Is the use of secukinumab after anti-TNF therapy greater than expected for the risk of developing inflammatory bowel disease?

OBJECTIVE: In this study, our objective was to present real-life data on the incidence of inflammatory bowel disease (IBD) among patients receiving secukinumab treatment. METHODS: The study consisted of 209 patients who had prior exposure to anti-tumor necrosis factor (TNF) or were biologically naive. Patients with a pre-existing history of IBD were excluded from the study. RESULTS: Of the 209 patients in the study, 176 (84.3%) had ankylosing spondylitis, while 33 (15.7%) had psoriatic arthritis. 112 (53.6%) patients had prior exposure to at least one anti-TNF treatment before initiating secukinumab. IBD developed in 10 (4.8%) of the 209 patients. The incidence of IBD among patients who initiated secukinumab as their first biologic agent was 1%. For patients who had previously received any anti-TNF treatment and subsequently transitioned to secukinumab, the incidence of IBD was 8% (p=0.018, odds ratio (OR): 8.38, 95% CI: 1.04-67.45). A mean of 3.67 months (±4.3) after anti-TNF use, whereas IBD symptoms developed in the biologically naive patient after 15 months. CONCLUSION: Our study observed IBD incidence in 4.8% of patients using secukinumab. Patients who initiated secukinumab after previous anti-TNF treatment exhibited a significantly higher rate and risk of developing IBD. The onset of IBD occurred earlier in these patients (mean 3.67 months), whereas a single case of IBD showed a longer duration (15 months). Further studies with larger patient numbers are warranted to provide a more comprehensive understanding of our findings.

Is the use of secukinumab after anti-TNF therapy greater than expected for the risk of developing inflammatory bowel disease? / El uso de secukinumab tras la terapia anti-TNF es mayor de lo esperado por el riesgo de desarrollar enfermedad inflamatoria intestinal?

Objective: In this study, our objective was to present real-life data on the incidence of inflammatory bowel disease (IBD) among patients receiving secukinumab treatment. Methods: The study consisted of 209 patients who had prior exposure to anti-tumor necrosis factor (TNF) or were biologically naive. Patients with a pre-existing history of IBD were excluded from the study. Results: Of the 209 patients in the study, 176 (84.3%) had ankylosing spondylitis, while 33 (15.7%) had psoriatic arthritis. 112 (53.6%) patients had prior exposure to at least one anti-TNF treatment before initiating secukinumab. IBD developed in 10 (4.8%) of the 209 patients. The incidence of IBD among patients who initiated secukinumab as their first biologic agent was 1%. For patients who had previously received any anti-TNF treatment and subsequently transitioned to secukinumab, the incidence of IBD was 8% (p=0.018, odds ratio (OR): 8.38, 95% CI: 1.04–67.45). A mean of 3.67 months (±4.3) after anti-TNF use, whereas IBD symptoms developed in the biologically naive patient after 15 months. Conclusion: Our study observed IBD incidence in 4.8% of patients using secukinumab. Patients who initiated secukinumab after previous anti-TNF treatment exhibited a significantly higher rate and risk of developing IBD. The onset of IBD occurred earlier in these patients (mean 3.67 months), whereas a single case of IBD showed a longer duration (15 months). Further studies with larger patient numbers are warranted to provide a more comprehensive understanding of our findings.(AU)

Objetivo: En este estudio, nuestro objetivo fue presentar datos de la vida real sobre la incidencia de la enfermedad inflamatoria intestinal (EII) entre los pacientes que reciben tratamiento con secukinumab. Métodos: El estudio consistió en 209 pacientes que habían tenido una exposición previa al factor de necrosis antitumoral (TNF) o eran biológicamente naive. Los pacientes con antecedentes preexistentes de EII fueron excluidos del estudio. Resultados: De los 209 pacientes del estudio, 176 (84,3%) tenían espondilitis anquilosante, mientras que 33 (15,7%) tenían artritis psoriásica. 112 (53,6%) pacientes tenían exposición previa a al menos un tratamiento anti-TNF antes de iniciar secukinumab. La EII se desarrolló en 10 (4,8%) de los 209 pacientes. La incidencia de EII entre los pacientes que iniciaron secukinumab como primer agente biológico fue del 1%. Para los pacientes que habían recibido previamente algún tratamiento anti-TNF y posteriormente hicieron la transición a secukinumab, la incidencia de EII fue del 8% (p=0,018, odds ratio (OR): 8,38, IC del 95%: 1,04-67,45). Una media de 3,67 meses (±4,3) después del uso de anti-TNF, mientras que los síntomas de la EII se desarrollaron en el paciente biológicamente naive después de 15 meses. Conclusión: Nuestro estudio observó una incidencia de EII en el 4,8% de los pacientes que usaban secukinumab. Los pacientes que iniciaron secukinumab después de un tratamiento anti-TNF previo mostraron una tasa y un riesgo significativamente mayores de desarrollar EII. El inicio de la EII ocurrió antes en estos pacientes (media de 3,67 meses), mientras que un solo caso de EII mostró una duración más prolongada (15 meses). Se justifican más estudios con un mayor número de pacientes para proporcionar una comprensión más completa de nuestros hallazgos.(AU)

Effects of acute aerobic exercise on brain-derived neurotrophic factor level in rheumatoid arthritis patients.

Objectives: The study aimed to investigate the variation of brain-derived neurotrophic factor (BDNF) levels following acute exercise in patients with rheumatoid arthritis (RA). Patients and methods: This cross-sectional study was conducted with 88 participants (25 males, 63 females; mean age: 45.1±8.3 years; range, 18 to 65 years) between July 2020 and May 2021. Of the participants, 44 were RA patients, and 44 were age-and sex-matched healthy controls. Aerobic exercise was utilized in all participants for a single session. Depression and anxiety levels were evaluated with the Beck Depression Inventory and Hospital Anxiety and Depression Scale. Blood samples were collected from all subjects before and immediately after the intervention. Results: Serum BDNF levels (both baseline and after exercise) were similar in the RA and control groups. Although serum BDNF levels significantly decreased in both groups after aerobic exercise (Wilcoxon rank p<0.05), ΔBDNF levels were significantly higher in the RA group than in the control group (p=0.047). Additionally, ΔBDNF levels were significantly correlated with the Hospital Anxiety and Depression Scale scores in the RA group (p<0.05) but not in the control group. Conclusion: A single bout of exercise may effectively decrease serum BDNF levels in patients with RA and healthy subjects. The long-term effect of exercise on BDNF levels should be investigated in prospective studies.

Retraction notice to "Successful treatment for a giant coronary saccular aneurysm complicated with myocardial infarction in a patient with Behcet's disease: Case report" [J Cardiol Cases 6(4) (2012) e118-e120].

[This retracts the article DOI: 10.1016/j.jccase.2012.07.002.].

The association of dynamic thiol-disulphide balance with white-coat hypertension.

OBJECTIVE: Dynamic thiol-disulphide homeostasis is an indicator of the antioxidant system that interacts early with the oxidative environment. This study aimed to assess the dynamic thiol/disulphide balance in individuals with white-coat hypertension (WCH). METHODS: This cross-sectional study included a total of 117 individuals who presented to our outpatient cardiology clinic. Seventy patients were diagnosed with WCH. All blood samples were obtained from the patients after a minimum of 8 h of fasting, centrifuged immediately, stored in Eppendorf tubes, and protected at -80°C. RESULTS: The two groups were well-balanced in terms of age, gender, and BMI. Native thiol and total thiol levels were lower in the WCH group than in normotensive individuals. However, disulphide levels were higher in the former. Serum disulphide concentration positively correlated with 24-h SBP, and 24-h DBP. In backward stepwise logistic regression analysis, serum disulphide [odds ratio (OR) = 1.165 (1.089-1.245), 95% confidence interval (CI), P < 0.001] and serum total thiol levels [OR = 0.992 (0.984-1.000), 95% CI, P = 0.050] were independently associated with WCH. CONCLUSION: We demonstrated that dynamic thiol/disulphide balance shifted strongly towards disulphide formation due to thiol oxidation in patients with WCH.

Bilateral Tibial Stress Fractures and Osteoporosis in a Young Patient.

Stress fractures result from microscopic bone injury due to repetitive submaximal stress and include fatigue and insufficiency fracture components. Fatigue fractures generally occur in runners and athletes and are caused by abnormal physical load on the bone. On the other hand, insufficiency fractures are generally seen in the elderly secondary to osteoporosis, typically involving the pelvis and surrounding bones. Insufficiency fracture occurs as a result of normal loading in the abnormal bone. In this case report, we describe a young patient with bilateral tibial stress fractures with both fatigue and insufficiency components.

The effect of secukinumab treatment on hematological parameters in ankylosing spondylitis and psoriatic arthritis.

OBJECTIVE: Secukinumab, a new treatment agent, selectively neutralizes interleukin (IL)-17A. It is used in the treatment of ankylosing spondylitis (AS), psoriatic arthritis (PsA), and psoriasis. It is known that the agents used in the treatment of rheumatic diseases have effects on hematological parameters. In this study, we aimed to determine whether hematological parameters are affected in secukinumab therapy in patients with AS and PsA. METHODS: Thirty-six patients on secukinumab treatment were included in the study by scanning the database of our hospital. Data on patients' age, gender, complete blood count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), uric acid, aspartate aminotransferase (AST), alanine aminotransferase (ALT), urea, creatinine values, and additional drug treatments were recorded from our database. The 0- and 6-month values of patients were analyzed. RESULTS: Sixteen males (44.4%) and 20 females (55.6%) were included in our study. The average age was calculated to be 39.8±8.9 years. Of these, 30 patients receiving secukinumab treatment were diagnosed with AS, and 6 patients were diagnosed with PsA. Twenty-three patients (63.9%) were continued with secukinumab treatment at the 6th month. When CBC, glucose, urea, creatine, AST, ALT, ESR, CRP, and uric acid values of the patients at 0 and 6 months were compared, there was no significant difference. CONCLUSION: In our study, no significant difference was found between 0 and 6 months in terms of CBC, AST, ALT, urea, creatinine, uric acid, glucose, CRP, and ESR levels in patients receiving secukinumab. However, an increase in hemoglobin values was observed in patients who continued the treatment. These results may suggest that secukinumab treatment has no negative effects on hematological parameters.

The relationship between visible thrombus aspiration material with no-reflow and in-hospital mortality ratio in patients with anterior ST-elevation myocardial infarction treated with primary percutaneous coronary intervention.

OBJECTIVE: The benefit of intracoronary thrombus aspiration (TA) during primary percutaneous coronary intervention (pPCI) in patients with ST-segment elevation myocardial infarction (STEMI) is not yet fully clear. The aim of this study was to investigate the clinical impact of visible thrombus aspiration (VTA) material. METHODS: A total of 295 patients with a Thrombolysis in Myocardial Infarction (TIMI) flow score of 0 or 1 after an anterior STEMI were included in the study. Manual TA devices were used before performing PCI. The patients were divided into 2 groups: (1) visible thrombus aspiration (VTA) group and (2) non-visible thrombus aspiration (non-VTA) group. No-reflow was defined as TIMI grade 0, 1, or 2 flow, or TIMI grade 3 with a myocardial blush of grade 0 or 1. The primary endpoint was the occurrence of no-reflow. RESULTS: VTA was retrieved in 178 (60.3%) of the patients. A no-reflow determination was significantly less frequent in the VTA group (p<0.001). The ejection fraction and ST-segment resolution values were higher, and the in-hospital mortality, Killip class II-IV rating, and post-pPCI TIMI frame count were lower in the VTA group (p<0.05 for each). CONCLUSION: VTA predicted a lower rate of in-hospital mortality and no-reflow in patients with anterior STEMI who underwent pPCI.

Static and dynamic analyses of fracture fixation bone-plate systems for different plate materials and dimensions.

BACKGROUND: Various techniques have been developed in the treatment of fractures. One of these techniques is the internal fixation, which has an important place in practice. OBJECTIVE: In this study, fractured tibia bone has been treated with implants as numerically to investigate the stress behavior and the effect of plate material, shape and dimensions under pressure load. METHODS: The outer part of the bone is chosen as orthotropic and the inner part is chosen as isotropic material. The plate has been modeled to take the form of the bone surface and the finite element method has been used for numerical analysis. The effect of stress on bones and implants has been examined for 1% healing by changing the plate length, plate width and plate material. RESULTS: It has been observed that the increase in plate length decreases cortical bone stress until a specific length. On the other hand, the increase in plate width has increased the stress on the bone. CONCLUSIONS: It is important to form the appropriate plate surface to the bone surface in terms of compliance with the bones.

Assessment of side branch patency using a jailed semi-inflated balloon technique with coronary bifurcation lesions.

OBJECTIVE: Many interventional cardiologists are concerned about the risk of side branch (SB) loss during main vessel (MV) stenting in complex bifurcation lesions. Therefore, novel techniques are required to reduce the risk of SB occlusion. The jailed semi-inflated balloon technique (JSBT) is one of these techniques. This article is a description of clinical experience with SB patency assessment using the JSBT. METHODS: A total of 64 patients with 82 distinct coronary bifurcation lesions underwent percutaneous coronary intervention (PCI) via JSBT at this institution. In the majority of patients, the SB balloon was inflated with a greater pressure (4.8±2.0 atm) than in the standard JSBT. Procedural and immediate clinical outcomes were reviewed via baseline and post-procedural quantitative coronary angiography analysis. RESULTS: The majority of the patients had acute coronary syndrome (60.9%) and almost one-third of the patients were Medina class 1.1.1. (32.8%). A jailed-balloon or wire was not entrapped during any PCI. SB ostial dissection was seen in only 2 patients. The minimal lumen diameter was improved in the MV and SB following PCI. There were no adverse cardiac events during in-hospital stay or at 1-month follow-up. CONCLUSION: JSBT provides maximum SB protection with bifurcation lesions and requires less time than a complex technique. There was no significant SB occlusion risk even though the SB balloon was inflated with a slightly higher pressure. The immediate clinical outcomes and procedural success of this study may encourage interventional cardiologists to use this technique safely with reliable preservation of SB patency.

The relationship between low thiol levels and major adverse cardiovascular events after primary percutaneous coronary intervention in patients with STEMI.

OBJECTIVE: The aim of this study was to investigate whether low thiol levels are associated with peri-procedural factors during primary percutaneous coronary intervention (pPCI) upon admission with ST-segment elevation myocardial infarction (STEMI), and the prognostic value at 6-month follow-up. METHODS: A total of 241 consecutive acute STEMI patients who underwent pPCI and a control group of 67 individuals with a normal coronary angiography were enrolled in the study. RESULTS: While age, contrast-induced nephropathy, N-terminal prohormone of brain natriuretic peptide (NT-proBNP), stent length, and creatinine were related to native thiol, NT-proBNP, contrast-induced nephropathy, and creatinine were related to total thiol. NT-proBNP was also related to the disulphide level. The left ventricular ejection fraction (LVEF) and the levels of native thiol, total thiol, low-density lipoprotein, and serum albumin were found to be independent predictors of major adverse cardiovascular events (MACEs) during 6 months of follow-up. CONCLUSION: Initial lower native thiol, total thiol, LVEF, LDL, and serum albumin may be used to identify patients with an increased long-term risk of unfavorable cardiac events in case of STEMI.

Impact of 25(OH)D3 on spontaneous reperfusion and SYNTAX score in patients with ST-elevation myocardial infarction.

OBJECTIVE: The aim of this study was to evaluate the potential relationship between 25-hydroxyvitamin D3 (25[OH]D3), the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score, and spontaneous reperfusion (SR) in patients with ST-elevation myocardial infarction (STEMI). METHODS: A total of 148 consecutive patients with acute STEMI who underwent primary percutaneous coronary intervention were retrospectively enrolled in the study. RESULTS: In all, 36 patients with a TIMI 3 flow score (spontaneous reperfusion [SR]) before coronary intervention constituted Group 1, and 112 patients with a TIMI flow score of 0-2 served as Group 2. The SYNTAX score and the in-hospital major adverse cardiovascular event (MACE) rate were significantly higher in Group 2 (p<0.001, p=0.012, respectively). The mean 25(OH)D3 level was significantly higher in Group 1 (p=0.003). Age, Killip class, left ventricular ejection fraction, and N-terminal pro-B-type natriuretic peptide were correlated with the SYNTAX score, and 25(OH)D3, troponin-I, C-reactive protein, and creatinine were weakly correlated with the SYNTAX score. Multilogistic regression analysis indicated that the SYNTAX score (p<0.001), Rentrop collateral (p=0.049), and troponin-I (p=0.004) were significantly effective at predicting SR, and 25(OH)D3 (p=0.079) and high-density lipoprotein (p=0.055) were borderline effective. CONCLUSION: A lower level of 25(OH)D3 may be associated with the absence of SR, increased disease severity, and inhospital MACE rates in patients with STEMI.

Epicardial Fat Thickness is Associated with Abnormal Left Ventricle Geometry in Newly Diagnosed Hypertension.

BACKGROUND: Epicardial adipose tissue is an emerging cardio metabolic risk factor. Although an association between epicardial fat thickness (EFT) and left ventricle (LV) hypertrophy in hypertensive patients is known, the relationship between abnormal LV geometric patterns and EFT has yet to be investigated. The aim of the present study was to investigate the relationship between EFT and abnormal LV geometric patterns in hypertensive patients. METHODS: Measurements were obtained from 343 patients with untreated essential hypertension (mean age 51.6 ± 5.5 years) and 52 healthy control subjects (mean age 51.8 ± 4.5 years). Four different geometric patterns (NG; normal geometry, CR; concentric remodeling, EH; eccentric hypertrophy, and CH; concentric hypertrophy) were determined according to LV mass index (LVMI) and relative wall thickness (RWt). EFT was measured using transthoracic echocardiography. High sensitive C-reactive protein (hs-CRP) and other biochemical markers were measured in all participants. RESULTS: The highest EFT and hs-CRP values were determined in the CH group (EFT = 8.9 ± 2.1 mm) compared with the controls (EFT = 5.7 ± 1.5 mm), followed by the NG (EFT = 5.9 ± 1.6 mm), CR (EFT = 5.9 ± 1.3 mm) and EH groups (EFT = 6.5 ± 1.6 mm) (all p < 0.05). In addition, the EFT values of the EH group were higher than the control, NG and CR groups (all p < 0.05). Multivariate linear regression analysis showed that EFT was independently associated with LV geometry (ß = 0.161, p = 0.032), total cholesterol level (ß = -0.129, p = 0.003), triglyceride level (ß = 0.266, p < 0.001), hs-CRP level (ß = 0.349, p < 0.001), and creatinine level (ß = 0.108, p = 0.010). CONCLUSIONS: EFT is independently associated with abnormal LV geometry, LV hypertrophy, creatinine level, and low grade chronic inflammation.

Thiol/disulphide homeostasis in thoracic aortic aneurysm and acute aortic syndrome.

AIM: The aim of this study was to evaluate whether ranging values of thiol and disulphide herald a dilatation or impending acute aortic syndrome at thoracic aorta. Results/methodology: Study population consisted of patients with aortic aneurysm (n = 58), with acute aortic syndrome (n = 32) and without aortic aneurysm (control group; n = 61). A spectrophotometric method was used to determine thiol and disulphide. Native and total thiol levels were moderately correlated with maximal aortic diameter. At the end of 6 months, there was statistically significant increase in native, total thiol levels and decrease in disulfide and disulphide/native thiol ratio in operated group. DISCUSSION/CONCLUSION: Lower thiol levels may be associated with the higher risk of aortic aneurysm development and may increase after surgical therapy.

Chronic statin treatment is a predictor of pre-interventional infarct-related artery patency in patients with ST elevation myocardial infarction treated with percutaneous coronary intervention.

BACKGROUND: Beyond lipid-lowering effects, early statin treatment has beneficial effects on prognosis after acute coronary syndrome. Infarct-related artery (IRA) patency before percutaneous coronary intervention (PCI) is known to be a strong pre-dictor of improved clinical outcome. AIM: We aimed to investigate the effects of chronic statin treatment before admission on IRA patency after myocardial infarction. METHODS: In this study, 938 ST elevation myocardial infarction (STEMI) patients admitted to the hospital within the first 12 h of symptom onset were prospectively enrolled (male, n = 682; female, n = 256; mean age 58.6 ± 12.4 years). All patients underwent emergent primary PCI. Patients were divided into two groups based upon angiographic IRA patency. Impaired IRA patency was defined as Thrombolysis In Myocardial Infarction (TIMI) grade 0 and 1 flow (non-patent IRA group). Angiographic IRA patency was defined as TIMI 2 and 3 flow (patent IRA group). RESULTS: Previous statin usage was more frequent in the patent IRA group (n = 138; 71.9%), than in the non-patent IRA group (n = 110; 14.7%; p < 0.001). Pre-PCI IRA patency was independently associated with body mass index (odds ra-tio [OR] = 1.087, 95% confidence interval [CI] 1.005-1.176, p < 0.001), previous chronic statin use (OR 0.065, 95% CI 0.043-0.098, p = 0.039), ejection fraction (OR 1.041, 95% CI 1.018-1.064, p < 0.001), and SYNTAX score (OR 0.927, 95% CI 0.899-0.957, p < 0.001) in multivariate logistic regression analysis. CONCLUSIONS: Chronic pre-treatment with statins is a significant predictor of the IRA patency in patients with STEMI.

The impact of diabetes on the association between epicardial fat thickness and extent and complexity of coronary artery disease in patients with non-ST elevation myocardial infarction.

BACKGROUND: Epicardial fat thickness (EFT) is associated with increased cardio metabolic risk. Recent studies have suggested that there is a strong relationship between diabetes and EFT. Although the relationship between EFT and coronary artery disease (CAD) is well known, the possible impact of diabetes on the relationship between EFT and extent and complexity of CAD was not fully investigated. AIM: We aimed to investigate the relationship between EFT and extent and complexity of CAD in patients with non-ST elevation myocardial infarction (NSTEMI) with and without diabetes. METHODS: We prospectively included 454 patients with NSTEMI (mean age: 61.8 ± 10.4 years) in the present study. Patients were classified into two groups according to their diabetes status (diabetic group and non-diabetic group). EFT was measured by transthoracic echocardiography on the right ventricle in individuals having the left lateral decubitus position. SYNTAX score was used to define the extent and complexity of CAD. High-sensitivity C-reactive protein (hs-CRP) and other biochemical markers were measured in all participants. RESULTS: Diabetic patients had higher EFT values compared with non-diabetics (p < 0.05). EFT is independently associated with diabetes, SYNTAX score, and hs-CRP in all patients (p < 0.05, for all). When patients were divided into two groups, as diabetic and non-diabetic, the association between EFT and SYNTAX score was stronger in diabetic patients compared with non-diabetics (r = 0.635; p < 0.001 vs. r = 0.179; p = 0.003). CONCLUSIONS: Epicardial fat thickness is associated with SYNTAX score in both diabetic and non-diabetic patients. Furthermore, there is a stricter relationship between EFT and SYNTAX score in diabetic patients.

Epicardial fat thickness is associated with aortic intima-media thickness in patients without clinical manifestation of atherosclerotic cardiovascular disease.

BACKGROUND: Although the relationship between epicardial fat thickness (EFTh) and coronary atherosclerosis is well established, this relation in the early periods of atherosclerosis has not been fully demonstrated. On the other hand, thoracic aortic intima-media thickness (IMT) rather than carotid IMT was reported as an earlier marker of preclinical atherosclerosis. OBJECTIVE: We aimed to assess the relationship between thoracic aortic IMT and EFTh in patients undergoing transesophageal echocardiography (TEE) examination for different indications. METHODS: We included 104 patients (mean age 38±11.4 years), who underwent TEE for various indications. The patients were divided into two groups according to the median thoracic aortic IMT values (IMT normal group<10 mm and IMT abnormal group≥10 mm). EFTh was obtained using two-dimensional transthoracic echocardiography on the right ventricular free wall during systole and diastole. RESULTS: The highest EFTh values (3.3±0.96 mm vs. 4.51±0.66 mm, P<.001) were observed in the abnormal aortic IMT group. Multivariate linear regression analysis showed that aortic IMT was independently correlate with EFTh (ß=0.423, P<.001). Moreover, EFTh was found to be associated with history of transient ischemic attack (r=.403, P<.001) and abnormal IMT (r=.643, P<.001) in bivariate analysis. CONCLUSION: Epicardial fat thickness is independently related to the extent of subclinical thoracic aortic atherosclerosis. Increase in EFTh may be crucial marker for initial atherosclerosis.

The Role of Thiol/Disulphide Homeostasis in Anthracycline Associated Cardiac Toxicity.

The aim of the present study was to evaluate whether the baseline thiol/disulfide state can predict the occurrence of anthracycline induced cardiac toxicity. A total of 186 cancer patients receiving anthracycline (doxorubicin)-based chemotherapy were enrolled. All patients underwent 2-dimensional (2D) speckle tracking echocardiography (STE) to determine their left ventricular ejection fraction (LVEF) and blood samples for measuring thiol forms were obtained before treatment and 4 weeks after completion of the chemotherapy. The mean dose of doxorubicin exposure was 255 ± 39.2 mg/m2. Baseline native thiol was found to be lower whereas baseline disulfide and the disulfide/total thiol ratio were found to be higher in patients who had a decrease in LVEF after anthracycline therapy. Also, the amount of decrease in LVEF was well correlated with the delta value of the thiol forms. Logistic regression analysis revealed that changes in BNP and global longitudinal strain (GLS), baseline level of native thiol, disulfide, and the disulfide/total thiol ratio were strong predictors for a decrease in LVEF.The thiol/disulfide pathway may be a factor for predicting chemotherapy-induced cardiac toxicity as one of the oxidative stress mechanisms.

Morning blood pressure surge and arterial stiffness in newly diagnosed hypertensive patients.

OBJECTIVE: We aimed to investigate the relationship between the morning blood pressure (BP) surge and arterial stiffness in patients with newly diagnosed hypertension. SUBJECTS AND METHODS: Three hundred and twenty four (mean age 51.7 ± 11.4 years) patients who had newly diagnosed hypertension with 24 h ambulatory BP monitoring were enrolled. Parameters of arterial stiffness, pulse wave velocity and augmentation index (Aix) were measured by applanation tonometry and aortic distensibility was calculated by echocardiography. RESULTS: Compared with the other groups, pulse wave velocity, day-night systolic BP (SBP) difference (p < 0.001, for all) and hs-CRP (p = 0.005) were higher in morning BP surge high group. Aortic distensibility values were significantly lower in morning BP surge high group compared to the other groups (p < 0.05, for all). Morning BP surge was found to be independently associated with pulse wave velocity (ß = 0.286, p < 0.001), aortic distensibility (ß= -0.384, p < 0.001) and day-night SBP difference (ß = 0.229, p < 0.001) in multivariate linear regression analysis. CONCLUSIONS: We found independent relationship between morning BP surge and arterial stiffness which is a surrogate endpoint for cardiovascular diseases. The inverse relationship between morning BP surge and aortic distensibility and direct relation found in our study is new to the literature.

Vitamin D insufficiency is associated with coronary artery tortuosity.

BACKGROUND: Increasing evidence suggests a relationship between vitamin D (VD) insufficiency and cardiovascular disease. AIM: We aimed to investigate the association between serum 25-hydroxyvitamin D (25-OH VD) with coronary tortuosity (CT) in patients with normal or near-normal (< 40% stenosis) coronary arteries. METHODS: The present study was cross-sectional and observational. We enrolled 356 consecutive patients who had undergone coronary angiography for suspected ischaemic heart disease and were found to have normal or near-normal coronary arteries. Patients were categorised as VD insufficient (< 30 ng/mL) or VD sufficient (≥ 30 ng/dL). CT was defined as the presence of ≥ three bends (defined as ≥ 45° change in vessel direction) along the main trunk of at least one coronary artery, present both in systole and in diastole. RESULTS: The study populations were divided into two groups according to the presence of CT: patients with CT (n = 103, 29%) and patients without CT (NCT; n = 253, 71%). CT is more frequently seen in elderly women and is positively correlated with hypertension. The incidence of VD insufficiency was significantly higher in the CT group (n = 46, 45%) than in the NCT group (n = 90, 36%; p = 0.005). In further multivariate logistic regression analyses, adjustment for major clinical parameters affecting CT showed statistically significant correlations between 25-OH VD and CT (odds ratio = 0.77, 95% confidence interval 0.66-0.98, p = 0.006). CONCLUSIONS: Vitamin D insufficiency was independently associated with coronary tortuosity.