Yusuf Kenan Tekin

Serum uric acid levels are associated with atrial fibrillation in patients with ischemic heart failure.

We evaluated the association between serum uric acid (SUA) and atrial fibrillation (AF) in patients with chronic heart failure (HF). Totally, 363 patients with chronic HF were included in the study. Of all, 78 patients had AF and 285 patients were in normal sinus rhythm. Serum uric acid was significantly increased in patients with AF compared with patients in normal sinus rhythm (P < .05). Comparing patients with AF and normal sinus rhythm, we found that age was significantly higher in patients group with AF. Echocardiographic parameters including ejection fraction, left atrial diameter, left ventricle end-diastolic diameter, and left ventricle end-diastolic volume were also significantly higher in patients with AF compared with patients in normal sinus rhythm. We have shown that patients with AF have significantly higher SUA and this was independently associated with AF in patients with ischemic HF.

Mean platelet volume in patients with nonvalvular atrial fibrillation.

The procoagulant and prothrombotic states in patients with chronic atrial fibrillation are higher than those in patients with normal sinus rhythm. Mean platelet volume (MPV) which is a marker of platelet function and activation can reflect changes either in the level of platelet stimulation or the rate of platelet production. In this study, we aimed to assess and compare the hematologic parameters of routine complete blood count analysis in elderly patients with nonvalvular atrial fibrillation and control individuals with normal sinus rhythm. One hundred and seven consecutive patients with nonvalvular chronic atrial fibrillation and 112 age and sex-matched control individuals with normal sinus rhythm were retrospectively included in the study from the outpatient cardiology clinic. Hematological variables, including MPV, platelet count, red blood cell and white blood cell count were measured in all patients and control individuals. Presence of coronary artery disease, hypertension, sex, hyperlipidemia, diabetes mellitus, smoking status, hematocrit and platelet count were comparable between two groups (P > 0.05 for all). However, MPV and white blood cell count were significantly higher in patients with atrial fibrillation compared to those without atrial fibrillation. Logistic regression analysis revealed that white blood cell count and MPV significantly and independently associated with atrial fibrillation. We have shown that MPV and white blood cell count is independently associated with chronic nonvalvular atrial fibrillation. To improve the clinical utility of MPV and role of inflammation in the pathogenesis of atrial fibrillation, further studies are needed to be carried out.

Mean platelet volume in patients with dilated cardiomyopathy: does it have a role in left ventricular thrombus formation?

We assessed the clinical echocardiograhic, hematological, and biochemical parameters in patients with dilated cardiomyopathy (DCMP) and control individuals mainly focusing on the mean platelet volume (MPV) in terms of DCMP and left ventricle (LV) thrombus formation. Consecutive patients (n = 251) with DCMP and 266 patients without DCMP were studied. Mean platelet volume was significantly greater in patients with DCMP than in control patients (P < .05 for all comparisons). Comparing DCMP patients with LV thrombus (19 patients, 8%) and without LV thrombus (232 patients, 92%) showed that the prevalence of smokers was significantly higher and ejection fraction was significantly lower in patients with LV thrombus. We have shown that patients with DCMP have significantly higher MPV suggesting more platelet activation and the MPV of patients with DCMP and LV thrombus is comparable to those of patients without LV thrombus.

Serum γ-Glutamyltransferase Activity in Patients With Nonvalvular Atrial Fibrillation

Procoagulant and prothrombotic states in patients with chronic atrial fibrillation (AF) are higher than those in patients with normal sinus rhythm. We assessed and compared serum γ-glutamyltranferase (GGT) activity in elderly patients with nonvalvular AF and control participants with normal sinus rhythm. Consecutive patients (n = 81) with nonvalvular chronic AF and 210 age- and gender-matched control participants with normal sinus rhythm were retrospectively included in the study from the outpatient cardiology clinic. Presence of coronary artery disease, hypertension, gender, hyperlipidemia, diabetes mellitus, smoking status, glucose, total cholesterol, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and ejection fraction were comparable between the 2 groups (P > .05 for all). However, serum γ-GGT activity was significantly higher (P = .003) in patients with AF compared with those without AF. We have shown that serum γ-GGT activity is independently associated with chronic nonvalvular AF.

Response to the letter: uric acid levels and atrial fibrillation.

The comments by Koza et al on our article entitled ‘‘Serum uric acid levels are associated with atrial fibrillation in patients with ischemic heart failure’’ are essentially about study limitations. We evaluated the association between serum uric acid (SUA) and atrial fibrillation (AF) in patients with chronic heart failure (HF) retrospectively. The retrospective design was a limitation of our study. We would prefer a prospective design that included more patients, but every study has its limitations! Atrial fibrillation and HF share similar risk factors, and one of them is hypertension. In our study, hypertension did not differ significantly between the 2 groups (ie, with and without AF). Other common risk factors (gender, hyperlipidemia, diabetes mellitus, and smoking status) also did not differ significantly between these 2 groups. We attribute this lack of difference to the fact that these risk factors (including hypertension) were common in both the groups, so that the differences were not significant. Fasting blood samples of all patients were drawn from the antecubital vein at admission to hospital. Plasma was obtained within 15 to 30 minutes by centrifugation at 3000g for 15 minutes and then assayed. The SUA levels were measured as a routine laboratory test using an enzymatic method on an Architect CI16200 (Abbott, Germany). Systemic levels of inflammatory markers such as C-reactive protein, tumour necrosis factor a, interleukin (IL) 6 , and IL-1 are elevated in AF and HF. B-type brain natriuretic peptide is associated with the severity of HF. If we had evaluated these markers prospectively, our results would be more useful. We could not evaluate left ventricular diastolic dysfunction, body mass index, or glomerular filtration rate due to the retrospective design of the study. Patients received chronic HF treatment including furosemide, thiazide, spironolactone, b-blocker, angiotensin-converting enzyme inhibitor/angiotensin receptor blockers, digoxin, statin, acetylsalicylic acid, warfarin, and other drugs for other comorbidities (eg, diabetes mellitus, hyperlipidemia, dyspepsia, etc). Medical treatment was adjusted individually according to the clinical need and investigation results. Despite the limitations we mentioned the difference in SUA levels was highly significant (P 1⁄4 .002) in the absence of significant differences in creatinine levels or thiazide use. Therefore, our findings support a link between SUA and AF. Furthermore, our observations will help improve the design of future studies.

Acute inferior myocardial infarction after injection of etofenamate

Allergic symptoms accompanied by myocardial ischemic symptoms are defined as Kounis syndrome. Etofenamate is a safe and effective non-steroidal antiinflammatory drug that has widespread utilization. We hereby present a 71-year-old man with Kounis syndrome. Following intramuscular 1 g etofenamate injection, the clinical presentation when admitted to the emergency department (ED) was erythematous rash, pruritus, nausea and vomiting, dizziness, diaphoresis, and chest pain resulting in cardiopulmonary arrest. After 10 minutes of successful cardiopulmonary resuscitation, the electrocardiogram revealed acute inferior myocardial infarction. Patients who admit to the ED with allergic symptoms accompanied by chest pain should consider Kounis syndrome for prompt management. Electrocardiographic examination should be an essential part of the initial evaluation in such patients.

Prostetik Mitral Kapaklı Hastada Warfarin Kullanımının Neden Olduğu Hemorajik Ovarian Kist Rüptürü

Prostetik Mitral Kapakli Hastada Warfarin Kullaniminin Neden Oldugu Hemorajik Ovarian Kist Rupturu

Erişkin Hastada Asemptomatik Cor Triatriatum Olgusu

Cor triatriatum eriskin yasta nadir gorulen bir kardiyak anomalidir. Fibromuskuler bir membran ile sol atrium ikiye bolundugunde cor triatriatum sinistrum olarak adlandirilir. Klinikte genellikle pulmoner venoz obstruksiyon ve mitral darlik benzeri tablo ve bunlarin sonucunda gelisen pulmoner hipertansiyon gorulur. Genellikle cocukluk caginda tespit edilir ve bu donemde tedavi edilmeyen vakalar %75 olumcul seyreder. Bu yazida, eriskin yas grubunda tesadufen saptanmis cor triatriatum sinister olgusu sunulmustur.

Response to Letter: Mean Platelet Volume in Patients With Dilated Cardiomyopathy and Left Ventricular Thrombus

In our study, blood samples were drawn from the antecubital vein at 08.00 and 12.00 AM after at least 8-hour fasting period. Tubes containing EDTA were used for collection of blood samples. All blood measurements were performed within 1 hour after venipuncture (both heart failure patients and control group). Collection and analysis of blood samples were done with the same technique in patients with and without thrombus and in control patients. Hematological variables, including mean platelet volume (MPV), platelet count, red blood cells, and white blood cells count, were measured by cell analyzers (BC 5500 Auto Hematology Analyzer, China). So that, we do not think that the blood collection and blood collection tube could affect study results. Spontaneous echo contrast (SEC) is defined as the presence of characteristic swirling and smoke-like echo-dense shadow with a motion of blood within the cardiac chambers in transthoracic echocardiography or transesophageal echocardiography. This echocardiographic imaging is an important marker for thromboembolic risk. The SEC in the left ventricle (LV) was assessed in patients with dilated cardiomyopathy by transthoracic echocardiography. When heart failure patients are divided into 2 groups, MPV was not significantly different in heart failure patients with and without SEC (Table 1). Due to the nonsignificant results in this study, we did not mention about LV SEC. Akpek et al have reported that platelet indices, including MPV, are associated with the presence of SEC and are independent risk factors for SEC in patients with mitral stenosis. But according to our study results, MPV was not associated with LV SEC in patients with dilated cardiomyopathy.

The Evaluation of Electrocardiogram Findings in Acute Abdominal Pain Patients Admitted to the Emergency Department

The aim of this study was to determine the diagnostic value of electrocardiogram in differential diagnosis of patients with nonspecific abdominal pain. This prospective observational study was conducted in a university emergency department over 2 weeks. One hundred twenty patients with complaints of abdominal pain were admitted to the emergency department. During the study period, a total of 120 cases were evaluated. The final emergency department disposition status of the 120 patients was 1 (0.8%) died in the emergency department, 28 (23.3%) were admitted to the general ward, 27 (22.5%) were admitted to other services, and 10 (8.3%) were admitted to the cardiology service and coronary care unit. The examination indicated that 38 (31.7%) patients with abdominal pain showed cardiac pathologies on their electrocardiograms; 3 (2.5%) patients with abdominal pain admitted to cardiology service had ST elevation, and 2 (1.6%) had electrocardiogram depression on their electrocardiograms. According to the results, the authors claim that the electrocardiogram played an important role in the treatment and diagnosis of patients presenting with abdominal pain in emergency medicine. For this reason, it was thought that emergency medicine specialists should understand the basis of the perception of abdominal pain and develop a focused approach to the initial evaluation of these patients.