Value of point-of-care neutrophil gelatinase associated lipocalin in early diagnosis of acute kidney injury in patients with left ventricular systolic dysfunction after coronary angiography.

BACKGROUND: Increased neutrophil gelatinase-associated lipocalin (NGAL) levels are associated with toxic or ischemic renal injury. OBJECTIVE: This study aimed to assess the usefulness of serial NGAL measurements with a point-of-care assay in patients with left ventricular systolic dysfunction (LVSD) for earlier detection of contrast-induced nephropathy (CIN). MATERIALS AND METHODS: A total of 84 patients with LVSD patients referred for coronary angiography were consecutively enrolled in the study. The study population was divided into two groups as the CIN and the non-CIN groups according to the CIN's determination. The serum creatinine levels were calculated 24 h before the procedure and at the 48th and 72nd h after the cardiac catheterization. The plasma NGAL concentration was measured before and at 4 and 24 h after the cardiac catheterization. RESULTS: Baseline and serial NGAL levels were significantly higher in patients with CIN compared to the patients without CIN. NGAL 24th h levels after the index procedure were found to be an independent and significant predictor of CIN in multivariate analysis. CONCLUSIONS: Serial point-of-care NGAL measurements might help earlier detection of CIN in patients with heart failure after coronary angiography.

Can hemodialysis change QRS axis in patients without cardiovascular disease?

OBJECTIVE: Due to rapid changes in volume and electrolyte concentration during hemodialysis (HD), some electrocardiographic (ECG) changes or arrhythmias can be seen. The aim of this study was to assess ECG QRS axis changes and other ECG parameters after HD in patients with end-stage renal disease (ESRD). METHODS: A total of 46 patients (65% male, mean age 52±15 years) with a sinus rhythm and without cardiovascular disease who were undergoing chronic HD treatment were included to the study. Blood samples, 12-lead electrocardiograms, and echocardiograms were recorded immediately before and at the end of an HD session. The QRS axis and other electrocardiographic, echocardiographic, electrolyte parameter, and volume changes were analyzed. RESULTS: The serum urea, creatinine, potassium, and B-type natriuretic peptide concentrations significantly decreased after HD, and the serum calcium levels significantly increased after HD. Body weight significantly decreased after HD. There was no significant difference in the QRS duration, PR interval, P-wave axis, QRS axis, or QT and QTc interval following HD. Based on a comparison of variables according to the any QRS axis change after HD treatment, there was no significant difference in biochemical values, HD time, ultrafiltration volume, left ventricular ejection fraction, or other echocardiographic findings. CONCLUSION: ESRD and HD are complex and dynamic processes, and the change in the QRS axis is rarely emphasized in these patients. In our study, there was no significant change in the QRS axis with HD in patients without cardiovascular disease.

Homocysteine, visceral adiposity-related novel cardiometabolic risk factors, and exaggerated blood pressure response to the exercise treadmill test.

OBJECTIVE: Exaggerated blood pressure response to exercise is a risk factor for the development of future hypertension. In this study, we aimed to investigate the association between homocysteine, epicardial fat thickness, nonalcoholic hepatic steatosis, and exaggerated blood pressure response to exercise. PARTICIPANTS AND METHODS: We included 44 normotensive and 40 patients with exaggerated blood pressure response to exercise who have normal resting blood pressure and without a previous diagnosis of hypertension. All patients underwent treadmill exercise test and clinical, ultrasonographic, and echocardiographic evaluation. Exaggerated blood pressure response to exercise is defined as peak exercise systolic blood pressure of at least 210 mmHg in men and at least 190 mmHg in women. Homocysteine and other biochemical parameters were determined with standardized automated laboratory tests. RESULTS: Mean age of all participants is 47.9±8.5 years, and 36 of 84 participants were female. The frequency of diabetes mellitus in both groups was similar (P=0.250). Homeostasis model assessment index-insulin resistance had a statistically insignificant trend to be higher in a patient with exercise hypertension (P=0.058). The nonalcoholic fatty liver was more frequent in patients with exercise hypertension (13.6 vs. 47.5%, P=0.002). Epicardial fat thickness was increased in patients with exercise hypertension (5.5±1.5 vs. 7.3±1.1 mm; P=0.001). However, homocysteine levels did not significantly differ between normotensive and exercise hypertensive patients [12.3 µmol/l (5.7-16.9 µmol/l) vs. 13 µmol/l (5.9-28.3 µmol/l); P=0.883]. CONCLUSION: In our study, homocysteine levels were not associated with exaggerated blood pressure response to exercise; however, fatty liver and epicardial fat thickness as visceral adiposity-related cardiometabolic risk factors were significantly related with exaggerated blood pressure response to exercise in patients without a previous diagnosis of hypertension.

The Relationship Between Increased Epicardial Fat Thickness and Left Ventricular Hypertrophy and Carotid Intima-Media Thickness in Patients With Nonfunctional Adrenal Incidentaloma.

BACKGROUND: Emerging evidences indicate that patients diagnosed with Adrenal Incidentaloma (AI) may present cardiovascular complications. Epicardial fat thickness (EFT) has recently been described as a new risk factor and an active player in metabolic syndrome and cardiovascular disease. OBJECTIVES: We aimed to evaluate the relationship between EFT and left ventricular hypertrophy and carotid intima-media thickness, which are both strong predictors of cardiovascular morbity and mortality, in patients with nonfunctioning AI. PATIENTS AND METHODS: We evaluated 51 patients (36 females and 15 males) diagnosed with AI and 35 (29 females, 6 males) age, gender and body mass index (BMI) matched healthy controls in terms of cardiovascular risk parameters. Epicardial fat was identified as the echo-free space between the outer wall of the myocardium and the visceral layer of the pericardium. RESULTS: Epicardial fat thickness was significantly higher in patients with AI when compared to the control group (0.89 ± 0.32 cm vs. 0.74 ± 0.26 cm; P = 0.023). left ventricular (LV) mass index and median carotid intima-media thickness (CIMT) were also higher in subjects with AI than in controls (99.8 g/m2 vs. 86.9 g/m2; P = 0.024 and 7.5 mm (5.5 - 11.5) vs. 6.5 mm (4.5 - 9.5); P = 0.017). There was a positive correlation between EFT, LV mass index, EFT and CIMT (r = 0.315, P = 0.004; r = 0.363, P < 0.001; respectively). CONCLUSIONS: In this study we showed that EFT, measured by echocardiography is higher in subjects with AI when compared to healthy controls. epicardial fat thickness had the best independent correlation with AI in multiple logistic regression analysis. Incidentaloma is also associated with increased left ventricular mass index and CIMT. Adrenal incidentaloma patients may show early cardiac changes, such as increased left ventricular mass and increased CIMT.

Evaluation of aortic elastic properties in patients with systemic sclerosis.

OBJECTIVES: The aim of this study was to investigate the elastic properties of the aorta, which are known to be predictors of cardiovascular morbidity and mortality in patients with systemic sclerosis (SSc). STUDY DESIGN: Forty patients (2 males, 38 females) with SSc who had been referred to echocardiography without any exclusion criteria were enrolled in the study. The control group consisted of 38 subjects (4 males, 34 females) who were examined in the cardiology out-patient clinic and referred to echocardiography for any indication in the same period. Parameters related to diastolic functions of the left ventricle were obtained by echocardiography and the following parameters of aortic elasticity were calculated according to these formulas: aortic strain = ([AOS - AOD]/AOD), aortic stiffness index (ß) = ln (systolic blood pressure/diastolic blood pressure)/aortic strain and aortic distensibility = 2 × aortic strain/pulse pressure. RESULTS: Aortic strain and distensibility were significantly lower, and aortic stiffness index ß was significantly higher in the SSc group compared to the control group. While the systolic diameter of the aorta did not differ between study and control groups, the diastolic diameter of the aorta was significantly higher in SSc patients. On the other hand, left ventricular diastolic functions were compromised in the SSc group. Mitral A velocity, E-wave deceleration time and E/Em ratio were increased and mitral E/A ratio, lateral and medial annular Em velocity were significantly decreased in SSc patients. CONCLUSION: Our study demonstrated that aortic stiffness is increased and left ventricular diastolic functions are compromised in patients with SSc.

An unusual case of idiopathic hypereosinophilic syndrome presenting with myopericarditis and a polypoid cardiac mass.

Idiopathic hypereosinophilic syndrome (IHES) is a rare systemic disorder with blood eosinophilia and multiple system involvement. Commonly, there is endocardial fibrosis with overlying mural thrombus, and mitral and tricuspid valves can be involved concomitantly. Outflow tracts near the aortic and pulmonary valves are generally protected. We herein describe an atypical case of IHES with a mass on the left ventricular outflow tract (LVOT), which showed regression under steroid therapy. There are two features that make our case worthy of reporting: First, the mitral and tricuspid valves are expected to be involved in IHES, and outflow tracts near the aortic and pulmonary valves are generally protected. Second, within one month of steroid therapy, the vegetation had reduced dramatically in size and signs of myocarditis and pericarditis had also disappeared.