Tunay Senturk

Effect of N-acetylcysteine on oxidative stress and ventricular function in patients with myocardial infarction.

Recent evidence suggests that postischemic myocardial dysfunction (“stunning”) may be mediated by oxygen free radicals. Various studies have reported the beneficial effects of antioxidants in ischemia–reperfusion injury. The aim of this study was to assess the effect of N-acetylcysteine (NAC) treatment on oxidative stress, infarct size, and left ventricular (LV) function, as adjunct therapy in myocardial infarction (MI). Patients with acute MI received either 15 g NAC infused over 24 h (n = 15) or no NAC (n = 15), combined with streptokinase. Peripheral venous blood was serially sampled to measure creatine kinase (CK)-MB levels. Plasma malondialdehyde (MDA) level was measured at admission and after 4 and 24 h. Echocardiography was performed within 3 days of MI and after 3 months. At admission, plasma MDA levels were not different between the groups. In the NAC-treated patients plasma MDA levels decreased, whereas in the nontreated NAC patients MDA levels increased at 4 and 24 h (P < 0.01 and P < 0.001, respectively). Left ventricular ejection fraction was higher (P < 0.05) and LV end-systolic and end-diastolic diameters were lower (P < 0.001 and P < 0.001) in patients receiving NAC on day 3. Left ventricular wall motion score index was significantly lower in patients treated with NAC on day 3 (P < 0.05). Left ventricular diastolic parameters were not different whether patients were treated with NAC or not. No difference in reduction of infarct size was detected between the groups according to CK-MB levels. It was thus demonstrated that administration of NAC in combination with streptokinase significantly diminished oxidative stress and improved LV function in patients with acute MI. These encouraging results would justify the performance of a larger controlled study.

Procalcitonin in patients with acute coronary syndrome: correlation with high-sensitive C-reactive protein, prognosis and severity of coronary artery disease.

Objectives — The aim of this study is to determine the relation of high-sensitive serum C-reactive protein (hsCRP) and procalcitonin with presence and severity of coronary artery disease and early prognosis in patients with acute coronary syndrome (ACS). Methods and results — Procalcitonin and hsCRP levels were measured at admission and after 48 hours in 50patients (41men, 9 women) with ACS. The patients were assigned to three groups according to their clinical diagnosis: unstable angina pectoris (UAP) (Braunwald III-B), non-ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI). Incidences of adverse cardiac events were recorded in a 3-month follow-up. Coronary angiography was performed to evaluate presence and severity of coronary artery disease. In the groups of STEMI, NSTEMI and UAP, procalcitonin (P=0.013, P=0.045 and P=0.0001, respectively) and hsCRP (P=0.0001, P=0.01 and P=0.001, respectively) levels were significantly increased. No significant correlation was found between these markers and the presence and severity of coronary artery disease.There was no correlation between procalcitonin and hsCRP levels at admission and after 48hours and primary end points after 3months except in the group of UAP with revascularization procedure. In the group of UAP, hsCRP levels at 48hours were found higher in the patients with a revascularization procedure (P=0.04). Conclusions — In conclusion, levels of hsCRP and procalcitonin are increased in patients with ACS but failed to correlate with severity of coronary disease and early prognosis.

Association between paraoxonase 1 activity and severity of coronary artery disease in patients with acute coronary syndromes

Objective — We sought to investigate serum paraoxonase/arylesterase activities in patients with acute coronary syndromes (ACS) and their correlations with the severity and extent of coronary artery disease (CAD). Methods and results — Three groups of patients were investigated: 89 patients with ACS, 54 patients with normal coronary angiograms (no-CAD group), and 27 healthy comparison subjects. ACS patients were divided into three groups according to their clinical presentation: unstable angina pectoris (UAP, Braunwald III-B, n = 31), non-ST elevation myocardial infarction (NSTEMI) (n = 27), and ST-elevation myocardial infarction (STEMI) (n = 31). Serum paraoxonase/arylesterase activities were measured spectrophotometrically.Angiographic CAD extent was expressed both by the number of vessels diseased and by the Gensini scoring system. Results showed that serum paraoxonase/arylesterase activities and the paraoxonase/high density lipoprotein-cholesterol (HDL-C) ratio were significantly lower in the STEMI, NSTEMI, UAP groups than in no-CAD and control groups. Serum paraoxonase/arylesterase activities and paraoxonase/HDL-C ratio were reduced in patients with 2-vessel disease (VD) and 3-VD compared to the 1-VD and no-CAD group (P < 0.001). In patients with ACS, the Gensini score correlated inversely with serum paraoxonase (r = –0.419, P < 0.001), arylesterase (r = –0.492, P < 0.0001), and the paraoxonase/HDL-C ratio (r = –0.377, P < 0.001). Serum arylesterase (r = 0.161, P = 0.03) and paraoxonase (r = 0.135, P = 0.002) activities were positively correlated with HDL-C levels. Serum arylesterase activity (P < 0.0001), gender (P = 0.0037), diabetes mellitus (P = 0.005) and LDL-C levels (P = 0.03) were independent predictors of CAD presence. Conclusions — Serum paraoxonase/arylesterase activities are reduced in ACS patients and inversely correlated with the severity of CAD.

Serial changes in circulating M30 antigen, a biomarker of apoptosis, in patients with acute coronary syndromes: relationship with the severity of coronary artery disease.

ObjectivesGrowing evidence has indicated the potential clinical usefulness of measuring different forms of cytokeratin 18 in patient sera (M30 antigen for apoptosis and M65 antigen for necrosis) for distinguishing different forms of cell death. Preliminary data have reported altered levels of cytokeratin 18 fragments in patients with acute coronary syndrome (ACS) and ischemic heart disease. In this study, serum levels of M30 and M65 were measured in 74 patients with ACS [including 17 cases with unstable angina and 57 patients with acute myocardial infarction (AMI)], 25 patients with stable angina, and 23 controls. MethodsIn patients with ACS, serial measurements of M30 and M65 were obtained, and for each patient, the following values were determined: (i) values at admission, (ii) values obtained 24 h after symptom onset, and (iii) values obtained at 48 h after symptom onset. The severity of coronary atherosclerosis was expressed using the Gensini score. ResultsOn admission, M30 and M65 levels in ACS patients were similar to those observed in stable angina patients and control participants. In AMI patients, serum levels of M30 peaked at 24 h and declined thereafter at 48 h. Notably, serum levels of M30 measured at 24 h correlated significantly and positively with the extent of coronary artery disease as measured by the Gensini score in AMI patients (r = 0.253, P<0.05). ConclusionSerum levels of the apoptotic marker M30 peak at 24 h after AMI and reflects the extent of coronary artery disease in this patient group.

Effects of off-pump versus on-pump coronary artery bypass grafting: apoptosis, inflammation, and oxidative stress.

BACKGROUND It has been suggested that off-pump coronary artery bypass grafting (CABG) surgery reduces myocardial ischemia-reperfusion injury, postoperative systemic inflammatory response, and oxidative stress. The aim of this study was to measure serum malondialdehyde (MDA), high-sensitivity C-reactive protein (hs-CRP), M30, and M65 levels and to investigate the relationship between M30 levels and oxidative stress and inflammation in patients undergoing on-and off-pump CABG surgery. METHODS Fifty patients were randomly assigned to on-pump or off-pump CABG surgery (25 patients off-pump and 25 on-pump CABG surgery), and blood samples were collected prior to surgery, and 30 minutes, 60 minutes, 6 hours, and 24 hours after CABG surgery. RESULTS Compared to the on-pump group, serum MDA levels at 30 minutes, 60 minutes, 6 hours, and 24 hours after the CABG surgery were significantly lower in the off-pump group (P=.001, P=.001, P=.001, and P=.001, respectively). Serum M30 levels were found to be elevated in both groups, returning to baseline at 24 hours. When compared to baseline, the hs-CRP level reached its peak at 24 hours at 13.28±5.32 mg/dL in the on-pump group, and 15.44±4.02 mg/dL in the off-pump group. CONCLUSION CABG surgery is associated with an increase in inflammatory markers and serum M30 levels, indicating epithelial/endothelial apoptosis in the early period.

The relationship between cardiac autonomic neuropathy and Tei index in patients with type II diabetes mellitus.

Objective — We have investigated the relationship between silent cardiac autonomic neuropathy (CAN), one of the most important causes of mortality in diabetic patients, and the Tei index, which is an indicator of global ventricular function. Methods — Among the patients with type 2 diabetes mellitus, 15 without autonomic neuropathy (Ewing score < 1) were accepted as CAN (-) and 18 with autonomic neuropathy (Ewing score ≥ 1) were accepted as CAN (+).Twelve healthy individuals were included in the control group. Diastolic dysfunction and Tei index were evaluated by means of 2-D and Doppler echocardiographic examination. Results — Not only Doppler mitral, but also tricuspid inflow parameters showed a significant decrease in E/A ratio, an increase in A wave amplitude and deceleration time with CAN (+) patients. Left ventricular Tei index and Ewing score were found to be positively correlated (P < 0.001, r = 0.55). Likewise to the correlation in the left ventricle, a positive correlation was also detected between right ventricular Tei index and Ewing score (P = 0.004, r = 0.43). Conclusions — We have shown that in patients with type II diabetes, CAN is related with left and right ventricular diastolic dysfunction.We also have determined that the Tei index is in correlation with CAN (Ewing score), which is a complication of diabetes.

Continuous positive airway pressure therapy improves arterial elasticity in patients with obstructive sleep apnea

BACKGROUND Reduced arterial elasticity is an important mediator of accelerated atherogenesis and consequent increased cardiovascular morbidity in obstructive sleep apnea (OSA). The aim of our study was to investigate whether continuous positive airway pressure (CPAP) therapy may improve arterial elasticity in subjects with OSA. METHODS In 44 subjects with OSA, we measured arterial elasticity by applanation tonometry before and after 6 months of treatment with CPAP. Nine OSA+ subjects withdrew from the study. RESULTS The 35 patients with OSA who completed the 6-month CPAP treatment showed a marked reduction in both the large artery (LAEI, P=0.001) and small artery (SAEI, P=0.009) elasticity indices, independent of potential confounders. In OSA+ subjects who withdrew from the study, SAEI and LAEI did not change significantly over time. CONCLUSIONS Six months of CPAP therapy improves arterial elasticity in subjects with OSA.

Cardiac metastasis in a laryngeal carcinoma and associated electrocardiographic changes.

In patients with cancer, metastases to the heart are rare and usually difficult to diagnose unless they cause symptoms. Cardiac metastasis of laryngeal carcinoma is also rarely reported in the literature. This report deals with a 63-year-old male patient with carcinoma of the larynx that involved the heart. The patient presented with chest pain, and the electrocardiogram revealed new ST segment elevation in the precordial leads. The cardiac markers were negative, and the electrocardiogram showed no changes during the course in the cardiology clinic. Although the patient was stable, he had massive hemorrhage at his tracheotomy site and died on the sixth day of hospitalization. A necropsy of the myocardium showed metastasis of squamous cell carcinoma to the heart. We conclude that the electrocardiographic changes in cancer patients during the course of the disease may provide a clue for detection of cardiac involvement. Heart metastasis in cancer patients is rare. When this rare events occurs, diagnoses are usually based on postmortem examinations. However, electrocardiographic changes may serve as a clue for detection of involvement of the myocardium. Here we present a male patient, aged 63 years, with laryngeal carcinoma with heart metastasis, a rare condition reported 3 decades ago by Harrer et al. A male patient aged 63 years was admitted to the emergency clinic because of dull sternal pain, nausea, and diaphoresis that had been present for the preceding 5 hours. His general condition was poor. His blood pressure and pulse rate were 130/80 mm Hg and 90/min, respectively. The presence of tracheotomy and coarse crackles in the lower right lung were remarkable in his lung exam. The patient had completed chemotherapy for squamous cell carcinoma

Serum paraoxonase activity in patients with ischaemic and nonischaemic dilated cardiomyopathy

Abstract Background: This study examined whether the serum PON1 activity is different in patients with ischaemic dilated cardiomyopathy (IDCM) and nonischaemic dilated cardiomyopathy (NDCM) and the relation between the serum PON1 activity and serum pro-BNP levels. Methods and results: In this study, we enrolled 60 patients with left ventricular systolic failure (New York Heart Association [NYHA] class III–IV) and a left ventricular ejection fraction (EF) < 40% as determined by echocardiography and 30 healthy subjects. The patients with systolic heart failure were divided into two groups: patients with IDCM and patients with NDCM. Blood samples were obtained to measure the serum PON1 activity and the serum pro-BNP levels. The median serum PON1 activities were lower among the patients with IDCM or with NDCM compared with the control subjects (p < .001, p = .043, respectively). Compared with the control subjects, the patients with IDCM or with NDCM had higher serum pro-BNP levels (p < .001, p < .001, respectively). The serum PON1 activity was negatively correlated with the serum pro-BNP levels in patients with IDCM (r = −0.548, p < .001). The area under the ROC curve of the serum PON1 activity was 0.798. Using a serum PON1 activity of 201.3 U/L as a cut-off value, the sensitivity was 86.84% and specificity was 66.67% for the diagnosis of IDCM. Conclusions: In this study, the serum PON1 activity was significantly reduced in the patients with IDCM or with NDCM compared with the control subjects. The serum PON1 activity of the patients with IDCM was negatively correlated with the serum pro-BNP levels.

Myocardial performance is impaired in patients with branch retinal vein occlusion

Objective To investigate whether the Tei index, which is an indicator of global myocardial function and an independent predictor of cardiac death, is increased in patients with branch retinal vein occlusion (BRVO). Methods The Tei index was used to evaluate myocardial performance, in addition to conventional echocardiographic evaluation of myocardial structural and functional changes, in patients with BRVO, patients with hypertension and healthy controls. Results Out of 36 patients with BRVO (18 female, 18 male; 17 hypertensive, 19 normotensive), 29 patients with hypertension (15 female, 14 male) and 28 healthy controls (15 female, 13 male), there were no significant between-group differences in age and sex. The mitral A wave was higher and mitral E/A ratio, mitral E wave and ejection time were lower, in patients with BRVO than in healthy controls. Mean Tei index was significantly higher in the BRVO group than in patients with hypertension or healthy controls. Compared with healthy controls, the Tei index was significantly higher in hypertensive and normotensive patients with BRVO. Conclusion Myocardial performance is decreased in patients with BRVO, independent of whether or not they have hypertension.