Endotrophin and matrix metalloproteinase-2 levels in bicuspid aortic valve and hypertension associated aortopathy and their relationship with strain parameters of the ascending aorta.

OBJECTIVE: Bicuspid aortic valve (BAV) is the most common congenital heart defect. Ascending aorta dilatation is related to BAV- and hypertension (HTN)-associated aortopathy. The aim of this study was to investigate aortic elasticity, as well as aortic deformation of the ascending aorta, using strain imaging, and to evaluate the possible relationship of biomarkers, such as endotrophin and matrix metalloproteinase-2 (MMP-2), with ascending aorta dilatation in patients with BAV- or HTN-associated aortopathy. PATIENTS AND METHODS: This prospective study included patients with ascending aorta dilatation with BAV (n = 33), or normal tricuspid aortic valve with HTN (n = 33), and 20 control subjects. The mean age of the total patients was 42.76 ± 10.4 years (67% male, 33% female). We calculated aortic elasticity parameters using the relevant formula by M-mode echocardiography and determined layer-specific longitudinal and transverse strains of the proximal aorta by speckle-tracking echocardiography. Blood samples of the participants were drawn for the analysis of endotrophin and MMP-2. RESULTS: Aortic strain and aortic distensibility were significantly decreased, whereas the aortic stiffness index was significantly increased in patient groups with BAV or HTN compared to the control group (p < 0.001). Moreover, longitudinal strain of both the anterior and posterior aortic walls of the proximal aorta were significantly impaired in BAV and HTN patients (p < 0.001). Serum endotrophin levels were significantly reduced in the patient cohort compared to the controls (p = 0.001). Endotrophin was noted to be significantly positively correlated with aortic strain and aortic distensibility (r = 0.37, p = 0.001; r = 0.45, p < 0.001, respectively), whereas inversely associated with aortic stiffness index (r = -0.402, p < 0.001). Furthermore, endotrophin was the single independent predictor of ascending aorta dilatation (OR = 0.986, p < 0.001). A cut-off value of endotrophin ≤ 82.38 ng/mL predicted ascending aorta dilatation with a sensitivity of 80.3% and specificity of 78.5% (p < 0.0001). CONCLUSIONS: The present study showed that aortic deformation parameters and elasticity are impaired in BAV and HTN patients, and strain imaging allows for a good analysis of ascending aorta deformation. Endotrophin could be a predictive biomarker of ascending aorta dilatation in BAV and HTN aortopathy.

Prognostic value of the C-reactive protein-to-albumin ratio in patients with infective endocarditis.

OBJECTIVE: Infective endocarditis (IE) is a life-threatening disease that causes various complications and mortality. The C-reactive protein-to-albumin ratio (CAR) has been reported as a novel prognostic marker in inflammatory and cardiovascular diseases. We retrospectively investigated whether there is a relationship between admission CAR values and prognosis in patients with IE. PATIENTS AND METHODS: The study population was classified into 2 groups: patients with a primary clinical outcome (n = 64) and those without (n = 132). The primary clinical outcome consisted of the need for intensive care unit treatment and in-hospital mortality. For all patients, serum CAR levels at hospital admission were calculated. RESULTS: In this study, 196 patients with a definite diagnosis of IE during a 5-year period were included. The mean age of the total patients was 52.7 ± 14.9 years (67% male, mean age 51.9 ± 15.0 years; 33% female, mean age 54.3 ± 14.4 years, respectively). Serum CAR values were associated with prognosis in IE patients. According to Cox regression analysis, admission CAR value remained an independent predictor of mortality (p < 0.05). In receiver operating curve analysis, a cutoff value of CAR > 20.24 predicted primary clinical outcome with a sensitivity of 82.4% and specificity of 70.3% (p < 0.001). CONCLUSIONS: For the first time, the present study showed that in IE, admission CAR could be a useful predictor of poor prognosis, including hospital death.

Identification of gene variants related to the nitric oxide pathway in patients with acute coronary syndrome.

Dysfunction of vascular endothelium is known to have an essential role in the atherosclerotic process by releasing mediators including nitric oxide (NO). Nitric oxide maintains endothelial balance by controlling cellular processes of vascular smooth muscle cells. Evidence suggests that variations in the NO pathway could include atherosclerotic events. The objective of this study was to determine the possible effects of genes on the nitric oxide pathway in the development of acute coronary syndrome (ACS). The blood samples of 100 patients with ACS and 100 controls were collected at Istanbul University, Department of Cardiology. DNA samples were genotyped by using Illumina Cyto-SNP-12 BeadChip. The additive model and Correlation/Trend Test were selected for association analysis. Afterwards, a Q-Q graphic was drawn to compare expected and obtained values. A Manhattan plot was produced to display p-values that were generated by -log10(P) function for each SNP. The p-values under 1×10(-4) were selected as statistically significant SNPs while p-values under 5×10(-2) were considered as suspicious biomarker candidates. Nitric oxide pathway analysis was then used to find the single nucleotide polymorphisms (SNPs) related to ACS. As a result, death-associated protein kinase 3 (DAPK) (rs10426955) was found to be most statistically significant SNP. The most suspicious biomarker candidates associated with the nitric oxide pathway analysis were vascular endothelial growth factor A (VEGFA), methionine sulfoxide reductase A (MSRA), nitric oxide synthase 1 (NOS1), and GTP cyclohydrolase I (GCH-1). Further studies with large sample groups are necessary to clarify the exact role of nitric oxide in the development of disease.

Left ventricular geometric patterns and QT dispersion in untreated essential hypertension.

The spectrum of left ventricular adaptation to hypertension, different types of hypertrophy patterns, and QT dispersion in different types of hypertrophy was investigated in 107 patients with untreated essential hypertension and 30 age- and gender-matched normal adults studied by 12-derivation electrocardiogram (ECG), two-dimensional, and M-mode echocardiography. Left ventricular mass (LVM), body mass index, total peripheral resistance (TPR), relative wall thickness (RWT), and QT dispersion were found to be statistically significantly higher in the hypertension group (P < .001 for all). Among hypertensive patients, 41.1% had both normal LVM and RWT, here called normal left ventricle in hypertension; 10.3% had concentric hypertrophy with increased LVM and RWT; 14.95% had eccentric hypertrophy with increased LVM and normal RWT; and 32.7% had concentric remodeling with normal LVM and increased RWT. Echocardiographically derived cardiac index was higher in the concentric hypertrophy and eccentric hypertrophy patterns (P = .002 and P < .0001, respectively), whereas TPR was higher in the concentric hypertrophy and concentric remodeling patterns (P = .017 and .02, respectively). QT dispersion values were found to be increased in the hypertensive group (P = .001), whereas similar values were calculated for different types of hypertrophy patterns. We conclude that the more common types of ventricular adaptation to essential hypertension are eccentric hypertrophy and concentric remodeling. Concentric hypertrophy is found to be associated with both volume and pressure overload, whereas eccentric hypertrophy is associated with volume overload only and concentric remodeling is associated with pressure overload. But different left ventricular geometric patterns seem to have similar effects on QT dispersion.

Left atrial geometric and functional remodeling in athletes.

The aim of this study was to evaluate left atrial (LA) volume and its changes with the phases of atrial filling, and to examine the effect of exercise capacity on these parameters. Using two-dimensional echocardiography, LA volumes were measured in 30 male endurance runners and 30 age-matched sedentary men (controls). Maximal oxygen consumption (VO2max) was measured using a metabolic chart during exercise. LA reservoir, pump, and conduit functions, kinetic energy and force were calculated. We found that athletes had higher LA volume and volume index (except the conduit volume), LA passive emptying fraction, and LA total emptying fraction compared to control subjects. We observed positive correlations between: VO2max and LA passive emptying fraction (r=0.49, p<0.05); VO2max and LA active emptying fraction (r=0.54, p<0.05); VO2max and LA kinetic energy (r=0.61, p<0.05); and VO2max and LA force (r=0.57, p<0.05). These findings suggest that atrial function reflects exercise capacity in athletes.

Left ventricular diastolic function abnormalities in hypopituitary patients with GH deficiency: evidence for a subclinical cardiomyopathy.

The aim of this study was to evaluate cardiac performance, in particular diastolic function, in adult patients with adulthood onset GH deficiency. The study group was composed of 19 GH deficient adult hypopituitary patients with at-least 3 additional pituitary hormone deficits and 19 age, sex and BMI matched healthy controls. Mean duration of hypopituitarism was 108.6 +/- 77.0 months. None of the patients and controls presented with or had previous diagnosis of concomitant diseases that could affect cardiac function. All hormone deficiencies, except for GH, were appropriately replaced in the patients. Left ventricular function and geometry were evaluated by two-dimensional, M-mode and Doppler echocardiography. Body composition was evaluated by bioelectrical impedance analysis. Not significant differences were observed with respect to left heart dimensions and left ventricular systolic function between patients and controls. Nevertheless 2 of the left ventricular diastolic function parameters, deceleration time and isovolumetric relaxation time, were significantly prolonged in the patients compared with controls (247.88 +/- 70.65 vs 143.26 +/- 31.70 milliseconds (ms) and 122.31 +/- 18.24 vs 89.47 +/- 12.12 ms respectively, p<0.001). Duration of hypopituitarism was significantly correlated with percent body fat mass (r=0.6119, p<0.01) and percent lean body mass (r=-0.5949, p<0.01). It is concluded that in adults affected by hypopituitarism, GH deficiency predominantly impairs diastolic function while systolic function at rest is spared. This observation might indicate a preclinical stage of a cardiomyopathy.

New support for clarifying the relation between ST segment resolution and microvascular function: degree of ST segment resolution correlates with the pressure derived collateral flow index.

OBJECTIVE: To investigate the relation between the degree of ST segment resolution (STR) after thrombolysis and the pressure derived collateral flow index (CFIp), determined using an intracoronary pressure measurement technique in patients with recent myocardial infarction. METHODS: 33 patients were studied. TIMI grade III flow was achieved in the infarct related artery by thrombolysis. A surface ECG was obtained on admission and 90 minutes later. The sum of ST segment elevations was measured by summing all leads with ST elevation on the baseline ECG and on the 90 minute ECG (after thrombolysis) and calculating the percentage recovery. The study population was divided into two groups, with good STR (> or = 50%; group 1) or poor STR (< 50%; group 2). After angiography, a fibreoptic pressure monitoring guidewire was advanced to the stenosis to be dilated. The CFIp was determined as the ratio [coronary wedge pressure - central venous pressure]/[mean aortic pressure - central venous pressure]. RESULTS: The mean STR on the surface ECG was 54.6% and mean (SD) CFIp was 0.25 (0.12) (range 0.10-0.41). There was an inverse correlation between the individually calculated percentage of STR and CFIp (r = -0.64, p < 0.01). The mean CFIp was lower in patients with a good STR than in those with a poor STR (0.18 (0.07) v 0.27 (0.10), p < 0.02). CONCLUSIONS: Although TIMI grade III flow was achieved after thrombolysis, a worse STR on the surface ECG was associated with higher CFIp measured in the infarct related artery. CFIp appears to reflect the degree of microvascular obstruction by quantifying impedance of the microvasculature.

Renovascular hypertension secondary to spontaneous renal artery dissection and treatment with stenting.

Renovascular disease is the cause of less than 1% of patients with hypertension; within this group aneurysm and dissection in renal artery are even rarer causes. It may be not only iatrogenic or traumatic, but may also develop spontaneously from fibromuscular disease or atherosclerotic lesions. We present a 26-year-old male patient with recently developed and progressive hypertension in whom renal angiography showed aneurysmal dilatation and dissection of the right renal artery. With the implantation of two stents in the true lumen, normal renal blood flow and thrombosis of the aneurysmal sac was established. As a result, stent implantation to renal artery dissection is effective, reliable and easy and can be an alternative to surgical treatment.

Bilateral renal artery stenosis after abdominal radiotherapy for Hodgkin's disease.

A 49-year-old woman was admitted with fatigue, dyspnoea, pretibial oedema and decreased daily urination. Seven years ago she was treated with doxorubicin, bleomycin, vinblastine and dacarbazine, alternating with mechlorethamine, vincristine, procarbazine and prednisone and 80 Gy abdominal radiotherapy for Hodgkin's disease. Two years later, malignant hypertension was diagnosed. Angiotensin-2 antagonist and beta-blocker treatment was given. After increased serum creatinine levels were determined, renal angiography was performed and total obstruction in the left renal artery and near total obstruction in the right side was observed. She was admitted to our clinic with oliguria, and acute renal failure was diagnosed. Balloon angioplasty and stent implantation was performed to the right renal artery. After a polyuric period, serum creatinine reduced to near normal levels. Angiotensin-2 antagonist treatment worsened the course in this patient. Patients with resistant hypertension occurring years after abdominal radiotherapy should be evaluated for renal artery stenosis.