Relation of a novel fibrosis marker and post-myocardial infarction left ventricular ejection fraction in revascularized patients.

Aim: To investigate the relationship between post-myocardial infarction (MI) left ventricular ejection fraction (LVEF) and fibrosis marker HE-4 in primarily revascularized patients with ST-segment elevation MI (STEMI). Patients & methods: In 94 consecutive STEMI patients (median age 57 [IQR: 50-69] years; 77.7% male), HE-4 values were measured at hospital admission and 4 days after STEMI. Transthoracic echocardiography was performed 4 days after STEMI (median 5 days [interquartile range: 4-6]). Results: HE-4 levels 4 days after STEMI were significantly higher in the low ejection fraction group (30.1 [26.0-46.5] pmol/l vs 48.5 [32.5-85.9] pmol/l, p = 0.004). In the multivariable analysis, HE-4 values (odds ratio: 1.029, 95% CI: 1.012-1.046, p = 0.001), troponin I levels, anterior MI and diabetes mellitus were independent predictors of low LVEF after STEMI. A negative correlation existed between ΔHE-4 levels and LVEF (r: -0.337, p = 0.001). Receiver operating characteristic analysis indicated 34.01 pmol/l HE-4 at 4 days after STEMI identified patients with low LVEF (AUC = 0.707; 95% CI: 0.601-0.813; p = 0.001). Conclusion: In revascularized STEMI patients, high HE-4 levels are associated with decreased LVEF. HE-4 may represent a diagnostic marker and treatment target for patients with heart failure or left ventricular systolic dysfunction after STEMI.

The predictive value of stress hyperglycemia on thrombus burden in nondiabetic patients with ST-segment elevation myocardial infarction.

: It is established that hyperglycemia directly effects the platelet functions and fibrin structure. In this study, we aimed to investigate the predictive value of hyperglycemia on thrombus burden in nondiabetic patients with ST-segment elevation myocardial infarction (STEMI) who underwent to primer percutaneous coronary intervention (PPCI). We enrolled 619 nondiabetic patients with STEMI who received PPCI. Patients were divided two groups according to thrombus burden. Stress hyperglycemia was determined as blood glucose concentration more than 180 mg/dl and angiographic coronary thrombus burden was scored based on thrombolysis in myocardial infarction thrombus grades. Patients with thrombus grades 4 were defined as large thrombus burden (LTB), patients with thrombus burden less than thrombus grades 4 were defined as small thrombus burden. A total of 68 (11.0%) STEMI patients had stress hyperglycemia, while 223 (36.0%) patients had LTB. Sex, the prevalence of hypertension, smoking, and dyslipidemia were not different between the thrombus burden groups (P > 0.05 for all parameters). Compared with the patients with small thrombus burden, the patients with LTB were had significantly higher admission blood glucose concentrations (135 ±â€Š39.1 mg/dl vs. 145.9 ±â€Š43.1, P = 0.002, respectively). The multivariate logistic regression analysis demonstrated that stress hyperglycemia is an independent predictor of LTB (odds ratio: 3.025, confidence interval 1.200-7.622, P = 0.019). Admission hyperglycemia is associated with the LTB which cause adverse cardiac outcomes. Hyperglycemia may play a role on thrombus development.

Contribution of platelets indices in the development of contrast-induced nephropathy.

Contrast-induced nephropathy (CIN) accounts for 10% of hospital-acquired renal failure, causes a prolonged in-hospital stay and represents a powerful predictor of poor clinical outcome. The underlying mechanism of the CIN development remains unclear and seems to be multifactorial. The potential link between platelet indices such as mean platelet volume (MPV) and platelet distribution width (PDW) with CIN is unknown. Herein, we aimed to investigate the correlation between MPV and PDW levels with the development of CIN. The incidence of CIN (20.5%) was prospectively evaluated in 430 patients with diagnosis of acute coronary syndrome. Initial creatinine (1.13 ±â€Š0.25 vs. 1.05 ±â€Š0.27 mg/dl, P = 0.01) and PDW (40.1 ±â€Š20.2 vs. 34.5 ±â€Š19.9%, P = 0.02) levels and the total volume of contrast media used (121 ±â€Š61 vs. 94 ±â€Š42 ml, P = 0.01) were higher in patients who developed CIN. MPV was similar between the two groups (P = 0.80). In a univariate regression analysis, age, increased creatinine, uric acid, phosphate, PDW levels and higher total volume of contrast media used were significantly correlated with CIN incidence. However, in a multivariate analysis, only total volume of CM used [odds ratio (OR) 1.011, 95% confidence interval (CI) 1.006-1.016; P = 0.01], increased age (OR 1.026, 95% CI 1.00-1.052; P = 0.05) and increased PDW levels (OR 1.009, 95% CI 1.00-1.022; P = 0.04) remained as the independent predictors of CIN. Among platelet indices, PDW, but not MPV, was associated with CIN development. The clinical significance of such link remains unclear, but may indicate involvement of platelet activation in CIN pathogenesis.

Correlation between the serum alkaline phosphatase level and the severity of coronary artery disease.

OBJECTIVES: The serum alkaline phosphatase (ALP) level has shown to be a prognostic factor in myocardial infarction and peripheral vascular disease by its promoting effect on vascular calcification. A few recent studies also showed that elevated ALP levels were associated with mortality and unfavorable prognosis in coronary artery disease (CAD). Herein, we aimed to investigate the correlation between serum ALP levels and the severity of CAD by assessing the Gensini score. MATERIALS AND METHODS: A total of 470 patients with stable angina pectoris were evaluated retrospectively.Upon admission, their ALP levels were measured with an automated analyzer by the enzymatic method, and the severity of CAD was documented for each patient according to their Gensini score. Patients with a Gensini score greater than 40 were defined to have an advanced CAD. Serum ALP levels higher than 129 mg/dl in men and higher than 104 mg/dl in women were defined as the elevated ALP groups. RESULTS: The mean ALP level was 97.3±56.4, ranging from 15 to 485 U/l with 66.0/82.5/106.0 U/l percentile values, and elevated ALP levels were obtained in 79 cases (16.8%). In 70% of the patients (n=329), advanced CAD was diagnosed. The mean Gensini score was 85.6±29.4 in the advanced CAD group and 12.8±15.8 in the remainder of the patients. The advanced CAD group included more men, patients with diabetes mellitus, hypertension, and a reduced left ventricular ejection fraction, and patients with lower levels of high-density lipoprotein cholesterol and higher levels of creatinine, red cell distribution width, and mean platelet volume. ALP levels (105.4±60.7 vs. 78.4±38.7 U/l, P<0.001) and the frequency of patients with elevated ALP levels (22 vs. 5.0%, P<0.001) were significantly higher in the advanced CAD group. Regression analysis showed a significant correlation between increased levels of serum ALP and advanced CAD in univariate (odds ratio 1.015, 95% confidence interval 1.008-1.1291, P<0.001) and multivariate analyses (odds ratio 1.013, 95% confidence interval 1.003-1.023, P=0.01). CONCLUSION: Elevated ALP levels are associated with higher Gensini scores and a more severe form of CAD.