A new risk factor for predicting stroke in patients with atrial fibrillation: morning blood pressure surge.

BACKGROUND: Stroke, the most feared complication in patients with atrial fibrillation (AF), is still an important cause of mortality and morbidity. In our study, we aimed to investigate the frequency of stroke and related parameters in patients with atrial fibrillation, for whom 24-h ambulatory blood pressure monitoring (ABPM) was performed. METHOD: A total of 282 patients with permanent AF were included in this study. 24-h ABPM was performed in all patients. Morning blood pressure surge (MBPS) was defined as the difference between the mean SBP in the first 2 h after awakening and the lowest blood pressure (BP) at night. We evaluated parameters associated with stroke in patients with atrial fibrillation using univariate and multivariate Cox regression analysis. RESULT: Patients were followed for 19 ± 9.3 months and 22 ischemic strokes were detected during the follow-up period. Also, strokes were significantly lower in atrial fibrillation patients with a dipper BP pattern, whereas strokes were significantly higher in atrial fibrillation patients with a reverse-dipper BP pattern. In multivariate analysis, a history of hypertension ( P = 0.020), BP pattern ( P < 0.001) and MBPS ( P < 0.001) were found to be significantly related to stroke. MBPS levels >32.5 mmHg predicted stroke with a sensitivity of 77% and a specificity of 60% (AUC, 0.741; 95% CI, 0.647-0.834; P < 0.001). CONCLUSION: MBPS, BP pattern and presence of hypertension as an independent risk factor in predicting stroke in patients with atrial fibrillation. The reduction of the MBPS may be a new therapeutic target for preventing stroke.

A CBCT Based Assessment of Canine Eruption and Development Following Alveolar Bone Grafting in Patients Born With Unilateral Cleft lip and/or Palate.

To three-dimensionally assess and visualize the eruption path and development of the maxillary canine following alveolar bone grafting in patients born with cleft lip and palate. A further objective of this analysis was to assess how the presence of the lateral incisor impacts the eruption path of the canine.Observational follow-up study.Stockholm Craniofacial Team, Karolinska University Hospital, Sweden.Thirty children born with non-syndromic unilateral cleft lip with or without palate were consecutively included.CBCT scans of the maxilla were taken six months before and six months after the alveolar bone-grafting surgery for each patient.Canine eruption (angulation and vertical movement) and canine development (length and volume).There was a significant difference pre- and post-operatively of the canine angulation between the cleft and non-cleft sides. The mean angulation on the cleft side was 14.7° (SD = 11.1°) while on the non-cleft side, it was 4.9° (SD = 9.2°). No significant differences were noted between cleft-side and non-cleft side canines in terms of amount of vertical eruption and volumetric development. Absence of the lateral incisor did not significantly contribute to either canine angulation or its vertical eruption on the cleft-side.Higher angulation of the canine on the cleft side indicates a higher risk of future canine impaction. Presence or absence of the lateral incisor did not significantly affect canine angulation or its vertical eruption. Increased age and children born with total cleft lip and palate imply a higher risk of angulated canines on the cleft side.

The Relationship Between Contrast Associated Nephropathy and Coronary Collateral Circulation in very Old Patients.

Background: The aim of this study was to investigate whether there is a relationship between coronary collateral circulation (CCC) and contrast associated nephropathy (CAN) in very elderly patients. Methods: Patients aged 90 years or older with at least one major occlusion of the coronary artery proximal or mid-section were included in the study. CCC was graded according to the Rentrop classification. CAN was defined as an increase in blood creatinine value of 25% or more on the second day after coronary angiography. Results: Thirty-six patients who met the study criteria were included in the study. In the study group, CAN developed in 12 patients (CAN (+) group), 24 patients did not develop CAN (CAN (-) group). The creatinine levels before coronary angiography were 1.05 ± 0.12 in the CAN (-) group and 1.22 ± 0.14 in the CAN (+) group. Baseline creatinine values were significantly higher in the CAN (+) group (p = 0.001). The contrast agent used in the CAN (+) group was significantly higher (p = 0.001). In the CAN (+) group, nine patients (43%) had poor collateral circulation, whereas only three patients (20%) had well-developed collateral circulation. In a logistic regression analysis, the collateral class was not a risk factor for CAN, whereas contrast agent volume and basal creatinine were independent predictors of CAN. Conclusion: We found that CCC grade was not associated with the development of CAN in very old patients, but the amount of contrast agent and pre-procedure creatinine values were independent variables in the development of CAN.

Using Soluble ST2 to Predict Adverse Postoperative Outcomes in Patients with Impaired Left Ventricular Function Undergoing Coronary Bypass Surgery.

Background and Objectives: The aim of this study was to investigate the prognostic value of soluble ST2 (sST2) in predicting postoperative adverse events in patients with impaired left ventricular (LV) function undergoing coronary artery bypass graft (CABG) surgery. Materials and Methods: This study included 80 consecutive patients with stable coronary artery disease (CAD) and impaired LV function (ejection fraction ≤ 45%) undergoing on-pump coronary artery bypass graft surgery. The patients were divided into the "high" or "low" group according to their ST2 levels (≥35 or <35 ng/mL). Results: Postoperative adverse events were more common in patients with high sST2 levels than in patients with low sST2 levels (100% vs 26%, p < 0.0001). Multivariate analysis showed that sST2 level was an independent predictor of the presence of postoperative adverse events (OR: 1.117 (95% CI: 1.016-1.228), p = 0.022). The receiver operating characteristic curve (ROC) analysis of sST2 revealed an area under the curve (AUC) of 0.812 (95% CI: 0.710-0.913, p < 0.001) in predicting postoperative adverse events. An sST2 level of 26.50 ng/ml was identified as the optimal cut-off value, with a sensitivity and specificity of 74.1% and 75.3%, respectively. Conclusion: Higher sST2 levels were associated with adverse outcomes after CABG in patients with impaired LV and stable CAD.

Prognostic value of rising mean platelet volume during hospitalization in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention.

BACKGROUND: The prognostic significance of changes in mean platelet volume (MPV) during hospitalization in ST segment elevation myocardial infarction (STEMI) patients underwent primary percutaneous coronary intervention (pPCI) has not been previously evaluated. The aim of this study was to determine the association of in-hospital changes in MPV and mortality in these patients. METHODS: Four hundred eighty consecutive STEMI patients were enrolled in this retrospective study. The patients were grouped as survivors (n = 370) or non-survivors (n = 110). MPV at admission, and at 48-72 h was evaluated. Change in MPV (MPV at 48-72 h minus MPV on admission) was defined as ΔMPV. RESULTS: At follow-up, long-term mortality was 23%. The non-survivors had a high ΔMPV than survivors (0.37 (- 0.1-0.89) vs 0.79 (0.30-1.40) fL, p <  0.001). A high ΔMPV was an independent predictor of all cause mortality ((HR: 1.301 [1.070-1.582], p = 0.008). Morever, for long-term mortality, the AUC of a multivariable model that included age, LVEF, Killip class, and history of stroke/TIA was 0.781 (95% CI:0.731-0.832, p <  0.001). When ΔMPV was added to a multivariable model, the AUC was 0.800 (95% CI: 0.750-0.848, z = 2.256, difference p = 0.0241, Fig. 1). Also, the addition of ΔMPV to a multivariable model was associated with a significant net reclassification improvement estimated at 24.5% (p = 0.027) and an integrated discrimination improvement of 0.014 (p = 0.0198). CONCLUSIONS: Rising MPV during hospitalization in STEMI patients treated with pPCI was associated with long-term mortality.

Morning blood pressure surge and its relation to insulin resistance in patients of reproductive age with polycystic ovary syndrome.

BACKGROUND: Our aim in this study was to investigate morning blood pressure surge (MBPS) in patients of reproductive age with polycystic ovary syndrome (PCOS) and its relation to insulin resistance (IR). METHODS: Fifty-three patients with PCOS without additional illness were included in the study. Forty-two age-matched subjects without PCOS were selected as the control group. All study subjects underwent 24-h blood pressure monitoring. Patients with additional illnesses, drug users, smokers, and alcohol and drug abusers were excluded. Blood insulin, fasting glucose, lipid profile, and hormone profile were measured. Insulin resistance was calculated using the HOMA-IR formula. RESULTS: Median age (years) was 27 (20-33) in the PCOS group and 27 (22-33) in the control group. Body mass index was higher in the PCOS group. Office systolic and diastolic blood pressure was higher in the PCOS group. Mean awakening 2-h BPs (mmHg) was 110 ± 7 in the control group and 118 ± 5 in the PCOS group (p < 0.001). Mean MBPS (mmHg) was 21 ± 6 in the control group and 29 ± 8 in the PCOS group. Mean MBPS was higher in the PCOS group (p < 0.001). IR was more frequent in the PCOS group. Based on logistic regression analysis, the presence of PCOS and IR were independent predictors for MBPS. CONCLUSIONS: The results of our study showed that MBPS increased excessively when compared to non-PCOS controls in young women with PCOS during reproductive age. In addition, PCOS and insulin resistance were independent risk factors for exaggerated MBPS.

The monocyte counts to HDL cholesterol ratio in obese and lean patients with polycystic ovary syndrome.

BACKGROUND: Women with polycystic ovary syndrome are more likely to suffer from obesity, insulin resistance, and chronic low-grade inflammation. In fact, the excessive activation of monocytes exacerbates oxidative stress and inflammation. However, high-density lipoprotein cholesterol neutralizes the pro-inflammatory and pro-oxidant effects of monocytes. The aim of this study is to investigate whether monocyte counts to high-density lipoprotein cholesterol ratio can predict the inflammatory condition in patients with polycystic ovary syndrome. METHODS: In this cross-sectional study, a total of 124 women (61 of them with polycystic ovary syndrome and 63 age-matched healthy volunteers) were included in the study population. Obese polycystic ovary syndrome patients (n = 30) with a body mass index of ≥25 kg/m2 and lean polycystic ovary syndrome patients (n = 31) with a body mass index of < 25 kg/m2 were compared to age-and body mass index-matched healthy subjects (30 obese and 33 non-obese). RESULTS: The monocyte counts to high density lipoprotein cholesterol values in women with polycystic ovary syndrome were significantly higher than in control subjects (p = 0.0018). Moreover, a regression analysis revealed that body mass index, the homeostasis model assessment of insulin resistance and the high sensitivity C-reactive protein levels were confounding factors that affected the monocyte counts to high density lipoprotein cholesterol values. Additionally, a univariate and multivariate logistic regression analysis demonstrated that the increased monocyte counts to high density lipoprotein cholesterol values were more sensitive than the other known risk factors (such as increased body mass index, homeostasis model assessment of insulin resistance and high sensitive C-reactive protein levels) in the prediction of the inflammation in patients with polycystic ovary syndrome. CONCLUSION: The present study demonstrated that the monocyte count to high density lipoprotein cholesterol may be a novel and useful predictor of the presence of polycystic ovary syndrome.

Relationship between high-density lipoprotein cholesterol and the red cell distribution width in patients with coronary artery disease.

BACKGROUND: The red cell distribution width (RDW) is a numerical measurement of variability in the size of red blood cells. Many studies have shown that high-density lipoprotein cholesterol (HDL-C), has an anti-inflammatory effect. The aim of this study was to investigate the relationship between the serum HDL-C level and RDW in patients with coronary artery disease (CAD). METHODS: Patients who underwent coronary angiography were reviewed. Patients who had moderate or severe heart failure, moderate or severe renal failure, significant systemic disease, anemia, a blood transfusion within the last 3 months, or a hematologic disease, as well as those who were taking lipid-lowering medication, were excluded from the study. The Gensini scoring system was used to determine the severity of CAD. Biochemical and hematological parameters were measured from venous blood samples taken after the patient fasted for at least 8 h. The RDW was routinely obtained from a hemogram. RESULTS: In total, 328 patients were included in the study. The patients were categorized according to quartiles. There were 80 patients in Quartile 1 (RDW < 13.2), 84 patients in Quartile 2 (13.2 ≥ RDW < 14.15), 81 patients in Quartile 3 (14.15 ≥ RDW < 16), and 83 patients in Quartile 4 (RDW ≥ 16). There was a significant and inverse relationship between the serum HDL level and RDW. Regression analysis showed that the HDL-C, hemoglobin, and hs-CRP levels and Gensini score were predictors for the RDW. CONCLUSION: We found an inverse and gradual association between the serum HDL-C level and RDW, and the serum HDL-C level was an independent predictor for the RDW.

Contrast-Induced Nephropathy Is Less Common in Patients with Good Coronary Collateral Circulation.

BACKGROUND/AIMS: Contrast-induced nephropathy (CIN) is a typically reversible type of acute renal failure that develops after exposure to contrast agents; underlying endothelial dysfunction is thought to be an important risk factor for CIN. Although the mechanism of coronary collateral circulation (CCC) is not fully understood, a pivotal role of the endothelium has been reported in many studies. The aim of this study was to investigate whether there is a relationship between CCC and CIN. METHODS: Patients with at least one occluded major coronary artery and blood creatinine analyses performed before and on the second day after angiography were included in the study. CIN was defined as a 25% or greater elevation of creatinine on the second day after exposure to the contrast agent. Collateral grading was performed according to the Rentrop classification. Patients were grouped according to whether they developed CIN or not, i.e., CIN(-) and CIN(+) group. RESULTS: A total of 214 patients who met the inclusion criteria were included in the study. CIN was diagnosed in 43 patients (20.1%) in the study population. Good CCC was identified in 112 patients (65.5%) in the CIN(-) group, whereas it was identified in 13 patients (30.2%) in the CIN(+) group. In the CIN(-) group, good CCC was significantly more frequent (p < 0.001). Furthermore, collateral circulation was an independent predictor of CIN. CONCLUSION: Good collateral circulation was associated with a lower frequency of CIN, and poor collateral circulation was an independent predictor of CIN.

Red cell distribution width is correlated with extensive coronary artery disease in patients with diabetes mellitus.

INTRODUCTION: Previous studies have predicted an independent relationship between red cell distribution width (RDW) and the risk of death and cardiovascular events in patients with coronary artery disease (CAD). The aim of this study was to investigate the relationship between RDW and extensiveness of CAD in patients with diabetes mellitus (DM). METHODS: Two hundred and thirty-three diabetic patients who underwent coronary angiographies at our centre in 2010 were included in the study. All of the angiograms were re-evaluated and Gensini scores were calculated. Triple-vessel disease was diagnosed in the presence of stenosis > 50% in all three coronary artery systems. RESULT: RDW was significantly higher in diabetic CAD patients (p < 0.001). Patients with CAD who had a RDW value above the cut-off point also had higher Gensini scores, higher percentages of obstructive CAD and triple-vessel disease (p ≤ 0.001 for all). According to the cut-off values calculated using ROC analysis, RDW > 13.25% had a high diagnostic accuracy for predicting CAD. RDW was also positively correlated with Gensini score, obstructive CAD and triple-vessel disease (r < 0.468 and p < 0.001 for all). CONCLUSION: RDW values were found to be increased in the diabetic CAD population. Higher RDW values were related to more extensive and complex coronary lesions in patients with DM.

Effect of Weight Loss Induced by Intragastric Balloon Therapy on Cardiac Function in Morbidly Obese Individuals: A Pilot Study.

OBJECTIVE: The aim of the study was to investigate the effect of intragastric balloon therapy on left ventricular function and left ventricular mass in a cohort of morbidly obese patients. SUBJECTS AND METHODS: A prospective trial was performed in a cohort of 17 class II and class III morbidly obese individuals. The intragastric balloon was retained in the stomach for an average of 6 months. Conventional and tissue Doppler echocardiography were performed in all patients before and after the procedure. RESULTS: The mean age of the study participants was 36 ± 10 years (range: 18-55). The mean body mass index was significantly decreased following the intragastric balloon insertion procedure (44 ± 8 vs. 38 ± 5, p < 0.001). The left ventricular mass index and left atrial volume index were significantly decreased following the procedure (112 ± 21 vs. 93 ± 17, p = 0.001 and 20 ± 6 vs. 14 ± 5, p = 0.02, respectfully). In addition, the ratio of mitral peak early diastolic velocity to tissue Doppler-derived peak diastolic velocity and tissue Doppler echocardiography-derived left ventricular myocardial performance index were decreased significantly following the procedure (9.5 ± 1.9 vs. 7.7 ± 1.5, p = 0.002 and 0.57 ± 0.11 vs. 0.46 ± 0.06, p = 0.001, respectively). CONCLUSIONS: Intragastric balloon therapy resulted in significant weight reduction in morbidly obese patients. This weight reduction was associated with improved left ventricular function.

The protective effect of single dose tadalafil in contrast-induced nephropathy: an experimental study.

OBJECTIVE: Contrast-induced nephropathy (CIN) is one of the most common causes of acute renal failure in hospitalized patients. The direct toxic effect of contrast media; ischemic damage caused by reactive oxygen species; increased perivascular hydrostatic pressure; high viscosity and changes in the activity of vasoactive substances play important roles in the pathogenesis. Tadalafil inhibits the phosphodiesterase enzyme which destroys nitric oxide. Nitric oxide causes renal vasodilatation, increases renal medullar blood flow and mediates the removal of free oxygen radicals. Drugs that increase levels of nitric oxide are expected to reduce the development of contrast nephropathy due to contrast media. We aimed to test the hypothesis that tadalafil reduces the development of contrast nephropathy due to contrast toxicity. METHODS: A total of 24 female Wistar albino rats, three groups of eight, were included in the study. After 48 hours of dehydration, contrast media (meglumine diatrozoate, 6 mL/kg) was administered to the first group, and contrast media with tadalafil (10 mg/kg) was administered to the second group. The third group served as the control group. Blood and tissue samples were taken 48 hours after this procedure. RESULTS: Serum cystatin C, serum creatinine and blood urea nitrogen (BUN) values were significantly lower in the contrast with tadalafil group compared to the group given only contrast. Serum and tissue malondialdehyde (MDA) levels were significantly lower in the contrast with tadalafil group than in the contrast only group. CONCLUSION: These results demonstrate the protective effect of tadalafil in the prevention of CIN in rats.

Association of fragmented QRS complexes on ECG with left ventricular diastolic function in hypertensive patients.

OBJECTIVES: Diastolic dysfunction occurs as a result of interstitial fibrosis in hypertensive patients. Fragmented QRS (fQRS) on ECG signifies myocardial fibrosis in various clinical situations. We investigated whether fQRS on ECG is related to diastolic dysfunction in patients with hypertension. STUDY DESIGN: The study population included 72 hypertensive patients with normal coronary angiogram. Fragmented QRS was defined as the presence of an additional R wave (R'), notching of the R or S wave or fragmentation in two contiguous leads corresponding to a major coronary artery. Echocardiography was performed to all patients to detect diastolic dysfunction. Diastolic dysfunction was regarded as non-severe if patients had normal diastolic function or grade 1 diastolic dysfunction or severe if they had grade ≥2 diastolic dysfunction. RESULTS: Thirty-two patients had fQRS on ECGs (fQRS [+] group) and there were 40 patients who did not have fQRS on their ECGs (fQRS [-] group). The two groups were similar in terms of baseline characteristics. In patients with fQRS on the ECG, severe diastolic dysfunction was more prevalent (59.4% vs. 7.5%, p<0.001). The duration of hypertension was longer in patients with fQRS on the ECG (p<0.001). The presence of fQRS on the ECG was an indicator for severe diastolic dysfunction (B=1.954; odds ratio=7; 95% confidence interval=1.4-35.4; p=0.018). CONCLUSION: The presence of fQRS complexes on ECG predicts more severe diastolic dysfunction in patients with hypertension.

The association of plasma vitamin A and E levels with coronary collateral circulation.

OBJECTIVE: To investigate if plasma levels of vitamin A and E have an association with coronary collateral development. METHODS: A total of 189 patients who underwent coronary angiography and had total occlusion in at least one major epicardial coronary artery were enrolled in the study. To classify coronary collateral circulation (CCC), the Rentrop scoring system was used. Patients were classified as having poor CCC (Rentrop grades 0-1) or good CCC (Rentrop grades 2-3), and all patients were also screened for hypertension, hypercholesterolemia, diabetes, and smoking history. RESULTS: There were no differences in plasma vitamin A and E levels between the two groups (vitamin A: 2.37 ± 0.65 vs. 2.35 ± 0.78, p = 0.253; vitamin E: 47.1 ± 12.8 vs. 44.6 ± 15.1, p = 0.082), and plasma vitamin A and E levels were not associated with CCC. Serum high-sensitivity C-reactive protein (hs-CRP) levels were significantly higher in patients with poor CCC (4.68 ± 2.52 vs. 3.89 ± 1.78, p = 0.001). The higher frequency of diabetes and higher serum hs-CRP levels were found to be an independent predictor for poor CCC (odds ratio = 2.44, p = 0.006; odds ratio = 1.24, p = 0.007, respectively). And a higher frequency of total occluded RCA was found to be a positive predictor for good CCC (odds ratio = 2.36, p = 0.06) in a multivariate logistic regression analysis. CONCLUSIONS: We found that serum hs-CRP levels, presence of diabetes, and total occlusion of RCA have an effect on coronary collateral development. We found no correlation between plasma vitamin A and E levels and CCC.

The effect of slow coronary flow on right and left ventricular performance.

OBJECTIVE: To evaluate left and right ventricular functions using tissue Doppler echocardiography (TDE) and myocardial performance index (MPI) methods in patients with slow coronary flow (SCF) and to determine the relationship between these parameters and thrombolysis in myocardial infarction frame count in SCF patients. SUBJECTS AND METHODS: Thirty-five patients (20 males and 15 females) with SCF who underwent coronary angiography and 35 age- and sex-matched controls (14 males and 21 females) without SCF who underwent elective coronary angiography were enrolled in the study. Left ventricular (LV) and right ventricular (RV) functions were examined using conventional echocardiography and TDE. RESULTS: LV systolic myocardial velocity (Sm), early myocardial velocity (Em), late myocardial velocity (Am), and Em/Am ratio were similar in both the SCF and control groups; however, isovolumetric relaxation time (IRT) was higher in the SCF group compared to the control group (IRT: 99 ± 17 vs. 88 ± 20; p = 0.01). In patients with SCF, LV MPI was higher than in the control group, but this was not statistically significant (0.61 ± 0.11 vs. 0.56 ± 0.12; p = 0.07). The RV tricuspid annular velocities and MPI were similar in the SCF and control groups. CONCLUSION: This study showed that SCF affected LV functions echocardiographically and could cause partially reduced LV performance. In addition, SCF did not affect RV functions echocardiographically.

Fragmented QRS complexes are associated with increased left ventricular mass in patients with essential hypertension.

BACKGROUND: Left ventricular hypertrophy (LVH) is an independent predictor of poor prognosis in patients with hypertension. In hypertensive hypertrophy, the pathophysiological mechanism is the accumulation of collagen in the myocardium. Fragmented QRS (fQRS) complexes are associated with myocardial fibrosis. METHODS: The study population included 90 patients with hypertension and a normal coronary angiogram. The fQRS was defined as the presence of an additional R wave (R'), notching of the R or S wave, or the presence of fragmentation in two contiguous leads corresponding to a major coronary artery. Echocardiographic examinations were performed according to the recommendations of the American Society of Echocardiography. RESULTS: Forty-five patients who had fQRS and were suitable for the study criteria were compared with 45 age- and gender-matched patients who did not have fQRS according to demographic data and echocardiographic findings. The left ventricular (LV) mass index (g/m(2) ) was significantly higher (P < 0.001) in the group with fQRS. The wall thickness, diameter, volume, and ejection fraction (EF) were higher in this group (P < 0.001). Concentric and eccentric hypertrophy were also higher in this group (P < 0.001). In the logistic regression analysis, fQRS on ECG was an indicator of LVH in hypertensive patients (B = 0.064; P < 0.001; odds ratio = 1.066; 95% confidence interval = 1.041-1.092) CONCLUSION: The LV mass index of the hypertensive patients who had fQRS on their ECGs was significantly higher than that of the patients who did not, and fQRS on ECG was an important indicator of LVH in hypertensive patients.

Presence of angina pectoris is related to extensive coronary artery disease in diabetic patients.

BACKGROUND: Due to sensorial autonomic neuropathy, the type and severity of angina pectoris in patients with diabetes mellitus (DM) may be rather different from the type and severity of angina pectoris in patients without DM. HYPOTHESIS: The aim of the study was to understand if angina pectoris is related to extensive coronary artery disease (CAD) in patients with DM. METHODS: The study included 530 patients with DM who underwent coronary angiography at our center in 2009 and 2010. Patients were divided into 4 groups according to type of chest pain: group 1, noncardiac chest pain or no pain; group 2, angina equivalent; group 3, atypical angina; and group 4, typical angina. All angiograms were re-evaluated and Gensini scores were calculated. Three-vessel disease was diagnosed in the presence of stenosis >50% in all 3 coronary artery systems. RESULTS: There were no statistically significant differences between the groups with regard to age, sex, systolic or diastolic blood pressures, body mass index, creatinine clearance, or lipid profile. Fasting blood glucose was significantly higher in group 4 than in group 2. Gensini scores were not statistically different between groups 1 and 2 or between groups 3 and 4; however, the scores for groups 3 and 4 were higher than the score for either group 1 or group 2. Prevalence of 3-vessel disease was significantly higher in groups 3 and 4 compared with the other groups. CONCLUSIONS: The presence of angina pectoris was related to extensive CAD in patients with DM. The extent of CAD was not correlated with the type of angina (typical or atypical).

Sodium bicarbonate versus isotonic saline for the prevention of contrast-induced nephropathy in patients with diabetes mellitus undergoing coronary angiography and/or intervention: a multicenter prospective randomized study.

INTRODUCTION: Contrast-induced nephropathy (CIN) is a leading cause of acute renal failure and affects mortality and morbidity. Although the incidence of CIN is quite low in the general population, CIN incidence is significantly increased in patients with diabetes mellitus (DM). OBJECTIVES: We compared the efficacy of prophylactic use consisting of a saline infusion or a sodium bicarbonate infusion for the prevention of CIN in patients with DM. MATERIALS AND METHODS: A total of 195 DM patients who had unselected renal function were randomized into 2 groups: 101 patients were assigned to saline infusion, and 94 patients were assigned to bicarbonate infusion. The primary end point was the maximum increase in the serum creatinine (SCr) level, whereas the secondary end point was the development of CIN after the procedure. RESULTS: The maximum increase in SCr levels was significantly lower in the saline group than in the bicarbonate group: -0.03 mg/dL (IQR, -0.09 to 0.10 mg/dL) versus 0.02 mg/dL (IQR, -0.09 to 0.13 mg/dL) (P = 0.014). The rate of CIN was significantly lower in the saline group than in the bicarbonate group (5.9% vs 16%, P = 0.024). In the subset of study participants with a baseline creatinine clearance of less than 60 mL/min, the maximum increase in SCr levels was significantly lower, -0.08 mg/dL (IQR, -0.13 to -0.04 mg/dL), in the saline group than in the bicarbonate group, 0.03 mg/dL (IQR, -0.13 to 0.12 mg/dL) (P = 0.004). CONCLUSIONS: The use of prophylactic hydration with isotonic saline before coronary procedures may decrease SCr levels and reduce the incidence of CIN in patients with DM with unselected renal functions to a greater extent than sodium bicarbonate can.

Evaluation of possible subclinical atherosclerosis in adolescents with a family history of premature atherosclerosis.

OBJECTIVE: To evaluate possible subclinical atherosclerosis using biomarkers and ultrasound-guided methods in a group of adolescents having fathers with premature atherosclerosis. METHODS: Thirty-three subjects whose fathers had a history of premature coronary artery disease and 30 counterparts whose fathers had no history of coronary artery disease were included in the study. RESULTS: The homocysteine levels, high-sensitivity C-reactive protein levels, and cardiac chamber sizes and functions did not differ between the two groups. The carotid stiffness index ß (CSI), the intima-media thickness (CIMT) and aortic pulse wave velocity (PWV) values were higher in the group with a family history of coronary artery disease, but only the difference in the CSI was statistically significant (CSI 3.07±1.33 vs 3.88±1.25, P=0.015; CIMT 0.53±0.09 mm vs 0.57±0.08 mm, P=0.068; PWV 3.49±0.53 m/s vs 3.78±0.63 m/s, P=0.053). CONCLUSION: Among several markers of subclinical atherosclerosis, the CSI was significantly higher in adolescents who had a family history of premature atherosclerosis. The small sample size, the multifactorial nature of atherosclerosis or the insufficient power of these methods may explain these results.