Zeydin Acar

Efficiency of atorvastatin in the protection of anthracycline-induced cardiomyopathy.

To the Editor: Antineoplastic agents of the anthracycline (ANT) group are commonly and effectively used in various forms of malignancies. Anthracyclines might lead to irreversible cardiomyopathy (CMP), despite their beneficial effects. A number of mechanisms, such as elevation in free superoxide

Epicardial Adipose Tissue Increased in Patients with Newly Diagnosed Subclinical Hypothyroidism

Objective: To investigate whether or not patients with subclinical hypothyroidism (SH) have increased epicardial adipose tissue (EAT). Subjects and Methods: Sixty-one patients with newly diagnosed SH and without any known cardiovascular disease were enrolled. Twenty-four subjects matched for age, gender and body mass index without any thyroid dysfunctions were included as a control group. The EAT was measured by echocardiography and thyroid functions were assessed by routine blood examination. Results: Patients with SH had higher EAT values than control subjects (3.6 ± 0.9 vs. 2.8 ± 1.4, p = 0.005). Also, SH patients with thyroid-stimulating hormone (TSH) ≥10 mU/l had higher EAT than those with SH with TSH <10 mU/l and control subjects (p = 0.013). In addition, while there was significant correlation between EAT and TSH (r = 0.31, p = 0.014) in patients with SH, there was no significant relation between EAT and TSH in normal subjects (r = 0.09, p = 0.64). Conclusions: There was a higher level of EAT in patients with SH compared with normal subjects and a significant correlation between EAT and TSH was found.

The effect of glucose-insulin-potassium treatment on myocardial oxidative stress in patients with acute coronary syndromes undergoing percutaneous coronary intervention.

ObjectivesIn this study, we sought to examine the effect of glucose–insulin–potassium (GIK) treatment on oxidative stress in patients with acute coronary syndromes (ACSs) undergoing percutaneous coronary interventions (PCIs). MethodsPatients with ACSs who had been electively treated with a stent implantation into the culprit vessel were included in this study. Patients were divided into two groups and were randomly administered either the GIK treatment (GIK group; n=28) or isotonic NaCl (control group; n=19) infusion during PCI. Blood samples from the coronary artery ostium (CO) were collected through the femoral artery and from the coronary sinus (CS) through the femoral vein, before and immediately after PCI. Superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GSH-Px) activities were measured. ResultsA total of 47 patients were included in the study. SOD, CAT, and GSH-Px activities, whether in the CO or the CS, were similar in both the GIK and control groups before the intervention (P>0.05). In the control group, SOD (in both the CO and the CS), CAT (in the CS), and GSH-Px (in the CS) activities were higher compared with baseline values (P<0.05). Such increases were, however, not seen in the GIK group (P>0.05). Although the CS–CO activity differences (venous–arterial) of SOD, CAT, and GSH-Px, which are parameters of myocardial reactive antioxidant enzyme production, were increased in the control group, there was no increase in the GIK group. ConclusionsIn patients with ACSs, reactive local enzyme activity increases for the scavenging to myocardial-free radicals during PCI. Administration of a solution of GIK as a metabolic support agent might prevent oxidative stress in the myocardial level, in these patients.

Increased frequency of fragmented QRS in patients with severe aortic valve stenosis.

Objective: To investigate the presence of myocardial fibrosis determined by fragmented QRS in patients with severe aortic valve stenosis. Subjects and Methods: Eighty-seven consecutive patients with severe aortic valve stenosis and 83 age- and gender-matched control subjects were enrolled into this study. Severe aortic valve stenosis was defined as an aortic valve area <1 cm2, a Vmax >4 m/s, or a mean gradient ≥40 mm Hg. Fragmented QRS was assessed using a 12-lead electrocardiogram. Results: Fragmented QRS was detected in 40 (46%) patients in the aortic valve stenosis group and in 15 (18%) control subjects (p < 0.001). In multivariate binary logistic regression analysis, the presence of aortic valve stenosis was the only independent factor associated with fragmented QRS (OR = 3.69; 95% CI 1.81-7.55, p < 0.001). Conclusion: A higher frequency of fragmented QRS was detected in patients with severe aortic valve stenosis compared to controls.

Atherosclerosis burden and coronary artery lesion complexity in acute coronary syndrome patients

BACKGROUND Syntax score (SS) is a prognostic marker in patients with acute coronary sydromes (ACS). Carotid intima media thickness (CIMT) and cardio ankle vascular index (CAVI) are well known surrogate marker of atherosclerosis burden. But association between atherosclerosis burden and coronary artery disease (CAD) complexity in ACS patients has not been investigated yet. METHODS AND RESULTS Consecutive patients with first time diagnosis of ACS (n = 172) were enrolled. SS, a marker of CAD complexity, was assessed by dedicated computer software. CIMT was examined by B-mode ultrasound. CAVI was assessed by VaSera VS-1000 cavi instrument. SS for low, intermediate and high tertiles of CIMT value were 10.1 ± 8.2 vs 11.4 ± ± 7.9 and 15.2 ± 8.8; p = 0.02). SS for normal, borderline and abnormal CAVI values were 4 ± 3.7 vs 11.1 ± 7.2 and 14.1 ± 9.1, respectively p = 0.009). Also, there was independent association between SS and CIMT (95% coinfidence interval [CI] 2.1-19, p = 0.014) and CAVI (95% CI 15-29, p = 0.021]. Neither traditional cardiovascular risk factor nor thrombolysis in myocardial infarction (TIMI) risk score was independent determinant of SS. CONCLUSIONS We have shown that patients with higher atherosclerosis burden have more complex coronary artery lesions. Also these patients may be identified early by using surrogate markers of atherosclerosis. Its clinical significance requires further research.

Earlobe crease may provide predictive information on asymptomatic peripheral arterial disease in patients clinically free of atherosclerotic vascular disease.

The diagonal earlobe crease (ELC) has been regarded as a simple marker of atherosclerosis. There is no knowledge concerning the relation of ELC to the presence, extent, and severity of peripheral arterial disease (PAD). Patients (n = 253) without known atherosclerotic vascular disease and symptoms were enrolled consecutively. Ankle brachial index (ABI) was measured. Patients with ELC had lower ABI compared to those with no ELC (1.02 ± 0.12 vs 1.11 ± 0.08, P < .001). Multivariate analysis demonstrated ELC (95% confidence interval [CI]: 3.3-21.9; P: .001) and age (95% CI: 0.87-0.99; P = .02) as independent determinants of abnormal ABI. There was incremental increased frequency of ELC from normal ABI to significant PAD. We have shown for the first time a significant and independent association between presence of ELC and increased prevalence, extent, and severity of PAD in patients without overt atherosclerotic vascular disease.

Increased Carotid Intima–Media Thickness is Associated With Higher SYNTAX Score

The main purpose of this study was to investigate the relation between carotid intima–media thickness (CIMT) and coronary artery disease (CAD) complexity. Consecutive patients (n = 360) with CAD confirmed by coronary angiography were enrolled. Mean CIMT and the overall SYNTAX score (SXscore) were 0.87 ± 0.12 mm and 15 ± 9, respectively. In univariate analysis, there was a significant correlation between the overall SXscore and CIMT (r = .42, P < .001), age (r = .23, P < .001), hypertension (r = .27, P = 0.001), diabetes (r = 0.11, P = 0.02), smoking (r = .24, P = .01), dyslipidemia (r = .2, P = 0.03), and β-blocker use (r = .19, P < .001). In multivariate analysis, CIMT (β = .34, P < .001) and age (β = .11, P < .019) were independently associated with SXscore. We have demonstrated a significant relation between CIMT and SXscore. Although this study is correlative and no causative conclusions can be drawn, our findings suggest that increased CIMT could reflect complex coronary artery lesions.

Association between mean platelet volume and coronary artery calcification in patients without overt cardiovascular disease: an observational study.

OBJECTIVE Platelets have an important role in the pathogenesis of atherothrombosis. It has been shown that platelet size measured by mean platelet volume (MPV), correlates with their reactivity and is still regarded as an easy, useful tool for indirect monitoring of platelet activity in different situations. Coronary artery calcification (CAC) has long been known to occur as a part of the atherosclerotic process. The aim of this study was to determine whether an association exists between MPV and CAC. METHODS In this observational study, we enrolled 259 participants with at least one cardiac risk factor but with unknown cardiovascular disease. Coronary calcification was assessed by multislice computerized tomography and MPV was measured in a blood sample collected in EDTA tubes. Statistical analysis was performed using Kruskal-Wallis, Chi-square, correlation tests and multiple regression analysis. RESULTS Calcium scores ranged from 0 to 735. There was a significant relation between CAC and MPV (r=0.24, p=0.02), age (r=0.32, p<0.001), hypertension (r=0.19, p=0.03), diabetes (r=0.16, p=0.005), smoking (r=0.17, p=0.001). In linear regression analysis, MPV (β=0.4, 95%CI 19.8- 31.1, p<0.001), age (β=0.13, 95%CI 0.23-2.4, p=0.01) and smoking (β=0.12, 95%CI 3.2-15.1, p=0.02) independently associated with CAC. In addition, there were significant differences in MPV between significant CAC group compared to the minimal and none (10.2 ± 2.4 versus 8.1 ± 0.9 and 7.6 ± 1.3; p<0.001). CONCLUSION We have found significant association between MPV and CAC. Although this study is purely correlative and no causative conclusions can be drawn, it may suggest that higher MPV may reflect increased atherosclerotic burden and cardiovascular risk.

Ankle–Brachial Index and Coronary Artery Lesion Complexity in Patients With Acute Coronary Syndromes

We investigated the relationship between peripheral artery disease (PAD) and coronary artery disease (CAD) complexity in patients with acute coronary syndromes (ACS). Consecutive patients with first time diagnosis of ACS (n = 150) were enrolled. SYNTAX score (SS), a marker of CAD complexity, was assessed by dedicated computer software and diagnosis of PAD was established by ankle–brachial index (ABI) value. SYNTAX score was higher in patients with overt and borderline PAD (ABI ≤ 0.99) than normal participants (ABI 1-1.29; 16.7 ± 8.2 vs 10.1 ± 5.5; P < .001). In addition, there was a strong negative correlation between ABI and SS (r = –.46; P < .001).We have demonstrated increased CAD complexity in patients with ACS and PAD and strong correlation between degree of PAD and coronary lesion complexity.

Giant Syphilitic Aortic Aneurysm Presenting With Pericardial Tamponade as an Initial Sign

![Figure][1] [![Graphic][3] ][3][![Graphic][4] ][4][![Graphic][5] ][5] A previously healthy 38-year-old man presented to our hospital with sudden-onset dyspnea, sharp, stabbing chest pain, and a clinical picture of cardiogenic shock. Echocardiography revealed a severely