Blood urea nitrogen/albumin ratio on admission predicts mortality in patients with non ST segment elevation myocardial infarction.

The aim of this study is to reveal the predictive power of biomarkers and SYNTAX (SX) score for short-term mortality in patients diagnosed with non-ST-segment elevation myocardial infarction (NSTEMI) in the emergency department. This is prospective observational cohort study. Demographic characteristics of the patients, laboratory parameters on admission, left ventricular ejection fraction (LVEF) percentages, affected vessels in angiography (CAG) and the treatment strategy [medical therapy, percutaneous transluminal coronary angioplasty (PTCA), coronary angio by-pass graft] and SX scores were recorded on the data collection form. ROC curve was used to investigate the predictivity of blood urea nitrogen/albumin ratio (BAR), procalcitonin, C-reactive protein (CRP), high sensitivity cardiac troponin I (Hs-cTnI), CRP to serum albumin ratio (CAR), neutrophil to lymphocyte ratio (NLR) and SX scores in mortality. Multivariate analysis of biomarkers and SX score was performed to estimate the patients' 30-day mortality. Of the 415 patients were included in the study. ROC analysis of BAR, CAR, CRP, Procalcitonin, Hs-cTnI, NLR and SX score to predict mortality was statistically significant. BAR (OR: 1.280, 95% CI: 1.113-1.472, p = .001) and SX score (OR: 1.071, 95% CI: 1.018-1.126, p = .007) were found to be independent predictors of 30 days mortality. LVEF reduction, SX score, the number of affected vessels and the frequency of LMCA lesions increase were found to be statistically significant in patients with BAR ≥4.8. BAR, which can be calculated easily and quickly on admission to the emergency department and in clinical practice, may be used to predict mortality in patients with NSTEMI.

Acute Myocardial Infarction due to Multiple Thrombosis without Cardiogenic Shock.

OBJECTIVE: Acute thrombotic occlusion of > 1 major coronary arteries is very rare (2.5%). Herein, we report a patient with simultaneous anterior and inferior myocardial infarction without cardiogenic shock. CLINICAL PRESENTATION AND INTERVENTION: A 43-year-old woman was admitted with severe chest pain. Electrocardiography showed ST segment elevation in anterior and inferior derivations. There was no severe hypotension. Urgent coronary angiography showed that there were thrombotic occlusions in both left anterior descending artery and right coronary artery. Both lesions were successfully treated with coronary stenting. CONCLUSION: If there is multiple ST segment elevation on presentation electrocardiography, clinicians should be aware of possible simultaneous coronary occlusions.

Myocardial repolarization is affected in patients with ascending aortic aneurysm.

OBJECTIVE: Ascending aortic aneurysm (AAA) is one of the major causes of ventricular diastolic dysfunction. Diastolic dysfunction can induce ventricular repolarization dispersion. Nevertheless, myocardial repolarization dispersion is not yet to be fully evaluated in patients with AAA. We aimed to evaluate ventricular repolarization using QT and Tp-Te interval and corrected (c) Tp-Te/QT ratio in patients with AAA. METHODS: One hundred-four patients with AAA without coronary artery disease (CAD) served as the aneurysm group and 82 patients having a normal aortic diameter as the control group. All patients underwent transthoracic echocardiography (TTE) for measurements of LV diastolic function and underwent electrocardiography (ECG) to calculate RR, QT, Tp-Te intervals and QT dispersion. Bazett's formula was used to calculate QTc and cTp-Te intervals. cTp-Te/QT ratio was also calculated. RESULTS: The groups were similar according to basal characteristics. We found left ventricular diastolic properties were impaired and QT dispersion, QTc interval, and both of Tp-Te and cTp-Te intervals were significantly prolonged in the aneurysm group than the control group. There were also significant correlations between TTE and ECG parameters. On multivariate linear regression analysis, indexed ascending aortic dimension (AAoD), LA diameter and E/e' ratio were independent predictors of ventricular repolarization dispersion in AAA patients. CONCLUSIONS: Our study results showed that patients with AAA may have an increased risk for ventricular arrhythmogenesis because of deteriorated the left ventricular diastolic function.

Epicardial fat thickness is associated with aortic intima-media thickness in patients without clinical manifestation of atherosclerotic cardiovascular disease.

BACKGROUND: Although the relationship between epicardial fat thickness (EFTh) and coronary atherosclerosis is well established, this relation in the early periods of atherosclerosis has not been fully demonstrated. On the other hand, thoracic aortic intima-media thickness (IMT) rather than carotid IMT was reported as an earlier marker of preclinical atherosclerosis. OBJECTIVE: We aimed to assess the relationship between thoracic aortic IMT and EFTh in patients undergoing transesophageal echocardiography (TEE) examination for different indications. METHODS: We included 104 patients (mean age 38±11.4 years), who underwent TEE for various indications. The patients were divided into two groups according to the median thoracic aortic IMT values (IMT normal group<10 mm and IMT abnormal group≥10 mm). EFTh was obtained using two-dimensional transthoracic echocardiography on the right ventricular free wall during systole and diastole. RESULTS: The highest EFTh values (3.3±0.96 mm vs. 4.51±0.66 mm, P<.001) were observed in the abnormal aortic IMT group. Multivariate linear regression analysis showed that aortic IMT was independently correlate with EFTh (ß=0.423, P<.001). Moreover, EFTh was found to be associated with history of transient ischemic attack (r=.403, P<.001) and abnormal IMT (r=.643, P<.001) in bivariate analysis. CONCLUSION: Epicardial fat thickness is independently related to the extent of subclinical thoracic aortic atherosclerosis. Increase in EFTh may be crucial marker for initial atherosclerosis.

Scorpion envenomation-induced acute thrombotic inferior myocardial infarction.

The occurrence of a serious cardiac emergency following scorpion envenomation has rarely been reported and, when so, mostly presented as non-ST segment elevation myocardial infarction, cardiogenic shock, or myocarditis. Possible mechanisms include imbalance in blood pressure and coronary vasospasm caused by the combination of sympathetic excitation, scorpion venom-induced release of catecholamines, and the direct effect of the toxin on the myocardium. We report a case of a 55-year-old man who presented with acute inferior wall myocardial infarction (MI) within 2 h of being stung by a scorpion. Coronary angiogram revealed total thrombotic occlusion of the left circumflex artery, which was treated successfully with glycoprotein IIb/IIIa inhibitor, thrombus aspiration, antivenom serum, and supportive therapy. Therefore, life-threatening MI can complicate the clinical course during some types of scorpion envenomation and should be managed as an acute coronary syndrome.

Coronary collateral development and arterial stiffness in patients with chronic coronary total occlusions.

OBJECTIVE: Coronary collateral circulation (CCC) mainly develops through arteriogenesis in response to shear forces. Increased arterial stiffness (AS) causes decreased coronary perfusion, which may reduce shear stress, arteriogenesis, and thus collateral formation. The aim of this study was to assess the relationship between CCC and AS in patients with chronic coronary total occlusion (CTO). DESIGN: We prospectively enrolled 163 patients with CTO. Patients were divided into two groups according to their Rentrop scores: (a) poorly developed (PD) CCC group (Rentrop 0-1) and (b) well-developed (WD) CCC group (Rentrop 2-3). AS measurements were carried out using a Mobil-O-Graph arteriography system. RESULTS: Fasting glucose, creatinine, uric acid, neutrophil count, and neutrophil-to-lymphocyte ratio were found to be higher in patients with PD-CCC. Moreover, patients with PD-CCC had significantly higher augmentation index (AIx) and pulse wave velocity (PWV) compared with WD-CCC group (27.3 ± 8.9 vs. 18.7 ± 7.4, p < 0.001 and 11.7 ± 2.6 vs. 8.5 ± 1.4, p < 0.001, respectively). In multivariate logistic regression analysis, PWV, AIx, and serum uric acid were found to be independently associated with the development of CCC. CONCLUSION: AS parameters, such as AIx and PWV, as well as serum uric acid are independently associated with the development of CCC in stable coronary artery disease with CTO.

Coronary flow velocity reserve in patients with ascending aorta aneurysm.

BACKGROUND: Ascending aorta aneurysms (AAA) are one of the leading causes of morbidity and mortality. Impairment in coronary flow may contribute to cardiovascular consequences in AAA patients. Coronary flow velocity reserve (CFVR) has been considered an important diagnostic index of the functional capacity of coronary arteries noninvasively. The aim of this study was to evaluate, by noninvasive CVFR, whether patients with AAA demonstrate significant coronary microvascular dysfunction in the absence of coronary artery disease (CAD). METHODS: We prospectively included 44 patients with thoracic AAA in the absence of concomitant CAD (30 men, 14 women; mean age 57.5 ± 8.4 years). A total of 36 patients without aortic dilatation (mean age 55.2 ± 9.9 years) were selected as the control group. Coronary flow velocities in the distal left anterior descending (LAD) artery were measured using transthoracic echocardiography. CFVR was calculated as the hyperemic to resting coronary diastolic peak velocities ratio. RESULTS: Compared with controls, patients with AAA had higher baseline LAD peak diastolic coronary flow velocities (28.3 ± 5.8 vs. 25.2 ± 4.5 cm/sec, P = 0.01), lower hyperemic LAD flow velocities (54.0 ± 10.3 vs. 57.2 ± 12.7 cm/sec, P = 0.220), and consequently lower CFVR (1.9 ± 0.3 vs. 2.3 ± 0.5, P < 0.001). Multivariate linear regression analysis showed that CFVR was independently associated only with aortic systolic diameter (AoSD) (ß = -0.679, P = <0.001). CONCLUSIONS: Our study demonstrates that noninvasive CFVR is significantly reduced in patients with AAA and AoSD is the most important determinant of impaired CFVR.

BUN/albumin ratio predicts short-term mortality better than SYNTAX score in ST-elevation myocardial infarction patients.

OBJECTIVE: The aim of the study is to compare the prognostic power of the BUN/albumin ratio (BAR) calculated on admission to the emergency department and the SYNergy between Percutaneous Coronary Intervention with TAXus (SYNTAX) score calculated after coronary angiography (CAG) in predicting 30-day mortality in patients with ST-segment elevation myocardial infarction (STEMI). METHOD AND MATERIAL: The study was conducted prospectively between March 2021 and March 2022 in the emergency department of a tertiary hospital. Patients over the age of 18 who underwent CAG with a diagnosis of STEMI were included in the study. Demographic charecteristics, comorbidities, laboratory parameters of the patients at the time of admission and SYNTAX (SX) score were recorded in the data form. RESULTS: A total of 1147 patients (77% male) diagnosed with STEMI were included in the study. When the receiver-operating characteristic analysis for SX score and laboratory parameters' power to predict mortality was examined, it was found that the AUC value of the BAR level (AUC: 0.736; 95% confidence interval: 0.670-0.802, P  < 0.001) was the highest. If the threshold value of the serum BAR level, which was determined to predict mortality, was taken as 4, the sensitivity was found to be 76.7% and the specificity was 56.9%. With multivariate logistic analysis, it was determined that the risk of mortality increased by 1.25 for each unit increase in the BAR value in STEMI patients ( P  < 0.001). CONCLUSION: According to the study data, the BAR may guide the clinician in the early period as a practical and valuable predictor of 30-day mortality in patients diagnosed with STEMI.

Serum Elabela Level Significantly Increased in Patients with Complete Heart Block.

OBJECTIVE: To investigate the change in serum Elabela level, a new apelinergic system peptide, in patients with complete atrioventricular (AV) block and healthy controls. METHODS: The study included 50 patients with planned cardiac pacemaker (PM) implantation due to complete AV block and 50 healthy controls with similar age and gender. Elabela level was measured in addition to routine anamnesis, physical examination, and laboratory tests. Patients were divided into two groups, with and without AV block, and then compared. RESULTS: In patients with AV block, serum Elabela level was significantly higher and heart rate and cardiac output were significantly lower than in healthy controls. Serum Elabela level was found to be positively correlated with high-sensitive C-reactive protein and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, but negatively correlated with heart rate, high-density lipoprotein cholesterol, and cardiac output. In linear regression analysis, it was found that these parameters were only closely related to heart rate and NT-proBNP. Serum Elabela level was determined in the patients with AV block independently; an Elabela level > 9.5 ng/ml determined the risk of complete AV-block with 90.2% sensitivity and 88.0% specificity. CONCLUSION: In patients with complete AV block, the serum Elabela level increases significantly before the PM implantation procedure. According to the results of our study, it was concluded that serum Elabela level could be used in the early determination of patients with complete AV block.

Coronary vasospasm and acute myocardial infarction induced by a topical capsaicin patch.

Capsaicin is the active component of chili peppers, which has been shown to possess several beneficial effects. Currently, the best-known medical use of capsaicin is as a topical painkiller. Drug-induced myocardial infarction is not a common phenomenon and the underlying mechanism has been related with coronary spasm in the majority of cases. We present a 29-year-old man who experienced coronary vasospasm and acute myocardial infarction (AMI) which were possibly induced by the use of a topical capsaicin patch to relieve lumbago. He presented with chest pain of one hour onset. The electrocardiogram showed ST-segment elevation in the leads II, III, and aVF, consistent with inferior wall AMI. Echocardiography confirmed inferior hypokinesia. Urgent coronary angiography showed normal right and left coronary arteries. Since he had no cardiac risk factors for coronary artery disease, nor a history of recent emotional or physical stress, or ingestion of any illicit substance, the vasospasm and subsequent AMI was attributed to the use of the capsaicin patch for six days. Upon institution of appropriate treatment and removal of the patch, no new anginal attacks or ischemic episodes were seen within a follow-up of one month. This is the first case report of AMI induced by the use of a topical capsaicin patch.

Increased Elabela levels in the acute ST segment elevation myocardial infarction patients.

Elabela is a bioactive peptide and a part of Apelinergic system. Elabela has an important role in the early embryonic stages. Elabela's beneficial effects in cardiovascular system were shown in some animal models or in vitro studies. Lately, some investigational studies in humans are started to be seen in literature. Our aims were to investigate serum Elabela levels in the first day of ST segment elevation myocardial infarction (STEMI), to compare with healthy controls, and to see if there is a correlation between other cardiac biomarkers in humans.The study was planned as cross-sectional. The patients group had 124 STEMI subjects. They were grouped as inferior (n = 59) and anterior myocardial infarction (n = 65) groups, and compared with the healthy control population (n = 77). Routine blood tests and serum Elabela levels were measured. Transthoracic echocardiography performed to all subjects.Frequency of diabetes mellitus, hypertension, smoking, and hyperlipidemia in both STEMI groups were significantly higher than control subjects. Glucose, high density lipoprotein (HDL) cholesterol, triglyceride, high sensitive C reactive protein (Hs-CRP), troponin I, N-terminal brain natriuretic peptide (NT-ProBNP), and Elabela levels were significantly higher in both STEMI groups. Other laboratory parameters were similar. Group 2 and 3 had significantly lower left ventricular ejection fraction (LVEF) than group 1. Group 3 had also significantly lower LVEF than group 2. There was a positive but moderate correlation between Elabela, troponin I, and NT-ProBNP. Elabela was negatively correlated with LVEF. This correlation was also moderate.We showed increased Elabela levels in STEMI patients in this study. Also, we observed a moderate positive correlation between troponin I, NT-ProBNP, and Elabela.

Aortic intima-media thickness can be used to determine target organ damage in adult patients with coronary artery disease risk factors.

INTRODUCTION: We aimed to evaluate the relationship between abdominal aortic intima-media thickness (AA-IMT) and thoracic aortic intima-media thickness (TA-IMT) values and to investigate their relationship with common carotid intima-media thickness (CC-IMT) in patients with coronary artery disease (CAD) risk factors. MATERIAL AND METHODS: This study included 100 patients who underwent transesophageal echocardiography (TEE) examination for different reasons with at least one CAD risk factor. CC-IMT, AA-IMT, and TA-IMT values were measured. Patients with CC-IMT > 0.9 mm were considered as having increased CC-IMT. Patients were divided into two groups with and without increased CC-IMT. RESULTS: Mean AA-IMT and TA-IMT values of all patients were 1.55 ±0.27 mm and 1.39 ±0.25 mm, respectively. In patients with increased CC-IMT, blood pressure, hyperlipidemia and hypertension frequency, creatinine, total and low-density lipoprotein (LDL) cholesterol, triglyceride, high-sensitivity C-reactive protein (hs-CRP) and uric acid levels, AA-IMT and TA-IMT values were higher, while the high-density lipoprotein (HDL) cholesterol level was lower than the normal CC-IMT group. AA-IMT, systolic blood pressure (SBP), total and HDL cholesterol levels independently determined the patients with CC-IMT > 0.9 mm. Each 0.1 mm increase in AA-IMT value was found to increase the probability of having CC-IMT > 0.9 mm. In addition, linear regression analysis showed that CC-IMT was closely and independently related to AA-IMT (p < 0.001 and ß = 0.599). When the cut-off value for AA-IMT was taken as 1.5 mm, it determined the patients with CC-IMT > 0.9 mm with 86% sensitivity and 82% specificity. CONCLUSIONS: The AA-IMT value was found to be higher than TA-IMT in the same patient. Also it was found that AA-IMT was more closely related to CC-IMT.

The influence of plasma 25-(OH) vitamin D levels in acute ST elevation myocardial infarction.

BACKGROUND: The preventive role of acute occurring of collateral circulation (AOCC) to infarct related artery (IRA) in patients presenting with acute ST-segment elevation myocardial infarction (STEMI) is well known. Therefore, we aimed to investigate whether there is an association between admission plasma 25-hydroxyvitamin D (25(OH)D3) levels and grade of collateralization in patients with STEMI. METHODS: We prospectively included 369 STEMI patients within the first 12 h of symptoms onset. Patients were divided into two groups according to their Rentrop collateralization grade to IRA: poorly developed collateral (PDC) group (Rentrop grade ≤ 1, 272 patients) and well developed collateral (WDC) group (Rentrop grade ≥ 2, 97 patients). RESULTS: We observed that AOCC grade to IRA was negatively correlated with high sensitive C-reactive protein (hs-CRP), N terminal pro-B-type natriuretic peptide (NT-proBNP), as well as peak troponin T levels, yet positively correlated with admission plasma 25(OH)D3 level (p < 0.05, for all). In multi¬variate analysis, 25(OH)D3 levels (OR 1.246, 95% CI 1.185-1.310, p < 0.001), together with hs-CRP, NT-proBNP, and peak troponin T levels were found independent predictors of AOCC to IRA in patients with acute STEMI. CONCLUSIONS: Admission level of plasma 25(OH)D3 levels together with cardiac risk biomarkers (troponin T, NT-proBNP, hs-CRP) are associated with collateralization grade to IRA in acute STEMI patients. In addition, 25(OH)D3 may be a promoter of AOCC in patients with acute STEMI.

Predictors of successful percutaneous coronary intervention in chronic total coronary occlusions.

INTRODUCTION: Percutaneous coronary intervention (PCI) of chronic total coronary occlusions (CTOs) is one of the most challenging procedures of interventional cardiology and is associated with increased risk of significant complications. However, debate continues in regard to which factors adversely influence the success rate of PCI and whether the benefits of revascularization of CTO outweigh the risks and challenges. AIM: To analyze the relationship between lesion characteristics and overall success rates as well as in-hospital outcomes after PCI for CTO. MATERIAL AND METHODS: We retrospectively examined the procedural outcomes of 173 consecutive native coronary artery CTO PCIs performed from February 2012 to March 2013 (78% men; mean age: 60.3 ±12.1 years). RESULTS: The CTO target vessel was the right coronary artery (53.8%), circumflex (10.4%) and left anterior descending artery (35.8%), respectively. The retrograde approach was used in 13.9% of all procedures. Successful revascularization was achieved in 83.2% of patients. Major complications occurred in 13.3% of patients. In multivariate analysis, bridge collaterals, severe calcification and tortuosity as well as tandem occlusions were independent predictors of procedural failure, whereas existence of micro-channels was the only predictor of procedural success. CONCLUSIONS: Revascularization of coronary CTOs may be performed with high success and low major complication rates. Bridge collaterals, severe calcification and tortuosity, tandem/multiple occlusions and micro-channels were independent predictors of successful CTO revascularization.

Both Systemic and Pulmonary Artery Stiffness Predict Ventricular Functional Recovery after Successful Percutaneous Closure of Atrial Septal Defects in Adults.

BACKGROUND: Percutaneous closure of atrial septal defect (ASD) has become the preferred method in treatment of the majority of cases. The aim of this study was to evaluate the echocardiographic effects of percutaneous closure of secundum ASD in adults and assess which parameters predict good response to closure. DESIGN: We prospectively included 42 patients with secundum ASD treated successfully with percutaneous device closure. All patients underwent transthoracic echocardiography examination with tissue Doppler imaging before, 24 hours after and within 3 months of intervention. Measurements of arterial stiffness were carried out using a Mobil-O-Graph arteriography system. RESULTS: Remodeling of heart chambers occurred immediately and persisted at 3 months after ASD closure. Significant decreases were observed in right ventricle (RV) end-diastolic diameter, right atrium volume index, and tricuspid annular plane systolic excursion both after the procedure and at 3 months (P < .01 for all). The RV and left ventricle (LV) tissue Doppler-myocardial performance index demonstrated to decline during follow up (P = .0001). Significant correlations were found between pulse-wave velocity, augmentation index, pulmonary artery stiffness, and LV-RV tissue Doppler-myocardial performance index at third month. Linear regression analyses showed that pulse-wave velocity is the most effective parameter of LV and pulmonary artery stiffness is the most effective parameter of RV functional recovery, respectively, assessed by tissue Doppler-myocardial performance index. CONCLUSIONS: Percutaneous closure of secundum ASD in adults has various sustained benefits on multiple echocardiographic parameters within 3 months. The changes in RV and LV function after device closure were significantly correlated with the degree of pulmonary artery stiffness and pulse-wave velocity, respectively.

Assessment of myocardial performance index and its association with aortic elasticity in patients with ascending aortic aneurysm.

OBJECTIVE: Ascending aortic aneurysms (AAA) are a leading cause of morbidity and mortality. Nevertheless, their effects on global cardiac functions are yet to be fully understood. Myocardial performance index (MPI) has been widely used to quantitatively assess myocardial functions. The aim of this study was to evaluate left ventricular (LV) functions in patients with AAA using tissue Doppler (TD) echocardiography and MPI in addition to conventional echocardiographic methods. METHODS: Fifty patients with AAA (33 men, 17 woman; mean age 55.5±7.90 years) were included, and 106 patients without aortic dilatation (mean age 54.1±8.18 years) were included as the control group. LV systolic and diastolic functions were analyzed using 2-dimensional, M-mode, and TD echocardiography. RESULTS: Patients with AAA had significantly higher MPI (0.5±0.04 vs 0.4±0.05, p<0.001), TD-MPI (0.5±0.02 vs 0.4±0.03, p<0.001), and reduced aortic elasticity, as indicated by reduced aortic distensibility (AD) (1.7±1.27 vs 3.1±1.25, p<0.001). Multivariate linear regression analysis showed that TD-MPI was independently correlated with reduced aortic distensibility (B=-0.006, p=0.019, 95% confidence interval,-0.011 to -0.001). CONCLUSION: MPI and TD-MPI indicated impairment of global cardiac functions in patients with AAA, which may be attributed to reduced aortic elasticity.

Serum elabela level significantly increased in patients with complete heart block

Abstract Objective: To investigate the change in serum Elabela level, a new apelinergic system peptide, in patients with complete atrioventricular (AV) block and healthy controls. Methods: The study included 50 patients with planned cardiac pacemaker (PM) implantation due to complete AV block and 50 healthy controls with similar age and gender. Elabela level was measured in addition to routine anamnesis, physical examination, and laboratory tests. Patients were divided into two groups, with and without AV block, and then compared. Results: In patients with AV block, serum Elabela level was significantly higher and heart rate and cardiac output were significantly lower than in healthy controls. Serum Elabela level was found to be positively correlated with high-sensitive C-reactive protein and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, but negatively correlated with heart rate, high-density lipoprotein cholesterol, and cardiac output. In linear regression analysis, it was found that these parameters were only closely related to heart rate and NT-proBNP. Serum Elabela level was determined in the patients with AV block independently; an Elabela level > 9.5 ng/ml determined the risk of complete AV-block with 90.2% sensitivity and 88.0% specificity. Conclusion: In patients with complete AV block, the serum Elabela level increases significantly before the PM implantation procedure. According to the results of our study, it was concluded that serum Elabela level could be used in the early determination of patients with complete AV block.

Epicardial fat thickness in stable coronary artery disease: its relationship with high-sensitive cardiac troponin T and N-terminal pro-brain natriuretic peptide.

OBJECTIVES: Epicardial adipose tissue is related to coronary atherosclerosis, left ventricle hypertrophy, myocardial dysfunction, cardiomyopathy, and inflammation, which produces a variety of cytokines that influence key pathogenic mechanisms of atherogenesis. The main goal of this study is to examine the relationship between epicardial fat thickness (EFT) and cardiovascular risk markers as well as the complexity of coronary artery disease (CAD) in patients with stable CAD. MATERIALS AND METHODS: We prospectively included 439 stable CAD patients undergoing coronary angiography in the present study (mean age: 62.2±10.7 years). Patients were divided into two groups (EFTlow and EFThigh groups) according to their median EFT values. EFT was evaluated by two-dimensional echocardiography before angiography. The SYNTAX score was calculated in all patients. N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitive C-reactive protein (hs-CRP), high-sensitive cardiac troponin T (hs-cTnT), uric acid, and other biochemical markers were also measured. RESULTS: Age, SYNTAX score, frequencies of diabetes, hyperlipidemia, and hypertension, NT-proBNP, hs-CRP, hs-cTnT, and uric acid levels were higher in EFThigh group compared with the EFTlow group (P<0.05 for all). EFT was associated independently with age (ß=-0.102, P=0.001), diabetes (ß=-0.083, P=0.011), SYNTAX score (ß=0.352, P<0.001), hs-CRP level (ß=0.217, P<0.001), hs-cTnT level (ß=0.197, P<0.001), and NT-proBNP level (ß=0.300, P<0.001) in multivariate analysis. CONCLUSION: EFT obtained by echocardiograpy may not only be an easy tool but also an important tool for early detection of increased cardiac risk as well as the extent and complexity of CAD in patients with stable CAD.

Serum 25-hydroxyvitamin D level is associated with aortic distensibility and left ventricle hypertrophy in newly diagnosed type 2 diabetes mellitus.

We aimed to evaluate the association between serum vitamin D status and elastic properties of aorta in patients with diabetes mellitus (DM). We studied 136 patients with newly diagnosed DM (mean age: 62.9 ± 10.6 years). Serum 25-hydroxyvitamin D was measured using a direct competitive chemiluminescent immunoassay. Aortic distensibility was calculated from the echocardiographically derived ascending aorta diameters and haemodynamic pressure measurements. Left ventricle mass index (LVMI) was determined according to the Devereux formula. Multiple linear regression analysis showed that vitamin D level is independently associated with LVMI (ß = -0.259, p = 0.001), aortic distensibility (ß = 0.369, p < 0.001), high-sensitive C-reactive protein (hs-CRP) (ß = -0.220, p = 0.002) and body mass index (ß = -0.167, p = 0.015) in patients with DM. In diabetic patients, serum 25-hydroxyvitamin D level is independently associated with aortic distensibility. Vitamin D may play a role on pathogenesis of impaired elastic properties of aorta in type 2 DM.

Serum 25-hydroxyvitamin D level is associated with arterial stiffness, left ventricle hypertrophy, and inflammation in newly diagnosed hypertension.

OBJECTIVES: Vitamin D may modulate vascular inflammation, vascular smooth muscle cell proliferation, the renin-angiotensin system, and cardiomyocyte proliferation, myocardial fibrosis, and proliferation. These mechanisms may play a role on arterial stiffness and left ventricle hypertrophy (LVH) in hypertensive patients. We aimed to evaluate the association between serum vitamin D with arterial stiffness and LVH in patients with hypertension. METHODS: We studied 133 patients with newly diagnosed hypertension [mean (SD) age, 62.9 (10.6) years]. Pulse wave velocity (PWV), which reflects arterial stiffness, was calculated using the single-point method via the Mobil-O-Graph ARCsolver algorithm. Left ventricular mass index (LVMI) was determined according to Deverux formula. The patients were divided into the following 2 groups according to serum vitamin D level: vitamin Dlow group with less than 20 ng/mL and vitamin Dhigh group with greater than or equal to 20 ng/mL. RESULTS: The highest PWV, high-sensitivity C reactive protein, and LVMI values were observed in vitamin Dlow group compared with vitamin Dhigh group. Multiple linear regression analysis showed that vitamin D level was independently associated with LVMI (ß = -0.235, P = 0.002) and PWV (ß = -0.432, P < 0.001). Adjustment for age, sex, parathyroid hormone level, body surface area, and mean blood pressure did not modify these associations. Vitamin D level was also independently associated with high-sensitivity C reactive protein (ß = -0.143, P = 0.047). However, adjustment for parathyroid hormone level or body surface area and mean blood pressure attenuate this association. CONCLUSIONS: Serum 25-hyroxyvitamin D is independently related with arterial stiffness, LVH, and inflammation. Vitamin D may play a role on pathogenesis of arterial stiffness and LVH in patient with newly diagnosed hypertension.