Yasin Türker

N-acetylcysteine for the prevention of postoperative atrial fibrillation: a prospective, randomized, placebo-controlled pilot study

AIMS Oxidative stress has recently been implicated in the pathophysiology of atrial fibrillation (AF). The aim of the present study was to evaluate the effects of antioxidant agent N-acetylcysteine (NAC) on postoperative AF. METHODS AND RESULTS The population of this prospective, randomized, double-blind, placebo-controlled study consisted of 115 patients undergoing coronary artery bypass and/or valve surgery. All the patients were treated with standard medical therapy and were randomized to NAC group (n = 58) or placebo (saline, n = 57). An AF episode >5 min during hospitalization was accepted as endpoint. During follow-up period, 15 patients (15/115, 13%) had AF. The rate of AF was lower in NAC group compared with placebo group (three patients in NAC group [5.2%] and 12 patients in placebo group [21.1%] had postoperative AF; odds ratio [OR] 0.20; 95% confidence interval [CI] 0.05 to 0.77; P = 0.019). In the multivariable logistic regression analysis, independent predictors of postoperative AF were left atrial diameter (OR, 1.18; 95% CI, 1.06-1.31; P = 0.002) and the use of NAC (OR, 0.20; 95% CI, 0.04-0.91; P = 0.038). CONCLUSION The result of this study indicates that NAC treatment decreases the incidence of postoperative AF.

Matrix metalloproteinases and inflammatory markers in coronary artery ectasia: their relationship to severity of coronary artery ectasia.

ObjectiveAlthough underlying mechanisms of coronary artery ectasia (CAE) are clearly unknown, destruction of extracellular matrix may be responsible for the ectasia formation. Thus, we investigated the role of matrix metalloproteinases (MMP), tissue inhibitor of matrix metalloproteinases (TIMP-1), and inflammatory markers [high-sensitive C-reactive protein, interleukins (ILs)] in CAE patients. MethodsThis study consisted of 28 consecutive CAE patients, 27 obstructive coronary artery disease (CAD) patients, and 22 controls with normal coronary arteries undergoing cardiac catheterization. Plasma levels of MMP-3, MMP-9, TIMP-1, and inflammatory markers were measured. ResultsPlasma level of MMP-3 was significantly higher in CAE patients compared with both CAD patients and controls (17.2±6.1, 11.2±3.2, and 9.2±3.4 ng/ml, respectively, both P=0.001) and so did MMP-9 level (27.4±5.9, 24.8±4.4, and 20.6±4.6 ng/ml, respectively, both P<0.05). IL-6 level was also higher in CAE patients than in controls (60.9±22.1 vs. 36.1±21.5 pg/ml, P=0.001) but were comparable in CAE and CAD patients. Plasma high-sensitive C-reactive protein, IL-1, and TIMP-1 levels were similar in three groups. MMP-3 levels correlated with diffuse (r=0.46, P=0.01) and multivessel ectasia (r=0.45, P=0.02). ConclusionOur results suggest that the increased level of MMP-3, MMP-9, and IL-6 may be responsible for ectasia formation in patients with CAE.

Mean platelet volume, an indicator of platelet activation, is increased in patients with mitral stenosis and sinus rhythm

Abstract Systemic thromboembolism is a serious major complication in patients with mitral stenosis. However, the pathogenesis of thromboembolism in mitral stenosis is not fully understood. Previous studies have demonstrated that platelet activation occurs in serum of patients with rheumatic mitral stenosis (MS). The aim of this study was to assess the mean platelet volume (MPV), an indicator of platelet activation, in patients with MS. The study group consisted of 36 patients with MS who were in sinus rhythm. An age and gender matched control group was composed of 30 healthy volunteers. We measured serum MPV values in patients and control subjects. MPV was significantly higher among MS patients with sinus rhythm (SR) when compared with the control group (9.2±1.4 vs 8.1±0.9 fl respectively; p<0.001). We have shown that MPV was significantly elevated in patients with MS who were in SR compared to control subjects.

The association between previous statin use and development of atrial fibrillation in patients presenting with acute coronary syndrome

AIMS To examine the association between statin use and the development of atrial fibrillation (AF) in patients presenting with acute coronary syndrome (ACS). METHODS From a total of 1000 patients presenting with ACS 241 were on and 759 were not on statin. An AF episode was accepted as endpoint. RESULTS The incidence of AF was less frequent in statin group compared to non-statin group (5% vs 10%, respectively, p=0.01). Independent predictors of AF were left atrial diameter, use of statin, age, hypertension, previous AF and use of angiotensin converting enzyme inhibitors or angiotensin receptor blockers. CONCLUSIONS In ACS patients, statin treatment was associated with lower incidence of AF.

Recurrent acute stent thrombosis associated with protein C and S deficiencies

Protein C and protein S deficiencies may uncommonly be responsible for coronary arterial thrombosis. We report a young woman with recurrent acute stent thrombosis due to the deficiency of protein C and S. After coronary stenting, stent thrombosis occurred two times despite aggressive antiplatelet therapy, including aspirin, clopidogrel and glycoprotein IIb/IIIa inhibitor. This report suggests that the deficiency of protein C and S should be born in mind in a young patient with recurrent thrombotic events, and that anticoagulants in addition to antiplatelet agents considered in the presence of their deficiency.

Association between renin-angiotensin-aldosterone system blockers and postoperative atrial fibrillation in patients with mild and moderate left ventricular dysfunction.

OBJECTIVE The aim of the study was to evaluate the association between renin - angiotensin - aldosterone system blockers and risk of postoperative atrial fibrillation (AF) development in patients with mild and moderate left ventricular systolic dysfunction. METHODS The population of this prospective and observational study consisted of 269 patients with an ejection fraction of < or = 50% undergoing coronary artery bypass and/or valve surgery. Use of renin -angiotensin-aldosterone system blockers (angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB) and spironolactone) and their association with postoperative AF (AF episode lasting < or = 5 min) were evaluated. In statistical analysis t test for independent samples, Chi-square test and Mann Whitney U test were used for comparison of variables between groups. Predictors of postoperative AF were determined by multiple logistic regression analysis. RESULTS During follow-up, 50 patients (13%) developed postoperative AF. With multiple logistic regression analysis, risk factors for postoperative AF were determined: left atrial diameter (OR- 1.09; 95%CI 1.01-1.16, p=0.02), age (OR-1.04; 95%CI 1.002- 1.08, p=0.04), aortic cross-clamp duration (OR- 1.03, 95%CI -1.00-1.05, p=0.01), use of left internal mammarian artery (OR-0.33; 95%CI 0.13-0.88, p=0.03), ACEIs treatment (OR-0.27; 95%CI 0.12-0.62, p=0.002), and ARBs treatment (OR - 0.21, 95%CI 0.07-0.62, p=0.005). CONCLUSIONS Our results indicate that although treatments with ACEIs and ARBs are associated with low incidence of postoperative AF in patients with mild and moderate left ventricular systolic dysfunction, treatment with spironolactone is not.

Heart rate variability and heart rate recovery in patients with coronary artery ectasia.

BackgroundCoronary artery ectasia (CAE) is characterized by an abnormal dilatation of the coronary arteries, which is a variant of coronary artery disease (CAD). Increased sympathetic activity or decreased vagal modulation of cardiac function assessed by heart rate variability (HRV) analysis has been associated with an increased risk of coronary artery disease and mortality and angiographic progression of coronary atherosclerosis, as well as arrhythmia and sudden cardiac death. Heart rate recovery index is a strong indicator of risk in asymptomatic and symptomatic CAD. To the best of our knowledge, no study has been conducted to investigate the relationship between HRV, heart rate recovery, and CAE. The purpose of this study was to examine the changes in heart rate recovery and HRV measurements in coronary artery ectasia. MethodsThe study population consisted of 50 consecutive patients (24 women; mean age 46±5 years) with CAE, and 35 asymptomatic healthy individuals comprised the control group (19 women; mean age 44±7 years). We performed electrocardiography, echocardiography, Holter analysis, exercise stress test, routine biochemical tests and evaluated the clinical characteristics. Time-domain parameters of HRV (mean R–R intervals; standard deviations of all N–N intervals; standard deviations of the averages of N–N intervals), the root mean square of the difference in successive R–R intervals, proportion derived by dividing the number of interval differences of successive N–N intervals greater than 50 ms by the total number of N–N intervals (pNN50) were evaluated. Heart rate recovery was defined as the difference in the heart rate from peak exercise to 1 min after peak exercise. ResultsStandard deviations of all N–N intervals (123.7±30.3 vs. 178.8±52.7, P<0.001), standard deviations of the averages of N–N intervals (95.2±27.1 vs. 120.2±39.6, P = 0.001), total number of N–N intervals (11.9±8.6 vs. 17.1±6.4, P = 0.004) were significantly lower in the CAE group than in healthy controls. The root mean square of the difference in successive R–R intervals was lower in CAE patients than controls, but the differences between groups were not statistically significant (47.5±23.1 vs. 56.2±23.6, P = 0.097). The heart rate recovery values measured during the recovery phase were significantly lower in the CAE group compared with the control group (21.3±11.1 vs. 29.3±11.9, P = 0.002). The incidence of abnormal heart rate recovery [22 (44%) vs. 5 (14%), P = 0.002] was greater in patients with CAE group than in controls. ConclusionThe results of this study showed that time-domain HRV parameters and heart rate recovery were reduced in patients with CAE.

Comparison of Changes in Anxiety and Depression Level Between Dabigatran and Warfarin Use in Patients With Atrial Fibrillation

We hypothesized that patients taking warfarin require frequent hospital follow-up and they are at higher risk for complications, so the incidence of depression and anxiety is higher in patients with atrial fibrillation (AF) in the period of taking warfarin compared to the period of taking dabigatran. Fifty patients having AF without valvular diseases under treatment of warfarin in whom a transition to dabigatran was planned were consecutively enrolled in this study and followed up prospectively between July 2013 and July 2014. All patients completed Beck Depression Inventory and Hamilton Anxiety Scale (HAS) at the initiation of study and 6 months after initiation of study. Of the patients enrolled in the study, age, gender, smoking status, and comorbidities were questioned. A total of 50 patients (28 women; mean age 74.6 ± 8.7 years) treated with warfarin in whom a transition to dabigatran was planned were included. Basal mean value of BDS (15.6 ± 7.8 vs 11.5 ± 4.8, P < .001) and HAS (16.8 ± 10.4 vs 12.6 ± 8.1, P < 0.001) was significantly higher in patients when they used warfarin than when they switched to dabigatran. In categorical analysis, frequency of patients with depression (mild, moderate, and severe) was significantly higher in period of warfarin use than after dabigatran transition (n = 24, 48% vs n = 14, 28%, P = .039). Our study demonstrates that patients with nonvalvular AF under treatment of dabigatran had lower BDS and HAS scores compared to warfarin. These findings suggest that dabigatran may increase quality of life and decrease morbidity and mortality due to reduction in anxiety and depression.

Relationship Between Mean Platelet Volume and Pulmonary Embolism in Patients With Deep Vein Thrombosis

BACKGROUND Mean platelet volume (MPV) has been demonstrated to be associated with deep vein thrombosis (DVT). However, its role in the prediction of pulmonary embolism (PE), which is a major complication of DVT, is still unclear. Therefore, we investigated the association of MPV values with acute PE in patients with DVT. METHOD The study included three groups: patients with DVT and PE (n=98); patients with DVT without PE (n=97); and control group (No DVT, No PE, n=98). We also evaluated DVT patients according to the MPV values on admission and categorised them into two groups: MPV≤9.15 fL (n=82) and MPV>9.15 fL (n=113). RESULTS MPV was significantly higher in all DVT patients than controls (9.3±0.9 fL vs 7.9±0.7 fL, p<0.001) and in DVT patients with PE than DVT patients without PE (9.9±0.6 fL vs 8.7±0.7 fL, p<0.001). The rate of PE was higher in patients with DVT with MPV>9.15 fL than those with MVP≤9.15 fL (75.2% vs 15.9%, p<0.001). The presence of PE in patients with DVT was independently associated with MPV (OR: 22.19, 95%CI: 9.39-53.19, P<0.001). CONCLUSION Although our findings should be considered within the limitations of the study, they suggest that MPV measures may be elevated in DVT patients and a higher MPV may be associated with PE in patients with DVT.

Is the neutrophil-to-lymphocyte ratio indicative of inflammatory state in patients with obesity and metabolic syndrome?

Objective: Obesity causes subclinical inflammation. Leukocyte count and high-sensitivity C-reactive protein (hs-CRP) are used to indicate inflammation in clinical practice. Also, inflammatory markers are evaluated as important indicators of cardiovascular risk in patients with obesity and metabolic syndrome (MetS). We aimed to investigate the usage of the neutrophil-lymphocyte ratio (NLR) as an inflammatory marker in obese patients with and without MetS. Methods: The study included a total of 1267 patients. The patients were assigned groups according to degree of obesity and status of MetS. Metabolic and inflammatory markers were compared between groups, and correlation analysis was performed. Results: Leukocyte count and hs-CRP were significantly different (p<0.001), but NLR was not different between body mass index (BMI) groups (p=0.168). Both lymphocyte and neutrophil counts were significantly increased with increased degree of obesity (p<0.001, p=0.028, respectively). Leukocyte, neutrophil, and lymphocyte counts and hs-CRP level showed a significant correlation with BMI (r=0.198, p<0.001; r=0.163, p<0.001; r=0.167, p<0.001; r=0.445, p<0.001, respectively), whereas NLR was not correlated with BMI (r=0.017, p=0.737). Only a significant association between a MetS severity of 5 and 4 with hs-CRP level was observed (p=0.028), whereas there was no statistically significant association for leukocyte count and NLR (p=0.246; p=0.643, respectively). Conclusion: NLR was not a good indicator of inflammation, while leukocyte and hs-CRP were more useful biomarkers to indicate inflammation in non-diabetic patients with obesity and MetS.