The Effect of Septoplasty on Endothelial Function in Patients With Marked Nasal Septal Deviation.

BACKGROUND: It is known that nasal septal deviation (NSD) has negative effects on the cardiovascular system, but the possible pathophysiological mechanisms of these effects still need to be explained. The aim of this study was to investigate the endothelial dysfunction (ED) caused by NSD and the effects of septoplasty on it. METHODS: The study included 40 patients between the ages of 18 to 50 years with a marked NSD indication for septoplasty and 40 healthy age-and gender-matched individuals. Nasal obstruction symptom evaluation scale was used to evaluate the severity of nasal obstruction and the effectiveness of septoplasty. All participants underwent detailed cardiac examination and ultrasonographic measurement of flow-mediated dilatation (FMD). The same cardiac evaluations and nasal obstruction symptom evaluation scale assessments were repeated in the patient group at the postoperative 3rd month. RESULTS: The mean FMD value in the control group was significantly higher than preoperative FMD in the patient group (9.1 ±â€Š2.9 versus 7.6 ±â€Š2.4, P  = 0.024). In the patient group, preoperative and postoperative FMD values were measured as 7.6 ±â€Š2.4 and 9.0 ±â€Š2.7, respectively, and there was a significant difference between them (P = 0.032). There was no significant difference in FMD values between the control group and postoperative patient group (P = 0.925). CONCLUSIONS: This study shows that NSD can cause ED, which is a precursor of atherosclerosis, and that successful septoplasty can improve ED.

Noninvasive assessment of subclinical atherosclerosis in patients with rosacea.

BACKGROUND: Rosacea is a chronic, inflammatory cutaneous disorder that is characterized by remissions and relapses that commonly occur in patients over the age of 30 years. There have been many studies in literature evaluating the relationship between cardiovascular disease and psoriasis, which is a chronic inflammatory disease; however, there have been very few studies to date evaluating the relationship between rosacea and cardiovascular disease risk. METHODS: The study included 52 consecutive rosacea patients and 52 healthy controls matched for age, gender and Body Mass Index. Demographic data, anthropometric measurements, lipid parameters, C-reactive protein (CRP), epicardial fat thickness (EFT) and carotid intima-media thickness (CIMT) were recorded. RESULTS: The main finding of the present study is the significantly higher EFT (P˂0.001) and CIMT (P˂0.001) values identified in patients with rosacea than in the control group and CRP (P=0.004), total cholesterol (P=0.003) and low-density lipoprotein (P=0.004) levels were also significantly higher in the rosacea group. EFT was significantly correlated with CIMT in the rosacea group (P=0.041). Total cholesterol (OR=1.032, P=0.017), CIMT (OR=7.391, P˂0.001) and EFT (OR=3.959, P=0.036) were independently associated with rosacea. CONCLUSIONS: Clinicians should be aware of the risk of cardiovascular disease when presenting with conditions involving persistent subclinical inflammation, as in the case of rosacea. EFT and CIMT measurements, which are noninvasive, easily accessible and cheap, can be useful to determine cardiovascular risk in rosacea patients.

The relation of endocan and galectin-3 with ST-segment resolution in patients with ST-segment elevation myocardial infarction.

BACKGROUND: ST-segment elevation myocardial infarction (STEMI) remains a leading cause of morbidity and mortality around the world. In patients with STEMI undergoing primary percutaneous coronary intervention (PPCI), electrocardiographic measures of ST-segment resolution (STR) may give information about the myocardial perfusion and poor prognosis. OBJECTIVES: To investigate the relation of endocan and galectin-3 levels with STR in STEMI patients. MATERIAL AND METHODS: In this cross-sectional study, 98 consecutive patients undergoing PPCI for STEMI were enrolled. Synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) scores were recorded. Electrocardiograms were assessed at baseline and 60 min after PPCI. According to STR levels, patients undergoing PPCI (n = 98) were divided into complete STR group (≥70%, n = 53) and incomplete STR group (<70%, n = 45). RESULTS: Serum glucose, total cholesterol, low-density lipoprotein cholesterol, SYNTAX score, endocan and galectin-3 levels were significantly higher and ejection fraction was significantly lower in the incomplete STR (<70%) group (p < 0.05 for all). Body mass index (BMI) (p = 0.046) and galectin-3 (p = 0.037) were independently associated with the SYNTAX score. Endocan (p = 0.044) and galectin-3 (p = 0.017) were independent predictors of incomplete STR. CONCLUSIONS: In patients with STEMI, the levels of endocan and galectin-3 may be helpful in identifying patients with a higher risk of insufficient myocardial perfusion and worse clinical outcome after PPCI.

Acute effects of electronic cigarette smoking on ventricular repolarization in adults.

BACKGROUND: Electronic cigarette (e-cigarette) use is constantly increasing. However, the association between e-cigarette use and ventricular arrhythmia is unknown. Thus, in this study, we aimed to evaluate the markers of ventricular repolarization such as QT interval, corrected QT (QTc), QT dispersion (QTd), peak-to-end interval of the T wave (Tp-e), corrected Tp-e and Tp-e/QT ratios in e-cigarette users. METHODS: The study population consisted 36 e-cigarette users and 40 healthy subjects. Ventricular repolarization parameters were obtained from 12-lead resting electrocardiogram. Ventricular repolarization parameters of the groups were compared. RESULTS: Basal demographic and laboratory data were similar in both groups. According to the electrocardiographic parameters, the Tp-e interval, corrected Tp-e, and Tp-e/QT ratio were significantly higher in individuals using e-cigarettes than in control subjects [74.9±6.4 milliseconds (ms) vs. 80.1±4.1ms, <0.001; 82.9±7.5 ms vs. 87.8±6.3 ms, p=0.003; 0.20±0.01 vs. 0.21±0.01, p=0.002; respectively]. CONCLUSION: This is the first study to show the disruption of ventricular repolarization properties in e-cigarette users. E-cigarette use in terms of public health leads to augmentation of transmural dispersion of repolarization, which may be potential indicator of ventricular arrhythmogenesis.

The Nonalcoholic Fatty Liver Disease Fibrosis Score Is Related to Epicardial Fat Thickness and Complexity of Coronary Artery Disease.

Nonalcoholic fatty liver disease (NAFLD) is a hepatic manifestation of the metabolic syndrome and is associated with cardiovascular disease (CVD). The NAFLD Fibrosis Score (NFS) is an index used for the detection of liver fibrosis. We investigated the relationship between NFS and complexity of coronary artery disease (CAD). In this cross-sectional study, 109 patients with CAD and 50 patients without CAD were enrolled. Demographic data, laboratory parameters, epicardial fat thickness (EFT), NFS, and Synergy between percutaneous coronary intervention with Taxus and cardiac surgery (SYNTAX) score were recorded. Waist circumference, fasting glucose, low-density lipoprotein cholesterol (LDL-C), EFT, and NFS were significantly higher in the CAD group (P < .05). High-density lipoprotein cholesterol (HDL-C) and ejection fraction were significantly lower in the CAD group (P < .05). The SYNTAX score was positively correlated with fasting glucose, LDL-C, EFT, and NFS and negatively correlated with HDL-C (P < .05). The NFS was positively correlated with EFT (P = .019). Multivariate linear regression analysis revealed that NFS (P = .012), EFT (P < .001), and LDL-C (P = .001) were independently associated with the SYNTAX score. In conclusion, NFS, as a marker of NAFLD, could identify patients at higher risk of CVD.

Vitamin D, vitamin D binding protein, vitamin D receptor levels and cardiac dysautonomia in patients with multiple sclerosis: a cross-sectional study / Vitamina D, proteína de ligação à vitamina D, níveis de receptores de vitamina D e disautonomia cardíaca em pacientes com esclerose múltipla: um estudo transversal

ABSTRACT Vitamin D is a pleiotropic steroid hormone that modulates the autonomic balance. Its deficiency has been described as an environmental risk factor for multiple sclerosis (MS). The aim of this study was to investigate the serum levels of vitamin D, vitamin D binding protein (VDBP) and vitamin D receptors (VDR) and to evaluate cardiac dysautonomia in MS patients due to bidirectional interaction between vitamin D and the autonomic nervous system. Methods: The current cross-sectional study was conducted on 26 patients with relapsing-remitting MS and on 24 healthy controls. Twenty-four-hour ambulatory blood pressure variability (BPV) was calculated and the participants were evaluated for orthostatic hypotension and supine hypertension. Serum levels of vitamin D, VDBP and VDR were measured. Results: The mean serum vitamin D level was significantly lower in MS patients than in controls (p = 0.044); however there was no significant difference in terms of VDR and VDBP levels between the groups. Supine hypertension and orthostatic hypotension were significant and the 24-hour systolic BPV was significantly decreased in patients with MS (p < 0.05) compared to controls. No correlation was found between vitamin D, VDBP and VDR with supine hypertension, orthostatic hypotension and systolic BPV values (p > 0.05). Also, there was a negative correlation between VDBP and the EDSS (p = 0.039, r = −0.406). Conclusion: There was no correlation between orthostatic hypotension, supine hypertension and systolic BPV values and serum vitamin D, VDBP and VDR in MS patients. Future prospective studies with large number of patients may help us to better understand the relationship between vitamin D and the autonomic nervous system.

RESUMO A vitamina D é um hormônio esteroide pleiotrópico que modula o equilíbrio autonômico. Sua deficiência tem sido descrita como fator de risco ambiental para esclerose múltipla (EM). O objetivo deste estudo foi investigar os níveis séricos de vitamina D, proteína de ligação à vitamina D (VDBP) e receptor de vitamina D (VDR) e avaliar a disautonomia cardíaca em pacientes com EM devida à interação bidirecional entre vitamina D e sistema nervoso autônomo. Métodos: O presente estudo transversal foi realizado em 26 pacientes com EM remitente-recorrente e em 24 controles saudáveis. A variabilidade da pressão arterial ambulatorial (BPV) por 24 horas foi calculada e os participantes foram avaliados quanto à hipotensão ortostática e hipertensão supina. Os níveis séricos de vitamina D, VDBP e VDR foram medidos. Resultados: O nível sérico médio de vitamina D foi significativamente menor nos pacientes com EM do que nos controles (p = 0,044); no entanto, não houve diferença significativa em termos de níveis de VDR e VDBP entre os grupos. Hipertensão supina e hipotensão ortostática foram significativas e a BPV sistólica de 24 horas diminuiu significativamente em pacientes com EM (p < 0,05) em comparação aos controles. Não foi encontrada correlação entre vitamina D, VDBP e VDR com hipertensão supina, hipotensão ortostática e BPV sistólica (p > 0,05). Também houve correlação negativa entre VDBP e EDSS (p = 0,039, r = −0,406). Conclusão: Não houve correlação entre hipotensão ortostática, hipertensão supina e valores de BPV sistólica e vitamina D sérica, VDBP e VDR em pacientes com EM. Futuros estudos prospectivos com grande número de pacientes podem nos ajudar a entender melhor a relação entre vitamina D e sistema nervoso autônomo.

Electrocardiographic changes in right ventricular metastatic cardiac tumor mimicking acute ST elevation myocardial infarction: A case of misdiagnosis.

INTRODUCTION: In patients with ST elevation myocardial infarction (STEMI), minimizing the reperfusion time is the goal of therapy worldwide. However, the differential diagnosis is critical and when a patient is encountered with chest pain and ST elevation, STEMI should not be the only diagnosis considered. By detailed history and focused physical examination, it is possible to avoid a mistaken diagnosis. CASE PRESENTATION: In this report, we present a case of a male patient with tongue cancer and accompanying myocardial metastasis that causes electrocardiographic changes, who was initially misdiagnosed with ST elevation myocardial infarction. CONCLUSION: Here, we reported a case of metastatic cancer in the heart which was initially diagnosed as acute myocardial infarction. Echocardiography, computed tomography and magnetic resonance imaging of the heart were used accordingly to confirm the myocardial metastasis.

The relationship between uric acid and erectile dysfunction in hypertensive subjects.

BACKGROUND: Endothelial dysfunction plays a major role in erectile dysfunction (ED). Uric acid (UA) is a marker of endothelial dysfunction. We hypothesized that increased UA levels may be associated with ED and aimed to investigate whether there is a relationship between, UA and ED in hypertensive patients. METHODS: A total of 200 hypertensive patients who have a normal treadmill exercise test were divided into two groups based on the Sexual Health Inventory for Men (SHIM) test (< 21 defined as ED n = 110, and ≥ 21 defined as normal erectile function n = 90). The differences between the ED and normal erectile function groups were compared and determinants of ED were analyzed. MAIN RESULTS: The prevalence of ED was found to be 55.0%. Office blood pressure level was comparable between groups. UA levels were significantly increased in the ED group (6.20 ± 1.56 vs 5.44 ± 1.32, p = 0.01). In a regression model, age [odds ratio (95% confidence interval): 1.08 (1.04-1.14), p = 0.001], smoking [odds ratio: 2.33 (1.04-5.20), p = 0.04] and UA [odds ratio: 1.76 (1.28-2.41), p = 0.04] were independent determinants of ED. An UA level of > 5.2 mg/dl had 76.2% sensitivity, 43.7% specificity, 62.9% positive and 59.4% negative predictive value for determining ED. CONCLUSION: UA is an independent determinant of ED irrespective of blood pressure control and questioning erectile function for hypertensive patients with increased UA levels may be recommended.

Acute coronary embolism without valve thrombosis in a patient with a prosthetic mitral valve--successful percutaneous coronary intervention: a case report.

We present a 44-year-old female patient with anterior myocardial infarction caused by embolization from mitral valve prosthesis due to inadequate anticoagulation. The patient underwent a cardiac catheterization within the 1st hour of arrival. The angiography showed total occlusion of the left anterior descending coronary artery after the second diagonal branch. Percutaneous transluminal coronary angioplasty and stenting were performed, and coronary artery perfusion was restored. The pain disappeared completely immediately after this intervention. Transthoracic echocardiography shortly after this intervention showed normal prosthetic valve function and no thrombus. Transesophageal echocardiography performed 2 days later revealed no thrombus at the prosthetic valve. In conclusion, this case demonstrated that coronary embolism may occur even without prosthetic valve thrombus or dysfunction with suboptimal International Normalized Ratio levels, and can be successfully treated with percutaneous transluminal coronary angioplasty and stenting.