Disease severity affects myocardial functions in patients with treatment-naive early rheumatoid arthritis.

OBJECTIVES: The cross-sectional study aimed to assess myocardial functions using global longitudinal strain (GLS) echocardiography and arrhythmia parameters with treatment naive newly diagnosed rheumatoid arthritis (RA) and no clinical evidence of cardiovascular disease (CVD). METHODS: Seventy seven newly diagnosed treatment-naive RA patients were enrolled. Disease severity was evaluated according to rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA) positivity, and Disease Activity Score 28 C-reactive protein (DAS28 CRP). Myocardial functions were assessed using conventional echocardiography and GLS technique and electrocardiogram parameters cQT and Tp-e/cQT. RESULTS: Twenty three patients had severe disease while 54 patients were non-severe. The Left Ventricle GLS (17.98 ± 1.24 vs 21.29 ± 1.03, P < .001), cQT (428.71 ± 9.05 vs 394.61 ± 17.83, P < .001), Tp-e/cQT (0.19 ± 0.02 vs 0.16 ± 0.01, P < .001) for severe RA patients was reduced compared to RA non-severe patients. Penalized maximum likelihood estimation logistic regression analysis revealed LVGLS as the only significantly independent predictor of severe RA disease (OR 0.70, CI 95% 0.52-0.92, P = .001). Receiver operating characteristic (ROC) curves of the LVGLS was revealed 19.9 as GLS discriminative value with 88.8% positive predictive value for predicting severity. Severe RA risk increases when log-odds value was over 0, corresponds to LVGLS value less than 18 by partial effect plots. CONCLUSION: RA severity was associated with lower LV systolic myocardial function and increased arrhythmia parameters. Only LVGLS was significantly independent predictor of RA disease severity.

Effect of Contrast-Induced Nephropathy on the Long-Term Outcome of Patients with Non-ST Segment Elevation Myocardial Infarction.

BACKGROUND: Contrast-induced nephropathy (CIN) has been traditionally associated with increased mortality and adverse cardiovascular events. We sought to determine whether CIN has a negative impact on the long-term outcome of patients with non-ST segment elevation myocardial infarction (NSTEMI). METHODS: A total of 312 consecutive patients (mean age 59 years, 76% male) who presented with NSTEMI and had undergone an early invasive procedure were retrospectively included. CIN was defined as either a 25% or 0.5-mg/dl increase in baseline serum creatinine (Cr) 72 h after the procedure. The primary endpoint of the study was mortality in the long-term follow-up (38 months, interquartile range 30-40). The secondary endpoint consisted of mortality and myocardial infarction (MI). RESULTS: CIN developed in 30 (9.6%) patients. Independent predictors of CIN were the contrast volume-to-Cr clearance ratio, left ventricular ejection fraction and hemoglobin concentration. The primary (20 vs. 8.5%, p = 0.042) and secondary endpoints (33.3 vs. 17%, p = 0.029) were observed more frequently in patients with CIN during long-term follow-up. The unadjusted odds ratio (OR) of CIN was 2.55 [95% confidence intervals (CI) 1.04-6.24, p = 0.040] for mortality and 2.15 (CI 1.09-4.25, p = 0.028) for mortality/MI. However, after adjustment for confounding factors, CIN was not an independent predictor of either mortality (OR 1.62, CI 0.21-12.57, p = 0.646) or mortality/MI (OR 1.12, CI 0.31-4.0, p = 0.860). CONCLUSION: The effect of CIN on the long-term outcome of patients with NSTEMI was substantially influenced by confounding factors. CIN was a marker, rather than a mediator, of increased cardiovascular risk, and the baseline renal function was more conclusive as a long-term prognosticator.

Clinical staging in chronic heart failure associated with low vitamin D and elevated parathormone levels.

OBJECTIVE: Growing evidence in the literature suggests a relationship between heart failure and vitamin D-parathormone cascade. The aim of the present study was to investigate the association of the clinical stage of the heart failure with vitamin D-parathormone levels. METHODS AND RESULTS: Ninety consecutive patients, who were admitted to our clinic from December 2012 to May 2013, were included in the present study. The patients with heart failure were clinically classified into four stages (stage A through stage D). Vitamin D and parathormone levels were measured and echocardiographic recordings were obtained from each patient. The patients with heart failure had significantly lower vitamin D levels compared to the control group (14.5 ng/ml versus 38 ng/ml, P < 0.001). In the four subgroups of patients with heart failure, vitamin D levels significantly decreased (30 ng/ml, 25 ng/ml, 13.5 ng/ml, and 6 ng/ml in stages A, B, C, and D, respectively), and parathormone levels significantly increased (50 pq/ml, 44 pq/ml, 70 pq/ml, and 98.5 pg/ml, respectively) with progression in the heart failure from stage A to stage D (P < 0.001). The log10 EF (B = -2.39, 95% CI = -3.36-1.42, P < 0.001), log10 BNP (B = 0.405, 95% CI = 0.13-0.69, P = 0.005, log10 vitamin D (B = -0.75, 95% CI = -1.18-0.31, P = 0.001) were the independent predictors of heart failure stage in multivariate regression analysis. CONCLUSIONS: Vitamin D and parathormone levels were closely associated with the stage of heart failure. There was a significant decrease in vitamin D levels and a significant increase in serum parathormone levels with clinical deterioration in heart failure.

[Nephrotoxicity of iodixanol versus iopamidol in patients with acute coronary syndrome]. / Akut koroner sendromlu hastalarda iyodiksanol ile iyopamidolün nefrotoksik etkilerinin karsilastirmasi

OBJECTIVES: The iso-osmolar contrast agent iodixanol may be associated with fewer contrast-induced acute kidney injuries when compared with low-osmolar contrast agents. The aim of this study is to compare iodixanol and iopamidol in patients with acute coronary syndrome (ACS) who are currently undergoing coronary angiography. STUDY DESIGN: Two hundred and seventy five consecutive patients who presented to a tertiary cardiovascular center with acute non-ST elevation myocardial infarction and underwent coronary angiography as a part of an early invasive strategy were included in the study (mean age 58±11 years, 79% male). Study participants were administered either iodixanol (n=45) or iopamidol (n=230) and the groups were compared for the highest creatinine levels, the absolute and percent change in creatinine levels, and for the development of contrast induced nephropathy within 72 hours of the procedure. RESULTS: Baseline demographic and clinical characteristics of the patients were similar between the two groups. There were no differences in the preprocedural serum creatinine (iopamidol 1.10±0.54 mg/dl, iodixanol 1.09±0.24 mg/dl, p=0.680), glomerular filtration rate (iopamidol 89±35 ml/dk/1.73 m(2), iodixanol 89±26 ml/dk/1.73 m(2), p=0.934), or contrast volume used during the procedure (iopamidol 180±80 ml vs. iodixanol 166±73 ml, p=0.226) between the groups. The absolute change in serum creatinine after the procedure (iopamidol 0.136±0.346 mg/dl, iodixanol 0.072±0.070 mg/dl, p=0.118) and the percent change in serum creatinine after the procedure (iopamidol 12.1±29.6%, iodixanol 6.8±6.9%, p=0.075) were not statistically significant between the two groups. Contrast induced nephropathy developed 10% (95% confidence interval [CI] 6-14%) in iopamidol group whereas it was 2.2% (95% CI -2-7%) in iodixanol group (p=0.144). CONCLUSION: Iodixanol was not superior to iopamidol regarding contrast induced acute kidney injury after coronary angiography in an unselected general patient population with ACS.