The association of plasma oxidative status and inflammation with the development of atrial fibrillation in patients presenting with ST elevation myocardial infarction.

Atrial fibrillation (AF) is the most common supraventricular arrhythmia following ST elevation myocardial infarction (STEMI). Oxidative stress and inflammation may cause structural and electrical remodeling in the atria making these critical processes in the pathology of AF. In this study, we aimed to evaluate the association between total oxidative status (TOS), total antioxidative capacity (TAC) and high-sensitivity C-reactive protein (hs-CRP) in the development of AF in patients presenting with STEMI. This prospective cohort study consisted of 346 patients with STEMI. Serum TAC and TOS were assessed by Erel's method. Patients were divided into two groups: those with and those without AF. Predictors of AF were determined by multivariate regression analysis. In the present study, 9.5% of patients developed AF. In the patients with AF, plasma TOS and oxidative stress index (OSI) values were significantly higher and plasma TAC levels were significantly lower compared to those without AF (p = .003, p = .002, p < .0001, respectively). Multivariate regression analysis results showed that, female gender (Odds ratio [OR] = 3.07; 95% Confidence Interval [CI] = 1.26-7.47; p = .01), left atrial diameter (OR =1.28; 95% CI =1.12-1.47; p < .0001), hs-CRP (OR =1.02; 95% CI =1.00-1.03; p = .001) and OSI (OR =1.10; 95% CI =1.04-1.18; p = .001) were associated with the development of AF in patients presenting with STEMI. The main finding of this study is that oxidative stress and inflammation parameters were associated with the development of AF in patients presenting with STEMI. Other independent predictors of AF were female gender, left atrial diameter and hs-CRP.

Nebivolol versus Carvedilol or Metoprolol in Patients Presenting with Acute Myocardial Infarction Complicated by Left Ventricular Dysfunction.

OBJECTIVE: The aim of this study was to evaluate the efficacy of nebivolol, carvedilol or metoprolol succinate on the outcome of patients presenting with acute myocardial infarction (AMI) complicated by left ventricular dysfunction. SUBJECTS AND METHODS: Patients (n = 172, aged 28-87 years) with AMI and left ventricular ejection fraction ≤0.45 were randomized to the nebivolol (n = 55), carvedilol (n = 60) and metoprolol succinate (n = 57) groups. Baseline demographic and clinical characteristics and composite event rates of nonfatal MI, cardiovascular mortality, hospitalization due to unstable angina pectoris or heart failure, stroke or revascularization during the 12-month follow-up were compared among the groups using the x03C7;2 test, t test or log-rank test as appropriate. RESULTS: Baseline demographic and clinical characteristics were similar in the three groups. The composite end point during follow-up was lower in the patients treated with nebivolol than those treated with metoprolol (14.5 vs. 31.5%; p = 0.03). However, event rates were similar between the patients treated with carvedilol and those treated with the metoprolol (20.3 vs. 31.5%, p > 0.05) and between the patients treated with nebivolol and carvedilol (14.5 vs. 20.3%, p > 0.05). CONCLUSION: The patients treated with nebivolol experienced 12-month cardiovascular events at a lower rate than those treated with metoprolol succinate. However, event rates were similar between the carvedilol and the metoprolol succinate groups and between the nebivolol and the carvedilol groups.

Association between the use of renin-angiotensin system blockers and development of in-hospital atrial fibrillation in patients with ST-segment elevation myocardial infarction.

BACKGROUND AND AIM: Atrial fibrillation (AF) is the most common supraventricular arrhythmia following ST-segment elevation myocardial infarction (STEMI). We evaluated the association between use of previous angiotensin converting enzyme inhibitors and/or angiotensin receptor blockers (renin-angiotensin system [RAS] blockers) and started RAS blockers after MI and development of AF in patients presenting with acute STEMI. MATERIALS AND METHODS: This retrospective study enrolled 1000 patients with acute STEMI who were admitted to the coronary care unit. Patients were divided into groups according to the use of RAS blockers before MI and development of AF rates was compared. Predictors of AF were determined by multiple logistic regression analysis. RESULTS: Of the 1000 patients presenting with STEMI, 247 received and 753 did not receive RAS blockers. The incidence of AF was 7.9%. The incidence of AF in patients receiving RAS blockers and did not receiving RAS blockers before MI were similar (5.7% vs. 8.6% respectively, P=0.13). On the other hand, AF rate was lower in patients in whom RAS blockers were administered during MI as compared to those in whom these agents were not administered (7.2% vs. 28.6%, P<0.001). Multiple regression analysis results showed that administration of RAS blockers or statins during hospitalization and left atrial diameter were associated with development of AF in patients with acute STEMI. CONCLUSIONS: Previous therapy with RAS blockers does not reduce the incidence of AF in STEMI. Administration of RAS blockers at the hospital may decrease the AF rate in STEMI.

Long-Term Outcome of Patients With Idiopathic Ventricular Fibrillation: A Meta-Analysis.

BACKGROUND: The long-term outcome of the patients with idiopathic ventricular fibrillation (IVF) is not well known. METHODS AND RESULTS: Relevant studies published through May 21, 2014 were searched and identified in the MEDLINE, PsycINFO, Cochrane Library, CINAHL, and EMBASE databases and a hand search of article references was also performed. Random-effect models were used for pooling proportions of mortality and recurrent events. Twenty-three studies were included with a total of 639 patients (449 males) with a mean age ranging from 33 to 51 years. Eighty percent of patients had received ICD implantation. Over an average of 5.3 years follow-up, 167 patients (31%) experienced a recurrence of ventricular arrhythmic events (proportion, 0.29 [95% CI 0.21-0.38]). Moreover, 17 patients (3.1%) died among all studies (proportion, 0.01 [95% CI 0.00-0.04]). No association was found between the induction of sustained ventricular tachycardia or ventricular fibrillation at baseline electrophysiological study and risk of recurrent ventricular arrhythmias (risk difference: 0.12 [95% CI, 0.08-0.32]). CONCLUSIONS: In patients with IVF, this meta-analysis revealed an estimated recurrent event rate of 31% and a pooled mortality rate of 3.1% during an average of 5 years follow-up. The results of baseline electrophysiological studies are not predictive of future ventricular arrhythmias.

The effects of good glycaemic control on left ventricular and coronary endothelial functions in patients with poorly controlled Type 2 diabetes mellitus.

OBJECTIVE: Diabetics are at risk for developing overt heart failure and subclinical left ventricular (LV) dysfunction. Also, impaired coronary flow reserve (CFR) reflecting coronary microvascular dysfunction is common in diabetics. However, no substantial data regarding the effects of good glycaemic control on subclinical LV dysfunction and CFR are available. CONTEXT: To investigate whether good glycaemic control had favourable effects on subclinical LV dysfunction and CFR. DESIGN: Prospective, open-label, follow-up study. PATIENTS: Diabetics (n = 202) were classified based on baseline HbA1C levels: patients with good (group 1) (<7·0%) and poor glycaemic control (≥7·0%). MEASUREMENTS: All patients underwent echocardiographic examination at baseline evaluation, and it was repeated at months 6 and 12. Based on HbA1C levels obtained at month 6, the patients with poor glycaemic control were divided into two groups: achieved (group 2) and not achieved good glycaemic control (group 3). RESULTS: The groups were comparable with respect to diastolic function parameters including left atrium diameter, mitral E/A, Sm , Em /Am , E/E' and Tei index, and these parameters did not significantly change at follow-up in the groups. At baseline, CFR was slightly higher in group 1 than in group 2 and group 3, but it did not reach statistically significant level. At follow-up, CFR remained unchanged in group 1 (P = 0·58) and group 3 (P = 0·86), but increased in group 2 (P = 0·02: month 6 vs baseline and P = 0·004: month 12 vs baseline). CONCLUSIONS: Diabetics with poor and good glycaemic control were comparable with respect to echocardiographic parameters reflecting subclinical LV dysfunction, and good glycaemic control did not affect these parameters. However, good glycaemic control improved CFR.

Metoprolol vs. carvedilol or carvedilol plus N-acetyl cysteine on post-operative atrial fibrillation: a randomized, double-blind, placebo-controlled study.

AIMS: Carvedilol and N-acetyl cysteine (NAC) have antioxidant and anti-inflammatory properties. Aim was to evaluate the efficacy of metoprolol, carvedilol, and carvedilol plus NAC on the prevention of post-operative atrial fibrillation (POAF). METHODS AND RESULTS: Patients undergoing cardiac surgery (n = 311) were randomized to metoprolol, carvedilol, or carvedilol plus NAC. Baseline characteristics were similar. The incidence of POAF was lower in the carvedilol plus NAC group compared with the metoprolol group (P < 0.0001) or the carvedilol group (P = 0.03). There was a borderline significance for lower POAF rates in the carvedilol group compared with the metoprolol group (P = 0.06). Duration of hospitalization was lower in the carvedilol plus NAC group compared to the metoprolol group (P = 0.004). Multivariate independent predictors of POAF included left-atrial diameter, hypertension, bypass duration, pre-randomization and pre-operative heart rates, carvedilol plus NAC group vs. metoprolol group, and carvedilol plus NAC group vs. carvedilol group. CONCLUSION: Carvedilol plus NAC decreased POAF incidence and duration of hospitalization compared with metoprolol and decreased POAF incidence compared with carvedilol.

Evaluation of total oxidative status and total antioxidant capacity in patients with endemic fluorosis.

The objective of the present study was to determine the plasma total oxidative status (TOS) and total antioxidant capacity (TAC) in patients with endemic fluorosis. A total of 79 (35 males and 44 females; mean age 44.0 ± 11.9 years) patients with endemic fluorosis and 55 (23 males and 32 females; mean age 48.3 ± 8.5 years) age-, sex- and body mass index-matched healthy controls were included in this study. The urine fluoride levels and plasma TOS and TAC levels were measured. The urine fluoride levels of fluorosis patients were significantly higher than control subjects as expected (1.91 ± 0.15 vs. 0.49 ± 0.13 mg/L, respectively; p < 0.001). TOS was significantly higher in fluorosis group than in control group (17.55 ± 3.82 vs. 15.06 ± 4.31 µmol H(2)O(2) Eq/L, respectively; p = 0.001). TAC was significantly lower in fluorosis group than in control group (1.60 ± 0.36 vs. 1.82 ± 0.51 mmol Trolox Eq/L, respectively; p = 0.004). Oxidative stress index (OSI) was significantly higher in fluorosis group than in control group (11.5 ± 3.8 vs. 8.8 ± 3.7, respectively; p < 0.001). Correlation analysis in all the groups indicated that TAC was negatively correlated with urine fluoride (r = -0.25, p = 0.003), TOS was positively correlated with urine fluoride (r = 0.34, p < 0.001) and OSI was positively correlated with urine fluoride (r = 0.36, p < 0.001). The results of our study demonstrate that oxidative stress plays an important role in the pathogenesis of the endemic fluorosis.

Elevated mean platelet volume is associated with impaired coronary microvascular function in patients with idiopathic dilated cardiomyopathy.

Attenuated coronary flow reserve (CFR) has been reported in patients with idiopathic dilated cardiomyopathy (IDC). On the other hand increased platelet activity has been demonstrated in patients with congestive heart failure and left ventricular dysfunction. Accordingly, we aimed to investigate whether mean platelet volume (MPV) is increased in patients with IDC and increased MPV correlates with the degree of coronary microvascular dysfunction. MPV was measured in 37 patients with IDC. Each patient with IDC also underwent echocardiographic examination including CFR measurement. Patients with IDC were divided into two groups based on median CFR value (lower CFR group and normal CFR group). MPV was significantly higher in the lower CFR group than in the normal CFR group (9.00 ± 0.56 vs. 8.25 ± 0.76 fl; respectively, p = 0.001). CFR correlated significantly and inversely to MPV (r = -0.475, p = 0.003). Logistic regression analysis revealed that MPV level was the independent predictor of lower CFR (ß = -0.750, p = 0.002). Furthermore, MPV was an accurate predictor of low CFR (p = 0.001); Area under the curve was 82% (95% CI 0.67-0.96). The best cut-off value of MPV to predict low CFR was 8.3 fl with 95% sensitivity and 69% specificity. In conclusion, the present study showed a negative correlation between MPV and CFR in patients with IDC.

Plasma concentrations of asymmetric dimethylarginine, nitric oxide and homocysteine in patients with slow coronary flow.

OBJECTIVES: Slow coronary flow (SCF) is slow progression of contrast agent in the coronary arteries in the absence of stenosis in epicardial coronary vessels. Endothelial dysfunction and diffuse atherosclerosis have been proposed for the etiology of SCF. Asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthesis, levels are associated with an increased risk of endothelial dysfunction and atherosclerosis. ADMA levels may be increased by homocysteine. The aim of this study was to evaluate the relationship between ADMA, nitric oxide and homocysteine in patients with SCF. METHODS: The study group consisted of 50 patients with SCF. An age- and gender-matched control group was composed of 30 patients with normal coronary arteries and normal coronary flow on coronary angiography. We measured ADMA, nitric oxide and homocysteine plasma concentrations in all patients. RESULTS: Plasma nitric oxide concentrations were significantly lower in the SCF group than in the control group (11.4 ± 6, 16.1 ± 9, p = 0.02). Plasma ADMA concentrations (0.9 ± 0.3, 0.7 ± 0.3, p = 0.01) and plasma homocysteine concentrations (12.4 ± 5, 9.8 ± 2, p = 0.03) were significantly higher in the SCF group than control group. The mean TIMI frame count (TFC) was significantly correlated with plasma ADMA (r = 0.26, p = 0.02) and homocysteine (r = 0.28, p = 0.02) concentrations, but not with nitric oxide concentrations (r = - 0.18, p = 0.13). In linear regression analysis, plasma ADMA concentrations (ß = 4.6, p = 0.005) and homocysteine concentrations (ß = 0.2, p = 0.03) were independently and positively associated with mean TFC. CONCLUSION: Our results suggest that plasma concentrations of ADMA and homocysteine are increased in SCF and also that these are independent predictors of SCF.

Percutaneous mitral balloon valvuloplasty reduces mean platelet volume in patients with rheumatic mitral stenosis.

BACKGROUND: Rheumatic mitral stenosis (RMS) is associated with increased thromboembolic event, especially in the presence of concomitant atrial fibrillation. In addition, increased platelet activity including elevated mean platelet volume (MPV) has been demonstrated in patients with RMS. It has also been reported that percutaneous mitral balloon valvuloplasty (PMBV) attenuates platelet activity. However, the impact of PMBV on MPV has never been studied. Accordingly, we aimed to investigate whether PMBV decreases MPV in patients with RMS. METHODS: In the present study, MPV was measured in 20 patients with RMS planned for PMBV just before and 1 month after the procedure. Twenty sex- and age- matched apparently healthy controls were used for comparison. Mitral valve area (MVA), transmitral gradient (TMG) and pulmonary artery pressure (PAP) were measured using transthoracic echocardiography. RESULTS: As compared to apparently healthy controls, patients with RMS had higher MPV (9.05 ± 1.26 vs. 7.56 ± 0.74 fl, p < 0.001). All patients with RMS underwent successful PMBV. One month after the procedure, MVA, TMG and PAP were reduced significantly (p < 0.0001). As compared to values obtained before the procedure, white blood cell count, hemoglobin concentration and hematocrit remained unchanged. However, 1 month after the procedure platelet count had increased (p < 0.05) and MPV decreased significantly (to 7.78 ± 0.59, p < 0.0001). PMBV induced an absolute decrease in MPV more than 0.2 fl in 19 of 20 patients (95%). CONCLUSIONS: As compared to apparently healthy controls, patients with RMS have higher MPV reflecting increased platelet activity, and PMBV is associated with a significant decrease in MPV 1 month after the procedure.

Elevated carbohydrate antigen 125 levels in patients with aortic stenosis: relation to clinical severity and echocardiographic parameters.

OBJECTIVES: Carbohydrate antigen 125 (CA 125), known as a tumor marker for ovarian cancer, has been reported to increase in relation to disease severity in heart failure patients with systolic dysfunction. Aortic stenosis (AS) has a wide clinical spectrum that often includes heart failure symptoms. The purpose of the present study is to evaluate the serum levels of CA 125 in patients with AS and its relation to clinical severity and echocardiographic parameters. STUDY DESIGN: The study group consisted of 42 patients (20 males, 22 females, mean age 62.5 ± 14.9 years) with AS and 35 healthy controls (17 men, 18 women; mean age 59.0 ± 9.1 years). All patients and control subjects underwent chest X-ray and echocardiographic evaluation. We measured serum CA 125 values in patients with AS and control subjects. RESULTS: The median (interquartile range) CA 125 level was significantly higher among AS patients than in the control group in covariate analysis (9.4 [2.5-38.1] vs. 6.8 [4.4-13.9] U/ml respectively; p=0.001). Spearman correlation analysis in the whole group indicated that CA 125 was positively correlated with aortic mean gradient (p=0.007, r=0.30) and creatinine levels (p=0.02, r=0.26). CONCLUSION: We found that CA 125 levels were elevated in patients with AS and were correlated with mean gradient and creatinine levels.

The Effect of Anthropometric Measurements on the Incidence of Atrial Fibrillation in Patients With Acute Myocardial Infarction.

Background and objective Atrial fibrillation (AFib) is the most common supraventricular arrhythmia occurring after myocardial infarction (MI). Height, body weight, waist and hip circumference, and body mass index (BMI) are considered potential risk factors for the development of AFib. The aim of this study was to investigate the effect of BMI and waist circumference on the incidence of AFib in patients with acute MI. Methods This prospective, cross-sectional, observational study was conducted in the coronary intensive care unit (CICU) of a tertiary care university hospital between July 2014 and February 2016. Patients diagnosed with ST-elevation myocardial infarction (STEMI) or non-ST-elevation myocardial infarction (NSTEMI) were included. Demographic, clinical, echocardiographic, and laboratory data, past medical history, and anthropometric measurements were recorded. Continuous electrocardiography (ECG) monitoring was performed for following up on the occurrence of AFib. Then, AFib predictors were identified using multiple regression analysis. Results AFib developed in 31 (9.3%) patients in the cohort. No significant difference was observed between patients with or without AFib in terms of BMI and waist circumference values (p=0.686 vs. p=0.728, respectively). Factors associated with AFib development as per the multivariate analyses included age (OR: 1.051, 95% CI: 1.013-1.09; p=0.008), pulse rate (OR: 1.043, 95% CI: 1.018-1.069; p=0.001), peak troponin T value (OR: 1.356, 95% CI: 1.135-1.619; p=0.001), and length of CICU stay (OR: 2.247, 95% CI: 1.163-4.340; p=0.016). Conclusion BMI and waist circumference measurements were similar in patients with and without AFib during acute MI. Age, pulse rate, peak troponin T, and duration of CICU stay were identified as independent predictors of AFib development.

Predictive value of oxidative, antioxidative, and inflammatory status for left ventricular systolic recovery after percutaneous coronary intervention for ST-segment elevation myocardial infarction.

OBJECTIVE: This study aimed to evaluate the association between left ventricular ejection fraction recovery and the total oxidant status, total antioxidant capacity, and high-sensitivity C-reactive protein levels. METHODS: A total of 264 ST-elevation myocardial infarction patients were classified into two groups according to baseline and 6-month follow-up left ventricular systolic function: reduced and recovery systolic function. Predictors of the recovery of left ventricular ejection fraction were determined by multivariate regression analyses. RESULTS: Multivariable analysis indicated that oxidative status index, baseline left ventricular ejection fraction and peak creatine-kinase myocardial bundle level, and high-sensitivity C-reactive protein were independently associated with the decreased of left ventricular ejection fraction at 6-month follow-up. CONCLUSION: Oxidative stress and inflammation parameters were detrimental to the recovery of left ventricular ejection fraction in patients with ST-elevation myocardial infarction.

Platelet indices in patients with acute pulmonary embolism.

Previous studies have demonstrated that platelet activation occurs in patients with acute pulmonary embolism (PE). The aim of this study was to assess the mean platelet volume (MPV), an indicator of platelet activation in patients with acute PE. The study group consisted of 107 patients with acute PE. Seventy subjects matched for age, gender, body mass index (BMI) and frequency of concomitant diseases served as control group. All patients and control subjects underwent physical examination and echocardiography. We measured MPV values and platelet counts on admission. MPV was significantly higher among patients with acute PE when compared with control group (9.6 ± 1.0 vs. 8.1 ± 0.8 fL respectively; < 0.001). Platelet count was significantly lower among acute PE patients when compared with control group (227.1 ± 77.0 vs. 268.7 ± 58.4 × 10(9)/L, respectively; < 0.001). MPV was correlated with right ventricular (RV) diameter (p < 0.001, r = 0.33) in correlation analysis. In linear regression analysis, MPV was independently correlated with RV dimension (ß = 0.29, p = 0.001). We have shown that MPV, an indicator of platelet activation, was increased in patients with acute PE and it was correlated with RV diameter. Platelet count was decreased in patients with acute PE.

Can comprehensive echocardiographic evaluation provide an advantage to predict anthracycline-induced cardiomyopathy?

OBJECTIVES: No definite markers have been established to identify patients in whom anthracycline-containing chemotherapy may represent a high risk for the development of cardiotoxicity. We aimed to evaluate the predictive value of comprehensive echocardiography in anthracycline-induced cardiomyopathy. STUDY DESIGN: In a prospective design, the study included 39 patients (9 males, 30 females; mean age 53.7±11.5 years) who received antineoplastic therapy including anthracycline. Comprehensive echocardiographic examination including tissue Doppler imaging and coronary flow reserve was performed before treatment with anthracycline and at the end of a six-month follow-up. RESULTS: Eight patients (20.5%) developed cardiomyopathy during the follow-up period. Compared to patients with unaffected left ventricular ejection fraction at 6 months, patients with cardiomyopathy exhibited significant differences in baseline left ventricular systolic diameter, mitral E/A, E-wave deceleration time, Sm, Em, Em/Am ratio, Sm-Em duration, and the Tei index. In univariate logistic regression analysis, only Sm (OR 0.40, p=0.002) and the Tei index (OR 3.24, p=0.02) were significant variables for the development of cardiotoxicity. These two were also the only independent predictors of anthracycline cardiotoxicity in multivariate linear regression analysis. Receiver operating characteristic curve analysis yielded a cut-off value of 8 cm/sec for Sm and 0.38 for the Tei index to predict cardiomyopathy. CONCLUSION: Our findings suggest that Sm and myocardial performance index (the Tei index) are significant independent markers to identify patients at high risk for the development of anthracycline-induced cardiomyopathy.

Influence of obstructive sleep apnea on left ventricular mass and global function: sleep apnea and myocardial performance index.

Obstructive sleep apnea (OSA) is associated with cardiovascular mortality and morbidity. It may predispose patients to left ventricular hypertrophy and heart failure. The aim of this study was to determine the left ventricular mass (LVM) and myocardial performance index (MPI) reflecting left ventricular global function in uncomplicated OSA patients. Sixty-four subjects without hypertension, diabetes mellitus, and any cardiac or pulmonary disease referred for evaluation of OSA underwent overnight polysomnography and complete echocardiographic assessment. According to the apnea hypopnea index (AHI), subjects were divided into three groups: group 1, control subjects with nonapneic snorers (AHI < 5, n = 18); group 2, patients with mild to moderate OSA (AHI: 5-30, n = 25); and group 3, severe OSA (AHI > 30, n = 21). Basic echocardiographic measurements, LVM, and LVM index were measured. Left ventricular MPI was calculated as (isovolumic contraction time+isovolumic relaxation time)/aortic ejection time by Doppler echocardiography. There were no significant differences in age, sex, body mass index, heart rate, and systolic and diastolic blood pressure among the three groups. Left atrium, interventricular septum, left ventricular posterior wall, left ventricular end-diastolic and end-systolic diameters, LVM mass, and LVM index were not significantly different among the three groups. Left ventricular MPI was significantly higher in severe OSA patients (0.64 +/- 0.18) than in controls (0.49 +/- 0.18; P < 0.05). There was no significant difference between controls (0.49 +/- 0.18) and mild to moderate OSA (0.61 +/- 0.16; P = 0.08) and between mild to moderate OSA (0.61 +/- 0.16) and severe OSA (0.64 +/- 0.18; P = 0.84). The present study demonstrates that patients with severe OSA have global left ventricular dysfunction.

Mean platelet volume is increased in patients with severe obstructive sleep apnea.

Increased platelet activation and aggregation which are closely related to cardiovascular complications have been reported in patients with obstructive sleep apnea (OSA). The aim of this study was to assess the mean platelet volume (MPV), an indicator of platelet activation in patients with OSA. The 95 subjects referred for evaluation of OSA underwent overnight polysomnography. Blood samples were taken for MPV determination. According to the apnea-hypopnea index (AHI), subjects were divided into three groups; group 1: control subjects without OSA (AHI < 5, n = 24), group 2: patients with mild to moderate OSA (AHI: 5-30, n = 42), and group 3: severe OSA (AHI > 30, n = 29). Body mass index (BMI) of patients with severe OSA was significantly higher than control subjects (31.5 ± 4.0 vs. 28.2 ± 5.0; p = 0.02). The MPV was significantly higher in patients with severe OSA than in the control group (8.9 ± 1.0 vs. 8.2 ± 0.7 fl; p = 0.01). Correlation analysis within 71 patients with OSA indicated that MPV was correlated with AHI (p < 0.001, r = 0.44) and DI (p = 0.001, r = 0.37). In multivariate regression analysis, when MPV was taken as independent with other study variables which are potential confounders such as age, gender and BMI, MPV was independently correlated with both AHI (ß = 0.44, p < 0.001) and DI (ß = 0.38, p < 0.001). We have shown that MPV was significantly higher in patients with severe OSA when compared with control subjects and MPV was correlated with AHI and DI.

Association of thrombotic and fibrinolytic factors with severity of culprit lesion in patients with acute coronary syndromes without ST elevation.

BACKGROUND: Increased procoagulant activity and/or impaired fibrinolysis contribute to the development and organization of thrombus, subsequently resulting in complete or incomplete obstruction in acute coronary syndromes (ACS). We investigated the relationship between culprit lesion severity and thrombotic and fibrinolytic parameters in patients who had non-ST elevation ACS (NSTE-ACS). METHODS: This study included 95 consecutive patients with NSTE-ACS. All patients underwent coronary angiography within the first 72 hours depending on the clinical situation. Stenosis >or=50% in the coronary artery was considered significant. NSTE-ACS patients were then divided into two groups: patients with critical stenosis (n = 53) and patients with noncritical stenosis (n = 35). Plasma levels of D-dimer, fibrinogen, thrombin-antithrombin III complex (TAT), and prothrombin fragment 1 + 2 (PF 1 + 2) were measured. RESULTS: D-dimer (338 +/- 192 vs. 190 +/- 170 microg/dL, P < 0.001), TAT (4.4 +/- 2.0 vs. 1.2 +/- 0.7 ng/mL, P < 0.001), and PF 1 + 2 (1.6 +/- 0.6 vs. 0.7 +/- 0.3 nmol/L) levels were significantly higher in the critical stenosis group as compared to the noncritical stenosis group. However, fibrinogen levels were similar in both groups. The levels of TAT (r = 0.76, P < 0.001) and PF 1 + 2 (r = 0.73, P < 0.001) were correlated with the culprit lesion severity, but D-dimer and fibrinogen levels were not. Thrombolysis in myocardial infarction flow grades were also correlated with TAT (r = -0.42, P < 0.001) and PF 1 + 2 (r = -0.40, P < 0.001). CONCLUSION: The severity of culprit lesion may be associated with plasma D-dimer, TAT, and PF 1 + 2 levels in NSTE-ACS patients. These prothrombotic factors may have a role in the development of significant stenosis in the NSTE-ACS setting.