U. Cagdas Yuksel

The small intestine: A critical linkage in pathophysiology of cardiac cachexia

Impaired functioning of the gastrointestinal system may also contribute to malnutrition and cardiac cachexia (CC) in patients with chronic heart failure (CHF). Targets for future interventions include the deranged hormonal systems involved in energy balance as well as malabsorption from the gut and dietary supplementation. Other targets are the inhibition of proteasome-dependent protein degradation and the direct inhibition of pro-inflammatory pathways. The beneficial effects of ACE inhibitors, aldesterone inhibitors and beta-blockers in preventing or delaying the collagen deposition in the small intestine wall need to be elucidated. We strongly believe that by improving our understanding of the role of the gut in CC will lead to the development of novel therapeutic strategies in the near future.

Vascular inflammation and aortic stiffness relate to early left ventricular diastolic dysfunction in prehypertension

Abstract Prehypertension is characterized by an increased cardiovascular risk and by an increased prevalence of target organ damage compared with the pure normotensive state. The present study was designed to assess in prehypertensive subjects the possible relationships between early left ventricular dysfunction, vascular inflammation and aortic stiffness. The study population consisted of 31 untreated prehypertensive subjects (age: 34 ± 6 years, mean ± SD) and 31 age-matched pure normotensive controls. Left ventricular function was assessed by echocardiography, aortic distensibility parameters were derived from aortic diameters measured by ultrasonography, and high-sensitivity C-reactive protein was assessed by latex-enhanced reagent. Prehypertensive subjects displayed a significantly lower E/A ratio and a significantly greater deceleration time and isovolumetric relaxation time compared with normotensive controls. They also displayed aortic systolic diameter, diastolic diameter and mean aortic stiffness index beta significantly increased while systo-diastolic diameter change, mean aortic distensibility and aortic strain were significantly reduced compared with controls. Values of inflammatory markers were increased. At multiple regression analysis, E/A ratio was significantly related to high-sensitivity C-reactive protein and aortic stiffness index beta, after correction for age, left ventricular mass index and mean blood pressure (β coefficient = −0.49, overall r2 = 0.24, p = 0.01 and β coefficient =−0.46, overall r2 = 0.21, p = 0.02, respectively). Thus, in prehypertension, left ventricular dysfunction is significantly related to vascular inflammation and aortic stiffness, suggesting that early cardiac and vascular alterations may have an increased inflammatory process as a common pathophysiological link.

Pediatric metabolic syndrome: a growing threat.

The prevalence of the metabolic syndrome (MS) is high among obese children and adolescents and increases with the severity of the obesity, and with central adiposity in particular. In addition, adverse biochemical markers of cardiovascular risk are already present in this population. The metabolic syndrome is an important risk factor for subsequent development of type 2 diabetes and/or cardiovascular diseases. Therefore, the key clinical implication of a diagnosis of MS is identification of a patient needing aggressive lifestyle modification focused on weight reduction and increased physical activity. In contrast to the data from adults, long-term cardiovascular risk in children and adolescents with the MS has not been clearly determined.

The impact of admission C-reactive protein levels on the development of no-reflow phenomenon after primary PCI in patients with acute myocardial infarction: The role of inflammation

The role of admission CRP levels on the prediction of poor myocardial perfusion grades after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) has not been clearly elucidated. Dynamic nature of acute coronary syndromes is usually associated with spontaneous ischemia-reperfusion injury in infarct related artery. So we considered that poor myocardial perfusion after primary PCI is not only related to procedural factors and clinical characteristics of the patients but may also be related to microvascular damage starting before coronary intervention. We suggested that CRP mediated complement activation and neutrophil plugging may be the factors contributing to the development of microvascular damage in patients with AMI.

C-reactive protein in chronic heart failure: A new predictor of survival

High CRP levels are associated with adverse outcomes in cardiovascular diseases. hsCRP levels increase with the severity of CHF in patients with diastolic HF as well as in systolic HF. This supports a potential role for CRP in immune activation not only in systolic but also in diastolic HF. The measurement of hsCRP levels thus has the potential to play an important role for risk assessment in patients with CHF.

P-wave dispersion and its relationship to aortic elasticity in young prehypertensive patients.

BACKGROUND Prolonged P-wave duration (P(dur)) and increased P-wave dispersion (PWD) are independent predictors of atrial fibrillation (AF) in patients with hypertension. This study was designed to evaluate the possible relationship between aortic elasticity and PWD in young prehypertensive patients. METHODS Twenty-five newly diagnosed prehypertensive patients (18 men, mean age = 34 +/- 6 years) and 25 healthy control subjects (16 men, mean age = 33 +/- 6 years) were enrolled in the study. The P(dur) measurements were calculated using a 12-lead surface electrocardiogram (ECG). Aortic elasticity parameters were derived from aortic diameters measured by echocardiography, and simultaneous blood pressure (BP) measurements by sphygmomanometry. RESULTS The baseline characteristics of patients with prehypertension were homogeneous with those of the controls. PWD and P(maximum) values were found to be higher in patients with prehypertension as compared to those of the controls (PWD; 65 ms vs. 35 ms, P < 0.001; P(maximum); 110 ms vs. 80 ms, P < 0.001). However, P(minimum) values were not significantly different between the two groups (40 ms vs. 45 ms, P = 0.358). Also, a moderate positive correlation was found between stiffness index (SI) and PWD (r = 0.500, P = 0.011), and a moderate negative correlation between aortic elasticity parameters (aortic distensibility and strain indexes) and PWD (for aortic distensibility, r = -0.498, P = 0.011; for strain index, r = -0.578, P = 0.002), in patients with prehypertension. CONCLUSIONS Young patients with prehypertension have increased PWD and arterial stiffness. These parameters are correlated and may pose additional risk factors for future cardiovascular events.

Woven Right Coronary Artery: A Case Report and Review of the Literature

Woven coronary artery is an extremely rare and is still not a clearly defined coronary anomaly in which epicardial coronary artery is divided into multiple thin channels at any segment of the coronary artery, and subsequently, these multiple channels merge again in a normal conduit. A few cases have been reported till now. In this case report, we present a 58‐year‐old male with a woven right coronary artery. Copyright

A new treatment modality in management of patients with cardiac syndrome X: Enhanced external counterpulsation

We have greatly enjoyed reading the recently published article by Kronhaus and Lawson entitled with ‘Enhanced external counterpulsation is an effective treatment for syndrome X’[1]. In that interesting clinical study enhanced external counterpulsation (EECP) was used to treat 30 patients with refractory angina due to cardiac syndrome X, with an initial improvement in Canadian Cardiovascular Society (CCS) angina class (3.57 to 1.43) and regional ischemia in all treated patients. At a mean of 11.9 months follow-up, 87% of patients had sustained improvement in angina and were without major adverse cardiovascular events (MACE). The authors conclude that EECP, by improving endothelial function, may be an effective and durable treatment for this often difficult to treat problem. Cardiac syndrome X (CSX) is now known to represent a heterogeneous group of patients, the definition of which remains under debate. Cardiac syndrome X is a clinical entity needing to be distinguished from angina pectoris due to obstructive coronary artery disease. It has 3 essential characteristics, each of which can be seen in other disorders [2]: Angina or angina-like chest painwith exertion; STsegment depression on treadmill exercise testing; normal coronary arteriography, with no spontaneous or inducible epicardial coronary artery spasm on ergonovine or acetylcholine provocation. Among patients with chest pain who are referred for coronary angiography, 15 to 20% have normal vessels or no vessel with 50% stenosis [3]. Until a specific diagnostic test is available, the diagnosis of CSX is one of exclusion.

The Impact of Preinfarction Angina on Electrocardiographic Ischemia Grades in Patients with Acute Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention

Objective: Grade 3 ischemia (G3I) is defined as ST elevation with distortion of the terminal portion of the QRS (emergence of the J point >50% of the R wave in leads with qR configuration, or disappearance of the S wave in leads with an Rs configuration). Patients with G3I on the presenting electrocardiogram (ECG) had worse prognosis than the patients with lesser (grade 2‐G2I) ischemia. The aim of this study is to examine the effects of preinfarct angina (PIA) on electrocardiographic ischemia grades.

Muscle wastage in heart failure: Orphan of the heart failure

The patients with heart failure (HF) often exhibit some degree of muscle wasting restricted to the lower limbs. This loss of tissue may become more extensive in some patients, usually when their HF is more advanced, and may affect all body compartments. The underlying metabolic causes are very complex and differ from patient to patient. Three essential contributors are dietary deficiency and loss of nutrients through the digestive tract and metabolic dysfunction. The development of cachexia is an ominous sign and new drugs will be added into our therapeutic armamentarium to fight against cardiac cachexia in the near-future.