Impact of Laparoscopic Sleeve Gastrectomy on Thrombomodulin Concentration and Early Markers of Atherosclerosis.

Background: Thrombomodulin, an integral membrane protein functioning as a cofactor in the anticoagulant pathways, has recently emerged as a marker of endothelial dysfunction. This study aimed to investigate the impact of laparoscopic sleeve gastrectomy (LSG) on thrombomodulin concentration and early markers of atherosclerosis. Methods: Forty-four subjects undergoing LSG were prospectively examined. The change in thrombomodulin concentration from baseline (preoperative) to the sixth postoperative month following the LSG and the relationship between the change in thrombomodulin concentration and BMI, CIMT, ABI, and blood lipids were examined. Results: The medical records were available for 44 patients (mean age: 37.2 ± 10.9 years, 65.9% male). LSG led to significant reductions in total body weight and body mass index (BMI) at postoperative six months (37.0 ± 5.6 kg/m2 vs. 47.1 ± 5.8 kg/m2, p < 0.001). Markers of early atherosclerotic events, including carotid intima-media thickness (CIMT) and ABI, improved. The change in thrombomodulin concentration (Δ TMD) was significantly correlated with the change in Δ BMI (r = 0.500, p=0.011), Δ LDL (r = 0.389, p=0.032), Δ systolic blood pressure (r = 0.384, p=0.012), and Δ CIMT (r = 0.327, p=0.012) and was negatively correlated with Δ HDL (r = -0.344, p=0.020) and Δ ABI (r = -0.357, p=0.020). Conclusion: LSG leads to significant improvements in blood lipids, systolic and diastolic blood pressure, and in surrogate markers of atherosclerotic burden and endothelial function, including thrombomodulin, ABI, and CIMT, at postoperative six months. LSG might prevent or reduce atherogenesis in the early stages by stopping endothelial dysfunction.

Angiotensin receptor neprilysin inhibitor for patients with heart failure and reduced ejection fraction: Real-world experience from Turkey (ARNi-TR).

OBJECTIVE: Heart failure (HF) is a growing public health problem with high morbidity and mortality. Recently, angiotensin receptor neprilysin inhibitor (ARNi) has emerged as a promising treatment for HF with reduced ejection fraction (HFrEF). Here, we shared our experience with the use of ARNi in HFrEF from multiple centers in Turkey. METHODS: The ARNi-TR is a multicenter, noninterventional, retrospective, observational study. Overall, 779 patients with HF from 22 centers in Turkey who were prescribed sacubitril/valsartan were examined. Initial clinical status, biochemical and echocardiographic parameters, and New York Heart Association functional class (NYHA-FC) values were compared with follow-up values after 1 year of ARNi use. In addition, the effect of ARNi on number of annual hospitalizations was investigated, and the patients were divided into 2 groups, depending on whether ARNi was initiated at hospitalization or under outpatient clinic control. RESULTS: N-terminal pro-brain natriuretic peptide (NT-proBNP), left-ventricle ejection fraction (LV-EF), and NYHA-FC values improved significantly in both groups (all parameters, p<0.001) within 1-year follow-up. In both groups, a decrease in hemoglobin A1c (HbA1c) values was observed in ARNi use (p<0.001), and a decrease in daily diuretic doses and hospitalizations owing to HF were observed after ARNi use (all comparisons, p<0.001). Hypotension (16.9%) was the most common side effect in patients using ARN. CONCLUSION: The ARNi-TR study offers comprehensive real-life data for patients using ARNi in Turkey. The use of ARNi has shown significant improvements in FC, NT-proBNP, HbA1c levels, and LV-EF. Likewise, reductions in the number of annual hospitalizations and daily furosemide doses for HF were seen in this study.

Evaluation of the hypertensive patients in southeastern Anatolia; demographic features and target organ damage.

We investigated the socio-demographic characteristics, blood and pulse pressure, and end organ damage of hypertensive patients applying to an outpatient cardiology clinic in southeastern Anatolia. End organ damage in 100 consecutive hypertensive patients was defined by left ventricular hypertrophy, retinopathy, and albuminuria. The determined independent risk factors of left ventricular hypertrophy were advanced age and low educational level; of nephropathy were high pulse pressure and unawareness of the name of anti-hypertensive drug; and for retinopathy were high pulse pressure and female gender. In order to prevent end organ damage, the most important aspect to focus on is patient training and pulse pressure.

Association of serum uric acid level and coronary blood flow.

OBJECTIVES: Slow coronary flow (SCF) has long since been identified and endothelial dysfunction and atherosclerosis of the epicardial coronary arteries and microvasculature are reported to be associated with SCF. Serum uric acid is an independent biochemical marker of atherosclerosis, oxidative stress and endothelial dysfunction. Consequently, we aimed to investigate the association between coronary blood flow and serum uric acid level by means of thrombolysis in myocardial infarction frame count (TFC) and other laboratory parameters, in patients with SCF compared with control participants. METHODS: Sixty-four patients with SCF and 369 control participants with normal coronary flow were studied after quantifying coronary blood flow according to TFC. Serum uric acid levels were determined using commercially available assay kits. The association between TFC and serum uric acid level and other clinical and laboratory parameters were evaluated. RESULTS: Statistically significant differences were present between SCF and control groups with respect to serum uric acid, and hemoglobin levels, heart rate, cigarette smoking and sex (P<0.05 for all). The mean TFC was significantly correlated with serum uric acid, urea, creatinine, high-density lipoprotein-cholesterol and hemoglobin levels, platelet count, male gender, cigarette smoking, heart rate and systolic blood pressure (P<0.05 for all). Serum uric acid level (chi(2)=22.86, beta=0.54, P<0.001), heart rate (chi(2)=7.42, beta=-0.034, P=0.032) and cigarette smoking (chi(2)=12.343, beta=0.969, P=0.025) were independent predictors of SCF, whereas serum uric acid level was the only independent predictor of the mean TFC (beta=0.298, P<0.001). CONCLUSIONS: These findings have shown that serum uric acid level is significantly associated with coronary blood flow and that elevated uric acid might be an independent predictor for the presence of SCF.