Association between excess catecholamine synthesis and polymorphic premature ventricular contraction.

BACKGROUND: The reasons for the etiology of premature ventricular contractions (PVCs) are not specifically known. Many patients are resistant to medical treatment, and a factor that would predict response to medical treatment cannot be identified. This study aims to investigate if a high catecholamine level results in polymorphic PVC. METHODS: This study was obtained by prospective data registry analysis. A total of 100 patients, 50 from the PVC group, and 50 from the control group have been evaluated. The participants who were included in the patient group had a polymorphic PVC of 5% or more in their 24-h Holter evaluations. Metanephrine showing the level of adrenaline and normetanephrine, showing the level of noradrenaline levels have been measured from these urine samples. RESULT: There was no difference between the two groups in terms of biochemical and essential characteristics. Normetanephrine level has been significantly higher in the PVC group compared to the control group (323.9 ± 208.9 µg to 129.25 ± 67.88 µg; p < 0.001). Similarly, metanephrine level has also been higher in the PVC group (124.75 ± 82.43 µg to 52.615 ± 36,54 µg; p < 0.001). A positive and moderate correlation has been identified between the number and ratio of PVC and the metanephrine and normetanephrine levels. CONCLUSION: In this study, we found that the catecholamine levels were higher in the polymorphic PVC group than in the healthy volunteers. Also, an increase in the number and rate of PVC has been observed as the catecholamine levels increased. CLINICAL TRIAL REGISTRATION: Urine Levels of Metanephrine and Normetanephrine in Patients With Frequent PVC; ClinicalTrials.gov number NCT03447002.

The Effect of the COVID-19 Pandemic on Vaccination Behaviour of Individuals over the Age of 65 Years in Turkey: Single-Centre Experience.

The aim of this study is to evaluate the awareness of individuals over 65 years of age who have had the COVID-19 vaccine at the Samsun Research and Training Hospital and to evaluate whether the COVID-19 pandemic affected the vaccination behaviour in the geriatric age group. A total of 290 people who were vaccinated against COVID-19 at the Samsun Training and Research Hospital between 16 April 2021 and 16 April 2022 and volunteered to participate in the study were included. The questionnaire form was created by the researchers. According to the national and global guidelines, the seasonal influenza vaccine, Td or Tdap vaccines (tetanus, diphtheria, and pertussis), shingles vaccine, and pneumococcal conjugate vaccine (PCV15 or PCV20), have been recommended to all adults over the age of 65. It was questioned whether the participants had the vaccines recommended for them before and after the pandemic, if they were not vaccinated, what were the reasons, and whether the COVID-19 pandemic affected the general view on vaccination in this age group. Demographic data and comorbidities were also recorded. After each response that showed that the participant was not vaccinated, reasons were investigated with new questions to find out the causes of vaccine refusal or vaccine hesitancy. Finally, all participants were asked whether they would have the relevant vaccinations when offered. It was shown that 282 (94.3%) of the 299 people who participated in the study were considering getting a regular COVID-19 vaccine from now on, while 84.3% of the participants mentioned that the COVID-19 pandemic had a positive effect on their general vaccination behaviour. While 39 (13%) people stated that their view on vaccination was not affected by the pandemic, 8 (2.7%) people stated that it was negatively affected. The most common reason about low vaccination rates before the pandemic was a lack of enough knowledge about the recommended vaccines. The pandemic increased the vaccination awareness among the adult population. We think that vaccination rates may be improved by education of the geriatric population on this subject.

An investigation of the relationship between arterial aortic stiffness and coronary slow flow that was detected during coronary angiography.

AIM: Increased intimal thickness in coronary arteries, extensive calcification, and atheromatous plaque that does not cause luminal irregularities in a significant portion of the patients with coronary slow flow (CSF). Arterial stiffness is an indicator for atherosclerosis. We aimed to investigate the relation between coronary slow flow phenomenon (CSFP) and arterial stiffness. METHOD: Total of 73 patients were included in the study, and a control group was formed with 64 individuals. Aortic stiffness index ß (ASIß) and pulse wave velocity (PWV) were used as the determinant of arterial stiffness in all analyses. RESULT: Pulse wave velocity values were significantly higher in the coronary slow flow group than the control group (P < .001). PWV, aortic stiffness index ß (ASIß) values were found to be significantly higher in the CSF group. ASIß value was 3.4 ± 1.0 in CSF patients and 2.2 ± 0.6 in the control group (P < .001). Receiver operating characteristic curve (ROC) analysis showed that PWV predicted coronary slow flow with 97% sensitivity and 90% specificity for 7.15 cutoff value. And aortic stiffness index was found to predict coronary slow flow with 83% sensitivity and 75% specificity for 2.63 cutoff value. CONCLUSION: Our findings prove that coronary slow flow phenomenon should be considered a subgroup of coronary artery diseases and that increased PWV is an indicator of CSFP.

Association of Left Atrial Spontaneous Echo Contrast to Uric Acid in Patients with Mitral Stenosis.

OBJECTIVES: Spontaneous echo contrast (SEC) is the presence of smoke-like echoes with a characteristic swirling motion of the blood in echocardiography. Previous clinical studies have shown that SEC is a risk factor for left atrial thrombus formation and a predictor of potential systemic embolism originating from the heart. There is an association between uric acid and prothrombotic state. Therefore, we aimed to investigate the role of uric acid in SEC in patients with mitral stenosis (MS). METHODS: A total of 85 consecutive patients with MS were enrolled in the study. Patients were divided into two groups according to whether SEC was present in the left atrium. RESULTS: There were 41 patients (mean age 46.4 ± 11.4 and 68% female) in the SEC(-) group and 44 patients (mean age 45.7 ± 7.2 and 64% female) in the SEC(+) group. High sensitive C-reactive protein (hs-CRP) levels were significantly higher in the SEC(+) group than in the SEC(-) group (9.5 ± 4.2 vs. 4.7 ± 2.2 mg/L, P < 0.001). Uric acid was also significantly higher in the SEC (+) group (6.3 ± 1.4 vs. 4.5 ± 1.3 mg/dL, P < 0.001). In receiver operating characteristics curve analysis, uric acid >5.2 mg/dL had a 73% sensitivity and 76% specificity in predicting SEC in patients with MS. At multivariate analysis, uric acid (OR 3.919, 95% CI 1.911-8.035; P < 0.002) was an independent risk factor for SEC in patients with MS. CONCLUSION: Uric acid is independently associated with SEC in patients with MS. Our findings suggest that this inexpensive, universally available marker may be a useful biomarker for the stratification of risk in patients with MS.

Protective effects of spironolactone against anthracycline-induced cardiomyopathy.

AIMS: The protective effect of beta-blockers, ACE inhibitors, and ARBs on anthracycline cardiotoxicity has already been demonstrated, but the effect of aldosterone antagonism, which inhibits the last step of the renin-angiotensin-aldosterone system (RAAS), was questioned. This study sought to investigate whether spironolactone protects the heart against anthracycline-induced cardiotoxicity. METHODS AND RESULTS: Eighty-three female patients who were diagnosed with breast cancer were included in the study. The study population was randomized into spironolactone and control groups. A dose of 25 mg/day spironolactone was administered to the patients in the spironolactone group. There were 43 patients (mean age 50 ± 11 years) in the spironolactone group and 40 patients (mean age 51 ± 10 years) in the control group. LVEF decreased from 67.0 ± 6.1 to 65.7 ± 7.4 (P = 0.094) in the spironolactone group, and from 67.7 ± 6.3 to 53.6 ± 6.8 in the control group (P < 0.001). When the general linear model was applied, the interaction of LVEF decrease between groups was significantly lower in the spironolactone group than in the control group (P < 0.001). The diastolic functional grade of subjects in the spironolactone group was protected (P = 0.096), whereas it deteriorated in the control group (P < 0.001). CONCLUSION: We showed that spironolactone administration used simultaneously with anthracycline group chemotherapeutics protects both myocardial systolic and diastolic functions. Spironolactone can be used to protect against anthracycline-induced cardiotoxicity. TRIAL REGISTRATION: NCT02053974.

Acute Effects of Intracoronary Tirofiban on No-Reflow Phenomena in Patients With ST-Segment Elevated Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention.

We evaluated the acute effect of intracoronary administration of tirofiban on no-reflow phenomenon in patients with ST-segment elevated myocardial infarction undergoing primary percutaneous coronary intervention. Consecutive patients (n = 162) were randomized into 2 groups based on whether intracoronary tirofiban was administered. After the administration of intracoronary tirofiban, thrombolysis in myocardial infarction (TIMI) flow grade significantly increased (P < .001) and successful reperfusion was achieved in 26 (32%) patients. In the placebo group, however, after the administration of intracoronary placebo the TIMI flow grade did not change (P = .070), and successful reperfusion was achieved only in 8 (10%) patients. In-hospital major adverse cardiac events (MACE) were significantly lower in the tirofiban group (36% vs 19%, P = .013). Intracoronary administration of tirofiban significantly improves TIMI flow grade and is associated with a lower in-hospital rate of MACE.

Increased serum asymmetric dimethylarginine level is an independent predictor of contrast-induced nephropathy.

OBJECTIVES: The aim of our study was to evaluate whether serum asymmetric dimethylarginine (ADMA) level is an independent predictor of contrast-induced nephropathy (CIN). STUDY DESIGN: The study involved 90 consecutive patients with stable angina pectoris who underwent coronary angiography and ventriculography. Baseline serum creatinine (SCr) levels ranged between ≥1.2 and <2 mg/dl. All patients were hydrated with intravenous isotonic saline at a rate of 1 ml/kg per hour for 6 hours before and 12 hours after the procedure. The primary end point was the occurrence of CIN. The secondary end point was the change in SCr levels at day 2 after the contrast exposure. Serum ADMA was determined by the ELISA method. RESULTS: The CIN rate was 11.1%. We detected a statistically significantly higher serum ADMA level in the CIN(+) group compared to that of the CIN(-) group [210.6 ng/ml (115.6-217.2) vs. 91.5 ng/ml (65.2-122.1), p=0.01]. Mehran risk score and diabetes mellitus (DM) ratio were higher in the CIN(+) group compared to those values in the CIN(-) group [8 (5.75-10) vs. 5 (5-7), p=0.01 and 70% vs. 26.3%, p=0.01, respectively]. Serum ADMA level, Mehran risk score and DM were independent predictors of CIN (odds ratio (OR) 1.030, 95% confidence interval (CI) 1.011-1.050, p=0.002; OR 1.565, 95% CI 1.102-2.223, p=0.012; OR 9.422, 95% CI 1.441-61.598, p=0.019, respectively). A serum ADMA level of >124.7 ng/ml had 80% sensitivity and 76% specificity in predicting the development of CIN. In addition, we found a positive correlation between SCr change and serum ADMA level (p=0.001, r=0.35). CONCLUSION: Our study demonstrates that increased serum ADMA level is an independent predictor of CIN.

Increased red cell distribution width level is associated with absence of coronary collateral vessels in patients with acute coronary syndromes.

OBJECTIVES: Several studies have evaluated a relationship between increased red cell distribution width (RDW) and morbidity and mortality of acute coronary syndrome (ACS). In this study, we aimed to investigate the association of serum RDW levels and development of coronary collateral vessel (CCV) in patients with ACS. STUDY DESIGN: We evaluated 226 patients with ACS in this prospective and cross-sectional study. Traditional laboratory and clinical parameters and serum RDW levels were measured on admission. All patients underwent coronary angiography on the first day after admission and patients with >80% stenosis were included in the study. The CCV was graded according to the Rentrop scoring system, and a Rentrop grade 0 was accepted as no CCV development (Group 1), while Rentrop grades 1-2-3 were accepted as presence of CCV development (Group 2). RESULTS: Only levels of RDW were significantly higher in Group 1 than in Group 2 (Group 1 RDW 14.6±1.9, Group 2 RDW 14.1±1.4, p=0.02). The predictive value of serum RDW level for absence of collaterals (sensitivity of 58% and specificity of 54%, area under the receiver operating characteristic (ROC) curve = 0.573) was 13.90. CONCLUSION: We found that high levels of RDW were associated with absence of CCV in patients with ACS.

Serum gamma-glutamyltransferase and the burden of atherosclerosis in patients with acute coronary syndrome.

OBJECTIVES: We evaluated the relationship between serum gamma-glutamyltransferase (GGT) levels and the burden of atherosclerosis in patients with acute coronary syndrome (ACS). STUDY DESIGN: This study involved 180 patients (139 male, 41 female; mean age 63±11 years) with the diagnosis of ACS (non-ST elevation myocardial infarction and unstable angina) who underwent coronary angiography on the first day after hospital admission. The burden of atherosclerosis was assessed by the number of involved vessels, and the Gensini and Syntax scores. Serum GGT levels were measured by enzymatic caloric test. RESULTS: Patients with high Syntax scores (>=33) were more frequently diabetic, hypertensive, and had higher GGT and creatinine levels compared to the patients with low Syntax scores (<=23). Similarly, patients with >=3 diseased vessels were more frequently diabetic, hypertensive, and smokers. In addition, these patients were older and had higher serum glucose, urea and GGT levels. Correlation analysis revealed that the level of GGT was significantly associated with Gensini and Syntax scores, number of diseased vessels, and the number of critical lesions (r=0.378 p<0.001, r=0.301 p<0.001, r=0.159 p=0.036, r=0.355 p<0.001, respectively). Multivariate linear regression analysis demonstrated that increased GGT level was an independent risk factor for high Gensini and Syntax scores (p=0.029 and p=0.035, respectively), together with age (p=0.001 and p=0.002, respectively) and serum glucose levels (p=0.017 and p=0.012, respectively). CONCLUSION: Serum GGT levels on admission are associated with increased burden of atherosclerosis in patients with ACS. This may account for the cardiovascular outcomes associated with increased GGT levels.

Relation between mean platelet volume and coronary collateral vessels in patients with acute coronary syndromes.

OBJECTIVE: Elevated mean platelet volume (MPV) has been proposed as a risk factor for coronary artery disease (CAD) and is associated with poor clinical outcome in acute coronary syndrome (ACS). We aimed to evaluate the association of MPV with presence of coronary collateral vessel (CCV) in patients with ACS. METHODS: A total of 417 patients with ACS were included in the study. All patients underwent coronary angiography on the first day after admission and patients with a greater than or equal to 80% obstruction in at least one epicardial coronary artery were included in the study. The CCVs are graded according to the Rentrop scoring system and a Rentrop grade 0 was accepted as no CCV development (group 1), Rentrop grade 1-2-3 were accepted as presence of CCV development (group 2). RESULTS: The median of MPV was 9.1±1.4fl. Mean age was 60±12 year. Group 1 consisted of 233 (55.9%) patients and Group 2 consisted of 184 (44.1%) patients. Presence of CCV was significantly associated with high levels of MPV (p=0.005). Presence of CCV was also associated with presence of diabetes and systolic blood pressure. CONCLUSION: High MPV on admission was associated with presence of CCV in patients with ACS.

Protective effects of nebivolol against anthracycline-induced cardiomyopathy: a randomized control study.

BACKGROUND: We aimed to evaluate the effect of prophylactic nebivolol use on prevention of antracycline-induced cardiotoxicity in breast cancer patients. METHODS: In this small, prospective, double-blind study, we randomly assigned 45 consecutive patients with breast cancer and planned chemotheraphy to receive nebivolol 5mg daily (n=27) or placebo (n=18). Echocardiographic measurements and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) levels were obtained at baseline and at 6-month of chemotherapy. RESULTS: Both studied groups had comparable echocardiographic variables and NT-pro-BNP levels at baseline. At 6-month, the left ventricular (LV) end-systolic and end-diastolic diameters increased in the placebo group (LVESD: 29.7 ± 3.4 to 33.4 ± 4.5mm; LVEDD: 47.2 ± 3.8 to 52.0 ± 4.6mm, p=0.01 for both) but remained unchanged in the nebivolol group (LVESD: 30.4 ± 3.5 to 31.0 ± 3.6mm, p=0.20; LVEDD: 47.0 ± 4.4 to 47.1 ± 4.0mm, p=0.93). The placebo group also had lower LVEF than the nebivolol group (57.5 ± 5.6% vs. 63.8 ± 3.9%, p=0.01) at 6-month. NT-pro-BNP level remained static in the nebivolol group (147 ± 57 to 152 ± 69 pmol/l, p=0.77) while it increased in the placebo group (144 ± 66 to 204 ± 73 pmol/l, p=0.01). CONCLUSIONS: Prophylactic use of nebivolol treatment may protect the myocardium against antracycline-induced cardiotoxicity in breast cancer patients.

Bilirubin levels and the burden of coronary atherosclerosis in patients with STEMI.

We investigated whether serum bilirubin level (a marker of heme oxygenase activity) is a predictor of high levels of SYNTAX score (SXscore) in patients with acute myocardial infarction. Patients (n = 281; male 77%; mean age 60 ± 12) who were admitted with ST-elevation myocardial infarctions (STEMIs) were enrolled. Patients were divided into 2 groups. Group 1 was defined as SXscore <22 and group 2 was defined as SXscore ≥22. Total bilirubin levels were significantly higher in the high-SXscore group than in the low-SXscore group (0.86 ± 0.42 vs 1.02 ± 0.51, P = .005). A significant correlation was detected between total bilirubin and SXscore (r = .42; P = .001). At multivariate analysis, total bilirubin (odds ratio: 1.86, 95% confidence interval 1.04-3.35; P = .038) was an independent risk factor for high SXscore in patients with STEMI. In conclusion, serum bilirubin level is independently associated with SXscore in patients with STEMI.

Is pneumothorax size on chest x-ray a predictor of neonatal mortality?

OBJECTIVE: Pneumothorax in newborns may result in a significant mortality and morbidity. To predict who will survive or die is of great importance in the clinical management. The aim of this study is to address whether assessment of pneumothorax size on chest X-ray may be a predictor of prognosis in newborns presenting with pneumothorax. METHODS: Of 5929 infants admitted to our neonatal intensive care unit (NICU) from January 2007 to April 2011, 60 (1.0%) newborns presenting with pneumothorax were included in the present study. Pneumothorax size was calculated by measuring the widest transverse diameter of pneumothorax area in the posteroanterior view and dividing it by the widest transverse diameter of thoracic cavity above the diaphragm. Clinical data were collected from the patients' records. FINDINGS: Overall mortality rate was 30% (18 patients). Pneumothorax size was significantly higher in nonsurvivors (31.1±2.8 vs 16.4±1.4, P < 0.001). The cut-off point of pneumothorax size for predicting survival was determined as 20%. The sensitivity was 72% whereas the specificity 83%. Preterm birth, low birth weight, resuscitation at birth, need for mechanical ventilation and chest tube insertion were of great significance in predicting mortality. However, of overall significant parameters, only pneumothorax size was the independent prognostic factor by regression analysis (P = 0.02). CONCLUSION: We conclude that the calculation of pneumothorax size in the newborns is a predictor of prognosis with high sensitivity and specificity. Furthermore newborns with pneumothorax size greater than 20% are likely to have worse prognosis.

The effects of significant coronary stenosis and percutaneous coronary intervention on aortic stiffness.

OBJECTIVES: Although aortic stiffness (AS) is a strong predictor of cardiovascular events, its value is unknown in patients who have coronary stenosis and undergo percutaneous coronary intervention (PCI). Our hypothesis was that AS might provide additional information about coronary hemodynamic status. In this context, we investigated the effects of coronary stenosis and PCI on AS. STUDY DESIGN: The study included 107 patients undergoing coronary angiography. The patients were divided into three groups based on the angiographic results: 39 patients with significant lesions (≥50%) formed the 'critical group' and 38 patients with nonsignificant lesions (<50%) formed the 'noncritical group'. The control group (30 patients) had normal angiograms. Aortic stiffness was determined using the carotid-femoral aortic pulse wave velocity (PWV) method. All patients in the critical group underwent successful PCI and repeat PWV measurements. RESULTS: All baseline characteristics were similar in the three groups except for the mean PWV, which was significantly higher (9.4±2.2 m/sec) in the critical group compared to the control group (5.7±1.1 m/sec) and the noncritical group (5.8±1.1 m/sec) (p<0.0001). The latter two groups had similar PWV values (p=0.6). After PCI, the mean PWV decreased significantly by 24.4% to 7.1±2.0 m/sec (p=0.002); however, it was still significantly higher than that of the control group (p<0.0001). In correlation analysis, PWV showed significant correlations with age (r=0.412, p=0.01), systolic blood pressure (r=0.342, p<0.01), and hemoglobin (r=-0.370, p=0.02). Multiple logistic regression analysis showed that PWV was a predictor for significant stenosis [Exp(B) 3.960, 95% CI 2.014-7.786]. CONCLUSION: Our findings suggest that significant coronary stenosis is associated with significantly increased AS and successful PCI improves AS to some extent.

Relation of neutrophil/lymphocyte ratio to coronary flow to in-hospital major adverse cardiac events in patients with ST-elevated myocardial infarction undergoing primary coronary intervention.

With the growing understanding of the role of inflammation in patients with atherosclerotic disease, studies have focused on high-sensitivity C-reactive protein (hs-CRP) and other inflammatory markers in their association with outcomes in ST-segment elevation myocardial infarction. The goal of this study was to investigate the association of the neutrophil/lymphocyte (N/L) ratio and in-hospital major adverse cardiac events (MACEs) in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI). The association of hs-CRP and N/L ratio on admission with Thrombolysis In Myocardial Infarction (TIMI) flow grade after PCI was assessed in 418 consecutive primary patients with PCI. The N/L ratio was significantly higher in the no-reflow group (TIMI grade 0/1/2 flow, n = 158) compared to that of the normal-flow group (TIMI grade 3 flow, n = 260, 4.6 ± 1.7 vs 3.1 ± 1.9, p <0.001). In-hospital MACEs were significantly higher in patients with no reflow (23% vs 7%, p <0.001). There was a significant and positive correlation between hs-CRP and N/L ratio (r = 0.657, p <0.001). In receiver operating characteristic analysis, N/L ratio >3.3 predicted no reflow with 74% sensitivity and 83% specificity. In a multivariate regression model, N/L ratio remained an independent correlate of no reflow (odds ratio [OR] 1.54, 95% confidence interval [CI] 1.34 to 1.76, p <0.001) and in-hospital MACEs (OR 1.14, 95% CI 0.98 to 1.32, p = 0.043). The N/L ratio, an inexpensive and easily measurable laboratory variable, is independently associated with the development of no reflow and in-hospital MACEs in patients with ST-segment elevation myocardial infarction undergoing primary PCI.

The prognostic value of serum gamma glutamyl transferase activity on admission in patients with STEMI undergoing primary PCI.

We assessed the association between serum gamma glutamyl transferase (GGT) activity with postprimary percutaneous coronary intervention (PCI) coronary flow and in-hospital major advanced cardiac events (MACEs) in patients with ST elevation myocardial infarction (STEMI). Patients with STEMI (n = 425; males 78%; mean age 60 ± 13 years) were enrolled. Patients were divided into 3 GGT tertiles and 2 groups according to thrombolysis in myocardial infarction (TIMI) flow grade. The TIMI flow percentages were similar in the 3 GGT tertiles (32%, 45%, and 42%, respectively, P = .336). Total MACE increased with GGT tertiles (among tertiles, respectively; P < .001). The total MACE was significantly higher in impaired flow group than in normal flow group (23% vs 7%; P < .001). At multivariate analyses, serum GGT activity was an independent predictor of in-hospital MACE (odds ratio [OR] 1.12, 95% confidence interval [CI] 1.01-1.33; P < .001). In conclusion, serum GGT activity is associated with in-hospital MACE in patients with STEMI undergoing primary PCI.

Hematologic parameters and angiographic progression of coronary atherosclerosis.

Hematologic parameters have prognostic importance in cardiovascular disease. However, the relation between atherosclerosis progression and hematologic parameters is not well defined. A total of 394 patients requiring repeat coronary angiography were included in the study. According to angiography, patients were divided into 2 groups, progressive (n = 196) and nonprogressive (n = 198) diseases. Hematologic parameters including mean platelet volume (MPV) and neutrophil/lymphocyte (N/L) ratio were measured. Glucose, creatinine, and cholesterol were significantly higher in the progressive group. Mean platelet volume count was similar in both groups. The N/L ratio was significantly higher in the progressive group (5.0 ± 5.1 vs 3.2 ± 3; P = .001). In multivariate analysis, the N/L ratio was significantly related with progression (relative risk [RR]: 2.267, 95% CI: 1.068-4.815, P = .03). Progression rate was significantly high in patients with high N/L ratio (39% vs 56%). Our results suggest that the N/L ratio is a predictor of progression of atherosclerosis.

High levels of serum uric acid predict severity of coronary artery disease in patients with acute coronary syndrome.

We aimed to elucidate the relation between serum uric acid (SUA) level and severity of coronary artery disease (CAD) in nondiabetic, nonhypertensive patients (n = 246) with acute coronary syndrome (ACS). Severity of CAD was assessed by the Gensini score. One, 2, and 3 or more diseased vessels were identified in 87 (35.4%), 55 (22.4%), and 104 (42.2%) patients, respectively. Patients with hyperuricemia had higher Gensini score, high number of diseased vessels, critical lesions, and total occlusion. Serum uric acid level was significantly associated with number of diseased vessels. Serum uric acid was an independent risk factor for multivessel disease by univariate analysis. High levels of SUA associated with the severity of CAD in nondiabetic, nonhypertensive patients with ACS.

Relation of left atrial spontaneous echocardiographic contrast in patients with mitral stenosis to inflammatory markers.

Spontaneous echocardiographic contrast (SEC) is the presence of smoke-like echoes with a characteristic swirling motion of blood in echocardiography. Previous clinical studies have demonstrated that SEC is a risk factor for left atrial thrombus formation and an important indicator of potential systemic embolism originated from heart. An established relation exists between the inflammatory status and the prothrombotic state. Therefore, we investigated the role of inflammatory status on SEC in patients with mitral stenosis (MS). A total of 62 consecutive patients with MS who undergoing mitral balloon valvuloplasty were enrolled in the present study. The patients were divided into 2 groups according to the formation of SEC in the left atrium. Of the 62 patients, 32 (mean age 45 ± 12 years; 75% women) were in the SEC-negative group and 30 patients (mean age 45 ± 11 years; 63% women) were in the SEC-positive group. The high-sensitive C-reactive protein levels were significantly greater in the SEC-positive group than in the SEC-negative group (3.9 ± 2.2 vs 10.6 ± 6.3, p = 0.024). The neutrophil levels (64.6 ± 9.4 vs 72.6 ± 8.6) were significantly greater in the SEC-positive group, and the lymphocyte levels (24.4 ± 6.9 vs 18.3 ± 6.0) were significantly greater in the SEC-negative group (p = 0.001 for each). The neutrophil/lymphocyte (N/L) ratio was also significantly greater in the SEC-positive group (3.0 ± 1.8 vs 4.5 ± 1.8, p = 0.003). In the receiver operating characteristics curve analysis, a N/L ratio > 3.1 mg/dl had a 80% sensitivity and 72% specificity in predicting SEC in patients with MS. On multivariate analysis, high-sensitive C-reactive protein (odds ratio [OR] 1.235, 95% confidence interval [CI] 1.040 to 1.466; p = 0.016), N/L ratio (OR 1.461, 95% CI 0.977 to 2.184; p = 0.02), left atrial volume (OR 3.012, 95% CI 1.501 to 5.611; p = 0.001), and mitral valve area (OR 0.135, 95% CI 0.020 to 0.503; p = 0.017) were independent risk factors of SEC in patients with MS. In conclusion, the high-sensitive C-reactive protein and N/L ratio were independently associated with SEC in patients with MS.