Yusuf Aslantas

Impact of body mass index on left ventricular diastolic dysfunction.

Background: The prevalence of obesity is increasing in the developed and developing world. It is an independent risk factor for heart failure. Left ventricular (LV) diastolic dysfunction has been demonstrated to be a strong predictor of heart failure. In the present study we aimed to assess the impact of body weight on LV diastolic function. Methods: The study was conducted on 2,228 participants (1,424 women, 804 men with a mean age of 49). Traditional and tissue Doppler echocardiographic examination were performed in all of the participants. The demographic and echocardiographic data were compared. Multivariate logistic regression analysis was used to assess the independent predictors of association of LV diastolic function. The study sample was divided into four groups: group 1 (body mass index [BMI] < 25.0 kg/m2), group 2 (BMI 25.0–29.9 kg/m2), group 3 (BMI ≥ 30–39.9 kg/m2), and group 4 (BMI ≥ 40 kg/m2). Results: Septal E was significantly lower in groups 2 and 3 compared to group 1 (P = 0.003). Septal A and septal A’ were significantly higher whereas septal E’ and lateral E’ were significantly lower in the groups 2, 3, and 4 compared to the normal weight group (P < 0.001). Lateral A’, deceleration time, and ejection time were significantly higher in obese when compared to the normal weight (P = 0.025, P < 0.001, and P = 0.009, respectively). The E/E’ ratio was significantly higher in groups 2, 3, and 4 compared to the group 1 (P < 0.001). Logistic regression analysis revealed that age, BMI (OR = 1.060 [95% CI = 1.040 and 1.080]; P < 0.001), hypertension, and diabetes mellitus were independent predictors of LV diastolic dysfunction. Conclusion: BMI is an independent predictor of LV diastolic dysfunction along with age, hypertension, and diabetes mellitus. (Echocardiography 2012;29:647‐651)

Association of omentin Val109Asp polymorphism with coronary artery disease.

OBJECTIVE Coronary artery disease (CAD) is the most important morbidity and mortality disease in the world. It is also one of the leading causes of death in Turkey. Omentin, a recently found adipocytokine, is reported to regulate insulin sensitivity. It has anti-inflammatory properties and is inversely associated with CAD. Omentin gene polymorphism in patients with CAD has not been studied yet. The aim of this study is to investigate the relationship between omentin Val109Asp polymorphism and CAD. METHODS This is an observational study on genetic association. 157 consecutive patients who had undergone coronary angiography were included in the study. Seventy-five of them had CAD and the rest serves the control group. Val109Asp polymorphism was analyzed and compared. Chi-square test was used in comparison of genotype frequencies, whereas ANOVA and chi-square tests were used in comparison of clinical characteristics according to the genotypes. RESULTS There was no significant difference between CAD patients and control subjects regarding omentin Val109Asp polymorphism. However, a 2.5 fold increase in Val/Val (homozygous mutant) genotype was detected in patients with CAD. The OR (80% Cl) for Val/Val genotype was 3.46 (1.14-10.49). CONCLUSION Although no significant difference was detected regarding omentin Val109Asp polymorphism, Val/Val genotype frequency was found to be more in patient group than control group. In conclusion, it may be speculated that Val/Val genotype increases the tendency for CAD, but this experiment should done with larger population to clarify this issue.

Serum visfatin and omentin levels in slow coronary flow

OBJECTIVE The adipocytokines visfatin and omentin have a direct effect on inflammation and endothelial injury. The expression of visfatin is closely associated with the expression of proinflammatory cytokines. Omentin has an anti-inflammatory effect and is inversely associated with coronary artery disease (CAD). The slow coronary flow phenomenon is an angiographic finding characterized by delayed distal vessel opacification in the absence of significant epicardial coronary disease. The pathophysiology of SCF has not been clearly identified, although multiple abnormalities including endothelial dysfunction, atherothrombosis and inflammation have been reported. However, the relationship between visfatin, omentin and SCF is still unknown. In this study, we aimed to investigate the relationship of these adipocytokines with SCF. METHODS The study included slow coronary flow (n=45) and normal coronary flow (n=55) subjects, according to the corrected TIMI frame count, who underwent angiography in the catheterization laboratory of Duzce University. Statistical analyses were performed with SPSS version 12. RESULTS Visfatin levels were significantly higher in patients with SCF than in controls (p<0.001). Plasma omentin levels were lower in the SCF group than in controls, although without statistical significance. Visfatin, gender and platelet count were significant predictors of SCF in multivariate logistic regression analysis (OR 0.748, 95% CI 0.632-0.886, p=0.01; OR 30.016, 95% CI 4.355-206.8, p=0.01; OR1.028, 95% CI 1.006-1.050, p=0.011, respectively). CONCLUSION Adipocytokines such as visfatin and omentin may play a role in the pathogenesis of coronary slow flow.

The relationship between acute coronary syndrome and sildenafil

Sildenafil is a drug used for male erectile dysfunction. Sildenafils fatal cardiac effects except due to hypotension with simultaneous nitrate use have not been reported.We reported in this case a 70-year-old man admitted to the emergency service with chest pain, which occurs in an hour after sildenafil use. Electrocardiogram showed inferoposterior ST-segment elevation. In angiography, total circumflex artery occlusion has been seen.

A novel indicator for assessment of mitral regurgitation severity: Pro-adrenomedullin

[1] Aldous SJ. Cardiac biomarkers in acute myocardial infarction. Int J Cardiol 2013;164:282–94. [2] Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med 2005;352:1685–95. [3] Dominguez-Rodriguez A, Abreu-Gonzalez P, Kaski JC. Inflammatory systemic biomarkers in setting acute coronary syndromes—effects of the diurnal variation. Curr Drug Targets 2009;10:1001–8. [4] Hoffmann G, Wirleitner B, Fuchs D. Potential role of immune system activationassociated production of neopterin derivatives in humans. Inflamm Res 2003;52:313–21. [5] Fuchs D, Avanzas P, Arroyo-Espliguero R, et al. The role of neopterin in atherogenesis and cardiovascular risk assessment. Curr Med Chem 2009;16:4644–53. [6] Gupta S, Fredericks S, Schwartzman RA, Holt DW, Kaski JC. Serum neopterin in acute coronary syndromes. Lancet 1997;349:1252–3. [7] Schumacher M, Halwachs G, Tatzber F, et al. Increased neopterin in patients with chronic and acute coronary syndromes. J Am Coll Cardiol 1997;30:703–7. [8] Garcia-Moll X, Coccolo F, Cole D, Kaski JC. Serum neopterin and complex stenosis morphology in patients with unstable angina. J Am Coll Cardiol 2000;35:956–62. [9] Avanzas P, Arroyo-Espliguero R, Cosin-Sales J, et al. Markers of inflammation and multiple complex stenoses (pancoronary plaque vulnerability) in patients with non-ST segment elevation acute coronary syndromes. Heart 2004;90:847–52. [10] Zouridakis E, Avanzas P, Arroyo-Espliguero R, Fredericks S, Kaski JC. Markers of inflammation and rapid coronary artery disease progression in patients with stable angina pectoris. Circulation 2004;110:1747–53. [11] Adachi T, Naruko T, Itoh A, et al. Neopterin is associated with plaque inflammation and destabilisation in human coronary atherosclerotic lesions. Heart 2007;93:1537–41. [12] Avanzas P, Arroyo-Espliguero R, Quiles J, Roy D, Kaski JC. Elevated serum neopterin predicts future adverse cardiac events in patients with chronic stable angina pectoris. Eur Heart J 2005;26:457–63. [13] Ray KK, Morrow DA, Sabatine MS, et al. Long-term prognostic value of neopterin: a novel marker of monocyte activation in patients with acute coronary syndrome. Circulation 2007;115:3071–8. [14] Kaski JC, Consuegra-Sanchez L, Fernandez-Berges DJ, et al. Elevated serum neopterin levels and adverse cardiac events at 6 months follow-up inMediterraneanpatientswith non-ST-segment elevation acute coronary syndrome. Atherosclerosis 2008;201:176–83. [15] Vengen IT, Dale AC, Wiseth R, Midthjell K, Videm V. Neopterin predicts the risk for fatal ischemic heart disease in type 2 diabetes mellitus: long-term follow-up of the HUNT 1 study. Atherosclerosis 2009;207:239–44. [16] Dominguez-Rodriguez A, Abreu-Gonzalez P, Avanzas P. Macrophage/monocyte activation and cardiovascular disease. Int J Cardiol 2012;159:245–6.

Amount of ST wave resolution in patients with and without spontaneous coronary reperfusion in the infarct -related artery after primary PCI: an observational study.

OBJECTIVE In patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), a patent infarct-related artery (IRA) on initial angiography was associated with better angiographic results and improved prognosis compared with patients without spontaneous reflow. The role of systematic emergency PCI in patients with spontaneous reperfusion during myocardial infarction is debated. We compared the amount of ST wave resolution (STR) in patients with and without spontaneous coronary reperfusion (SCR) in the infarct related artery. METHODS This study was designed as an observational cohort study. One hundred sixty-one consecutive patients (121 males, 40 females, with a mean age of 56±10 years) who had STEMI and treated with primary PCI without previous thrombolytic therapy were included in the study. All patients were treated with primary PCI within 12 hours from the onset of the symptoms and had stent implantation in the culprit lesion. ST wave resolution was measured as percent resolution of ST segment elevation from electrocardiogram (ECG), before and after PCI, classified as complete (>70%), partial (30% to 70%), or absent (<30%). SCR was defined as a TIMI grade III flow in the IRA on baseline coronary angiogram. The amount of ST wave resolution (STR) in patients with and without SCR in the IRA was compared. We used Chi-square test, Students t-test and the Mann-Whitney U test for statistical analysis. RESULTS At the baseline coronary angiography 40 (25%) patients had SCR and 121 patients (75%) had TIMI flow grade 0, 1 or 2 (non-SCR group). ST segment resolution amount was significantly higher in patients without SCR (53±17 versus 13±23 mm; p<0.001). In fact; in five patients whom had patent infarct related artery in initial angiography, ST segment elevation increased according to pre-PCI ECG. CONCLUSION Mean ST wave resolution was lower in patients with spontaneous coronary reperfusion who were treated with primary PCI compared to their counterparts who did not have spontaneous coronary reperfusion on initial coronary angiography.

Psoriazisli Hastalarda Serum Asimetrik Dimetilarjinin (ADMA) ve Yüksek Sensitif C-Reaktif Protein (hsCRP) Seviyeleri

Aim: Asymmetric dimethylarginine (ADMA) is a major inhibitor of nitric oxide synthesis inhumans. Recent reports have demonstrated that elevated high sensitive C-reactive protein(hsCRP), an inflammatory marker, and plasma ADMA levels are associated with endothelialdysfunction and increased atherogenesis. We aimed to determine the presence of endothelialdysfunction in psoriatic patients and if psoriazis is an independent risk factor for cardiovasculardiseases by measuring the serum levels of ADMA and hsCRP in patients with psoriazis.Material and Methods: Thirty five psoriatic patients not having traditional cardiovascular riskfactors and 26 healthy controls were included into the study. Serum levels of ADMA, hsCRP,HDL, LDL, triglyceride, and total cholesterol, and BMI analyses were assessed and comparedbetween patient and control subjects. The association of psoriazis area and severity index (PASI)scores with ADMA and hsCRP levels were evaluated. Results: There was no statistically significant difference for the demographic characteristics,and all laboratory parameters levels between psoriazis and control groups. ADMA values were0.63±0.30 μmol/L (mean±sd) and 0.68±0.45 μmol/L (mean±sd) in patients and control group,respectively. hsCRP levels were 1.40±1.51 mg/L (mean±sd) in control group, while 1.91±2.13mg/L (mean±sd) in patients group. There was no statistically significant difference betweenpatients and control groups, in terms of ADMA and hsCRP values (p>0.05). Statisticallysignificance and moderate correlation was found between PASI scores and serum hsCRP levels(r=0,73; p<0,01).Conclusion: This study concludes that there isn’t an increasedvascular endothelial dysfunction which could be shown by ADMAand hsCRP biochemical markers in mild and moderate psoriazis.Also, it suggests that mild and moderate psoriazis is not anindependent risk factor for cardiovascular diseases. However, itis concluded that the levels of hsCRP could be used as an objectivemarker alternative to PASI to determine the response to thetreatment and the severity of the disease

Major Adverse Events Rate and Characteristics in Duzce, The Results of Melen Study with 36 Months Prospective Follow-up

Objectıve: Novel studies which investigated extraskeletal effects of vitamin D showed that vitamin D plays important role in whole body health, beyond bone health. Vitamin D receptors are present in various cell types including osteoblasts, cardiomyocytes, myocytes, endothelium, immune cells and neurons. Vitamin D deficiency is defined as 25-hydroxy D3 values 20 ng/ml and its prevalence varies from 27% to 55% in different series. Decline in systolic and diastolic functions of the heart has been reported in patients with vitamin D deficiency.In this study, we aimed to investigate short-term effects of vitamin D treatment on systolic and diastolic functions of the heart in patients with vitamin D deficiency. Methods: Fifty patients (3 male/ 47 female, mean age 46 12 years) diagnosed as having vitamin D deficiency and osteoporosis were included in this study. All patients underwent detailed transthoracic echocardiography for evaluation of left ventricular systolic and diastolic functions of the heart.Oral Vitamin D was administered to all study paitents for 8 days (a total of 300.000 IU). Transthoracic echocardiography was repeated for all patients at 30th days. Results: After one month treatment with oral Vitamin D, serum 25-hydroxy D3 value increased from 11 4 ng/ml to 21 5 ng/ml, p<0.001). After initiation of supplementary vitamin D treatment LVEF (62,6 5% to 63.8 4, p1⁄40.025) indicating LV systolic function improved significantly. Also mitral E/A ratio, a measure of diastolic function, improved significantly after treatment with vitamin D treatment (1.16 0.3 to 1.2 0.3, p1⁄40.028). However, IVCT (95.2 15 to 96 13, p1⁄40.54) and EDEC (197 28 to 197 22, p1⁄40.95) were similar to baseline values. Change in serum level of vitamin D (6Vit D) was correlated with change in LVEF (6EF, r1⁄40.39 and p1⁄40.005) and change in mitral E/A ratio (6E/A, r1⁄40.340 and p1⁄40.016). Linear regression analysis revealed that change in serum 25-hydroxy D3 level (6Vit D) was significantly associated with change in LVEF (6EF) (coefficientb1⁄40.36, p1⁄40.013). Conclusıon: Results of this study show that supplementary vitamin D treatment leads to improvement in LV systolic and diastolic function in patients with vitamin D deficiency, even at short term follow-up. Our results also show that change in Vitamin D level is significantly associated with improvement in LVEF.

PP-242 COMPLETE DISSECTION OF LEFT ANTERIOR DESCENDING ARTERY IN A YOUNG WOMAN AFTER MYOCARDIAL INFARCTION

Spontaneous coronary artery dissection (SCAD) is a rare clinical condition that causes acute coronary syndrome and sudden cardiac death. Herein, we report a case of left anterior descending artery dissection after myocardial infarction. On the third day of myocardial infarction after successful thrombolysis, the patient had recurrent chest pain without any ST wave elevation. She was referred to our clinic for coronary angiography which showed completely dissected left anterior descending (LAD) artery. She was referred to a tertiary centre with intravascular ultrasonography (IVUS) capability. Her control angiogram showed restored flow with only minimal dissection (so IVUS was not performed) in the mid LAD. The lesions in the distal and mid LAD were stented. The final angiogram showed TIMI-III flow. Percutaneous coronary intervention is the first choice of treatment in patients with single-vessel spontaneous coronary artery dissection with ongoing signs of ischemia.