Is There a Need for Sex-Tailored Lipoprotein(a) Cut-Off Values for Coronary Artery Disease Risk Stratification?

BACKGROUND: Lipoprotein(a) [Lp(a)] plasma level is a well-known risk factor for coronary artery disease (CAD). Existing data regarding the influence of sex on the Lp(a)-CAD relationship are inconsistent. OBJECTIVE: To investigate the relationship between Lp(a) and CAD in men and women and to elucidate any sex-specific differences that may exist. METHODS: Data of patients with Lp(a) measurements who were admitted to a tertiary university hospital, Koc University Hospital, were analyzed. The relationship between Lp(a) levels and CAD was explored in all patients and in subgroups created by sex. Two commonly accepted Lp(a) thresholds ≥ 30 and ≥ 50 mg/dL were analyzed. RESULTS: A total of 1858 patients (mean age 54 ± 17 years; 53.33% females) were included in the analysis. Lp(a) was an independent predictor of CAD according to the multivariate regression model for the entire cohort. In all cohort, both cut-off values (≥ 30 and ≥ 50 mg/dL) were detected as independent predictors of CAD (p < 0.001). In sex-specific analysis, an Lp(a) ≥ 30 mg/dL was an independent predictor of CAD only in women (p < 0.001), but Lp(a) ≥ 50 mg/dL was a CAD predictor both in men and women (men, p = 0.004; women, p = 0.047). CONCLUSION: The findings of this study may suggest that different thresholds of Lp(a) level can be employed for risk stratification in women compared to men.

The Relationship of Systolic Pulmonary Artery Pressure with Perioperative Mortality and Morbidity in Patients Undergoing Non-Cardiac Surgery: A Single-Center Experience.

OBJECTIVE: Pulmonary hypertension (PH) is associated with adverse perioperative events in patients undergoing non-cardiac surgery. In this study, we aimed to investigate the relationship between systolic pulmonary artery pressure (sPAP), evaluated by transthoracic echocardiography (TTE) before surgery, and perioperative mortality and morbidity in patients who underwent non-cardiac surgery in our center. METHODS: Of the 3425 retrospectively screened patients who underwent non-cardiac surgery, 3049 patients whose estimated sPAP values were previously determined by TTE were included in the study. Patients were classified into 3 groups according to their estimated sPAP levels. sPAP <35 mmHg formed group 1, 35-39 mmHg group 2, and ≥ 40 mmHg group 3. All demographic and perioperative data obtained from the database of our institute were compared in three groups. RESULTS: Of the 3049 patients enrolled in the study, 2406 (78.9%) were in group 1, 259 (8.5%) in group 2, and 384 (12.6%) in group 3. Thirty-day all-cause mortality was observed in 82 (2.7%) patients, cardiac mortality occurred in 9 patients (0.3%). In the group with sPAP ≥40 mmHg, cardiac mortality was 0.5% and all-cause mortality was 7.3%. Thirty-day all-cause mortality, acute pulmonary edema, and acute renal failure were significantly higher in group 3 than in the other groups. Cardiac mortality did not differ significantly between the groups. Age, sPAP value, and chronic obstructive pulmonary disease history were revealed as independent predictors of all-cause mortality in multivariate logistic regression analysis. CONCLUSION: In conclusion, increased sPAP is associated with adverse postoperative outcomes. The evaluation of sPAP with TTE before non-cardiac surgery in patients whose clinical features and examination findings suggest PH may contribute to preoperative risk assessment.

Relationship between the triglyceride-glucose index and the SYNTAX score 2 in patients with non-ST elevation myocardial infarction.

We evaluated if admissiontriglyceride-glucose index (TyG index) correlated with the anatomical synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) score 2 in non-ST elevation myocardial infarction (NSTEMI), nondiabetic patients. Methods: SYNTAX score 2 (SSII) was retrospectively evaluated in 260 nondiabetic patients hospitalized with NSTEMI who underwent coronary angiography. The TyG index was calculated using the following equation: log [fasting triglycerides (mg/dl) × fasting glucose (mg/dl)/2]. We stratified patients according to tertiles of SSII (≤21.5, 21.5-30.6, and ≥30.6). These score ranges were defined as SSII low, SSII mid, and SSII high, respectively. Results: The average age of the patients was 57.2 ± 10.9 years; 135 patients (52.2%) were males. The average TyG index was 8.68 ± 0.12, and SSII was 18.9 ± 9.9. A moderate correlation was found between TyG index and SSII (r = 0.347; P < 0.001) and TyG index was independent risk factors for SSII high [odds ratio (OR), 6.0; 95% CI, 2.7-17.0; P < 0.001]. Conclusion: In nondiabetic patients with NSTEMI, TyG index correlated with the SSII.

The triglyceride-glucose index and contrast-induced nephropathy in non-ST elevation myocardial infarction patients undergoing percutaneous coronary intervention.

The triglyceride glucose (TyG) index is an indicator of insulin resistance and associated with increased risk of diabetes mellitus and cardiovascular events. Our study investigates the correlation between TyG index and contrast induced nephropathy (CIN) in non-diabetic patients with non-ST elevation myocardial infarction (NSTEMI) undergoing percutaneous coronary intervention (PCI). 350 non-diabetic NSTEMI patients (183, 52.3% male) undergoing PCI were retrospectively enrolled. The enrolled cohort was divided into 2 groups based on the calculated TyG index, namely values < 8.65 or higher. CIN was defined as an increase in serum creatinine > 25% or 0.5 mg/dL from baseline in the first 48 to 72 hours after PCI. A total of 56 (16%) cases of CIN were diagnosed. In contrast to patients with lower TyG indexes, patients with higher TyG indexes (≥8.65) had a higher frequency of CIN, 9.5%. versus 20.8% respectively (P .004). Patients with CIN also had higher TyG indexes (8.74 ±â€…0.12 vs 8.67 ±â€…0.11, P < .001). In addition, TyG index, age, and glomerular filtration rate were identified as independent risk factors for CIN in logistic regression model (OR: 2.5 CI: 1.3-4.6, P .006, OR: 1.0 CI: 1.0-1.1, P < .001, OR: 1.0 KI: 1.03-1.06, P .025). In the ROC analysis, the area under the curve predictive of CIN was 0.666 (P < .001, 95% [CI] 0.58-0.75) with a cutoff value of 8.69 (sensitivity 71,4%, specificity 55.1%) TyG index. Higher TyG indexes are associated with an increased risk of CIN in non-diabetic patients with NSTEMI.

Effects of iron deficiency on left ventricular functions in young women regardless of anemia: A speckle tracking echocardiography study.

BACKGROUND: Iron deficiency is one of the most common metabolic disorders worldwide and affects multiple organs and systems including the cardiovascular (CV) system. Iron deficiency can cause structural and functional changes in the myocardium. The aim of the study is to evaluate left ventricular (LV) functions in patients with low ferritin levels without anemia by two-dimensional "speckle tracking" echocardiography (2D STE). METHODS: We studied 90 participants (all female) that were divided into two groups according to ferritin levels (49 patients with ferritin levels <30 ng/mL, 41 age-matched controls with >30 ng/mL). Patients with anemia (hemoglobin level <12 g/dL), known CV disease, diabetes mellitus, low ejection fraction (<55%), active infection, high ferritin levels (>200 ng/mL) were excluded. All patients were evaluated by transthoracic echocardiography. In addition to conventional echocardiographic parameters and Doppler measurements, LV global longitudinal strain (GLS) and strain rate (GLSR) were obtained by 2D STE. RESULTS: Mean ferritin level was 18.96 ± 7.29 ng/mL in low ferritin group, and was 61.22 ± 26.14 ng/mL in control group. There were no significant differences according to conventional and Doppler echocardiographic parameters between the groups. LV GLS and GLSR values were significantly lower in low ferritin group comparing with control group (17.31% ± 1.56 and 18.96% ± 1.53, p < 0.001; 0.64 ± 0.13 1/s and 0.81 ± 0.13 1/s, p < 0.001, respectively). There was a significant positive correlation between ferritin levels and LV GLS and GLSR values in study group (r = 0.482, p < 0.001; r = 0.387, p < 0.001, respectively). Ferritin level was also detected as an independent risk factor for GLS value < -18% in logistic regression analysis. In ROC curve analysis, the area under the curve for predicting GLS < -18% was 0.801 (p < 0.001, 95% CI 0.70-0.89) and the threshold of ferritin value was 28.5 ng/mL (sensitivity 76.1%, specificity 77.3%). DISCUSSION: Low ferritin levels can cause subclinical LV systolic dysfunction in patients without anemia. STE provides detailed information about LV functions. With larger studies, these patients should be followed more closely and considered for iron replacement treatment before developing anemia.

Evaluation of pulmonary arterial stiffness and comparison with right ventricular functions in patients with cirrhosis preparing for liver transplantation.

OBJECTIVE: Pulmonary complications are common in patients with liver cirrhosis. Devolopment of pulmonary hypertension (PH) is associated with a poor prognosis in these patients. Pulmonary arterial stiffness (PAS) is considered an early sign of pulmonary vascular remodeling. The aim of this study is to investigate PAS and compare it with right ventricular (RV) functions in patients with cirrhosis who are scheduled for liver transplantation. METHODS: The study included 52 cirrhosis patients (mean age 51.01 ± 12.18 years, male gender 76.9%) who were prepared for liver transplantation and 59 age and sex matched (mean age 51.28 ± 13.63 years, male gender 62.7%) healthy individuals. Patients with left ventricular ejection fraction (LVEF) less than 55%, ischemic heart disease, more than mild valvular heart disease, chronic pulmonary disease, congenital heart disease, rheumatic disease, moderate to high echocardiographic PH probability, rhythm or conduction disorders on electrocardiography were excluded from the study. In addition to conventional echocardiographic parameters, PAS value, pulmonary vascular resistance (PVR) and RV ejection efficiency was calculated by the related formulas with transthoracic echocardiography (TTE). RESULTS: Demographic characteristics and cardiovascular risk factors of the groups were similar. PAS, PVR, and sPAP values were found to be significantly higher in the patient group (20.52 ± 6.52 and 13.73 ± 2.05; 1.43 ± 0.15 and 1.27 ± 0.14; 27.69 ± 3.91 and 23.37 ± 3.81 p < 0.001, respectively). RV FAC and RV Ee were significantly lower and RV MPI was significantly higher in the patient group (45.31 ± 3.85 and 49.66 ± 3.62, p < 0.001; 1.69 ± 0.35 and 1.85 ± 0.23, p = 0.005; 0.39 ± 0.07 and 0.33 ± 0.09, p = 0.001, respectively). PAS was significantly correlated with RV FAC and MPI (r = -0.423, p < 0.001; r = 0.301, p = 0.001, respectively). CONCLUSIONS: Increased PAS in cirrhosis patients may be associated with early pulmonary vascular involvement. Evaluation of RV functions is important to determine the prognosis in these patients. FAC, MPI, and RV Ee measurements instead of TAPSE or RV S' may be more useful in demonstrating subclinical dysfunction. The correlation of PAS with RV FAC and MPI may indicate that RV subclinical dysfunction is associated with early pulmonary vascular remodeling in patients with liver cirrhosis.

A case of reversible cardiomyopathy associated with acute toluene exposure.

Inhalation of toluene-based products is popular among young adults. It has been shown to have a variety of adverse effects on several organs and systems. Although the heart seems to be a sensitive target organ to toluene, cardiotoxicity has often been ignored, especially in cases of acute toluene abuse, with relatively low concentrations. Thereby, routine cardiac examination and echocardiography for cardiotoxicity should be performed in cases of acute toluene exposure, even though there is no cardiovascular sign or symptoms.

The relationship between blood pressure variability and Pooled Cohort Risk Assessment Equations 10-year cardiovascular risk score.

BACKGROUND: Recent attention has focused on the clinical significance of blood pressure variability (BPV) in explaining the adverse cardiovascular consequences of hypertension. We therefore analyze the impact of 24 h BPV on the development of future cardiovascular disease determined by The Pooled Cohort Risk Assessment Equations 10-year risk calculator. MATERIALS AND METHODS: We analyzed 250 adult patients, ages 40-80 years old. The ambulatory blood pressure monitoring was recorded automatically. We defined the mean blood pressure values, SD, and coefficient of variation (CV) of blood pressure on the basis of the recorded 24 h ambulatory blood pressure monitoring values as an indicator for BPV.Patients were divided into two groups according to their Pooled Cohort Risk Assessment Equations 10-year risk profile (<7.5 and ≥7.5%). RESULTS: Besides the mean systolic blood pressure (SBP), parameters showing the BPV such as SD and CV of mean blood pressures were also significantly higher in patients with an elevated 10-year risk score compared with others. Only CV of SBP and pulse pressure showed a clear association with the 10-year risk in multivariate logistic regression analysis. The results suggested that each 1% increase in CV of SBP could lead to a 1.258-fold increase in The Pooled Cohort Risk Assessment Equations 10-year risk score. CONCLUSION: In the present study, we found that independent of baseline SBP, increased CV of SBP within 24 h was associated with increased cardiovascular risk, as assessed by The Pooled Cohort Risk Assessment Equations 10-year risk calculator.

Evaluation of variability of phase indices of the left ventricle in the course of time.

OBJECTIVE: Since the effect of time on phase indices is still unclear, the aim of the study was to evaluate the variability of phase indices of the left ventricle which were derived from stress and rest single-photon emission computed tomography (SPECT) imaging acquired at early and late times. METHODS: One hundred twenty-one patients (72 men, 49 women) were included into the study. All stress and rest gated myocardial perfusion imaging (gMPI) acquisitions were acquired at two different time points as early in 15 ± 5 min and late in 45 ± 5 min. The peak of the phase histogram (PP), the standard deviation of the phase distribution (SDPH), the width of the band (BPH), and the symmetry (histogram skewness, HS) and peakedness of the phase histogram (histogram kurtosis, HK) which are the parameters for assessing left ventricular systolic dyssynchrony were calculated in all stress and rest SPECT images acquired twice. RESULTS: The phase indices derived from the late rest scans were smaller than those of the early rest scans but, the differences were not significant. When considering the comparisons of phase indices derived from two different time points after stress, PP showed a tendency to decrease (from 160.8 ± 18.3 to 152.5 ± 17.3; p < 0.001) over time but SDPH (from 20.2 ± 10.6 to 22.4 ± 12.2; p = 0.018) and BPH (from 61.5 ± 36.0 to 66.3 ± 37.3; p = 0.045) tended to increase over time. When the post-stress and the resting dyssynchrony parameters derived at two different time points were compared to each other; PP decreased at early and late times approximately 12 and 9 %, respectively, SDPH increased at early and late times approximately 28.5 and 14 %, respectively, and BPH increased at early and late times approximately 23 and 12 %, respectively. CONCLUSIONS: In resting conditions, phase indices of the left ventricle, and therefore, the phase histogram tend to remain constant over time but, in conditions after exercise, the phase histogram tend to be long and narrow due to changes in phase indices and it shows tendency to return to resting conditions in time. Therefore, it appears that postexercise acquisition times should be standardized if we want to compare the phase indices results of the studies in the literature.