Cut-off value for interleukin-34 as an additional potential inflammatory biomarker for estimation of slow coronary flow risk.

BACKGROUND: Inflammatory markers may provide insights into the underlying mechanisms of slow coronary flow (SCF), including subclinical atherosclerosis and endothelial dysfunction. Interleukin-34 (IL-34), known for its role in immuno-inflammatory diseases, might hold significance in SCF. We aimed to explore the potential association between IL-34 and SCF in patients undergoing diagnostic elective coronary angiography. METHODS: This observational, cross-sectional study enrolled 256 participants: 124 with SCF and 132 with normal coronary flow (NCF). All participants had undergone outpatient coronary angiography for suspected coronary artery disease. SCF assessment employed the TIMI frame count (TFC) for quantifying coronary flow rate. RESULTS: SCF patients exhibited significantly elevated TFC in all three major coronary arteries compared to controls (p < 0.05). IL-34 displayed a noteworthy positive correlation with average TFC [for all participants: r = 0.514, p < 0.001; for SCF patients: r = 0.526, p < 0.001; for normal controls: r = -0.288, p > 0.05]. Similarly, high-sensitivity C-reactive protein (hsCRP) showed a significant and positive relationship with average TFC [for all participants: r = 0.504, p < 0.001; for SCF patients: r = 0.558, p < 0.001; for normal controls: r = -0.148, p > 0.05]. SCF patients presented coronary arteries of larger size compared to controls. CONCLUSION: Mean coronary diameter and IL-34 emerged as independent predictors of SCF. Additionally, hsCRP, mean coronary diameter, and IL-34 exhibited a positive correlation with mean TFC values. IL-34 appears to be a more effective indicator than hsCRP in SCF patients.

Predictive value of the systemic immune inflammatory index in cardiac syndrome x.

INTRODUCTION: Patients with normal coronary arteries in whom increased vasospasm cannot be detected with the stress test should be evaluated in terms of cardiac syndrome x (CSX). Inflammatory systems are effective in endothelial activation and dysfunction in CSX. The systemic immune inflammation index (SII) is thought to be an important factor in determining the course of diseases, especially in infectious diseases or other diseases, as an indicator of the inflammation process. The aim of this study is to determine the role of SII levels in the diagnosis of CSX disease. METHODS: The study group included 80 patients who applied to the cardiology department of Firat University with typical anginal complaints between October 2021 and April 2022, and were diagnosed with ischemia after the myocardial perfusion scan, and then coronary angiography was performed and normal coronary arteries were observed. RESULTS: When the study and control groups were examined according to age, gender and body mass index, hypertension, smoking, diabetes mellitus, dyslipidemia and family history, no statistical significant difference was observed between the groups. It was observed that there was a significant difference between the high sensitive C- reactive protin levels of the individuals in the study and control groups (p = 0.028). SII levels measured in samples taken from patients were significantly higher than control subjects (p = 0.003). SII cutoff at admission was 582 with 82% sensitivity and 84% specificity (area under the curve 0.972; 95% CI:0.95-0.98;p < 0.001). CONCLUSION: It has been demonstrated that systemic SII parameters, which can be simply calculated with the data obtained from the complete blood count and do not require additional costs, can contribute to the prediction of CSX disease.

Monocyte/high-density lipoprotein ratio predicts the mortality in ischemic stroke patients.

OBJECTIVE: The inflammatory process is a very important stage in the development and prognosis of acute ischemic stroke (AIS). The monocyte to high-density lipoprotein (HDL) ratio (MHR) is accepted as a novel marker for demonstrating inflammation. However, the role of MHR as a predictor of mortality in patients with AIS remains unclear. METHODS: We retrospectively enrolled 466 patients who were referred to our clinic within the first 24hours of symptom presentation and who were diagnosed with AIS between January 2008 and June 2016. Four hundred and eight controls of similar age and gender were also included. The patient group was classified into two groups according to 30-day mortality. The groups were compared in terms of monocyte counts, HDL, and MHR values. RESULTS: The patient group had significantly higher monocyte counts and lower HDL levels; therefore, this group had higher values of MHR compared to controls. Additionally, the monocyte count and MHR value were higher, and the HDL level was lower in non-surviving patients (p<0.001). The MHR value was also observed as a significant independent variable of 30-day mortality in patients with AIS (p<0.001). The optimum cut-off value of MHR in predicting the 30-day mortality for patients with AIS was 17.52 (95% CI 0.95-0.98). CONCLUSION: Our study demonstrated that a high MHR value is an independent predictor of 30-day mortality in patients with AIS.

The Effect of Eosinopenia on Mortality in Patients with Intracerebral Hemorrhage.

INTRODUCTION: Inflammation may determine the prognosis of intracerebral hemorrhage (ICH), which has high mortality and morbidity rates. Recent studies have increasingly demonstrated eosinopenia as a prognostic factor, particularly in bacteremia, chronic obstructive pulmonary disease, and myocardial and cerebral infarction. Nonetheless, its significance regarding the determination of prognosis in patients with ICH has not yet been clarified. MATERIALS AND METHODS: Our study included 296 patients who presented to our clinic within 24 hours of the onset of symptoms and who were diagnosed with ICH between January 2008 and June 2016, along with 180 age- and sex-matched controls. During their hospitalization, 120 of these 296 patients died. Patients and controls were compared in terms of neutrophil count/percentage and eosinophil count/percentage; these were also compared between nonsurviving and surviving patients. The significance of eosinopenia in predicting mortality was also evaluated. RESULTS: Patients had a significantly higher neutrophil count/percentage and a significantly lower eosinophil count/percentage than controls; these results were similar between nonsurviving and surviving patients (P < .001). Consequently, the patient group was divided into 4 subgroups depending on the presence of eosinopenia and/or neutrophilia. The mortality rate was highest (62%) in the group that had both eosinopenia and neutrophilia. Univariate and multivariate logistic regression analyses indicated that neutrophilia and eosinopenia were independent predictors of mortality in ICH (P = .002; P = .004) DISCUSSION: These results indicate that eosinopenia can occur in patients with ICH and that although the mechanism is unclear, eosinopenia is closely associated with mortality in these patients, particularly when accompanied by neutrophilia.

Can serum interleukin 34 levels be used as an indicator for the prediction and prognosis of COVID-19?

OBJECTIVE: Interleukin 34 (IL-34) is a molecule whose expression is increased in conditions such as autoimmune disorders, inflammation, and infections. Our study aims to determine the role of IL-34 in the diagnosis, follow-up, and prognosis of Coronavirus Disease-19 (COVID-19). METHOD: A total of 80 cases were included in the study as 40 COVID-19 positive patient groups and 40 COVID-19 negative control groups. The COVID-19-positive group consisted of 20 intensive-care unit (ICU) patients and 20 outpatients. Serum IL-34, c-reactive protein (CRP), ferritin, D-dimer, troponin I, hemogram, and biochemical parameters of the cases were studied and compared between groups. RESULTS: IL-34 levels were significantly higher in the COVID-19-positive group than in the negative group. IL-34 levels increased in correlation with CRP in predicting the diagnosis of COVID-19. IL-34 levels higher than 31.75 pg/m predicted a diagnosis of COVID-19. IL-34 levels did not differ between the outpatient and ICU groups in COVID-19-positive patients. IL-34 levels were also not different between those with and without lung involvement. CONCLUSION: While IL-34 levels increased in COVID-19-positive patients and were successful in predicting the diagnosis of COVID-19, it was not found to be significant in determining lung involvement, risk of intensive care hospitalization, and prognosis. The role of IL-34 in COVID-19 deserves further evaluation.

The association between serum serglycin level and coronary artery disease severity in patients with stable angina pectoris.

BACKGROUND: Serglycin plays a key role in the inflammatory status however the relationship between coronary artery disease (CAD) and serglycin is still unknown. AIM: In this study, we aimed to investigate association of serglycin levels with CAD severity in patients with stable angina pectoris (SAP). METHODS: In total, 100 SAP patients diagnosed by coronary angiography and clinical manifestations, and 100 control subjects matched for age and sex were enrolled in this case-control study. Plasma levels of serglycin, high-sensitivity C-reactive protein (hsCRP), lipid profiles, and clinical parameters were assayed for all participants. The severity of coronary lesions was evaluated based on the SYNTAX score (SS) assessed by coronary angiography. RESULTS: Positively correlated with the SS (r = 0.564, p < 0.001), the plasma serglycin level in the SAP group was higher than that in the control group (11.17 ± 1.82 vs. 19.28 ± 1.88 ng/mL, p < 0.001). The plasma serglycin level was an inde-pendent predictor for both SAP (odds ratio [OR] 1.037, 95% confidence interval [CI] 1.020-1.054, p < 0.001) and a high SS (OR = 1.087, 95% CI 1.051-1.124, p < 0.001) in a multivariate logistic regression model. In the receiver operating characteristic curve analysis, the plasma serglycin level was found to have a better predictive value for a high SS (area under the curve [AUC] 0.858, 95% CI 0.788-0.929, p < 0.001) compared with hsCRP (AUC 0.665, 95% CI 0.557-0.773, p = 0.006; Z = 2.94, p < 0.001), with an optimal cut-off value of 17.25 ng/mL (sensitivity 94.3%, specificity 68.2%). CONCLUSIONS: Plasma serglycin levels correlate with both the presence and severity of coronary stenosis in patients with SAP, suggesting that it could be a potential predictive marker of severe stenosis in SAP patients.

Adropin and circadian variation of blood pressure.

BACKGROUND: Nocturnal hypertension and non-dipping pattern are often associated with endothelial dysfunction. Previous studies suggested that adropin, a novel secreted energy homeostasis protein, has the unique ability to regulate endothelial cell function. AIM: This study aims to investigate the association between absolute night-time blood pressure (BP) and circadian BP pat-tern with serum adropin and high-sensitivity C-reactive protein (hsCRP) levels in patients with newly diagnosed untreated arterial hypertension. METHODS: Twenty-four-hour ambulatory BP monitoring was recorded in 100 hypertensives (50 dippers, 50 non-dippers) and 50 healthy controls. Serum levels of adropin and hsCRP were measured and recorded. RESULTS: A strong correlation was found between night-time BP levels with adropin and hsCRP levels (p < 0.001). On the other hand, the non-dipper group demonstrated lower adropin levels compared to the dipper and normotensive groups: non dipper group, 2580 ± 457 pg/mL; dipper group, 3298 ± 530 pg/mL; normotensive group, 3681 ± 411 pg/mL; p < 0.001). HsCRP levels were significantly higher in the non-dipper group than in the two other groups (p = 0.017). In a multivariate logistic regression analysis, adropin (p = 0.012) and hsCRP (p = 0.039) were independently associated with a non-dipping pattern. CONCLUSIONS: Decreased adropin levels were found in the nocturnal hypertensive and non-dipper groups. Adropin and hsCRP were found to be independently associated with a non-dipping pattern. We suggest that decreased levels of adropin in non-dipper hypertensive patients might be associated with a longer duration of exposure to high BP. These results point to a possible future role of adropin in identifying hypertensive patients at higher risk of target organ damage.

The role of SCUBE1 in the development of late stent thrombosis presenting with ST-elevation myocardial infarction.

INTRODUCTION AND AIM: There is an important link between platelets and inflammation, thrombosis, and vascular and tissue repair mechanisms. SCUBE1 (signal peptide-CUB-EGF domain-containing protein 1) may function as a novel platelet-endothelial adhesion molecule and play pathological roles in cardiovascular biology. Stent thrombosis (ST) following percutaneous coronary intervention is an uncommon and potentially catastrophic event that can manifest as myocardial infarction and sudden death. High platelet reactivity is a risk factor for thrombotic events, including late ST. For this reason, in the current study, we researched the role of SCUBE1 in the development of late coronary ST. METHODS: We included 40 patients admitted to our hospital with a diagnosis of ST-elevation myocardial infarction (STEMI) and signs of late ST on a coronary angiogram. For the control group, we recruited 50 healthy gender- and age-matched individuals who were seen for health check-ups. We also randomly included 100 patients with a diagnosis of STEMI without ST. RESULTS: There were no significant differences between the groups in terms of baseline and demographic characteristics. The mean SCUBE1 level in patients with STEMI with late ST at admission and the STEMI without ST group was significantly higher than in the control group (p<0.01). The mean SCUBE1 level in the STEMI with late ST group was significantly higher than in the STEMI without ST group (p=0.03). In multivariate regression analysis, serum SCUBE1 (odds ratio [OR]: 1.022; 95% confidence interval [CI]: 1.011-1.033, p<0.001) remained an independent predictor for the presence of late ST. In addition, receiver operating characteristic curve analysis was used to determine the optimal SCUBE1 cut-off value for predicting late ST. The area under the curve was 0.972 (95% CI 0.95-0.98). The SCUBE1 cut-off value was 59.2 ng/ml, with a sensitivity of 95.4% and specificity of 82.9%. CONCLUSION: The present work is the first clinical study to demonstrate that serum SCUBE1 levels are significantly higher in patients with late ST and serum SCUBE1 was an independent predictor for the presence of late ST in our study population.

The role of SCUBE1 in the pathogenesis of no-reflow phenomenon presenting with ST segment elevation myocardial infarction.

OBJECTIVE: SCUBE1 [signal peptide-CUB (complement C1r/C1 s)-EGF (epidermal growth factor)-like domain-containing protein 1] might function as a novel platelet-endothelial adhesion molecule and play pathological roles in cardiovascular biology. Acute myocardial infarction is one of the most common causes of death in modern society. The concept of "no reflow" (NR) refers to a state of myocardial tissue hypoperfusion in the presence of a patent epicardial coronary artery. The main mechanisms of this phenomenon are thought to be high platelet activity and much thrombus burden. So, we researched the role of SCUBE1 in the pathogenesis of NR. METHODS: A total of 142 patients with ST elevation myocardial infarction (STEMI) (n=42 with NR and n=100 without NR) and 50 healthy individuals were prospectively case-control recruited between March 2015 and October 2016 from our outpatient clinics of cardiology department. Patients with STEMI were diagnosed according to American Heart Association (AHA) guideline for the management of STEMI. RESULTS: The mean SCUBE1 levels of the control subjects were 34±8.4 ng/mL, the mean SCUBE1 levels of patients with STEMI who were treated successfully with primary percutaneous coronary intervention (PCI) were 51±6.2, and the mean SCUBE1 levels of patients with STEMI who had NR phenomenon after primary PCI procedure were 97.2±8.9 ng/mL. CONCLUSION: In our opinion, SCUBE1 might contribute to NR phenomenon via thrombus activation and aggregation. The pathophysiology of NR phenomenon is unclear. The present study is the first clinical study that demonstrated that serum SCUBE1 level was significantly higher in patients with NR and that serum SCUBE1 was an independent predictor for the presence of NR in our study population.

Association of rs10757274 and rs2383206 Polymorphisms on 9p21 locus with Coronary Artery Disease in Turkish Population.

BACKGROUND AND OBJECTIVES: Genetic predisposition is an important risk factor for coronary artery disease (CAD). In this study, we aimed to evaluate the impact of rs10757274 and rs2383206 polymorphisms in chromosome 9p21 on presence and severity of CAD in a Turkish population. SUBJECTS AND METHODS: A total of 646 patients who underwent coronary angiography were included in this study. Coronary vessel score and Gensini score were calculated to assess the angiographic severity of CAD. Alleles of AA, AG, and GG were determined for rs10757274 (polymorphism-1) and rs2383206 (polymorphism-2) polymorphisms located in chromosome 9p21 from the blood samples. RESULTS: There was a significant difference between the alleles in polymorphism-1 in the presence of coronary artery disease (38.9% in AA, 48.0% in GG and 56.4% in AG, p=0.017). However, there was no difference between the alleles in polymorphism-2. According to vessel scores, there was a significant difference between the alleles in polymorphism-1 (AA 0.71±1.04, GG 0.88±1.07, AG 1.06±1.12, p=0.018). In polymorphism-2, vessel scores did not show a difference between the alleles. In polymorphism-1, there was a significant difference in Gensini score (p=0.041). Gensini scores did not differ between the alleles in polymorphism-2 (p>0.05 for all). In multivariate analyses, none of the alleles was an independent factor for presence of CAD. CONCLUSION: The presence of rs10757274 polymorphism including AG allele in chromosome 9p21 was related to CAD. However, this relationship was not independent of other cardiovascular risk factors.

A shift in the balance of regulatory T and T helper 17 cells in rheumatic heart disease.

BACKGROUND: Autoimmunity plays an essential role in the pathogenesis of rheumatic heart disease (RHD); however, cellular mechanisms of autoimmune response are unclear. Whereas T helper 17 (TH17) and regulatory T cells (Treg) cells share a common differentiation pathway, they play opposite roles in the immune tolerance and autoimmune diseases. Although high TH17/Treg ratio has been shown in several autoimmune diseases, no data are available in RHD. This study investigated the balance between TH17 and Treg in rheumatic mitral valve disease (MVD). METHODS: Forty patients with rheumatic MVD and 23 control subjects were enrolled into the study. All subjects underwent clinical, electrocardiographic, and echocardiographic evaluation. The percentages of circulating TH17 and Treg cells were analyzed by flow cytometry. Serum levels of high-sensitivity C-reactive protein (hs-CRP) and cytokines were assessed by enzyme-linked immunosorbent assay. RESULTS: As compared with control subjects, rheumatic MVD patients showed significant increase in peripheral TH17 percentage, high serum levels of TH17-related cytokine interleukin 17A, and an obvious decrease in the percentage of Treg cells. T helper 17/Treg ratio was significantly high in rheumatic MVD patients compared with control subjects (P = 0.0001). Serum concentrations of hs-CRP in rheumatic MVD group were higher than those of the control subjects, and hs-CRP levels correlated with the TH17/Treg ratio (r = 0.71, P = 0.0001). Serum levels of transforming growth factor ß1 were increased in rheumatic MVD group compared with those of the control subjects. CONCLUSIONS: The results indicated that high TH17/Treg ratio exists inrheumatic MVD. This imbalance may play a role in the pathogenesis, and TH17/Treg balance may be a promising therapeutic approach in RHD.