Turhan Kürüm

The effects of nebivolol on fibrinolytic parameters in mild and moderate hypertensive patients

BACKGROUND The aim of the present study was to investigate the effects of nebivolol (5 mg daily) on plasma levels of hemostatic and fibrinolytic endothelial function markers in mild or moderate hypertensive patients. METHODS AND RESULTS Thirty-five (22 female, 13 male; mean +/- SD 54.7 +/- 11.3 years of age) mild and moderate hypertensive patients were included the study. The mean systolic blood pressure [BP] was 160 mmHg (range 150 mmHg to 165 mmHg) and the mean diastolic BP was 100 mmHg (range 90 mmHg to 100 mmHg). Plasma tissue plasminogen activator antigen (tPA-Ag), plasminogen activator inhibitor type 1 antigen (PAI-1-Ag), PAI-1 activity, tPA-Ag/PAI-1-Ag index, fibrinogen and euglobulin lysis time were determined before and after two months of therapy. tPA-Ag and PAI-Ag levels were measured by ELISA. After this period, treatment with nebivolol (5 mg/day) in all patients was associated with a significant decrease in systolic BP and diastolic BP (P<0.001 for each), heart rate (P<0.01), fibrinogen (P<0.005) and euglobulin lysis time (P<0.01). The tPA-Ag and tPA-Ag/PAI-1-Ag index levels were increased significantly (P<0.001 for each) in all patients, but the PAI-1-Ag (P>0.05) and PAI-1 activity (P>0.05) did not show significant change. In the present study, there was no correlation between decreases in arterial BP and decreases in fibrinolytic parameters (P>0.05), but there was a positive, statistically significant correlation between fibrinogen and body mass index (P<0.001). CONCLUSIONS The results indicated that, compared with no treatment, a two-month treatment trial with nebivolol was associated with a more favourable modification of hemostatic and fibrinolytic status in addition to antihypertensive effects.

Incidence of Antiheparin−Platelet Factor 4 Antibodies and Heparin-Induced Thrombocytopenia in Turkish Patients Undergoing Cardiac Surgery

The frequency of antiheparin−platelet factor 4 antibodies by means of antigenic and functional assays (14 C-serotonin release assay and citrated plasma platelet aggregation) was determined in 115 Turkish patients undergoing cardiac surgery. Blood samples were taken immediately before surgery and on days 5 and 10 ± 2. Platelet counts were recorded and thrombotic events were determined by clinical methods. Antibody generation measured by enzyme-linked immunosorbent assay before surgery (n = 44) and on days 5 (n = 44) and 10 (n = 115) was 15.9%, 34.1%, and 65.2%, respectively. Positive samples from functional assays were 4.4% on day 0 and 7.0% on day 10. All positive samples had been negative on day 0. A high frequency of antiheparin−platelet factor 4 antibody generation and a low frequency of clinical heparin-induced thrombocytopenia were determined in these patients. These results obtained for Turkish patients are similar to those of other studies of heparin-induced thrombocytopenia.

Acute Myocardial Infarction in a Patient with Essential Thrombocythemia Treated with Glycoprotein Ilb/Illa Inhibitor

Essential thrombocythemia (ET) rarely causes obstruction of coronary arteries or acute myocardial infarction. Treatment of acute myocardial infarction in patients with ET may be a problem due to the important role of platelets in the pathogenesis of infarction. There is no reported case of acute myocardial infarction with essential thrombocythemia treated with a glycoprotein lIb/Illa inhibitor. In this report, a 49-year-old woman with essential thrombocythemia, admitted with a diagnosis of acute inferolateral myocardial infarction, was treated with tirofiban, a glycoprotein IIb/IIIa receptor blocker.

Relationship with plasma neurohormones and dyssynchrony detected by Doppler echocardiography in patients undergoing permanent pacemaker implantation.

Objective — To determine whether isovolumic relaxation flow (IRF) and isovolumic contraction flow (ICF) resulted from asynchrony and asynergy due to VVI and DDD pacemakers modulated neurohormones, we measured neurohormone levels in plasma and investigated the characteristics of IRF and ICF using Doppler echocardiography. Methods and results — We studied 11 patients with dual-chamber pacemakers (DDD) and 11 patients, with ventricular inhibiting mode (VVI). All patients underwent Doppler echocardiography of the left ventricle. Atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), renin and aldosteron were measured.The LV was scanned for the presence of intracavitary flow during the isovolumic relaxation and isovolumic contraction period. The plasma levels of BNP and ANP were significantly lower in DDD mode than in VVI mode (56±32 pg/ml vs. 94±32 pg/ml, p = 0.022 and 98 ± 20 pg/ml vs. 134 ± 17 pg/ml, p = 0.042, respectively).There were no significant differences in the plasma level of renin or aldosteron. VVI mode versus DDD mode increased isovolumic relaxation flow time (129 ± 41 vs. 111 ± 36 sec, p = 0.020) and isovolumic relaxation flow velocity (50 ± 4 vs. 37 ± 2 cm/s, p = 0.018).∞ A strong relationship between blood ANP and BNP levels and IRF velocity was found in patients with a VVI pacemaker (r: 0.632, p: 0.028; r: 0.528, p: 0.024, respectively). Conclusion — VVI mode has a longer isovolumic relaxation time, isovolumic relaxation flow velocity and has higher ANP and BNP plasma levels than DDD mode. IRF resulting from asynergy and asynchrony in VVI mode pacemakers versus DDD mode pacemakers affects the plasma levels of ANP and BNP compared to renin and aldosteron.

A case of primary antiphospholipid syndrome who developed acute myocardial infarction followed by early-onset pre-eclampsia.

Primary antiphospholipid syndrome (PAPS) is a noninflammatory autoimmune disease associated with an increased risk of vascular thrombosis [1]. Here we describe a 29-year-old woman with PAPS who developed acute myocardial infarction (MI) followed by an earlyonset pre-eclampsia (EOPE), who was treated by thrombolytic therapy. The patient was admitted to the emergency unit with acute chest pain radiating to her left shoulder for 4 h. Her medical history consisted of pregnancy ending in spontaneous labour 4 years ago, and a first-trimester abortion 2 years ago. In addition, she had developed EOPE, characterised by hypertension (180/120 mmHg), oedema, ascites, proteinuria (6 g/day) and severe fetal growth retardation that ended with medical abortion 4 weeks ago. There was no premature ischaemic heart disease (IHD) or autoimmune rheumatic disease in her family. Her ECG (Fig. 1) showed acute anterior wall MI. Serum creatine kinase MB (CK-MB) and troponin-I levels were 12.2 ng/ml (N: 0–4.3) and 12.4 ng/ml (N: 0–1), respectively. Medical therapy including tissue plasminogen activator (tPA) was begun. ST segment elevations were lowered, the chest pain diminished and reperfusion arrhythmia (accelerated idioventricular rhythm) appeared in the second hour of the tPA therapy. On angiography the coronary arteries were found to be normal, but anteroseptal and apical hypokinesia was observed. Transthoracic echocardiography demonstrated moderate severe mitral regurgitation, decreased midseptal and apicoseptal wall motion. ESR was 64 mm/h and CRP was 1.25 mg/dl. CBC and C3, C4, serum urea, creatinine, ALT, AST, albumin, globins, triglycerides, total and HDL, LDL and VLDL cholesterols levels were within normal limits. No proteinuria was detected on urine analysis. In further examinations Clin Rheumatol (2003) 22: 160–161 DOI 10.1007/s10067-002-0674-1

Differentiating the Infarct-Related Artery on Initial Electrocardiogram in Single or Multi-Vessel Disease in Acute Inferior Myocardial Infarction and Evaluating Involvement of Vessels Using Correspondence Analysis

Initial electrocardiography changes were compared prospectively with the findings of coronary angiography to predict the infarct-related artery (IRA) in cases of single- and multi-vessel disease and to demonstrate the relationship between other coexisting coronary involvements and IRA in patients who presented with acute inferior myocardial infarction (AMI). ST elevations or depressions of at least 1 mm (0.1 mV) were evaluated in the leads I, aVL, and V1-V6. Of the 160 patients hospitalized due to inferior AMI, 153 (96%) underwent coronary angiography using standard methods. The angiograms were screened for stenotic lesions using quantitative coronary angiography to confirm significance, which was considered >50% vessel lumen diameter reduction. Among single-vessel involvements, the IRA was either the circumflex artery (Cx) or right coronary artery (RCA). In conditions in which IRA was detected as either Cx or RCA, 1-, 2-, and 3-vessel involvements were also detected. Correspondence analysis was performed to show the vessel involvements accompanying IRA. Compared with patients with IRA as RCA, the presence of ST depressions in the leads V1 or V2 and aVL were more frequently seen in patients with IRA as Cx (p=0.000, p=0.015, respectively). Among all vessel involvements in which IRA was either Cx or RCA, a ST-segment depression in leads V1 or V2 (p=0.000) and aVL (p=0.000) and a ST-segment elevation in lead I (p=0.005) were considered to be significant for Cx, and a ST-segment depression in lead I for RCA involvement (p=0.010). According to correspondence analysis, the most frequent single-vessel involvement seen in inferior AMI was RCA; when IRA was RCA, a multi-vessel involvement included RCA and Cx; and when IRA was Cx, a single-vessel involvement included the left anterior descending (LAD) artery most frequently, and RCA+LAD less frequently (p=0.000). In inferior AMI, RCA was the most common IRA; however, the possibility of multi-vessel disease is increased when Cx is found to be the IRA. In patients presenting with inferior AMI, the presence of ST-depression in the leads aVL and V1-2 is a sensitive finding that indicates Cx stenosis rather than RCA stenosis and is not affected by coexisting other coronary artery involvements.