Epicardial adipose tissue thickness and NGAL levels in women with polycystic ovary syndrome.

BACKGROUND: Polycystic ovary syndrome (PCOS) is associated with an increased cardiovascular disease (CVD) risk and early atherosclerosis. Epicardial adipose tissue thickness (EATT) is clinically related to subclinical atherosclerosis. In the present study, considering the major role of neutrophil gelatinase-associated lipocalin (NGAL) which is an acute phase protein rapidly releasing upon inflammation and tissue injury, we aimed to evaluate NGAL levels and EATT in PCOS patients and assess their relationship with cardiometabolic factors. METHODS: 64 patients with PCOS and 50 age- and body mass index-matched healthy controls were included in the study. We evaluated anthropometric, hormonal and metabolic parameters. EATT was measured by echocardiography above the free wall of the right ventricle. Serum NGAL and high-sensitive C- reactive protein (hsCRP) levels were measured by ELISA. RESULTS: Mean EATT was 0,38 +/-0,16 mm in the PCOS group and 0,34 +/-0,36 mm in the control group (p = 0,144). In the obese PCOS group (n = 44) EAT was thicker compared to the obese control group (n = 41) (p = 0.026). Mean NGAL levels of the patients with PCOS were 101,98 +/-21,53 pg/ml, while mean NGAL levels were 107,40 +/-26,44 pg/ml in the control group (p = 0,228). We found a significant positive correlation between EATT and age, BMI, waist circumference, fasting insulin, HOMA-IR, triglyceride and hsCRP levels in PCOS group. CONCLUSIONS: Thickness of the epicardial adipose tissue can be used to follow the risk of CVD development in obese PCOS cases. However serum NGAL levels do not differ in patients with PCOS and control group.

Relationship of fragmented QRS with prognostic markers and in-hospital MACE in patients undergoing CABG.

BACKGROUND: Fragmented QRS complex (fQRS) is associated with increased morbidity and mortality, sudden cardiac death and recurrent cardiovascular events. However, its prognostic role has not been studied comprehensively in patients undergoing coronary artery bypass graft (CABG) surgery. In this study, we investigated the relationship between the presence of fQRS, and the prognostic markers and in-hospital major adverse cardiovascular events (MACE). METHODS: Two hundred and forty two eligible patients who underwent CABG surgery at our institution were enrolled consecutively. In analysis of fragmentations on electrocardiograms, presence of fQRS was defined as various RSR' patterns (≥ 1 R' or notching of S wave or R wave) with or without Q waves without a typical bundle-branch block in two contiguous leads corresponding to a major coronary artery territory. MACE was defined as cardiac death, recurrent myocardial infarction, heart failure, cerebrovascular event, sustained ventricular tachycardia or fibrillation. RESULTS: Patients with fragmented QRS had older age (64 ± 10 vs. 61 ± 9 years, p = 0.03), prolonged QRS time (99 ± 11 vs. 87 ± 11 ms, p < 0.001), higher rate of Q wave on ECG (29% vs. 12%, p = 0.001), higher European system for cardiac operative risk evaluation (EUROSCORE) (4.0 ± 1.9 vs. 2.6 ± 1.6, p < 0.001) and lower left ventricular ejection fraction (LVEF)% (43 ± 12 vs. 60 ± 12, p < 0.001) in comparison to patients with non-fragmented QRS. In addition, the patients with fQRS had longer cross-clamp time (67 ± 23 vs. 55 ± 20 minutes, p = 0.001) and extracorporeal circulation (105 ± 31 vs. 91 ± 30 minutes, p = 0.003), increased inotropic usage (p < 0.001) and prolonged cardiac surgery intensive care unit (53 ± 25 vs. 35 ± 12 hours, p < 0.001) and in-hospital stay after CABG. CONCLUSION: FQRS may have additional value in the assessment of cardiac function and in prediction of intra- and post-operative hemodynamic instability and adverse cardiovascular events. Fragmentations on admission ECG may be useful for identifying patients with higher risk who will need additional support after CABG surgery.

Relationship of the angiographic extent of peripheral arterial disease with coronary artery involvement.

OBJECTIVE: To determine the co-incidence of coronary artery disease (CAD) in patients investigated for peripheral arterial disease (PAD), and to establish the relationship between the risk factors in the two groups of patients. METHODS: The prospective study, done from January 2005 and April 2009, at the Cardiology Clinic of Rize Education and Research Hospital, Rize and John F. Kennedy Hospital, Istanbul, Turkey, had a cohort of 307 patients who had been diagnosed with peripheral artery disease either clinically or by ultrasonography for the arteries of the lower extremities and had undergone coronary angiography and peripheral angiography in the same or different sessions. The patients were evaluated in terms of age, gender and atherosclerotic risk factors. Relationship of the extent of peripheral arterial disease with coronary artery involvement was investigated. RESULTS: Of the 307 patients, 251 (81.8%) were male, and the mean age was 62.1 +/- 9.5 years. In the study population, 178 (58.0%) patients were diagnosed as hypertensive, 84 (27.4%) patients were diabetic, 18 (5.9%) patients had a family history of coronary artery disease, 111 (36.2%) were smokers, 149 (48.5%) were hypercholesterolemic, and 20 (6.5%) had cerebrovascular/carotid disease. In 92.3% of patients with peripheral arterial disease, various levels of coronary stenosis (P = 0.007) was noticed. Hypertension was a risk factor for both coronary and peripheral artery diseases (p = 0.012 and 0.027, respectively). Univariate logistic regression analysis demonstrated that the presence of peripheral artery disease was related to the coronary variety (Odds ratio [OR]: 6, 95% CI: 1.4-25.5, P = 0.016) and severe cases (diffused atherosclerotic stenosis and complete occlusion in all segments) significantly indicated the presence of some coronary pathology (OR: 8, 95% CI: 1.7-37.4, P = 0.008). This relationship maintained its significance after adjustment for age, gender, hypercholesterolaemia, smoking, hypertension, diabetes, family history, and the presence of cerebrovascular/carotid disease (p = 0.010). CONCLUSIONS: Peripheral coronary artery diseases had similar risk factors. The extent of peripheral arterial disease observed during peripheral lower extremity angiography was significantly associated with the presence and severity of coronary artery disease. Particular attention should be focused on the possibility of coronary artery disease in patients with established and extensive peripheral arterial disease. Non-invasive, as well as invasive tests, should be performed to decrease morbidity and mortality risk of such patients.

Primary percutaneous coronary intervention for the treatment of a patient with cardiogenic shock due to acute total occlusion of unprotected left main coronary artery without supportive collateral flow.

Total occlusion of unprotected left main coronary artery (LMCA) is rarely encountered in clinical practice and the incidence cannot be determined precisely, since most of the patients die before hospital admission. Malignant arrhythmia, cardiogenic shock or sudden death due to pump failure develops in most of these patients. The cases complicated by cardiogenic shock have bad prognosis in both the short and long term, despite the advancements in reperfusion treatments. Successful treatment of sudden total occlusion of unprotected LMCA has been rarely reported. Over the last decade, many cases and comparisons in patients with LMCA lesions were reported on percutaneous interventions for unprotected LMCA using different stent and stenting procedures or in comparison to coronary bypass surgery. On the other hand, these patients either had stable coronary artery disease or a partially occluded LMCA in the setting of acute coronary syndromes with well supporting collateral flow. In our case, a 50 year-old male patient with cardiogenic shock and extensive anterior ST-elevation myocardial infarction due to acute total occlusion of unprotected LMCA, who was not receiving collateral flow from the right coronary system, was treated successfully through primary percutaneous coronary angioplasty, was presented. In our case, there was an totally occluded unprotected LMCA without any supportive coronary flow to left system. In this regard, our case is unique in literature.

Association between plasma monocyte chemoattractant protein-1 levels and the extent of atherosclerotic peripheral artery disease.

Peripheral artery disease occurs at advanced ages and accounts for substantial cardiovascular morbidity and mortality. Monocyte chemoattractant protein-1 (MCP-1), a member of the cysteine-cysteine family of chemokines, is one of the cytokines involved in the pathogenesis of atherosclerosis and is also known as cysteine-cysteine chemokine ligand 2 (CCL2). The aim of the current study was to investigate the association between the extent of atherosclerotic peripheral artery disease (PAD) and the increase in MCP-1 level. Eighty consecutive patients who had undergone peripheral angiography for suspected PAD were included. Of these patients, 48 (60%) had hypertension, 23 (28.8%) had type 2 diabetes mellitus, 39 (48.8%) had a family history of coronary artery disease, 23 (28.8%) were cigarette smokers, and 42 (52.5%) had hypercholesterolemia. Angiography revealed that the peripheral arteries of the lower extremity were normal in 41 (51.3%) patients, whereas 39 (48.7%) patients had varying degrees of PAD. The patients were queried regarding age, gender, and atherosclerotic risk factors. The plasma MCP-1 levels were significantly lower in the patients without PAD than those in the patients with PAD (172.27 ± 38.05 pg/mL vs. 200.87 ± 39.31 pg/mL, p = 0.001). Moreover, as the severity of PAD increases, MCP-1 levels also increase. Thus, the plasma MCP-1 level can be used in the diagnosis of PAD and in determining the extent of atherosclerotic PAD of the lower extremities, as in determining the extent of coronary artery disease.