The role of myocardial perfusion imaging in predicting myocardial ischemia in patients diagnosed with long COVID.

OBJECTIVE: Incomplete recovery with long-term complications weeks beyond the acute coronavirus disease 2019 (COVID-19) infection is referred to as long COVID. Among the well-known long-term complications of COVID-19, myocardial damage is a frequently encountered side effect. Yet there is a lack of data for identifying high-risk patients who are more likely to develop long-term cardiovascular complications following COVID-19. Myocardial perfusion imaging (MPI) is the primary functional imaging modality in evaluating myocardial ischemia This study aimed to investigate the role of MPI in predicting myocardial ischemia in patients diagnosed with long COVID. METHODS: Subjects were selected from eligible long COVID patients and control subjects without a prior history of COVID-19 who were referred to the nuclear medicine department for stress and rest single-photon emission computed tomography (SPECT) MPI. All participants' past medical records and clinical, and demographic characteristics were scanned. In addition, patients undergoing coronary angiography (CAG) following SPECT MPI were documented and patients with critical coronary stenosis were identified. RESULTS: Our results revealed that long COVID patients had higher rates of abnormal summed stress scores compared to the control subjects (p < 0.05). Additionally, serum CRP level, SPECT lung-to-heart ratio (LHR), and the presence of long COVID were independent predictors of ischemia. The presence of long COVID was the best predictor of ischemia among the aforementioned parameters (p < 0.001). CONCLUSION: Our data indicate that SPECT MPI provides comprehensive information on myocardial perfusion and left ventricular function in long COVID patients.

Assessment of Long-Term Sequelae of Pulmonary Dysfunction Associated with COVID-19 Using Pulmonary Pulse Transit Time.

Background: Studies report deleterious impacts of severe acute respiratory syndrome coronavirus 2 on multiple organs in the human body, not only in the acute infection period but also in the long-term sequelae. Recently defined pulmonary pulse transit time (pPTT) was found to be a useful parameter regarding the evaluation of pulmonary hemodynamics. The purpose of this study was to determine whether pPTT might be a favorable tool for detecting the long-term sequelae of pulmonary dysfunction associated with coronavirus disease 2019 (COVID-19). Materials and Methods: We evaluated 102 eligible patients with a prior history of laboratory-confirmed COVID-19 hospitalization at least 1 year ago and 100 age- and sex-matched healthy controls. All participants' medical records and clinical and demographic features were analyzed and underwent detailed 12-lead electrocardiography, echocardiographic assessment, and pulmonary function tests. Results: According to our study, pPTT was positively correlated with forced expiratory volume in the 1st s, peak expiratory flow, and tricuspid annular plane systolic excursion (r = 0.478, P < 0.001; r = 0.294, P = 0.047; and r = 0.314, P = 0.032, respectively) as well as negatively correlated with systolic pulmonary artery pressure (r = -0.328, P = 0.021). Conclusion: Our data indicate that pPTT might be a convenient method for early prediction of pulmonary dysfunction among COVID-19 survivors.

Serum prolidase activity in patients with cardiac syndrome X.

OBJECTIVE: Although the underlying mechanism is not yet fully understood, Cardiac Syndrome X (CSX) is defined as microvascular dysfunction. Prolidase plays a role in collagen synthesis. Increased serum prolidase activity (SPA) has been shown to correlate with collagen turnover. Augmented collagen turn-over may be associated with vascular fibrosis and microvascular dysfunction. In this study, we assessed whether there was a correlation between CXS and prolidase activity. METHODS: This case-control study included 45 consecutive CSX patients (mean age 50.7±6.5 years, 27 women) and 40 healthy controls (mean age 51.2±6.5 years, 25 women). Prolidase activity was determined with the Human Xaa-Pro Dipeptidase/Prolidase enzyme-linked immunosorbent assay kit (Cusabio Biotech Co. Ltd, China). RESULTS: Mean prolidase activity was 898.8±639.1 mU/mL in the CSX group and 434.1±289.8 mU/mL in the control group (p<0.001). In ROC analysis, it was found that the SPA value above 350 mU/mL sympathizes with the diagnosis of CSX. CONCLUSION: Increased SPA in CXS patients may play an essential role in the pathophysiology of CSX, leading to augmented oxidative stress and vascular fibrosis, endothelial dysfunction, and increased microvascular resistance.

Association between galectin-3 levels and isolated coronary artery ectasia.

BACKGROUND: Coronary artery ectasia (CAE) is a well-recognised disorder characterised by abnormal dilation of the coronary arteries. Underlying mechanisms associated with abnormal luminal dilation in CAE remain to be elucidated. However, histopathological features resemble those of coronary atherosclerosis. Galectin-3 (Gal-3) is a valuable biomarker for both progression and destabilisation of atherosclerotic lesions. To the best of our knowledge, there is no study in the literature examining serum Gal-3 levels in patients with isolated CAE. In the present study, therefore, we aimed to investigate the possible relationship between serum Gal-3 levels and isolated CAE. METHODS: Between March 2016 and March 2017 this prospective, case-controlled study included a total of 49 consecutive isolated CAE patients (31 males, 18 females) diagnosed with CAE by coronary angiography at the catheter laboratory of Medeniyet University, Goztepe Training and Research Hospital, and 43 individuals (19 males, 24 females) with normal coronary arteries. Physical examination, medical history, blood biochemistry and transthoracic echocardiography were performed in both groups. Serum concentrations of Gal-3 were measured using blood samples. RESULTS: Median Gal-3 levels were significantly higher in isolated CAE patients than in the controls [23.2 (23.9 ± 7.1) vs 16.8 ng/ml (17.8 ± 7.3); p < 0.001]. According to the Markis classification, the extent of CAE was not correlated with Gal-3 levels (p = 0.41). Multivariate regression analysis revealed that Gal-3 concentration was an independent predictor of isolated CAE. CONCLUSIONS: Our study results suggest that Gal-3 serum concentrations significantly increased in patients with isolated CAE, indicating that Gal-3 may be involved in the pathogenesis of isolated CAE.

The Relationship between Epicardial Adipose Tissue Thickness and Serum Interleukin-17a Level in Patients with Isolated Metabolic Syndrome.

In this study, it was aimed to investigate the relationship between the epicardial adipose tissue thickness (EATT) and serum IL-17A level insulin resistance in metabolic syndrome patients. This study enrolled a total of 160 subjects, of whom 80 were consecutive patients who applied to our outpatient clinic and were diagnosed with metabolic syndrome, and the other 80 were consecutive patients who were part of the control group with similar age and demographics in whom the metabolic syndrome was excluded. The metabolic syndrome diagnosis was made according to International Diabetes Federation (IDF)-2005 criteria. EATT was measured with transthoracic echocardiography (TTE) in the subjects. IL-17A serum levels were determined using the ELISA method. Fasting blood glucose, HDL, triglyceride, and fasting insulin levels were significantly higher in the metabolic syndrome group compared to the control group. In addition, the metabolic syndrome group had significantly higher high-sensitivity C-reactive protein (hs-CRP) and Homeostatic Model Assessment Insulin Resistance (HOMA-IR) levels than the control group. Similarly, serum IL-17A levels were significantly elevated in the metabolic syndrome group compared to the control group statistically (p < 0.001). As well, EATT was higher in the metabolic syndrome than the control group. Conclusion: By virtue of their proinflammatory properties, EATT and IL-17 may play an important role in the pathogenesis of the metabolic syndrome.

Relationship between interleukin-17A and isolated coronary ectasia.

The aim of this study was to evaluate serum interleukin (IL)-17A levels in patients with coronary artery ectasia (CAE), the relationship between IL and 17A and CAE, and to determine the relationship between the severity of coronary ectasia and the level of IL-17A. In total, 41 patients (19 female and 22 male) with ischemic symptoms whose non-invasive cardiac tests were positive for myocardial ischemia, and in whom coronary artery ectasia were detected after coronary angiography, and 45 patients (32 female and 13 male) with normal coronary arteries were included in this study. Echocardiographic assessments were performed. Serum IL-17A levels of all patients were evaluated using an enzyme-linked immunosorbent assay. IL-17A levels of the group with isolated coronary artery ectasia were significantly higher compared with the control group (4.86 ±â€¯3.24 and 1.37 ±â€¯1.56 ng/ml, respectively; p < 0.001). There was no correlation between the levels of IL-17A and the extension of the CAE, but IL-17A levels were high in both groups. CAE patients have significantly increased levels of IL-17A, fibrinogen, and RDW compared to patients with normal coronary arteries. It was demonstrated that increased levels of IL-17A were associated with ectasia formation in CAE patients.

Evaluation of atrial electromechanical functions in dipper and nondipper hypertension patients using left atrial strain P-wave dispersion and P terminal force.

OBJECTIVE: Nondippers are known to carry a high risk of cardiovascular morbidity and mortality. The aim of this study was to investigate the effects of dipper and nondipper status of hypertension on left atrial (LA) systolic and diastolic functions using two-dimensional speckle tracking echocardiography (2D-STE), P-wave dispersion (PWD), and P terminal force (PTF) in hypertensive patients. METHODS: A total of 72 patients and 39 healthy individuals were included in the study. The patients were classified as nondippers if their daytime ambulatory systolic and diastolic blood pressure did not decrease by at least 10% during the night. Atrial electromechanical delay times, LA strain values were obtained by 2D-STE with automated software and compared between the groups. PWD and PTF data were calculated on the electrocardiography. RESULTS: Inter-atrial (dippers: 25.5 ± 3.9, nondippers: 32.2 ± 7.4, P < .001), left-atrial (dippers: 14.9 ± 3.7, nondippers: 18.2 ± 6.0, P = .016), and right atrial (dippers: 10.5 ± 2.1, nondippers: 14.2 ± 5.2, P < .001) electromechanical delay times were significantly longer in nondippers. LA strain S (dippers: 34.2 [29.7-38.7], nondippers: 27.7 [22.7-32.2], P < .001), LA strain E (dippers: 18.2 [16.6-20.1], nondippers: 14.4 [11.6-16.8], P < .001), and LA strain A (dippers: 15.8 [13.5-17.9], nondippers: 12.7 [9.9-14.5], P < .001) were significantly lower in nondippers. Nondippers also had an increased values of maximum P-wave duration (dippers: 0.117 [0.10-0.12], nondippers: 0.126 [0.12-0.14], P < .001), PWD (dippers: 0.062 [0.06-0.07], nondippers: 0.069 [0.06-0.08], P = .004), and PTF (dippers: 0.055 ± 0.02, nondippers: 0.066 ± 0.02, P = .02). CONCLUSION: Nondipping pattern in hypertensive patients had a worse cardiac remodeling, and impaired mechanical LA function compared with dipping pattern. The PWD and PTF findings support these changes.

[Relationship between serum level of CD40 ligand and persistent lone atrial fibrillation]. / Serum CD40 ligand düzeyi ile tek basina israrci atriyum fibrilasyonu iliskisi.

OBJECTIVE: Inflammation is thought to play a role in the pathogenesis of atrial fibrillation. The relationship between CD40 ligand (CD40L), a prothrombotic and proinflammatory molecule, and lone atrial fibrillation was presently investigated for the first time. Levels of serum CD40L were also tested, regarding potential to distinguish patients with lone atrial fibrillation from healthy individuals. METHODS: Presently included were 35 patients with lone persistent atrial fibrillation and a control group of 30 healthy individuals. Serum levels of CD40L and high-sensitive C-reactive protein (hs-CRP) were measured, and transthoracic echocardiography was performed. RESULTS: Mean serum CD40L, hs-CRP, left ventricular end-diastolic diameter, and left atrial diameter values were significantly higher in the group with lone persistent atrial fibrillation than in the control group (7.4±3.5 ng/mL vs 4.3±1.2 ng/mL, p<0.0001; 3.7±1.6 mg/L vs 1.7±0.8 mg/L, p<0.0001; 53.0±4.2 mm vs 46.0±3.8, p<0.0001; 43.5±3.5 mm vs 33.7±3.5, p<0.0001, respectively). Serum CD40L levels were positively correlated with left atrial diameter (r=0.81, p<0.0001) and hs-CRP (r=0.72, p<0.0001). Receiver operating characteristic curve analysis revealed that serum CD40L at the optimal cut-off level of >4.5 ng/mL successfully discriminated patients with lone atrial fibrillation from controls (area under the curve: 0.847; 95% confidence interval: 0.759-0.934; p<0.0001). CONCLUSION: The present findings suggest that CD40L levels play a crucial role in the development of lone atrial fibrillation. In addition, results support that regular clinical follow-up of these patients is necessary, due to increased cardiovascular disease risk, determined by elevated CD40L levels.

Diagnostic significance of serum galectin-3 levels in heart failure with preserved ejection fraction.

OBJECTIVE: Galectin-3, reflecting cardiac fibrosis, is a promising biomarker in early detection of heart failure with preserved ejection fraction (HFpEF). We aimed to clarify the clinical utility of galectin-3 levels in the diagnosis of HFpEF and to compare galectin-3 with N-terminal pro-brain-type natriuretic peptide (NT-proBNP) levels. METHODS AND RESULTS: The study included 44 HFpEF patients (mean age 60 ± 6.78 years, 24 men) and 38 control subjects (mean age 57 ± 8.98 years, 20 men). Galectin-3 and NT-proBNP levels were assessed by the ELISA kits. The receiver operating characteristics (ROC) curve was used to examine the diagnostic performance of galectin-3 and NT-proBNP in HFpEF. Galectin-3 and NT-proBNP levels were significantly increased in patients with HFpEF compared to controls [5.35 ng/ml (0.86 ­ 14.90) vs 0.51 ng/ml (0.15 ­ 1.71) P < 0.0001, 617.75 ± 271.30 pg/ml vs 66.35 ± 54.01 pg/ml P < 0.0001, respectively]. Galectin-3 correlated with NT-proBNP, left atrial volume index, left ventricular mass index, and E/E' (r = 0.90, P < 0.0001; r = 0.75, P = 0.0001; r = 0.86, P = 0.0001; r = 0.80, P = 0.0001; respectively). The area under the ROC curve was 0.98 for galectin-3 and 1.0 for NT-proBNP. CONCLUSIONS: Our results support that, in addition to NT-proBNP, galectin-3 is also a valuable biomarker for the diagnosis of patients with HFpEF.

Does Inflammation Have a Role in the Pathogenesis of Cardiac Syndrome X? A Genetic-Based Clinical Study With Assessment of Multiple Cytokine Levels.

We compared Turkish patients with cardiac syndrome X (CSX) and controls with respect to serum pro- and anti-inflammatory cytokine levels, as well as the single-nucleotide polymorphisms located in the promoter regions of their related genes. This study included 111 consecutive patients angiographically diagnosed with CSX and 111 healthy controls with similar demographic characteristics. Serum interleukin (IL) 6, tumor necrosis factor α (TNF-α), and IL-10 levels were measured, and the genotypes of the patients and controls were determined using standard methods. Serum IL-6 and IL-10 levels were significantly higher in the CSX group than in the control group (P < .01, respectively). Serum TNF-α level was lower in the CSX group than in the control group (P < .001). On the other hand, participants with CSX and healthy controls were not significantly different with respect to the genotype distributions of IL-6, TNF-α, and IL-10 genes. As a result of our study, both pro-inflammatory and anti-inflammatory cytokines may play a role in the pathogenesis of CSX. In contrast, the studied gene polymorphisms did not influence CSX pathogenesis.

The Trends in Utilizing Nonvitamin K Antagonist Oral Anticoagulants in Patients With Nonvalvular Atrial Fibrillation: A Real-Life Experience.

Dabigatran and rivaroxaban are novel nonvitamin K antagonist oral anticoagulants (NOACs) approved for thromboprophylaxis in atrial fibrillation (AF). In Turkey, like other countries, the efficacy of translation of the clinical trial results and current guideline recommendations into daily clinical practice is yet to be discovered. Using data from medical records of three tertiary care cardiology centers, we identified patients with nonvalvular AF on dabigatran or rivaroxaban treatment. Baseline characteristics and utilization trends were compared between dabigatran and rivaroxaban groups. Secondarily, clinical events including ischemic stroke and/or transient ischemic attack, systemic embolism, and bleeding were evaluated. Among 294 patients with AF included, dabigatran was utilized in 177 (60.2%) and rivaroxaban in 117 (39.8%). Overall, 76% of patients had received long-term warfarin therapy. The use of 110 mg twice a day (55.4%) was the prevailing strategy in dabigatran group, whereas in rivaroxaban group 20 mg every day (67.5%) was the preferred option. Of the patients, 37.3% had severe valvular disease in which mitral regurgitation was the predominant valve abnormality. Scores of CHADS2, CHA2DS2VASc, and HAS-BLED were similar in both the groups. Of the patients, 24% in dabigatran group and 13.7% in rivaroxaban group were prescribed the lower dose inappropriately. The two NOACs did not differ significantly in terms of clinical events. The results of this study indicate that in daily practice, the physicians' behavior in utilizing the NOACs is shaped by the clinical trials and the guideline recommendations. On the other hand, in dose selection, this adherence is not of high quality.

Relationship between epicardial adipose tissue thickness and vitamin D in patients with metabolic syndrome.

INTRODUCTION: Metabolic syndrome is a systemic disorder and manifests as a group of conditions including abdominal obesity, dyslipidemia, hypertension and coronary artery disease. The importance of epicardial adipose tissue has been proven through recognition of its contribution to inflammation by pro-inflammatory cytokine discharge. Several investigations have been performed on vitamin D receptors in different tissues. In this study, epicardial adipose tissue thickness (EATT) and the levels of vitamin D were measured and compared with a healthy control group. MATERIAL AND METHODS: 84 patients who had metabolic syndrome without diabetes and 64 healthy individuals were enrolled into the study. In all patients, the EATT was calculated by ecocardiography and the level of serum 25 (OH) vitamin D was measured. RESULTS: It was observed that EATT in patients with metabolic syndrome increases significiantly compared to the healthy control group (P < 0.001). No significant difference between patients and control group was found for the levels of 25 (OH) vitamin D (P = 0.507). There was no correlation between 25 (OH) vitamin D and EATT (P = 0.622). CONCLUSIONS: We observed that EATT increased in patients with metabolic syndrome. In contradiction to literature; the levels of 25 (OH) vitamin D was not found to be high in patients with metabolic syndrome. Any significant correlation was not found between EATT and 25 (OH) vitamin D levels. Further studies with a larger patient population are required to assess the relationship.

Low vitamin D status associated with dilated cardiomyopathy.

In recent years, a growing body of evidence supports that vitamin D plays a crucial role in various cardiovascular diseases. Cardiac muscle cells have vitamin D receptors as well as calcitriol-dependent Ca(2+) binding protein. Therefore, the vitamin D may have an effect on cardiac function. In this research, we investigated the association between vitamin D status and dilated cardiomyopathy (DCMP). We compared serum 25-hydroxy-vitamin D3 (25OHD3) concentrations in 39 patients (mean age 50.4 ± 11.7 years, 15 women) with DCMP and in 35 healthy controls (mean age 54.6 ± 13.2 years, 17 women). Parathyroid hormone (PTH), calcium (Ca++), phosphorus, lipid profile, albumin and echocardiographic parameters (left-ventricular (LV) ejection fraction, LV fractional shortening, LV-end-diastolic and end-systolic dimensions) were measured in all study participants. The mean serum 25OHD3 concentrations in patients with the DCMP were significantly lower in compared to healthy controls (24.1 ± 10.4 ng/mL versus 41.4 ± 20.9 ng/mL, P < 0.0001). PTH concentrations were significantly higher in patients with DCMP in comparison with healthy controls (90.6 ± 29.8 pg/mL versus 49.1 ± 18 pg/mL, P < 0.0001). Additionally, we observed a significant negative correlation between 25OHD3 concentrations and PTH concentrations, LV end-diastolic dimensions, LV end-systolic dimensions (r = -0.66; P < 0.0001, r = -0.49; P < 0.0001, r = -0.50; P < 0.0001, respectively). Moreover, 25OHD3 was positively correlated with LV ejection fraction, LV fractional shortening, stroke volume, cardiac output, cardiac index (r = 0.46; P < 0.001, r = 0.44; P < 0.001, r = 0.25; P = 0.03, r = 0.37; P < 0.001, r = 0.25; P = 0.03; respectively). Our findings support that vitamin D has a potential role both in the development of DCMP and LV remodeling.

The Association between the Epicardial Adipose Tissue Thickness and Oxidative Stress Parameters in Isolated Metabolic Syndrome Patients: A Multimarker Approach.

The risk for cardiovascular diseases and type 2 diabetes mellitus significantly increases in the patient population with metabolic syndrome (MeS). The present study aimed to investigate the association between the epicardial adipose tissue thickness (EATT) and the oxidative stress parameters in MeS patients. The study included 181 patients as a patient group of 92 consecutive patients with MeS and a control group of 89 consecutive patients with similar age and gender. EATT was evaluated by transthoracic echocardiography. Serum levels of total oxidant status (TOS), total antioxidative capacity (TAS), paraoxonase-1 (PON-1), and arylesterase activities were measured. EATT was higher in the MeS group compared to the control group (6.0 ± 2.0 mm and 4.0 ± 1.0 mm, resp.; P < 0.001). The level of TOS was higher in the MeS group compared to the control group (P < 0.001). Additionally, the TAS level was higher in the MeS group compared to the control group (P < 0.001). Furthermore, the serum levels of PON-1 and arylesterase were lower in the MeS group compared to the control group (P < 0.001). EAT may cause an increased risk of cardiovascular diseases by leading to increased oxidative stress in patients with MeS.