Evaluation of the Relationship Between Microalbuminuria and Urine Ischemia-Modified Albumin Levels in Patients with Diabetic Nephropathy.

INTRODUCTION: Ischemia-modified albumin (IMA) is a marker which can be associated with oxidative stress in various ischemic and non-ischemic processes. Oxidative stress plays roles in diabetes mellitus, its complications and pathogenesis. Serum IMA levels are examined in various clinical events. However, urine IMA levels have not yet been evaluated in diabetic patients. In this study, we aim to examine the relationship between metabolic features and urine microalbuminuria levels of diabetic patients and their urine IMA levels. MATERIALS AND METHODS: There were totally 50 type 2 diabetic patients in the study at the Mevlana University Hospital. Patients with cerebrovascular disease, acute myocardial infarction, hemodialysis patients with end stage chronic renal failure, pulmonary embolism, and malignant disease were excluded from the study. Metabolic features, urine IMA levels and cardiological parameters of patients were evaluated. RESULTS: Mean age of patients was 59 ± 9 years, 20 of them (40%) were male and 30 of them (60%) were female. There were six patients with albuminuria value of <0.03 mg/g (normal), there were 39 patients with microalbuminuria value of 0.03-0.3 mg/g and there were five patients with macroalbuminuria of >0.3 mg/g. According to the analysis of patients with microalbuminuria (n = 39), there was no correlation between IMA levels and numerical demographic data, albuminuria, glucose, HbA1c, lipid profile, creatinine, uric acid, hematological parameters. DISCUSSION: Conclusively, there was no relationship between urine IMA levels and microalbuminuria related to the diabetic nephropathy. These findings can be associated with urinary excretion mechanisms of IMA.

Evaluation of Echocardiographic Epicardial Fat Thickness as a Sign of Cardiovascular Risk in Positive Exercise Test Patients.

BACKGROUND: The association between epicardial fat thickness (EFT) and positive exercise test results for the diagnosis of coronary artery diseases (CAD) has yet to be evaluated. This study assessed the predictive value of EFT for CAD on the angiographs of patients with positive exercise tests. METHODS: A total of 91 subjects were chosen consecutively from stable angina pectoris patients who were referred for coronary angiography due to a positive exercise test result. The EFT measures were obtained by echocardiographic parasternal long-axis views on the free wall of the right ventricle at end-systole of three cardiac cycles. Gensini scores were calculated by a conventional coronary angiography technique using a calculation method previously defined. RESULTS: Receiver operator characteristic (ROC) curve analysis revealed a 0.65 cm (95% confidence interval: 0.628, 0.832, p < 0.001) area under the curve with 74.3% sensitivity and 62.3% specificity at the cut-off value of EFT for the prediction of critical coronary artery stenosis. Following ROC curve analysis, two groups were defined according to EFT cut-off value (groups 1 and 2). The severe coronary stenosis ratio was significantly higher in group 2 compared to group 1 (31.9 % vs. 11%, p < 0.001) and Gensini scores were significantly higher in group 2 (6.3 ± 13.3 vs. 16.5 ± 17.9; p < 0.001). There was no significant correlation between Gensini scores and EFT in group 1 (r = 0.093, p = 0.549), but there was a strong significant correlation in group 2 (r = 0.730, p < 0.001). Linear multivariate regression analysis revealed that EFT (> 0.65 cm) was the only independent risk factor for critical coronary artery stenosis (ß = 0.451, p < 0.001). CONCLUSIONS: EFT was significantly correlated with the severity and prevalence of coronary artery disease in positive exercise test patients.

Deterioration of heart rate recovery index in patients with erectile dysfunction.

OBJECTIVE: Heart rate recovery (HHR) after exercise is a function of vagal reactivation. This study aimed to evaluate HHR index in patients with erectile dysfunction. METHODS: Men over the age of 18 years who were diagnosed with erectile dysfunction were included in the study. Ninety patients with erectile dysfunction (mean age=56.1±8.3 years) and 50 healthy subjects as controls (mean age=53.1±10.4 years) were compared. The erectile status of patients was evaluated using the sexual health inventory for men questionnaire. Basal electrocardiography, echocardiography, and treadmill exercise testing were performed in all patients and controls. The HHR index was defined as the reduction in heart rate from the rate at peak exercise to the rate at the first minute (HRR1), second minute (HRR2), third minute (HRR3), and fifth minute (HRR5) after terminating exercise stress testing. An independent sample t-test, Pearson correlation coefficient test, linear multivariate regression analysis, and receiver operating characteristic curve analysis were used for statistical assessment. RESULTS: All HHR indices were found to be significantly decreased in patients with erectile dysfunction (p<0.001). Effort capacity was markedly lower (9.1±2.3 vs. 10.4±2.3 METs, p=0.002) among patients with erectile dysfunction. HRR1 and HRR3 were found to be an independent risk factor for erectile dysfunction (Beta=0.462, p<0.001; Beta=0.403, p<0.001; respectively) in linear regression analysis. CONCLUSION: Decreased HHR index may be considered as one of the independent predictors of impaired autonomic function in patients with erectile dysfunction.

Association between PDW and Long Term Major Adverse Cardiac Events in Patients with Acute Coronary Syndrome.

BACKGROUND: The aim of the present study was to perform a preliminary evaluation of the potential association between platelet distribution width (PDW) and frequency of major adverse cardiovascular events (MACEs) development in an observational study of acute coronary syndrome (ACS) patients. METHODS: A total of 679 consecutive patients with ACS (498 (73.3%) males; mean age was 63.31±11.2 years; study population composed of 320 patients with acute myocardial infarction and 359 patients with unstable angina pectoris) subjected to primary percutaneous coronary intervention with transradial approach (TRA) were retrospectively enrolled to the study. Tertiles were formed based on PDW levels. The associations between PDW and in-hospital and long-term MACEs were analysed. RESULTS: The frequencies of in-hospital instent thrombosis (P=0.05), long-term instent restenosis (P=0.005) and long-term total MACEs (P=0.008) were higher in tertiles having a high PDW value. In multivariate analyses, PDW was an independent predictor of in-hospital and long-term MACEs (odds ratio 1.081, 95% confidence interval 1.003-1.165; p=0.042). The projected Kaplan-Meier incidence of a MACEs in the PDW tertiles groups were 12.8%, 12.1%, and 21.6% at 40 months (respectively, p=0.003). CONCLUSIONS: The pre-procedural PDW may be an independent predictor of both in-hospital and long-term adverse outcomes in patients with ACS.

Outcomes of transradial primary percutaneous intervention from a tertiary cardiac centre in Turkey.

OBJECTIVES: The aim was to study transradial approach (TRA) and transfemoral approach (TFA) in terms of feasibility, effectiveness, usefulness, and procedure characteristics in patients having ST-segment elevation myocardial infarction (STEMI) and undergoing primary percutaneous coronary intervention (PCI). Along with the said aim, major adverse cardiovascular events (MACE) at follow-up were also compared. METHODS: The present study was conducted on 344 consecutive patients having ST-segment elevation myocardial infarction and qualifying for PCI. Patients were classified into two groups according to radial and femoral approaches. Patients were followed-up for MACE. RESULTS: PCI was found to be successful in all patients. In TRA group the time between the end of the intervention to removal of the sheath, and duration of mobilization and hospitalization were significantly shorter when compared to TFA group (12 ± 2 minutes vs. 240 ± 12 minutes; P = 0.001, 13 ± 2 hours vs. 22 ± 2 hours; P = 0.001, and 96 ± 45 hours vs. 125 ± 55 hours; P = 0.001, respectively). In TRA group, two patients had hematomas greater than 2 cm while fourteen patients in TFA group had hematomas greater than 5 cm (1% vs. 8%; P = 0.002). TRA group had lower in-hospital MACE rates (5% vs. 11%; P = 0.036). The long terms MACE rates of the groups were similar (23% vs. 22%; P = 0.888). CONCLUSIONS: In patients with STEMI, PCI via TRA had the same effectiveness as TFA. Moreover, Time to ambulation and rates of bleeding complications were reduced by TRA, which allowed early rehabilitation. TRA reduced the incidence of in-hospital MACEs.

The association between thoracic periaortic fat and major adverse cardiovascular events.

AIM: The study aimed to examine the association between thoracic periaortic fat tissue volume and the long-term incidence of major adverse cardiovascular events. METHODS: This retrospective cohort study included 433 consecutive patients (372 male and 61 female). Periaortic fat tissue volume was measured via electrocardiogram-gated 64-multidetector computed tomography. The patients were evaluated on an average 3 years of follow-up for major adverse cardiovascular events. The patients were divided into groups according to the presence of major adverse cardiovascular events. RESULTS: Major adverse cardiovascular events were noted in 44 (10.2 %) patients during follow-up. Periaortic fat tissue volume was significantly higher in the major adverse cardiovascular events (+) group (35.4 ± 26.1 cm(3) vs. 24.1 ± 14.9 cm(3), P = 0.001). The logistic regression model showed that periaortic fat tissue volume (hazard ratio: 1.03; 95 % CI: 1.01-1.05; P = 0.001), the glomerular filtration rate (hazard ratio: 0.98; 95 % CI: 0.96-0.99; P = 0.03), and male gender (hazard ratio: 4.76; 95 % CI: 1.08-20.90; P = 0.04) were independent predictors of major adverse cardiovascular events. CONCLUSION: Thoracic periaortic fat tissue volume may be considered a useful new parameter for predicting major adverse cardiovascular events.

An epidemiological study to evaluate the use of vitamin K antagonists and new oral anticoagulants among non-valvular atrial fibrillation patients in Turkey- AFTER-2 study design.

OBJECTIVES: Atrial fibrillation (AF) is one of the most common causes of preventable ischemic stroke and is related to increased cardiovascular morbidity and mortality. There is a lack of data in Turkey on the use of new oral anticoagulants (NOACs), and time in therapeutic INR range (TTR) in vitamin K antagonist users and AF management modality. In this multi-center trial, we aimed to analyze, follow and evaluate the epidemiological data in non-valvular AF patients. STUDY DESIGN: Four thousand one hundred consecutive adult patients from 42 centers with at least one AF attack identified on electrocardiography will be included in the study. Patients with rheumatic mitral valve stenosis and prosthetic valve disease will be excluded from the study. At the end of one year, the patients will be evaluated in terms of major cardiac end points (death, transient ischemic attack, stroke, systemic thromboembolism, major bleeding and hospitalization). RESULTS: First results are expected in June 2015. Data about major cardiovascular end-points will be available in January 2016. CONCLUSION: The rates and kind of oral anticoagulant use, TTR in vitamin K antagonist users and main management modality applied in non-valvular AF patients will be determined by AFTER-2 study. In addition, the rate of major adverse events (MACEs) and the independent predictors of these MACEs will be detected (AFTER-2 Study ClinicalTrials.gov number, NCT02354456.).

Epicardial Fat Tissue Predicts Increased Long-Term Major Adverse Cardiac Event in Patients With Moderate Cardiovascular Risk.

We investigated the relationship between epicardial fat volume (EFV) measured by multislice computed tomography (MDCT) and long-term major adverse cardiac events (MACEs). Consecutive patients (n = 564) were enrolled in this retrospective study. Patients were divided into tertiles according to EFV. Patients were followed up for an average of 18 months. Patients in each tertile were similar in terms of gender and risk factors. Patients with greater EFV in the third group were more likely to be overweight (P = .001) and older (P = .001). High-density lipoprotein cholesterol levels were relatively lower in the third tertile (45 ± 9, 45 ± 11, and 43 ± 9 mg/dL, respectively; P = .018). The third group had a significantly higher rate of myocardial infarction (0.6%, 1.1%, and 3.7%, respectively; P = .043). The incidence of MACEs during the follow-up period was highest in the third group 15.9% (4.1%, 7.7%, and 15.9%, respectively; P = .001). Epicardial fat volume measured by MDCT was associated with increased long-term cardiovascular risk.

The relationship between uric acid and erectile dysfunction in hypertensive subjects.

BACKGROUND: Endothelial dysfunction plays a major role in erectile dysfunction (ED). Uric acid (UA) is a marker of endothelial dysfunction. We hypothesized that increased UA levels may be associated with ED and aimed to investigate whether there is a relationship between, UA and ED in hypertensive patients. METHODS: A total of 200 hypertensive patients who have a normal treadmill exercise test were divided into two groups based on the Sexual Health Inventory for Men (SHIM) test (< 21 defined as ED n = 110, and ≥ 21 defined as normal erectile function n = 90). The differences between the ED and normal erectile function groups were compared and determinants of ED were analyzed. MAIN RESULTS: The prevalence of ED was found to be 55.0%. Office blood pressure level was comparable between groups. UA levels were significantly increased in the ED group (6.20 ± 1.56 vs 5.44 ± 1.32, p = 0.01). In a regression model, age [odds ratio (95% confidence interval): 1.08 (1.04-1.14), p = 0.001], smoking [odds ratio: 2.33 (1.04-5.20), p = 0.04] and UA [odds ratio: 1.76 (1.28-2.41), p = 0.04] were independent determinants of ED. An UA level of > 5.2 mg/dl had 76.2% sensitivity, 43.7% specificity, 62.9% positive and 59.4% negative predictive value for determining ED. CONCLUSION: UA is an independent determinant of ED irrespective of blood pressure control and questioning erectile function for hypertensive patients with increased UA levels may be recommended.

No relevant association between coronary artery ectasia and mean platelet volume, gamma-glutamyltransferase and uric acid levels.

OBJECTIVES: In this study, we aimed to investigate whether there is an association between mean platelet volume (MPV), gamma-glutamyltransferase (GGT) and uric acid and coronary artery ectasia (CAE) in a large patient population. STUDY DESIGN: A total of 406 patients (245 male, 161 female; mean age: 55±9 years) were selected retrospectively as the study population from among 3265 individuals who underwent coronary angiography between August 2011 and December 2012. Information regarding blood tests of the patients obtained during hospitalization was extracted from the institute electronic database. RESULTS: MPV, GGT and uric acid levels were significantly higher in subjects with stenotic coronary artery disease (CAD) and in subjects with both CAD and CAE compared with subjects with isolated CAE and subjects with normal coronary arteries (NCA). There were no significant differences between the isolated CAE and NCA groups in terms of MPV (8.6±1.2 fL vs. 8.6±1.1, respectively, p=0.993), serum GGT (33±15 U/L vs. 30±15 U/L, respectively, p=0.723) and uric acid levels (5.4±1.6 mg/dl vs. 5.2±1.7 mg/dl, respectively, p=0.845). CONCLUSION: Unlike previous studies, our study failed to demonstrate any association between CAE and MPV, uric acid and GGT levels.