The Relationship Between Carcinoembryonic Antigen and Epicardial Adipose Tissue

Abstract Background: Inflammation, which is associated with an unhealthy lifestyle, plays a critical role in the development of both cardiometabolic diseases (CMD) and cancer. Carcinoembryonic antigen (CEA) is a tumor marker which also has proinflammatory properties. Recent studies have reported CEA to be associated with atherosclerosis, metabolic syndrome, and visceral adiposity. Epicardial adipose tissue (EAT) can exhibit highly inflammatory and pathogenic properties, and is a known risk factor for CMD. However, its relationship with CEA is still unknown. Objectives: This study aimed to investigate the possible association of CEA with EAT. Methods: A total of 134 Caucasian (males = 56, females = 78) individuals, aged (22-83 years), who were admitted for routine health control, were enrolled in this cross-sectional study. CEA was measured with chemiluminescent microparticle immunoassay (CMIA). EAT was measured by transthoracic echocardiography, and the visceral fat rating (VFR) was assessed by a body composition analyzing machine. The p-value <0.05 was considered statistically significant. Results: CEA levels were categorized as tertiles: T1, 0.5-1.04; T2, 1.06-1.69; and T3, ≥1.7 ng/ml. The mean age, weight, VFR, EAT, and fasting glucose, as well as the median of systolic blood pressure (SBP), creatinine, and AST increased with the increasing CEA tertiles. CEA was significantly associated with EAT (r = 0.55, P<0.001) and VFR (r = 0.36, P<0.001). Multivariate linear regression analysis confirmed that gender, age, and EAT were the significant independent variables associated with CEA. Conclusion: Individuals with increased EAT have higher levels of CEA, suggesting that this biomarker is most likely produced by EAT; however, additional investigations are required to improve the present work.

Impact of arterial stiffness on echocardiographic myocardial work indices in patients with isolated bicuspid aortic valve.

OBJECTIVE: Data related to the existence of left ventricular (LV) abnormalities in normal functional bicuspid aortic valve (BAV) disease is scarce. In addition, the impact of afterload and the involved mechanisms are unclear. In this work, we study the relationship between LV function assessed with myocardial work index (MWI) and arterial stiffness in a cohort of normal functioning BAV patients. METHODS: In this study, we included a total of 38 consecutive patients with isolated BAV and 44 age- and gender-matched control subjects with tricuspid aortic valve. All participants underwent transthoracic echocardiography to assess conventional parameters and global longitudinal strain (GLS). In addition, MWI was measured by the noninvasive LV pressure-strain cycle method. Aortic pulse wave velocity (PWV) and wave reflection were evaluated by applanation tonometry. RESULTS: The mean aortic PWV was significantly higher in BAV patients (6.4 ± 0.80, 7.02 ± 0.1.2, p = .01, respectively). LV-MWI related parameters such as global work efficiency (GWE) (96.261.69 and 97.051.27, p = .02) and global wasted work (GWW) (78.232.1 and 61.824.4, p = .01) were found significantly different between the BAV and control groups. However, global working index and global constructive working were not different between groups (1969 ± 259 and 2014 ± 278, p = .45; 2299 ± 290 and 2359 ± 345, p = .39, respectively). Multivariable ordinary least squares regression analysis revealed that BAV (ß = 8.4; 95% CI: 1.5-15.3; p = .04) and PVW (ß = 5.6; 95% CI: 0.7-10.5; p = .01) were significant predictors of GWV. CONCLUSION: GWW is increased and GWE is decreased in patients with BAV compared with controls, and these changes are related to arterial stiffness. The relationship between aortic PWV and GWW may help to explain the exact mechanism of subclinical myocardial dysfunction in patients with isolated BAV.

Comparação das Novas Equações de Martin/Hopkins e Sampson para o Cálculo do Colesterol de Lipoproteína de Baixa Densidade em Pacientes Diabéticos / Comparison of Novel Martin/Hopkins and Sampson Equations for Calculation of Low-Density Lipoprotein Cholesterol in Diabetic Patients

Resumo Fundamentos A determinação precisa do colesterol de lipoproteína de baixa densidade (LDL-C) é importante para se alcançar concentrações de LDL-C recomendadas por diretrizes e para reduzir resultados cardiovasculares adversos em pacientes diabéticos. A equação de Friedewald comumente usada (LDL-Cf) produz resultados imprecisos em pacientes diabéticos devido a dislipidemia diabética associada. Recentemente, duas novas equações - Martin/Hopkins (LDL-CMH) e Sampson (LDL-Cs) - foram desenvolvidas para melhorar a precisão da estimativa de LDL-C, mas os dados são insuficientes para sugerir a superioridade de uma equação sobre a outra. Objetivos O presente estudo comparou a precisão e a utilidade clínica das novas equações de Martin/Hopkins e Sampson em pacientes diabéticos. Método Foram incluídos no estudo quatrocentos e dois (402) pacientes com diabetes. O risco cardiovascular dos pacientes e as metas de LDL-C foram calculadas por diretrizes europeias. As concentrações de LDL-Cmh, LDL-Cs, e LDL-Cf calculadas foram comparadas à concentração de LDL-C direto (LDL-Cd) para testar a concordância entre essas equações e LDL-Cd. Um P valor <0,05 foi aceito como estatisticamente significativo. Resultados A LDL-CMH e a LDL-Cs tiveram concordância melhor com o LDL-Cd em comparação com a LDL-Cf, mas não houve diferenças estatísticas entre as novas equações para concordância com o LDL-Cd (Alfa de Cronbach de 0,955 para ambos, p=1). Da mesma forma, a LDL-CMH e a LDL-Cs tinham um grau semelhante de concordância com o LDL-Cd para determinar se o paciente estava dentro da meta de LDL-C (96,3% para LDL-Cmh e 96,0% para LDL-Cs), que eram ligeiramente melhores que a LDL-Cf (94,6%). Em pacientes com uma concentração de triglicérides >400 mg/dl, a concordância com o LDL-Cd foi ruim, independentemente do método usado. Conclusão As equações de Martin/Hopkins e Sampson mostram uma precisão similar para o cálculo de concentrações de LDL-C nos pacientes com diabetes, e ambas as equações são ligeiramente melhores que a equação de Friedewald.

Abstract Background The accurate determination of low-density lipoprotein cholesterol (LDL-C) is important to reach guideline-recommended LDL-C concentrations and to reduce adverse cardiovascular outcomes in diabetic patients. The commonly used Friedewald equation (LDL-Cf), gives inaccurate results in diabetic patients due to accompanying diabetic dyslipidemia. Recently two new equations - Martin/Hopkins (LDL-Cmh) and Sampson (LDL-Cs) - were developed to improve the accuracy of LDL-C estimation, but data are insufficient to suggest the superiority of one equation over the other one. Objective The present study compared the accuracy and clinical usefulness of novel Martin/Hopkins and Sampson equations in diabetic patients. Methods This study included 402 patients with diabetes. Patients' cardiovascular risk and LDL-C targets were calculated per European guidelines. Calculated LDL-Cmh, LDL-Cs, and LDL-Cf concentrations were compared with direct LDL-C concentration (LDL-Cd) to test agreement between these equations and LDL-Cd. A p-value <0.05 was accepted as statistically significant. Results Both LDL-Cmh and LDL-Cs had a better agreement with LDL-Cd as compared to LDL-Cf, but no statistical differences were found among novel equations for agreement with LDL-Cd (Cronbach's alpha 0.955 for both, p=1). Likewise, LDL-Cmh and LDL-Cs showed a similar degree of agreement with LDL-Cd in determining whether a patient was in a guideline-recommended LDL-C target (96.3% for LDL-Cmh and 96.0% for LDL-Cs), which were marginally better than LDL-Cf (94.6%). In patients with a triglyceride concentration >400 mg/dl, agreement with LDL-Cd was poor, regardless of the method used. Conclusion Martin/Hopkins and Sampson's equations show a similar accuracy for calculating LDL-C concentrations in patients with diabetes, and both equations were marginally better than the Friedewald equation.

Comparison of Novel Martin/Hopkins and Sampson Equations for Calculation of Low-Density Lipoprotein Cholesterol in Diabetic Patients. / Comparação das Novas Equações de Martin/Hopkins e Sampson para o Cálculo do Colesterol de Lipoproteína de Baixa Densidade em Pacientes Diabéticos.

BACKGROUND: The accurate determination of low-density lipoprotein cholesterol (LDL-C) is important to reach guideline-recommended LDL-C concentrations and to reduce adverse cardiovascular outcomes in diabetic patients. The commonly used Friedewald equation (LDL-Cf), gives inaccurate results in diabetic patients due to accompanying diabetic dyslipidemia. Recently two new equations - Martin/Hopkins (LDL-Cmh) and Sampson (LDL-Cs) - were developed to improve the accuracy of LDL-C estimation, but data are insufficient to suggest the superiority of one equation over the other one. OBJECTIVE: The present study compared the accuracy and clinical usefulness of novel Martin/Hopkins and Sampson equations in diabetic patients. METHODS: This study included 402 patients with diabetes. Patients' cardiovascular risk and LDL-C targets were calculated per European guidelines. Calculated LDL-Cmh, LDL-Cs, and LDL-Cf concentrations were compared with direct LDL-C concentration (LDL-Cd) to test agreement between these equations and LDL-Cd. A p-value <0.05 was accepted as statistically significant. RESULTS: Both LDL-Cmh and LDL-Cs had a better agreement with LDL-Cd as compared to LDL-Cf, but no statistical differences were found among novel equations for agreement with LDL-Cd (Cronbach's alpha 0.955 for both, p=1). Likewise, LDL-Cmh and LDL-Cs showed a similar degree of agreement with LDL-Cd in determining whether a patient was in a guideline-recommended LDL-C target (96.3% for LDL-Cmh and 96.0% for LDL-Cs), which were marginally better than LDL-Cf (94.6%). In patients with a triglyceride concentration >400 mg/dl, agreement with LDL-Cd was poor, regardless of the method used. CONCLUSION: Martin/Hopkins and Sampson's equations show a similar accuracy for calculating LDL-C concentrations in patients with diabetes, and both equations were marginally better than the Friedewald equation.

FUNDAMENTOS: A determinação precisa do colesterol de lipoproteína de baixa densidade (LDL-C) é importante para se alcançar concentrações de LDL-C recomendadas por diretrizes e para reduzir resultados cardiovasculares adversos em pacientes diabéticos. A equação de Friedewald comumente usada (LDL-Cf) produz resultados imprecisos em pacientes diabéticos devido a dislipidemia diabética associada. Recentemente, duas novas equações ­ Martin/Hopkins (LDL-CMH) e Sampson (LDL-Cs) ­ foram desenvolvidas para melhorar a precisão da estimativa de LDL-C, mas os dados são insuficientes para sugerir a superioridade de uma equação sobre a outra. OBJETIVOS: O presente estudo comparou a precisão e a utilidade clínica das novas equações de Martin/Hopkins e Sampson em pacientes diabéticos. MÉTODO: Foram incluídos no estudo quatrocentos e dois (402) pacientes com diabetes. O risco cardiovascular dos pacientes e as metas de LDL-C foram calculadas por diretrizes europeias. As concentrações de LDL-Cmh, LDL-Cs, e LDL-Cf calculadas foram comparadas à concentração de LDL-C direto (LDL-Cd) para testar a concordância entre essas equações e LDL-Cd. Um P valor <0,05 foi aceito como estatisticamente significativo. RESULTADOS: A LDL-CMH e a LDL-Cs tiveram concordância melhor com o LDL-Cd em comparação com a LDL-Cf, mas não houve diferenças estatísticas entre as novas equações para concordância com o LDL-Cd (Alfa de Cronbach de 0,955 para ambos, p=1). Da mesma forma, a LDL-CMH e a LDL-Cs tinham um grau semelhante de concordância com o LDL-Cd para determinar se o paciente estava dentro da meta de LDL-C (96,3% para LDL-Cmh e 96,0% para LDL-Cs), que eram ligeiramente melhores que a LDL-Cf (94,6%). Em pacientes com uma concentração de triglicérides >400 mg/dl, a concordância com o LDL-Cd foi ruim, independentemente do método usado. CONCLUSÃO: As equações de Martin/Hopkins e Sampson mostram uma precisão similar para o cálculo de concentrações de LDL-C nos pacientes com diabetes, e ambas as equações são ligeiramente melhores que a equação de Friedewald.

Lack of right ventricular hypertrophy is associated with right heart failure in patients with left ventricular failure.

Presence of right heart failure (RHF) is associated with a worse prognosis in patients with left ventricular failure (LVF). While the cause of RHF secondary to LVF is multifactorial, an increased right ventricular (RV) afterload is believed as the major cause of RHF. However, data are scarce on the adaptive responses of the RV in patients with LVF. Our aim was to understand the relationship of right ventricular hypertrophy (RVH) with RHF and RV systolic and diastolic properties in patients with LVF. 55 patients with a left ventricular ejection fraction of 40% or less were included in the present study. A comprehensive two-dimensional transthoracic echocardiographic examination was done to all participants. 12 patients (21.8%) had RHF, and patients with RHF had a significantly lower right ventricular free wall thickness (RVFWT) as compared to patients without RHF (5.3 ± 1.7 mm vs. 6.6 ± 0.9 mm, p = 0.02) and the difference remained statistically significant after adjusting for confounders (Δx̅:1.34 mm, p = 0.002). RVFWT had a statistically significant correlation with tricuspid annular plane systolic excursion (r = 0.479, p < 0.001) and tricuspid annular lateral systolic velocity (r = 0.360, p = 0.007), but not with the indices of the RV diastolic function. None of the patients with concentric RVH had RHF, while 22.2% of patients with eccentric RVH and 66.7% of patients without RVH had RHF (p < 0.01 as compared to patients with concentric RVH). In patients with left ventricular systolic dysfunction, absence of RVH was associated with worse RV systolic performance and a significantly higher incidence of RHF.

Transcutaneous Puncture and Successfully Retrieval of Undeflated Peripheral Angioplasty Balloon.

Percutaneous transluminal angioplasty has gained increasing popularity in the treatment of peripheral artery disease. However, the increase in the frequency of this procedure also increases the risk of complications. Percutaneous transluminal angioplasty has serious and general complications in terms of device and technique at puncture and dilatation sites. In this case, we describe the easy and practical management of deflating an undeflated ballon in the right superficial femoral artery.

Peripheral neural blockade for pain control in patients undergoing percutaneous angioplasty for complex infrapopliteal disease.

In recent years, percutaneous transluminal angioplasty has become the preferred revascularization option for chronic limb-threatening ischemia (CLTI) and infrapopliteal (IP) arterial disease. CLTI and IP disease require complex and lengthy procedures that necessitate multiple balloon inflations and frequent contrast injections. It will lead to severe discomfort if periprocedural pain control is inadequate. Conventional methods such as local anesthesia and systemic opioids are usually inadequate to provide pain control for complex IP arterial disease interventions. Ultrasound-guided peripheral nerve blockade (PNB) has been recently employed in peripheral procedures, with several small studies reporting favorable results in patients who underwent not complex interventions. In the present series, we report our experience of 4 patients who underwent PNB to relieve pain during endovascular treatment of complex IP disease, and in whom we have observed excellent periprocedural pain control that led to satisfactory postprocedural outcomes.

Is subcutaneous fat tissue embolization effective and safe as a septal reduction technique in a patient with hypertrophic obstructive cardiomyopathy?

Hypertrophic obstructive cardiomyopathy is an inheritable cardiac disease that typically manifests with an increased left ventricular outflow tract gradient. In most cases, basal septal hypertrophy and systolic anterior motion of the anterior mitral valve leaflet are the key components of the left ventricular outflow tract obstruction. The goal of septal reduction therapy, a widely accepted treatment modality, is to remove this obstruction. Although myectomy is a wellestablished and effective surgical technique for septal reduction therapy, transcoronary alcohol septal ablation is an alternative therapy for patients who decline to have surgery or who are not suited to a surgical intervention. A new septal reduction method has also been described in the literature. This case report describes the successful treatment of hypertrophic obstructive cardiomyopathy in a 57-year-old female using the new septal reduction technique.

Severe mitral regurgitation is associated with increased copeptin levels in heart failure with reduced ejection fraction.

BACKGROUND AND AIM: The objective of this study was to assess the potential role of mitral regurgitation (MR) in the release of copeptin in heart failure patients with reduced ejection fraction (HFrEF). METHODS: The study included 63 patients of whom 33 had functional mild MR (Group 1) and 30 had functional severe MR (Group 2). The functional class of both groups was New York Heart Association (NYHA) Class III. Blood samples for the determination of plasma copeptin and B-type natriuretic peptide (BNP) levels were obtained on the same day with the echo-cardiographic examination. Standard echocardiographic studies were performed. RESULTS: Copeptin and BNP levels showed a substantial agreement in the whole study group (Kappa level: 0.607, p < 0.0001). Also, copeptin and BNP showed a strong correlation and were both increased and significantly higher in Group 2 than in Group 1 (p < 0.001 and p < 0.05, respectively). Left ventricular global longitudinal strain and left ventricular ejection fraction values were similar in both groups. The study population were divided into two subgroups on the basis of copeptin median level (6.4 ng/mL), and the prevalence of severe MR was significantly higher in the above-median-copeptin subgroup. A linear regression analysis showed that the presence of severe MR was the only independent predictor of high circulating plasma copeptin level (OR 7.5, 95% CI 2.8-12.1; p = 0.002). CONCLUSIONS: Severe MR is an independent predictor of elevated plasma copeptin level in HFREF irrespective of systolic function.