A Novel Marker of Impaired Aortic Elasticity in Never Treated Hypertensive Patients: Monocyte/High-Density Lipoprotein Cholesterol Ratio.

BACKGROUND: Monocyte to high density lipoprotein cholesterol ratio (MHR) is generally understood to be a candidate marker of inflammation and oxidative stress. Therefore, we aimed to assess the association between MHR and aortic elastic properties in hypertensive patients. METHODS: A total of 114 newly-diagnosed untreated patients with hypertension and 71 healthy subjects were enrolled. Aortic stiffness index, aortic strain and aortic distensibility were measured by using echocardiography. RESULTS: Patients with hypertension had a significantly higher MHR compared to the control group (p < 0.001). Also, aortic stiffness index (p < 0.001) was significantly higher and aortic distensibility (p < 0.001) was lower in the hypertensive group. There was a positive correlation of MHR with aortic stiffness index (r = 0.294, p < 0.001) and negative correlation with aortic distensibility (r = -0.281, p < 0.001). In addition, MHR and high sensitivity C-reactive protein have a positive correlation (r = 0.30, p < 0.001). Furthermore, MHR was found to be an independent predictor of aortic distensibility and aortic stiffness index. CONCLUSIONS: In patients with newly-diagnosed untreated essential hypertension, higher MHR was significantly associated with impaired aortic elastic properties.

Evaluation of Tp-E Interval and Tp-E/QT Ratio in Patients with Aortic Stenosis.

BACKGROUND: The risk of syncope and sudden cardiac death due to ventricular arrhythmias increased in patients with aortic stenosis (AS). Recently, it was shown that Tp-e interval, Tp-e/QT, and Tp-e/QTc ratio can be novel indicators for prediction of ventricular arrhythmias and mortality. We aimed to investigate the association between AS and ventricular repolarization using Tp-e interval and Tp-e/QT ratio. METHODS: Totally, 105 patients with AS and 60 control subjects were enrolled to this study. The severity of AS was defined by transthoracic echocardiographic examination. Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios were measured from the 12-lead electrocardiogram. RESULTS: Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios were significantly increased in parallel to the severity of AS (P < 0.001, P = 0.001, and P = 0.001, respectively). Also, it was shown that Tp-e/QTc ratio had significant positive correlation with mean aortic gradient (r = 0.192, P = 0.049). In multivariate logistic regression analysis, Tp-e/QTc ratio and left ventricular mass were found to be independent predictors of severe AS (P = 0.03 and P = 0.04, respectively). CONCLUSIONS: Our study showed that Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios were increased in patients with severe AS. Tp-e/QTc ratio and left ventricular mass were found as independent predictors of severe AS.

Relationship between serum vitamin D levels and angiographic severity and extent of coronary artery disease.

BACKGROUND: Vitamin D is known for its effect in calcium and bone homeostasis. There is an increasing evidence for health benefits accomplished by activated vitamin D that go beyond these classical functions. Previous studies have suggested that lower vitamin D levels are associated with increased cardiovascular disease risk. Therefore, we aimed to evaluate relationship between vitamin D levels and extent and severity of coronary artery disease. MATERIALS AND METHODS: A total of 746 patients in whom coronary angiography was performed between August 2012 and July 2013 were enrolled in this study. Serum vitamin D levels were measured, and patients were grouped according to their serum vitamin D levels (vitamin D <20 ng/mL (n = 602) Group 1 versus >20 ng/dL (n = 144) Group 2). Gensini score system was used to evaluate the association between serum vitamin D levels and severity and extent of coronary artery disease. RESULTS: There was no significant difference between the groups in terms of baseline characteristics and demographic characteristics. Mean serum vitamin D levels of all patient cohort was 15.54 ± 7.46 ng/mL. Group 1 and Group 2 had an average serum vitamin D levels of 12.6 ± 3.3 ng/mL and 27.5 ± 7.8 ng/mL, respectively. Gensini score for all cohort was 26.25 ± 34.32. Group 1 had an average Gensini score of 26.4 ± 35.7; on the other hand, Gensini score was 25.5 ± 27.5 in Group 2 (P = 0.097). CONCLUSIONS: This study failed to demonstrate significant relationship between serum vitamin D levels and the severity and extent of coronary artery disease. Further studies with more participation and homogenous groups with comparable individual and environmental features are needed to evaluate the association of serum vitamin D levels and cardiovascular diseases.

The association of red cell distribution width with in-stent restenosis in patients with stable coronary artery disease.

Increased red cell distribution width (RDW) is closely related to the poor prognosis and adverse events of cardiovascular diseases. We aimed to investigate the association of serum RDW levels and in-stent restenosis (ISR) after coronary stenting with bare-metal stent in patients with stable coronary artery disease. A total of 251 patients (age 62 ± 11 years, 69% male) with a history of coronary stenting who underwent control coronary angiography (128 with ISR and 123 without ISR) were enrolled into the study. Laboratory parameters were measured before angiography. ISR was defined as luminal stenosis ≥50% within the stent or within 5 mm of its edges by the quantitative coronary analysis. The patients were divided into the two groups: ISR group and no-ISR group. Baseline characteristics of the patients were similar. The ISR group had significantly higher RDW levels compared with patients in no-ISR group (14.47 ± 1.37 vs. 13.59 ± 0.88, p < 0.001). Furthermore, the ISR group had significantly longer stent length and lower stent diameter when compared to no-ISR group (p = 0.001 and p = 0.004, respectively). In a multivariate analysis, RDW levels >13.75%, high-sensitivity C-reactive protein levels, stent diameter and stent length were independently associated with ISR [odds ratio (OR) = 2.12, 95% confidence interval (CI) = 1.71-3.15, OR = 2.80, 95% CI = (1.34-4.61), OR = -2.60, 95% CI = -(1.19-4.51), OR = 2.02, 95% CI = 1.99-3.76, p = 0.001, respectively]. We concluded that increased serum RDW levels were independently associated with bare-metal ISR in patients with stable coronary artery disease.

A rare cause of 2:1 atrioventricular block: carbamazepine.

We report a case of carbamazepine-induced 2:1 atrioventricular (AV) block. A 56-year-old man was admitted to our emergency department for recurrent attacks of dizziness and syncope. His serum carbamazepine level was within therapeutic range, and his electrocardiogram revealed 2:1 AV block. After withdrawal of carbamazepine therapy, the arrhythmia completely resolved. This report suggests that carbamazepine-induced AV block can occur even in therapeutic serum concentrations and that it can be reversible.

Relationship between Epicardial Adipose Tissue Thickness and Atrial Electromechanical Delay in Hypertensive Patients.

OBJECTIVES: Epicardial adipose tissue (EAT) and atrial electromechanical delay (AEMD) have been shown to be closely linked with atrial fibrillation. In this study, we aimed to investigate the relationship between EAT and AEMD. METHODS: Ninety-six patients were included in this study. Echocardiographic measurements were performed, and laboratory parameters were recorded. Patients were divided into two groups according to their inter-AEMD values. Patients with an inter-AEMD value of <42.6 msec formed group 1 and patients with an inter-AEMD value of ≥42.6 msec formed group 2. RESULTS: The EAT thickness (3.7 ± 1.2 vs. 5.0 ± 1.6, P < 0.001) and LAVI (20.4 ± 2.9 vs. 24.5 ± 6.7, P = 0.001) were significantly higher in group 2. There was a significant positive correlation between AEMD parameters with EAT and LAVI. After multivariate logistic regression analysis, EAT (OR: 1.505; 95% CI: 1.056-2.143, P = 0.023) and LAVI (OR: 1.140; 95% CI: 1.018-1.277, P = 0.023) were found as independent predictors of prolonged AEMD. CONCLUSIONS: We found that EAT thickness was closely related with AEMD, and we also found that EAT and LAVI were independent predictors of prolonged AEMD. These findings may be helpful to explain some pathogenic mechanisms in the development of AF.

Comparison of three diuretic treatment strategies for patients with acute decompensated heart failure.

BACKGROUND: There are few prospective data available for establishing a standard diuretic administration regimen for patients with acute decompensated heart failure (ADHF). We aimed to assess the safety and efficacy of three regimens of furosemide administration in patients with ADHF with regard to diuresis, renal functions, and in-hospital outcomes. METHODS: A total of 43 patients who presented with ADHF were randomized into three groups: (a) continuous infusion (cIV) of 160 mg furosemide for 16 h/day (n = 15); (b) bolus injections (bI) of 80 mg furosemide twice a day (n = 14); (c) and administration of 160 mg furosemide plus hypertonic saline solution (HSS) as an infusion for 30 min once a day (n = 14). All regimens were continued for 48 h. Study endpoints were negative fluid balance assessed by loss of body weight, change in the serum creatinine (baseline to 48 h and baseline to compensated state), and length of hospitalization. RESULTS: There was no significant difference in the mean change in serum creatinine level at the end of 48 h between groups (p = 0.08). There was also no significant difference among groups regarding loss of body weight (p = 0.66). A significantly shorter hospitalization was observed in patients treated with HSS compared with the other groups (cIV group 6.6 ± 3.4 days vs. bI group 7.9 ± 4.1 days vs. HSS group 3.7 ± 1.3 days; p < 0.01). CONCLUSION: All three furosemide regimens have similar renal safety and efficacy measures. However, administration of furosemide plus HSS may be the preferred diuretic strategy because of its shorter hospital stay.

High Sensitive CRP Level Is Associated With Intermediate and High Syntax Score in Patients With Acute Coronary Syndrome.

High sensitive C-reactive protein (hs-CRP) levels are associated with short- and long-term mortality in patients with acute coronary syndrome (ACS). We investigated whether baseline hs-CRP levels are associated with burden of coronary atherosclerosis assessed by SYNTAX score (SXScore).We enrolled 321 patients with ACS who underwent coronary angiography. The patients were divided into tertiles according to the SXScore: low SXScore (≤ 22), and intermediate-high SXScore (≥ 23).Subjects in the intermediate-high SXScore tertile had higher serum hs-CRP levels compare to low SXScore tertile patients (7.7 ± 3.4 mg/L versus 4.9 ± 2.5 mg/L, P < 0.001). The mean age of patients and prevalance of diabetes in the intermediate-high SXScore tertile were significantly higher than in the low SXScore tertile (63 ± 13 versus 58 ± 12 years P = 0.001 for age, P = 0.007 for diabetes). Multivariate logistic regression analysis showed that the strongest predictors of high SXScore were increased serum hs-CRP levels (OR: 1.14) together with multivessel disease (OR: 0.23), left ventricular ejection fraction (LVEF) (OR: 0.90), and troponin levels (OR: 1.12).Serum hs-CRP levels on admission in patients with ACS could predict the severity and complexity of coronary atherosclerosis together with multivessel disease, LVEF, and troponin levels. Thus, increased serum levels of hs-CRP were one of the strong predictors of high SXScore in ACS patients.

Increased epicardial adipose tissue thickness is linked to aortic stiffness in patients with primary hypertension.

AIMS: In patients with hypertension (HT), increased aortic stiffness is related to higher cardiovascular morbidity and mortality. Recent investigations have shown that epicardial adipose tissue (EAT) is a new potential cardiometabolic risk factor. The aim of our study was to examine the relation between echocardiographically measured EAT thickness and aortic stiffness in patients with primary HT. METHODS: The study included 144 newly diagnosed and untreated essential hypertensive outpatients. Transthoracic echocardiographic EAT thickness and aortic stiffness measurements were performed for all study participants. Afterwards patients were divided in two groups according to their median EAT thickness values. The patients with EAT thickness of < 7 mm were included in group 1 and patients with EAT thickness of ≥ 7 mm were included in group 2. RESULTS: Aortic strain and distensibility parameters of group 2 were lower than in group 1. The aortic stiffness index of group 2 was found to be higher than group 1. Multivariate regression analysis revealed that EAT thickness was the only independent variable for all three parameters of aortic stiffness index, aortic strain and aortic distensibility. CONCLUSION: In patients with newly diagnosed primary HT, increased EAT thickness was significantly linked to impaired aortic elastic properties independently of other conventional adiposity measurements.

Acute coronary syndrome secondary to clarithromycin: the first case and review of the literature.

Kounis syndrome (KS) is characterized by concurrent acute coronary syndrome and allergic reaction, in which acute inflammatory mediators cause spasm and/or erosion and rupture of coronary atheromatous plaque. In this report, we remind clinicians to consider KS in patients who are subjected to allergenic substances and demonstrate acute chest pain. A 36-year-old woman had chest pain, severe dyspnea, hypotension, and symmetrical negative T waves on the anterior leads during electrocardiography approximately two hours after the use of clarithromycin. KS was considered as a possible diagnosis based on the presentation. Laboratory tests revealed an elevated level of troponin I, suggesting myocardial infarction, and an elevated level of serum tryptase level, suggesting an allergic reaction. The patient promptly underwent coronary angiography, which revealed only plaques in all main coronary arteries without any obstructive lesion. To the best of our knowledge, we report herein the first case in the literature describing an association between clarithromycin and KS.