patients had VSD and 26 had ASD. Plasma BNP values were compared with the Qp/Qs ratios derived from quantitative Doppler flow measurements. Mean BNP was 29 ± 42 pg/ml, with a range between <5 pg/ml and 208 pg/ml. Sixteen patients had Qp/Qs values >1.5 and 19 had values <1.5. The difference of mean BNP in these patient groups was statistically significant (45 ± 56 vs 14 ± 17, p = 0.03). BNP was positively correlated with shunt significance. Receiver operating characteristic curve analysis revealed a sensitivity of 69% and a specificity of 79% at a plasma BNP cut-off level of ≥20 pg/ml. Bedside measurement of BNP correlates with magnitude of ASD and VSD in children. BNP can provide information for the management of children with ASD or VSD. It can be used as part of the evaluation of a child with a preliminary diagnosis of a congenital defect.

Independent prediction of metabolic syndrome by plasma fibrinogen in men, and predictors of elevated levels

UNLABELLED The role of plasma fibrinogen levels in predicting metabolic syndrome (MetS) and assessment of determinants of these levels were investigated. A total of 2234 men and women, aged 49+/-12 years, representative of Turkish adults who had plasma fibrinogen determinations, were prospectively evaluated and followed for a mean of 6.6 years. The modified Clauss method was used for assays. MetS was defined by ATPIII criteria modified for male abdominal obesity. MetS cases at baseline were excluded in prospective analyses. Median (interquartile range) fibrinogen values were 2.87 (2.29; 3.56) g/L. Fibrinogen levels predicted significantly newly developing MetS in men (RR 1.40 [95%CI 1.07; 1.83] for a 2-fold increment), after adjustment for age and smoking status, and (RR 1.32 [95%CI 0.95; 1.83] again for doubling), after additional adjustment for all 5 components of MetS. MetS was not significantly predicted by fibrinogen levels in women in either multivariable model. By regression analysis of eight covariates, not waist circumference, but systolic blood pressure, current smoking and C-reactive protein (CRP) in men, and age in women were predictors of elevated (>3.0 g/L) fibrinogen at follow-up (p<0.05 in all). CONCLUSIONS Plasma fibrinogen predicts MetS independently of its components in men, in contradistinction to women, and, hence, is likely one of its components. Hyperfibrinogenemia representing an inflammatory state is postulated as the underlying mechanism. Central obesity is linked to elevation in fibrinogen mainly through the mediation of blood pressure, CRP, and via being affected by cigarette smoking.

Acute myocardial infarction due to a bee sting manifested with ST wave elevation after hospital admission.

Acute myocardial infarction following bee sting has been rarely reported previously. Bee venom contains epinephrine, dopamine, leukotrienes and thromboxanes, which cause severe platelet aggregation and direct vasoconstriction, therefore can lead to an acute myocardial infarction. Here, we describe a 44 year old man with acute myocardial infarction with ST-segment elevation after a bee sting treated with primary percutaneous coronary intervention (PCI).

HLA-DR B1 and DQ B1 polymorphisms in patients with coronary artery ectasia

Objectives — The purpose of our study was to evaluate the significance of polymorphisms in HLA class II genes in coronary artery ectasia (CAE) patients. Methods and results — Twenty-six patients with CAE without associated cardiac defects were enrolled in the study.CAE was defined as luminal dilation of 1.5- to 2.0-fold of normal limits. Ninetyfive healthy subjects who were donors for different organ transplantations, were chosen as control group. Physical examination, electrocardiography and chest X-ray were completely normal in these cases. Both the patients and the control group were screened and compared for their HLA class II genotypes. HLA-DR B1*13, DR16, DQ2 and DQ5 genotypes were significantly more frequent in the patient group.When the known risk factors of coronary heart disease were compared in the patients carrying these genotypes with the non-carrying group, no significant differences were encountered. Conclusions — HLA-DR B1*13, DR16, DQ2 and DQ5 may be associated with the pathogenesis and increase the risk of CAE.

Elastic Properties of the Ascending Aorta and Left Ventricular Function in Patients with Hypothyroidism: ELASTIC PROPERTIES OF ASCENDING AORTA AND LV FUNCTION

Background: We sought to clarify the possible role of elastic properties of the ascending aorta in the development of cardiac disease associated with hypothyroidism (HT). Methods: A total of 37 patients with HT (age: 39.3 ± 8.9 years) and 29 control subjects were studied. Ascending Aortic (Ao) diameter, Ao elastic indexes, strain (AoST), distensibility (AoD), stiffness index (AoSI), and pressure strain modulus were calculated from the echocardiographically derived Ao diameters. Myocardial performance index (MPI), E/A ratio, isovolumetric relaxation time (IVRT), deceleration time (DT) were measured by Doppler echocardiography to assess diastolic LV function. Patients were treated with levothyroxine and followed‐up for 6 months. Thyroid function tests and echocardiographic measurements were repeated at the end of the study. Results: AoD (cm2 dyn−1 10−3) and AoST (%) were significantly lower (3.8 vs. 6.1; P < 0.001, 7.4 vs. 12.6, P < 0.001; respectively), whereas AoSI was higher in HT patients (6.2 vs. 3.3; P < 0.001). After treatment, AoD and AoST were increased (5.7; P < 0.001 and 11.8; P < 0.001; respectively), whereas AoSI was decreased significantly (3.7; P < 0.001). Also, early/late mitral peak velocity ratio (Emax/Amax) was significantly lower in HT patients (1.19 vs 1.34; P < 0.01), whereas MPI was higher (0.52 vs. 0.42; P < 0.001). MPI showed a strong correlation with aortic root indexes [AoST (r =−0.61/P < 0.001); AoD, (r =−0.57/P < 0.002); AoSI, (r = 0.53/P < 0.005)] in the HT group. After 6 months of therapy, MPI significantly decreased P < 0.001) and E/A ratios were normalized (P < 0.001). Conclusions: Ao root functions have an important role on diastolic LV function. Levothyroxine replacement therapy can reverse all of these adverse effects of HT.

Relationship between arterial blood gas values, pulmonary function tests and treadmill exercise testing parameters in patients with COPD

Objective:  There have been controversial reports regarding the relationship between exercise tolerance and resting pulmonary function in patients with COPD. The aim of this study was to examine the relationship between resting pulmonary function tests (rPFT) and cardiopulmonary exercise testing parameters (CETP) and their value in estimating exercise tolerance of patients.

Relation of asymmetric dimethylarginine levels with conventional risk score systems in the healthy subjects with positive family history for coronary artery disease

OBJECTIVE Coronary artery disease is the most common cause of death in Turkey and the world. Asymmetric dimethylarginine is the major inhibitor of nitric oxide synthesis in humans. It has been shown that increased levels of asymmetric dimethylarginine is associated with endothelial dysfunction and increased atherogenesis. In this study, we aimed to investigate whether asymmetric dimethylarginine level is related with conventional risk score systems in subjects who had family history of coronary artery disease. METHODS Fifty two subjects within 20-40 years old of whom first degree relatives had myocardial infarction at young ages and 26 age and sex matched control subjects were included in this cross-sectional observational study. Frequency of diabetes, hyperlipidemia, smoking and serum levels of homocysteine, high-sensitive C-reactive protein (hsCRP) and asymmetric dimethylarginine were compared between risk group and control subjects. Relation of asymmetric dimethylarginine level with Framingham and TEKHARF risk scores was also compared. Chi-square and Mann-Whitney U tests were used to compare categorical and continuous variables, respectively. RESULTS Fasting serum glucose, triglyceride, high-density lipoprotein, diastolic blood pressure, waist circumference and TEKHARF scores were increased in the subjects who had family history of myocardial infarction. Total cholesterol, low-density lipoprotein, hsCRP, homocysteine, creatinine and Framingham risk score were similar in studied groups . Asymmetric dimethylarginine levels were 0.1 µmol/L higher in the risk group; however this difference could not reach significance (0.7±0.1 µmol/l vs 0.8±0.1 µmol/l; p=0.061). CONCLUSION Measurement of serum asymmetric dimethylarginine levels did not reveal utility in defining conventional coronary artery disease risk score systems in cases that had positive family history. Larger studies including patients with different risk tertiles are needed.

Three years of experience with a mobile angiograph in a center without on-site surgical back-up.

Background The safety of percutaneous coronary interventions (PCI) performed in centers without surgical back-up is controversial, but data from several western countries indicates that this approach can be extended to a larger number of hospitals. We assessed the safety and efficacy of performing angiography and PCI with a mobile C-arm angiograph in a center without on-site surgical back-up, and compared our data with that reported in the literature. Methods We retrospectively analyzed 1485 coronary angiograms and 172 PCI procedures performed in our center from January 2001 to May 2003 using a mobile angiograph. Half of the patients that have undergone PCI had refractory unstable angina and one-third had acute myocardial infarction (AMI). The safety of PCI was assessed by the analysis of in-hospital complications (death, urgent need for repeated revascularization, AMI with or without ST elevation and stroke). The PCI procedures were considered effective when the post-PCI residual stenosis did not exceed 50% with distal Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow. Results In patients who underwent diagnostic coronary angiography there were no deaths, anaphylatic shock, acute renal failure or major ischemic complications. In patients who underwent PCI, the mortality rate was 1.1% (2 deaths), two patients (1.1 %) developed acute MI with ST segment elevation, one patient (0.5%) underwent repeated PCI and three patients (1.7%) were referred for urgent by-pass surgery. Conclusions Diagnostic and PCI procedures can be safely performed using a mobile angiograph. The efficacy and safety requirements of PCI, performed in a center without an on-site surgical back-up facility using a mobile angiograph were similar to other data reported in the literature.