Neutrophil-to-lymphocyte ratio as a possible indicator of epicardial adipose tissue in patients undergoing hemodialysis.

INTRODUCTION: Chronic inflammation is a major risk factor in the pathogenesis of cardiovascular disease in end-stage renal disease (ESRD) patients. Epicardial adipose tissue (EAT) is the true visceral fat depot of the heart. The relationship between coronary artery disease and EAT was shown in healthy subjects and ESRD patients. In the present study we aimed to investigate the relationship between EAT and inflammation parameters including neutrophil-to-lymphocyte ratio (NLR) in hemodialysis (HD) patients. MATERIAL AND METHODS: Forty-three HD patients (25 females, 18 males; mean age: 64.1 ±11.9 years) receiving HD and 30 healthy subjects (15 females, 15 males; mean age: 59.1 ±10.8 years) were enrolled in the study. Epicardial adipose tissue measurements were performed by echocardiography. RESULTS: Neutrophil-to-lymphocyte ratio levels were significantly higher in HD patients than in the healthy control group. Hemodialysis patients were separated into two groups according to their median value of NLR (group 1, NLR < 3.07 (n = 21) and group 2, NLR ≥ 3.07 (n = 22)). Group 2 patients had significantly higher EAT, C-reactive protein and ferritin levels, while albumin levels were significantly lower in this group. In the bivariate correlation analysis, EAT was positively correlated with NLR (r = 0.600, p < 0.001) and ferritin (r = 0.485, p = 0.001) levels. CONCLUSIONS: Neutrophil-to-lymphocyte ratio was found to be an independent predictor of EAT in HD patients (odds ratio = 3.178; p = 0.008). We concluded that this relationship might be attributed to increased inflammation in uremic patients.

Beneficial Effects of Ozone Therapy on Oxidative Stress, Cardiac Functions and Clinical Findings in Patients with Heart Failure Reduced Ejection Fraction.

The aim of study was to determine the effects of ozone therapy on the oxidative stress, cardiac functions and clinical findings in patients with heart failure reduced ejection fraction (HFrEF). A total of 40 patients with New York Heart Association 2 and 3 HF with left ventricular ejection fraction (LVEF) <35%, and 40 subjects without HF as control group were included in the study. Patients with HFrEF were given additional ozone therapy of major and minor administrations along with conventional HF treatment for 5 weeks. Before and after ozone therapy, left ventricular end-systolic and end-diastolic volumes (LVESV, LVEDV) and the 6 minute walk distance (6MWD) and blood levels of the superoxide dismutase (SOD), catalase (CAT), glutathione (GSH), glutathione peroxidase (GSHPx), malondialdehyde (MDA), nitric oxide (NO) and N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured. Ozone therapy significantly reduced the serum levels of NO and MDA (p < 0.001, respectively) and significantly increased the levels of SOD, CAT, GSH and GSHPx (p < 0.001, respectively). LVEDV and LVESV were found to be significantly reduced; however, LVEF was not found to be significantly increased (p = 0.567). As the biochemical improvement marker of HF, NT-proBNP was significantly reduced (p < 0.001). The clinical HF improvement marker of 6 minute walk distance was also modestly increased (p < 0.001). Ozone therapy might be beneficial in terms of activating antioxidant system and merit further therapeutic potential to conventional HF treatment in patients with HFrEF.

Myocardial deformation and total atrial conduction time in the prediction of cardiac involvement in patients with pulmonary sarcoidosis.

AIMS: In this study, we aim to evaluate the left atrial global longitudinal strain (LAGLS), total atrial conduction time (TACT) and left ventricle (LV) functions in recently diagnosed pulmonary sarcoidosis (PS) patients. METHOD: Fifty recently diagnosed PS patients (group 1) and a control group of 50 healthy individuals (group 2) were evaluated in the study. Two-dimensional echocardiography images were obtained from LV apical 4-chamber (4C), long-axis (L) and 2-chamber (2C) views. Peak longitudinal strain and strain rate (SR) were obtained from 4C, L and 2C views. Mean values of the three views were calculated. LV global longitudinal strain and LV-SR torsion were determined as the net differences in the mean rotation between the apical and basal levels. LAGLS and TACT values were calculated. RESULTS: The study found that LAGLS was significantly lower in group 1 than in group 2 (P < 0.05). TACT was also significantly longer in group 1 than in group 2 (respectively group 1: 111.6 ± 15.1 ms; group 2: 103.4 ± 5.8 ms, P < 0.001). There was a significant moderate negative correlation between LAGLS and TACT (r = -0.36, P < 0.05). Patients with sarcoidosis had significantly lower LV longitudinal strain and SR measurements than the control group. Although LV basal rotation (LVR) values were similar in both groups, LVR-apical and LV-torsion (LVTR) values were significantly higher in the patient group (group 1). CONCLUSION: The identification of left atrial and left ventricular myocardial deformation using speckle tracking echocardiography in patients with PS allows subclinical LV dysfunction and subclinical electrophysiologic changes to be detected earlier.

Determinants of Chronic Total Occlusion in Patients With Peripheral Arterial Occlusive Disease.

Chronic total occlusion (CTO) is a common finding in 40% of the patients with peripheral arterial disease (PAD). The aim of this study was to investigate the determinants of CTO in patients with PAD. The study included a total of 211 nonanemic patients with PAD. All patients were categorized according to the Fontaine classification. In lower extremity angiography cohorts, CTO- patients were designated as group 1 and CTO+ patients were designated as group 2. Patients with CTO had significantly higher red cell distribution width (RDW), neutrophil-lymphocyte ratio, uric acid, and high-sensitivity C-reactive protein compared to patients without CTO ( P ≤ .001, P = .036, P ≤ .001, and P = .015, respectively). Albumin, total bilirubin, and direct bilirubin were significantly lower in the patients with CTO compared to patients without CTO ( P = .023, P ≤ .001, and P = .049, respectively). Multivariate logistic regression analysis showed that RDW, uric acid, and total bilirubin were independent predictors of CTO in patients with PAD. We demonstrated that increased RDW and uric acid levels and lower total bilirubin values were independently associated with CTO in patients with PAD.

Melatonin Attenuates Contrast-Induced Nephropathy in Diabetic Rats: The Role of Interleukin-33 and Oxidative Stress.

BACKGROUND: Inflammation and oxidative stress (OxS) contribute to the pathogenesis of diabetic kidney disease (DKD) and contrast-induced nephropathy (CIN). Patients with DKD were found to be more prone to CIN. Interleukin-33 (IL-33) is a proinflammatory cytokine, but its role in DKD and CIN is unknown. METHODS: Thirty male Sprague-Dawley rats were enrolled. The first group was comprised of healthy rats (HRs), whereas the other four groups were made up of diabetic rats (DRs), diabetic rats with contrast-induced nephropathy (CIN + DRs), melatonin-treated diabetic rats (MTDRs), and melatonin-treated CIN + DRs (MTCIN + DRs). All groups except the HRs received 50 mg/kg/day streptozotocin (STZ). CIN + DRs were constituted by administrating 1.5 mg/kg of intravenous radiocontrast dye on the 35th day. MTDRs and MTCIN + DRs were given 20 mg/kg/day of intraperitoneal injection of melatonin (MT) from the 28th day for the constitutive seven days. RESULTS: We observed increased IL-33 in the kidney tissue following induction of CIN in DRs. To determine whether MT is effective in preventing CIN, we administered MT in CIN + DRs and demonstrated that kidney tissue levels of OxS markers, inflammatory cytokines, and IL-33 were significantly diminished in MTCIN + DRs compared with other groups without MT treatment (p < 0.05). CONCLUSION: Inhibition of IL-33 with MT provides therapeutic potential in DKD with CIN.

Predictive Value of Atrial Electromechanical Delay on Long-Term Cardiovascular Outcomes in Hemodialysis Patients.

BACKGROUND: Atrial electromechanical delay (AEMD) times were considered independent predictors of cardiovascular morbidity among the general population. We aimed at evaluating AEMD times and other risk factors associated with 2-year combined cardiovascular (CV) events in HD patients. MATERIAL AND METHODS: Sixty hemodialysis (HD) and 44 healthy individuals were enrolled in this prospective study. Echocardiography was performed before the mid-week dialysis session for HD patients. Data were expressed as mean ± SD. Spearman test was used to assess linear associations. Survival was examined with the Kaplan-Meier method. Multivariate Cox regression analysis was used to determine the predictors of combined CV events in this cohort. RESULTS: At the beginning of the study, left intra-atrial-AEMD times were significantly longer in HD patients compared to the left intra-atrial-AEMD times in healthy individuals. After 24 months, 41 patients were still on HD treatment and 19 (31.6%) had died. Serum triglyceride, total cholesterol and albumin were found to be higher and C-reactive protein (CRP) levels, left intra-atrial EMD time (LIAT) and interatrial EMD times were found to be lower in survived HD patients. With the cut-off median values of 3.5 g/dl for albumin, 0.87 mg/dl for CRP, 157 mg/dl for total cholesterol and 151 mg/dl for triglyceride, the Kaplan-Meier curves demonstrated significant differences in terms of all-cause mortality. We also demonstrated the Kaplan-Meier survival curves of HD patients according to tertile values of LIAT. Cox regression analysis revealed that increased CRP and higher LIAT were found to be independent predictors of combined CV events. CONCLUSIONS: Increased LIAT and inflammation were found to be closely associated with 2 years combined CV events and all-cause mortality in HD patients.

Serum YKL-40/chitinase 3-like protein 1 level is an independent predictor of atherosclerosis development in patients with obstructive sleep apnea syndrome.

OBJECTIVE: The inflammatory process plays an important role in the development of cardiovascular complications in patients with obstructive sleep apnea syndrome (OSAS). YKL-40/chitinase 3-like protein 1 is a novel biomarker of systemic inflammation. This study aimed to investigate whether carotid intima-media thickness (CIMT), a useful marker for early atherosclerosis, is associated with serum YKL-40/chitinase 3-like protein 1 levels in patients with normotensive and nondiabetic OSAS. METHODS: The study included 40 OSAS patients and 40 age- sex- and body mass index-matched healthy controls. Serum YKL-40 levels were detected by enzyme-linked immunosorbent assay. CIMT was measured by B-mode ultrasound. RESULTS: The patients with OSAS had significantly increased CIMT and higher YKL-40 and high sensitivity C-reactive protein (hsCRP) levels than those of the controls. CIMT was strongly correlated with serum YKL-40 levels (r=0.694, p<0.001), hsCRP (r=0.622, p<0.001), age (r=0.525, p=0.001), and weakly correlated with apnea-hypopnea index (AHI) (r=0.365, p=0.021) and the percentage of recording time spent (PRTS) of oxygen saturation<90% (r=0.488, p=0.001). Moreover, it was detected that serum YKL-40 levels were strongly correlated with AHI (r=0.617, p<0.001), and weakly correlated with SaO2<90% of PRTS (r=0.394, p=0.012) and hsCRP (r=0.486, p=0.001). In multiple regression analyses, age and serum levels of YKL-40 and hsCRP were found to be independent predictors of CIMT. CONCLUSION: In patients with OSAS, CIMT was increased. This increase was associated with serum YKL-40 level. Increased serum level of YKL-40 may be an early predictor of atherosclerosis development in patients with OSAS.

New inflammatory markers for prediction of non-dipper blood pressure pattern in patients with essential hypertension: Serum YKL-40/Chitinase 3-like protein 1 levels and echocardiographic epicardial adipose tissue thickness.

The aim of the present study was to investigate whether YKL-40 levels and epicardial adipose tissue (EAT) thickness were associated with non-dipping pattern in essential hypertension (HT). Age- and sex-matched 40 dipper hypertensive patients and 40 non-dipper hypertensive patients were included in the study. Non-dippers had significantly increased EAT thickness and higher YKL-40 and high-sensitivity C-reactive protein levels than dippers. Multivariate logistic regression analysis showed that the EAT thickness and serum levels of YKL-40 and high-sensitivity C-reactive protein were independent predictors of non-dipping pattern in essential HT. In essential HT, presence of non-dipping pattern is associated with increased inflammatory response.

Relationship of the total atrial conduction time to subclinical atherosclerosis, inflammation and echocardiographic parameters in patients with type 2 diabetes mellitus.

OBJECTIVES: The aim of our study was to evaluate the total atrial conduction time and its relationship to subclinical atherosclerosis, inflammation and echocardiographic parameters in patients with type 2 diabetes mellitus. METHODS: A total of 132 patients with type 2 diabetes mellitus (mean age 54.5 ± 9.6 years; 57.6% male) and 80 age- and gender-matched controls were evaluated. The total atrial conduction time was measured by tissue-Doppler imaging and the carotid intima-media thickness was measured by B-mode ultrasonography. RESULTS: The total atrial conduction time was significantly longer in the patients with type 2 diabetes mellitus than in the control group (131.7 ± 23.6 vs. 113.1 ± 21.3, p<0.001). The patients with type 2 diabetes mellitus had significantly increased carotid intima-media thicknesses, neutrophil to lymphocyte ratios and high-sensitivity C-reactive protein levels than those of the controls. The total atrial conduction time was positively correlated with the high-sensitivity C-reactive protein level, neutrophil to lymphocyte ratio, carotid intima-media thickness and left atrial volume index and negatively correlated with the early diastolic velocity (Em), Em/late diastolic velocity (Am) ratio and global peak left atrial longitudinal strain. A multiple logistic regression analysis demonstrated that the neutrophil to lymphocyte ratio, carotid intima-media thickness and global peak left atrial longitudinal strain were independent predictors of the total atrial conduction time. CONCLUSIONS: We suggest that subclinical atherosclerosis and inflammation may represent a mechanism related to prolonged total atrial conduction time and that prolonged total atrial conduction time and impaired left atrial myocardial deformation may be represent early subclinical cardiac involvement in patients with type 2 diabetes mellitus.

Diabetes mellitus and female gender are the strongest predictors of poor collateral vessel development in patients with severe coronary artery stenosis.

BACKGROUND: Coronary collateral vessel development (CVD), i.e., arteriogenesis, is regarded as one of the most important mechanisms­along with angiogenesis­to result in protection of the myocardium. Coronary CVD is associated with a reduction in infarct size, future cardiovascular events and improved survival in patients with occlusive coronary artery disease by enhancing regional perfusion in the chronically ischemic myocardium. In the present study, we aimed to investigate the relation of cardiovascular risk factors and hematological parameters with collateral development in patients with severely stenotic (≥95%) and totally occluded coronary artery disease including at least one major coronary artery. MATERIALS AND METHODS: The study population was selected from the patients who underwent coronary angiography between January 2008 and March 2009. Five hundred and two patients who had at least one coronary artery stenosis ≥95% (368 men; mean age 59 ± 10 years) comprised the study population. Of the 502 patients, 228 had total occlusion in at least one major epicardial coronary artery. Collateral artery grading was performed by using Cohen-Rentrop method to the vessel with coronary artery stenosis of ≥95% and patients with chronic total occlusions (CTO). Patients with grade 0-1 collateral development were regarded as the poor collateral group, and patients with grade 2-3 collateral development were regarded as the good collateral group. RESULTS: Two hundred and fifty-eight (51%) of 502 patients had poor collateral development, and 244 (49%) had good collateral development. Logistic regression analysis revealed that DM was independently associated with poor CVD in patients with ≥95% stenosis (p < 0.001). Additionally, female gender and DM were found to be independently associated with poor CVD in patients with CTO (p = 0.005 and p < 0.001, respectively). Monocyte count was found to be independent of CVD neither in patients with ≥95% stenosis nor in patients with CTO. CONCLUSION: Our data show that DM is an independent factor for poor coronary CVD both in patients with severe coronary artery stenosis and in patients with CTO. Female gender or being in post-menopausal period is another negative risk factor for poor CVD in addition to DM in patients with CTO.

Relationship of the total atrial conduction time to subclinical atherosclerosis, inflammation and echocardiographic parameters in patients with type 2 diabetes mellitus

OBJECTIVES: The aim of our study was to evaluate the total atrial conduction time and its relationship to subclinical atherosclerosis, inflammation and echocardiographic parameters in patients with type 2 diabetes mellitus. METHODS: A total of 132 patients with type 2 diabetes mellitus (mean age 54.5±9.6 years; 57.6% male) and 80 age- and gender-matched controls were evaluated. The total atrial conduction time was measured by tissue-Doppler imaging and the carotid intima-media thickness was measured by B-mode ultrasonography. RESULTS: The total atrial conduction time was significantly longer in the patients with type 2 diabetes mellitus than in the control group (131.7±23.6 vs. 113.1±21.3, p<0.001). The patients with type 2 diabetes mellitus had significantly increased carotid intima-media thicknesses, neutrophil to lymphocyte ratios and high-sensitivity C-reactive protein levels than those of the controls. The total atrial conduction time was positively correlated with the high-sensitivity C-reactive protein level, neutrophil to lymphocyte ratio, carotid intima-media thickness and left atrial volume index and negatively correlated with the early diastolic velocity (Em), Em/late diastolic velocity (Am) ratio and global peak left atrial longitudinal strain. A multiple logistic regression analysis demonstrated that the neutrophil to lymphocyte ratio, carotid intima-media thickness and global peak left atrial longitudinal strain were independent predictors of the total atrial conduction time. CONCLUSIONS: We suggest that subclinical atherosclerosis and inflammation may represent a mechanism related to prolonged total atrial conduction time and that prolonged total atrial conduction time and impaired left atrial myocardial deformation may be represent early subclinical cardiac involvement in patients with type 2 diabetes mellitus. .

The relation between erectile dysfunction and extent of coronary artery disease in the patients with stable coronary artery disease.

INTRODUCTION: Erectile dysfunction (ED) and coronary artery disease (CAD) are closely related as a result of endothelial dysfunction leading to the restriction of blood flow. ED is a potential independent risk factor of CAD. We investigated the prevalence and severity of ED, the extent of CAD and the time interval between the symptoms of ED and CAD in the stable coronary artery patients. MATERIALS AND METHODS: 161 patients applied coronary angiography were divided into two groups according to SYNTAX score as group 1 (n=81) SYNTAX score ≤22, and group 2 (n=80) SYNTAX score >22. The prevalence and severity of ED was determined by using The International Index of Erectile Function (IIEF). RESULTS: The prevalence of ED was 43.2% in group 1 and 61.3% in group 2 (P=0.022). The score of IIEF was 23.1 (15-29) in group 1, 19.3 (6-29) in group 2; there was a significant difference (P=0.000). In the multivariate logistic regression analysis carried out in order to determine the independent predictors on Syntax score, it was found that LDL (odds ratio: 1.032, 95% confidence interval: 1.009-1.055, P=0.007) and IIEF score (odds ratio: 0.825, 95% confidence interval: 0.733-0.928, P=0.001) were the independent predictors. The time between the symptoms of ED and CAD 30.1 ± 4.8 months in group 1, and 40.5 ± 4.3 months in group 2 (P=0.000). CONCLUSION: The severity of ED is an independent factor predicting the extent of CAD. The early detection of ED enables to make a cardiovascular evaluation. Therefore, taking the cardiovascular risk factors under an aggressive treatment may contribute to prevent the cardiovascular cases which may develop in the future.

Increased Epicardial Adipose Tissue Thickness is Associated With Angiographic Thrombus Burden in the Patients With Non-ST-Segment Elevation Myocardial Infarction.

We aimed to evaluate the relation among epicardial adipose tissue (EAT) thickness, angiographic presence of thrombus, and the no-reflow in the patients with non-ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. The study population consisted of 229 patients. The EAT thickness and neutrophil to lymphocyte ratio (NLR) were significantly higher in the patients with coronary thrombus than in those without coronary thrombus (6.1 ± 1.1 vs 5.1 ± 1.3 mm, P < .001 and 3.4 ± 0.9 vs 2.5 ± 0.7, P < .001, respectively) and in the patients with no-reflow compared to patients with reflow. The EAT thickness was found to be correlated positively with the degree of the thrombus burden, NLR, and waist circumference and negatively with high-density lipoprotein cholesterol. Multivariate logistic regression analysis demonstrated that EAT thickness and NLR independently predicted coronary thrombus formation and no-reflow. We have suggested that EAT can play an important role in the pathophysiology of coronary thrombus formation and the no-reflow.

Relationship of left atrial global peak systolic strain with left ventricular diastolic dysfunction and brain natriuretic peptide level in patients presenting with non-ST elevation myocardial infarction.

BACKGROUND: In patients presenting with non-ST elevation myocardial infarction, we investigated the relationship of left atrial deformational parameters evaluated by 2-dimensional speckle tracking imaging (2D-STI) with conventional echocardiographic diastolic dysfunction parameters and brain natriuretic peptide level. MATERIAL AND METHODS: We enrolled 74 non-ST segment elevation myocardial infarction patients who were treated with percutaneous coronary intervention and 58 healthy control subjects. Non-ST segment elevation myocardial infarction patients had echocardiographic examination 48 h after the percutaneous coronary intervention procedure and venous blood samples were drawn simultaneously. In addition to conventional echocardiographic parameters, left atrial strain curves were obtained for each patient. Average peak left atrial strain values during left ventricular systole were measured. RESULTS: BNP values were higher in non-ST segment elevation myocardial infarction patients compared to controls. Mean left atrium peak systolic global longitudinal strain in Group 2 (the control group) was higher than in the non-ST segment elevation myocardial infarction group. Left atrium peak systolic global longitudinal strain was significantly correlated with left ventricular ejection fraction. There was a significant inverse correlation between left atrium peak systolic global longitudinal strain and brain natriuretic peptide level, left atrium volume maximum, and left atrium volume minimum. CONCLUSIONS: Our study shows that Left atrium peak systolic global longitudinal strain values decreased consistently with deteriorating systolic and diastolic function in non-ST segment elevation myocardial infarction patients treated with percutaneous coronary intervention. Left atrium peak systolic global longitudinal strain measurements may be helpful as a complimentary method to evaluate diastolic function in this patient population.

Spontaneous lingual and sublingual haematoma: a rare complication of warfarin use.

Warfarin is commonly used for prevention of embolic events. Bleeding is the main side effect of warfarin. Lingual and sublingual haematoma are rare. In the literature, nine cases have so far been reported. We report the case of a 70-year-old Caucasian woman who developed spontaneous lingual and sublingual haematomas while on warfarin therapy. Spontaneous lingual and sublingual haematoma are rare, but can be potentially life-threatening complications as they cause airway obstruction. To the best of our knowledge, this is the first reported case of earliest haematoma after warfarin use.

Mean platelet volume in patients with dilated cardiomyopathy: does it have a role in left ventricular thrombus formation?

We assessed the clinical echocardiograhic, hematological, and biochemical parameters in patients with dilated cardiomyopathy (DCMP) and control individuals mainly focusing on the mean platelet volume (MPV) in terms of DCMP and left ventricle (LV) thrombus formation. Consecutive patients (n = 251) with DCMP and 266 patients without DCMP were studied. Mean platelet volume was significantly greater in patients with DCMP than in control patients (P < .05 for all comparisons). Comparing DCMP patients with LV thrombus (19 patients, 8%) and without LV thrombus (232 patients, 92%) showed that the prevalence of smokers was significantly higher and ejection fraction was significantly lower in patients with LV thrombus. We have shown that patients with DCMP have significantly higher MPV suggesting more platelet activation and the MPV of patients with DCMP and LV thrombus is comparable to those of patients without LV thrombus.

Relationship of urocortin-2 with systolic and diastolic functions and coronary artery disease: an observational study.

OBJECTIVE: The urocortin (Ucn) hormones have many important roles in the cardiovascular system. Apart from systolic dysfunction (SD), there is no sufficient data on the relationship between serum Ucn-2 and diastolic dysfunction (DD), or coronary artery disease (CAD). We investigated serum Ucn-2 levels in SD, DD, and CAD. METHODS: In this observational cross-sectional study, study population was enrolled among outpatients who underwent coronary angiography with the pre-diagnosis of CAD. By examining the echocardiography 86 subjects were selected to study after coronary angiography. The subjects distributed over three groups to investigate the relationship between serum Ucn-2 and SD according to their ejection fraction (EF): subjects with moderate to severe SD (Group A, EF=33.6%), subjects with mild to moderate SD (Group B, EF=46.1%), and those without SD (Group C, EF=64.5%). Apart from these groups, the serum Ucn-2 levels were compared between subjects with and without DD (EF≥45%), and also compared between subjects with and without CAD (EF≥55%). Statistical analyses were performed using one-way ANOVA, Kruskal-Wallis, Chi-square, Mann-Whitney U, Spearman correlation and multiple regression analyses tests. RESULTS: Serum Ucn-2 levels were decreased in Group A and were increased in Group B compared to Group C (9.4±3.4, 12.8±3.6 vs. 10.4±3.9 pg/mL, respectively, p=0.003). Unlike SD; there was no significant difference in serum Ucn-2 levels between subjects with and without DD (11.4±4.1 vs 11.7±3.9 pg/mL, p=0.8) or CAD (10.7±4.7 vs 10.2±3.2 pg/mL, p=0.7). CONCLUSION: Ucn-2 is elevated in mild to moderate SD. But, DD (impaired relaxation pattern), or CAD (without myocardial infarction) seems to have no effect on Ucn-2 hormone levels.

Plasma viscosity and mean platelet volume in patients undergoing coronary angiography.

BACKGROUND: Markers of platelet activation and haemorrheological indices have been demonstrated to play a role in the pathophysiology of atherosclerosis and cardiovascular events. In this study, we aimed at investigate the association between plasma viscosity and platelet indices in patients undergoing coronary angiography. MATERIALS AND METHODS: Three hundred and eighty four consecutive patients scheduled to undergo coronary angiography were included in the study. Prior to coronary angiography, blood samples were withdrawn to determine routine biochemical markers, blood cell analyses and viscosity measurements. According to the results of coronary angiography, patients were classified either in a subgroup with coronary artery disease (CAD; 1 or more stenoses >50%) or normal coronary arteries (NCA; no stenoses or <50%). RESULTS: There was a statistically significant correlation between plasma viscosity and mean platelet volume levels in all patients undergoing coronary angiography (r=0.199, p<0.001). Additionally, when correlation analysis was performed within each group, plasma viscosity significantly correlated with MPV both in patients with CAD (r=0.18, p=0.004) and in patients with NCAs (r=0.272, p=0.002). Linear regression analysis revealed that plasma viscosity was positively associated with MPV while platelet number was inversely but significantly associated with MPV. CONCLUSION: We have shown for the first time that MPV correlates with plasma viscosity in patients undergoing coronary angiography, suggesting a relation with plasma proteins and activation of circulating platelets or peripheral consumption of platelets. To evaluate this relation further controlled studies also in patients with acute coronary syndromes are warranted.

Thromboembolic complications in patients with newly diagnosed dilated cardiomyopathy immediately after initiation of congestive heart failure treatment: just a coincidence or should we pay more attention?

Recently, we have experienced cerebrovascular embolic events in 2 consecutive patients in our outpatient clinic. Accordingly, we want to share our comments with literature on these 2 patients. Both patients had newly diagnosed left ventricular (LV) dysfunction, sinus rhythm, and cerebrovascular event within the first week after initiation of heart failure treatment. Although, our cases are not enough to make a general statement or conclusion, we can recommend that patients with newly diagnosed severe LV dysfunction with normal sinus rhythm and without echocardiographically visible thrombus should also be closely followed up for thromboembolic complications at least during the first weeks of congestive heart failure treatment.

Effect of slow coronary flow on electrocardiographic parameters reflecting ventricular heterogeneity.

QT interval dispersion reflects regional variations in ventricular repolarization and cardiac electrical instability. Previous studies have showed that QT interval dispersion changes during episodes of myocardial ischemia. Slow coronary flow (SCF) in epicardial coronary arteries is a rare and unique angiographic finding. Whether this pattern of flow is associated with electrocardiographic abnormalities is unknown. Therefore, this study was designed to investigate whether SCF results in electrocardiographic (ECG) changes compared to normal coronary flow. For this aim 24 patients with angiographically proven SCF who had no obstructive coronary lesion (group I) and 25 patients without coronary artery disease (group II) were included in the study. Both groups underwent a routine standard 12-lead surface electrocardiogram recorded at 50 mm/s during rest. QT dispersion (QTd), corrected QT (QTc), and corrected QT dispersion (QTcd) were calculated. Distributions of sex, age, body mass index (BMI), and cardiac risk factors were similar in the 2 groups. Mean heart rate was similar in the 2 groups (74 +/-8 vs 77 +/- 7 p > 0.05). Mean QRS interval durations were similar in the groups (92 +/-7 vs 90 +/-6 ms p > 0.005). In group I, QTd, QTcd, and QTc, were significantly higher than in group II (QTd: 73 +/-14 vs 40 +/-14; QTcd: 71 +/-15 vs 42 +/-9; QTc: 414 +/-14 vs 388 +/-13, respectively p <0.05). In conclusion, SCF was found to be associated with prolonged QT interval and increased QT dispersion. Ischemia in microvascular level and/or altered autonomic regulation of the heart may be responsible mechanisms.