Zeynep Cerit

Relationship between Vitamin D and the development of atrial fibrillation after on-pump coronary artery bypass graft surgery.

Summary Background: Vitamin D deficiency is associated with many diverse cardiovascular disorders, such as hypertension, heart failure, stroke, coronary artery disease and atrial fibrillation. The relationship between Vitamin D and the development of atrial fibrillation after coronary artery bypass surgery (CABG) has not been studied. Therefore, we assessed the relationship between Vitamin D and the development of postoperative atrial fibrillation (POAF) after CABG. Methods: Medical records of consecutive patients who underwent CABG surgery were retrospectively reviewed for the development of atrial fibrillation in the postoperative period. Vitamin D, other biochemical parameters, and clinical and echocardiographic parameters were evaluated in all patients. The independent variables for the development of postoperative atrial fibrillation were defined and their predictive values were measured. Results: The study group consisted of 128 patients, of whom 41 (32%) developed POAF. Age, diabetes mellitus, chronic obstructive pulmonary disease, history of transient ischaemic attack/stroke, heart failure, left atrial diameter, platelet:largecell ratio, and creatinine, urea, uric acid, calcium and potassium levels were identified as important variables for the development of POAF. However, with logistic regression analysis, chronic obstructive pulmonary disease (OR: 28.737, 95% CI: 0.836–16.118, p < 0.001), heart failure (OR: 15.430, 95% CI: 0.989–7.649, p = 0.006), diabetes mellitus (OR: 11.486, 95% CI: 0.734–11.060, p = 0.001) and left atrial diameter (OR: 1.245, 95% CI: 0.086–6.431, p = 0.011) appeared as independent variables predicting the development of POAF. Conclusion: In our study, although there was a significant negative correlation between Vitamin D and left atrial diameter, Vitamin D level was not an independent predictor for POAF.

Relationship between coronary tortuosity and plateletcrit coronary tortuosity and plateletcrit

Summary Background Coronary tortuosity (CorT) is a common angiographic finding and may be associated with myocardial ischaemia, even without coronary artery disease. Platelets play a crucial role in inflammatory and thrombotic processes and the physiopathology of cardiovascular disease. Larger platelets are more active enzymatically and have higher thrombotic ability compared to smaller platelets. Plateletcrit (PCT) provides complete information on total platelet mass. We aimed to evaluate the relationship between CorT and PCT in patients with chronic stable angina. Methods The medical records of consecutive patients who underwent coronary angiography from January 2013 to January 2016 were retrospectively reviewed for CorT. CorT and clinical, echocardiographic, haematological and biochemical parameters were evaluated. Taking into consideration the inclusion criteria, 106 patients with CorT and 108 with normal coronary angiographies (control group) were included in the study. CorT was defined as three fixed bends during both systole and diastole, with each bend ≥ 45°. Results The median PCT, mean platelet volume (MPV), platelet:large-cell ratio (P-LCR), neutrophil:lymphocyte ratio (NLR) and platelet:lymphocyte ratio (PLR) of the CorT group were significantly higher than those of the control group (0.26 ± 0.02 vs 0.2 ± 0.03%, p < 0.001; 10.6 ± 0.14 vs 9.6 ± 0.65 fl, p < 0.001; 29.3 ± 6.7 vs 23.4 ± 5.1, p < 0.001; 2.3 ± 1 vs 1.47 ± 0.48, p < 0.001; 1.28 ± 0.5 vs 0.82 ± 0.23, p < 0.001, respectively). The incidence of diabetes mellitus, hypertension and female gender were significantly higher in the CorT group (18.9 vs 1.9%, p < 0.001, 90.6 vs 50%, p < 0.001, 70.8 vs 44.4%, p < 0.001, respectively). Multivariate logistic regression analysis revealed age, hypertension, diabetes mellitus and plateletcrit were independently associated with CorT. Conclusion CorT was associated with increased PCT, MPV, P-LCR, NLR and PLR, even in the absence of coronary artery disease. Age, hypertension, diabetes mellitus and plateletcrit were independently associated with CorT.BACKGROUND Coronary tortuosity (CorT) is a common angiographic finding and may be associated with myocardial ischaemia, even without coronary artery disease. Platelets play a crucial role in inflammatory and thrombotic processes and the physiopathology of cardiovascular disease. Larger platelets are more active enzymatically and have higher thrombotic ability compared to smaller platelets. Plateletcrit (PCT) provides complete information on total platelet mass. We aimed to evaluate the relationship between CorT and PCT in patients with chronic stable angina. METHODS The medical records of consecutive patients who underwent coronary angiography from January 2013 to January 2016 were retrospectively reviewed for CorT. CorT and clinical, echocardiographic, haematological and biochemical parameters were evaluated. Taking into consideration the inclusion criteria, 106 patients with CorT and 108 with normal coronary angiographies (control group) were included in the study. CorT was defined as three fixed bends during both systole and diastole, with each bend ≥ 45°. RESULTS The median PCT, mean platelet volume (MPV), platelet:large-cell ratio (P-LCR), neutrophil:lymphocyte ratio (NLR) and platelet:lymphocyte ratio (PLR) of the CorT group were significantly higher than those of the control group (0.26 ± 0.02 vs 0.2 ± 0.03%, p < 0.001; 10.6 ± 0.14 vs 9.6 ± 0.65 fl, p < 0.001; 29.3 ± 6.7 vs 23.4 ± 5.1, p < 0.001; 2.3 ± 1 vs 1.47 ± 0.48, p < 0.001; 1.28 ± 0.5 vs 0.82 ± 0.23, p < 0.001, respectively). The incidence of diabetes mellitus, hypertension and female gender were significantly higher in the CorT group (18.9 vs 1.9%, p < 0.001, 90.6 vs 50%, p < 0.001, 70.8 vs 44.4%, p < 0.001, respectively). Multivariate logistic regression analysis revealed age, hypertension, diabetes mellitus and plateletcrit were independently associated with CorT. CONCLUSION CorT was associated with increased PCT, MPV, P-LCR, NLR and PLR, even in the absence of coronary artery disease. Age, hypertension, diabetes mellitus and plateletcrit were independently associated with CorT.

Preventive Effect of Preoperative Vitamin D Supplementation onPostoperative Atrial Fibrillation

Objective To assess the relationship between preoperative vitamin D (vitD) supplementation and the development of postoperative atrial fibrillation (POAF). Methods The study group consisted of 328 consecutive patients. The ınfluence of preoperative vitD supplementation on POAF was reviewed in 136 patients who underwent coronary artery bypass graft surgery with vitD insufficiency (n=80) and vitD deficiency (n=56). Patients were assigned to receive either oral vitD (50.000 U) (treatment group, n=68) or not (control group, n=68) 48 hours before surgery. Patients were followed up during hospitalisation process with respect to POAF. Results There was no significant difference between treatment and control groups with regards to age, gender, diabetes mellitus, smoking history, chronic obstructive pulmonary disease, left atrial diameter, and biochemical parameters. Also, there was no significant difference between these groups with regards to mean vitD level on both insufficiency and deficiency patients (24.6±3.7 vs. 24.9±3.9 ng/ml P=0.837, 11.4±4.9 vs. 10.9±5.2 ng/ml P=0.681, respectively). Although the occurrence of POAF was not significantly different among treatment and control groups in patients with vitD insufficiency (31% vs. 33% P=0.538), there was a significant difference between the two groups regarding to POAF in patients with vitD deficiency (18% vs. 29% P=0.02). Conclusion Although preoperative vitD supplementation was not found to be associated with prevention of POAF in patients with vitD insufficiency, it was found to be strongly associated with prevention of POAF in those with vitD deficiency.

Like two peas in a pod: abdominal and epicardial adipose tissue

To the Editor: Tomsa et al reported that endothelial-dependent reactive hyperemia and peripheral vascular stiffness are significantly impaired in relation to obesity in children. This endothelial dysfunction appears to be modulated by insulin resistance related to total body fat and abdominal adiposity. Epicardial adipose tissue (EAT) is a particular form of visceral fat deposited around the heart and is an indicator of visceral adiposity. EAT may influence coronary atherosclerosis and myocardial function. EAT has various endocrine and inflammatory functions, secretes inflammatory adipokines, such as tumor necrosis factor alpha, interleukin-6, interleukin-1b, plasminogen activator inhibitor-1, resistin, and monocyte chemoattractant protein-1, and producesmediators,which can cause endothelial dysfunction. EAT is related to insulin resistance and dyslipidemia, leading to a higher risk of metabolic syndrome and cardiovascular disease. Mahfouz et al reported that accumulation of EAT was associated with a decrease inflow-mediateddilatation in childrenwith family history of type 2 diabetes, with a cut-off value of 5 mm for EAT thickness as a powerful predictor of endothelial dysfunction. In this study, relationship of endothelial function to body composition, insulin sensitivity, glycemia, and circulating inflammatory markers in normal weight and overweight adolescents with and without abnormalities in glucose metabolism are evaluated. Correlation of results with EAT volumemay be beneficial because of the close association between EAT and endothelial dysfunction.

The relation between vitamin B12 and SYNTAX score

BACKGROUND Vitamin B12 is required in the metabolism of homocysteine. Vitamin B12 deficiency has been implicated in endothelial dysfunction and cardiovascular disease via hyperhomocysteinaemia. However, the association of vitamin B12 and the severity of coronary artery disease has not been studied to date. AIM This study was conducted with the aim of evaluating the relationship between vitamin B12 and SYNTAX score. METHODS Medical records of consecutive patients who underwent coronary artery bypass grafting surgery were retrospectively reviewed. The study group consisted of 127 patients. Vitamin B12, other biochemical parameters, clinical and echocardiographic parameters, and SYNTAX score were evaluated for all patients. RESULTS Patients with vitamin B12 deficiency had a higher prevalence of cardiovascular risk factors such as diabetes mellitus, and history of transient ischaemic attack/stroke and heart failure. The SYNTAX score was significantly higher in patients with vitamin B12 deficiency (29.2 ± 4.9 vs. 22.5 ± 4.5, p < 0.05). CONCLUSIONS In our study, we found a significant relationship between vitamin B12 deficiency and SYNTAX score, demon-strating the severity and complexity of coronary artery disease.

Prediction of childhood obesity with or without vitamin D deficiency

With interest, I have read the article by Manios et al. about CORE-index as a screening tool for the early identification of infants that are potentially at higher risk for becoming obese at their childhood and adolescence [3]. I have the following comments. Childhood obesity is an international public health problem leading to an increased risk of adult obesity and associated with mortality and morbidity [5]. Vitamin D may regulate adipose tissue mass, differentiation, and metabolism in ways that might contribute to overweight and/or obesity possibly by effects on lipogenesis and/or adipogenesis [1]. Vitamin D has been found to be a predictor significantly associated with overweight and/or obesity and other components of metabolic syndrome including raised plasma glucose concentration and insulin resistance [4]. Ekbom et al. [2] reported that higher vitamin D levels were related to a decreased l ip id prof i le in obese chi ldren and adolescents. In this context, considering close association of vitamin D with both childhood obesity and metabolic syndrome parameters, in order to predict childhood obesity, new scoring system including CORE-index and serum vitamin D level might be beneficial. Compliance with ethical standards

Polycystic ovary syndrome, epicardial fat thickness, and cardiovascular diseases

I have read the article entitled “A visceral adiposity indexrelated dietary pattern and the cardiometabolic profiles in women with polycystic ovary syndrome” by Ehsani et al. [1] with great interest, recently published in journal. The investigators reported that visceral adiposity index dietary pattern affects most cardiometabolic variables in controls, but to a lesser extent in polycystic ovary syndrome (PCOS) women. Our study suggests that relationships between diet and cardiometabolic risk profiles may be modified by PCOS status [1]. PCOS is characterized by menstrual disturbance, anovulation, hyperandrogenism, infertility and obesity and is reported to be associated with an increased risk of cardiovascular disease (CVD) and early atherosclerosis [2]. Epicardial fat thickness (EFT) is related to abdominal visceral adiposity, coronary artery disease, subclinical atherosclerosis, and visceral fat changes during weight loss intervention. Additionally, the EFT has been shown to be a metabolically active organ and a source of several bioactive adipokines including tumor necrosis factor alpha, monocyte chemoattractant protein-1, interleukin (IL)-6, IL-1b, plasminogen activator inhibitor-1, resistin [3]. EFT was positively correlated with age, body mass index (BMI), waist circumference, fasting insulin, HOMA-IR, triglyceride and hsCRP levels. Therefore, EFT can be used to follow the risk of CVD development in obese PCOS cases [4]. Cakir et al. [5] reported that mean EFT and carotid artery intima-media thickness (CIMT) levels were higher in patients with PCOS. Furthermore, the EFT showed an independent association with CIMT. The EFT also showed significant correlations with cardiometabolic parameters independently of age and body mass index. In this context, considering association among EFT, PCOS, and CVD correlation of this results [1] with EFT might be beneficial.

Childhood Obesity, MMP-9 Levels, and Vitamin D

3. Cerit Z. Prediction of childhood obesity with or without vitamin D deficiency. Eur J Pediatr. 2017;176(4):557. doi: 10.1007/s00431-017-2860-9. 4. Coussens A, Timms PM, Boucher BJ, Venton TR, Ashcroft AT, Skolimowska KH, et al. A1alpha, 25-dihydroxyvitamin D3 inhibits matrix metalloproteinases induced by Mycobacterium tuberculosis infection. Immunology. 2009;127:539-48. doi: 10.1111/j.1365-2567.2008.03024..