Fibrosis in heart failure subtypes.

BACKGROUND: The differences in concentrations of biomarkers between heart failure patients with dilated cardiomyopathy (HF-D) and with ischemic cardiomyopathy (HF-I) have yet to be defined. The objectives of this study were to compare the concentrations and correlation of biomarkers of inflammation, extracellular matrix (ECM) turnover and oxidative stress parameters between these populations. PATIENTS AND METHODS: Our study consisted of 36 subjects with HF-D (LVSD = 47.2 ± 7.3 mm, LVDD = 65.1 ± 6.3 mm), 44 subjects with HF-I (LVSD = 38.0 ± 4.4 mm, LVDD = 58.5 ± 6.0 mm) and 38 controls without heart failure. Concentrations of matrix metalloproteinase (MMP)-1, MMP-2, MMP-9, MMP-13, Galectin-3, prolidase, TNF-alpha, and oxidative stress index (OSI) were measured. RESULTS: Serum levels of MMP-2, MMP-9, and prolidase were significantly increased in HF-I group compared to healthy controls (p = 0.039, 0.019, 0.012 respectively), whereas the increases in MMP-1 and MMP-13 were not significant. This significance was stronger in the HF-D group than the HF-I group (p = 0.004, 0.001, 0.002 respectively). TNF-α, a marker of inflammation, was significantly increased in heart failure (p = 0.004) but there was no difference between HF-D and HF-I groups; however, Galectin-3 was significantly increased in the HF-D group compared to the HF-I group (p = 0.005). OSI showed the same response pattern as TNF-α (p = 0.019, 0.002 respectively). There was a positive correlation of MMP-9 levels with prolidase activity (r = 0.612, p: 0.003). CONCLUSIONS: MMPs and Galectin-3 are important in cardiac remodeling; prolidase may share an undefined role in fibrosis in heart failure and may have a role in the diffuse fibrosis of heart failure.

Increased epicardial fat thickness is related with body mass index in women with polycystic ovary syndrome.

AIM: We aimed to investigate the relationship between PCOS and epicardial fat thickness with transthoracic echocardiography. PATIENTS AND METHODS: PCOS patients were divided into two groups according to the lean or obesity status: PCOS patients with lean 34 subjects (BMI: 23.3±2.8; mean age: 25.5±4), PCOS patients with obese16 subjects (BMI: 32.3±7.6; mean age: 27.2±3.7) were compared with control healthy lean subjects (BMI: 23.5±1.7; mean age: 25.9±2.2). RESULTS: There was increased epicardial thickness in obese PCOS subjects compared to lean PCOS subjects (6.3±0.9 mm, 4.7±0.5, respectively, p < 0.001). However, epicardial fat thickness between lean PCOS subjects and lean healthy control groups were not significantly varied (4.7±0.5 mm, 4.5±0.5, respectively, p = 0.6). There was increased epicardial thickness in obese PCOS subjects compared to lean healthy control subjects (6.3±0.9 mm, 4.5±0.5, respectively, p < 0.001). This sudy showed for the first time that increased epicardial fat thickness measured using transthoracic echocardiography is associated with increased BMI in PCOS subjects. CONCLUSIONS: Epicardial fat thickness between lean PCOS subjects and lean healty control group were similar which indicate the importance of obesity in PCOS subjects.

The association between mean platelet volume and coronary collateral circulation.

BACKGROUND: Platelets are important in the pathogenesis of atherosclerotic complications. Higher mean platelet volume (MPV) levels are related to greater in vitro aggregation, and have been identified as an independent risk factor for myocardial infarction, and for death or recurrent vascular events. AIM: To determine the relationship between MPV and the coronary collateral circulation. METHODS: The sample consisted of 96 patients with coronary artery disease, and patients were separated into two groups according to their poorly developed or well-developed collateral circulation. Coronary collateral vessels were analyzed according to the Cohen and Rentrop grading system of 0-3. RESULTS: All analyses were conducted using SPSS 11.5 (SPSS for Windows 11.5, Chicago, IL, USA). Continuous variables were expressed as mean ± SD, and categorical variables were expressed as percentages. Comparison of categorical and continuous variables between the group with well-developed coronary collateral vessels and the group with poorly developed vessels was performed using the chi-squared test and independent samples t-test, respectively. Platelet count and MPV values were similar between the two groups. CONCLUSIONS: Our study found that MPV levels are not related to coronary collateral circulation.  

Asymptomatic and isolated accessory mitral valve tissue in adult population: three case reports and review of the literature.

Accessory mitral valve tissue is a rare congenital cardiac anomaly and commonly it may cause left ventricular outflow tract obstruction (LVOTO). This anomaly occurs as a part of other congenital cardiac anomalies. However, it may be seen isolated. Structures in LVOT such as tumor, vegetation, cysts may have attention for differential diagnosis. The number of cases is increasing with the routinely using of two-dimensional echocardiography. Accessory mitral valve tissue is detected first early in children with symptoms of LVOT and is very rarely diagnosed in adults. One third of cases may asymptomatic, but commonly significant left ventricular outflow tract gradient can be detected in these cases, especially adult period. Optimal treatment of this anomaly is surgery if there is a significant LVOTO. In this report, we presented the three asymptomatic adult cases with accessory mitral valve tissue, without increased gradient in LVOT. Surgical excision was recommended to the first case in another hospital with diagnosis of cardiac cyst. Two cases are presented.

Spontaneous healing of occlusive type F coronary artery dissection.

In the presence of resistance to circumferential expansion of atherosclerotic plaques due to mechanical dilation high shear stresses between stiff plaques and normal vessel segments may occur and thus may result in coronary dissection. Limited data are available on the clinical and angiographic outcome of severe (type E, type F) coronary dissections. Herein, we report a case of type F dissection (causing total occlusion) of proximal right coronary artery during balon angioplasty which healed spontaneously. In conclusion, although the type F dissection has worse prognosis due to complete cessation of distal vessel perfusion, the possibility of spontaneous healing should be kept in mind after unsuccessful intervention.

Effect of hypoglycemic drugs on aspirin resistance in patients with diabetes mellitus.

BACKGROUND: Aspirin reduces the odds of an arterial thrombotic event in high-risk patients. However, 10%-20% of patients with an arterial thrombotic event who are treated with aspirin have a recurrent arterial thrombotic event during long-term followup. Aspirin resistance has been described in some patient populations such as those with an acute coronary syndrome, ischemic stroke, percutaneous coronary intervention with drug-eluting stent, stent re-stenosis, and diabetes mellitus (DM). The aim of this study was to assess aspirin resistance and to compare it to the use of oral anti-diabetic drugs and insulin in patients with diabetes. METHODS AND RESULTS: Platelet aggregation was measured after aspirin treatment in 101 diabetic patients undergoing percutaneous coronary intervention. Two patient populations were included in the investigation: use of insulin (group 1) and use of oral anti-diabetic agents (OAD) (group 2) in diabetic patients. Platelet aggregation was determined using a multichannel Multiplate analyzer. Among group 1 patients, 4.7% were aspirin non-responders and among group 2 patients, 8.6% were aspirin non-responders. Statistical differences were not found between the groups (p = 0.359). CONCLUSIONS: This study demonstrated that there was no significant difference in aspirin resistance between type 2 diabetes mellitus patients on insulin treatment and type 2 diabetes mellitus patients on OAD treatment.

The medical approaching to a pellet injury of the heart.

A 55-year-old man with multiple pellet injuries was brought to the Emergency room. In his physical examination, there were multiple wounds in face, neck, shoulders, arms, thorax and upper abdomen. The therapeutic options include pericardial drainage, conservative treatment, and surgical removal of the pellet. But, he was successfully managed with conservative medical treatment. This case showed that the treatment of heart injuries due to shotgun pellet should be individualized.

Is the pepper spray a triggering factor in myocardial infarction? A case report.

Forty-year-old man was admitted to emergency department with complains of chest pain and dispnea after exposure the pepper gas that sprayed to environment during a social event. Physical examination and electrocardiogram was revealed acute myocardial infarction.

OTc prolongation and torsade de pointes ventricular tachycardia in a small dose voriconazole therapy.

Torsade de pointes (TdP) is a life-threatening arrhythmia that can result from long QT syndrome. Drug-induced QT prolongation is a potentially dangerous adverse effect of some drug combinations. A 34-year-old woman with history of nephrotic syndrome and rheumatic mitral valve disease was admitted to our Hospital because of high fever. The patient continued to be febrile until antifungal treatment was switched to voriconazole. The electrocardiogram demonstrated sinus tachycardia and a prolonged QTc interval of 580 ms. Patient was resuscitated with electrical cardioversion and had an emergent temporary pacemaker placed. We recommend careful monitoring for QTc prolongation and arrhythmia in patients who are receiving voriconazole, particularly those who have significant electrolyte disturbances.

Serum cytokine and pro-brain natriuretic peptide (BNP) levels in patients with migraine.

OBJECTIVE: Although migraine has been related with an increased risk for ischemic stroke and cardiovascular events, there is insufficient data for role of pro-brain natriuretic peptide (pro-BNP) in migraine. In present case-control study, serum levels of pro-inflammatory (TNF-alpha, IL-1beta and IL-6) and anti-inflammatory cytokines (IL-2, and IL-10) of migraine patients were investigated to determine the role of cytokines and pro-BNP in migraine. PATIENTS AND METHODS: Sixty-four consecutive newly diagnosed migraine patients and 34 healthy controls were enrolled. Serum TNF-alpha, IL-1beta, IL-2, IL-6, IL-10 and pro-BNP levels were measured by using a chemiluminescence assay. RESULTS: Migraine patients had significantly higher concentrations of IL-1beta and IL-6 compared with the healthy controls (for IL-1beta; 5.73 +/- 1.44 vs. 4.90 +/- 1.40 pg/mL, respectively, p = 0.006; for IL-6; 3.1 +/- 1.44 vs. 2.40 +/- 0.22 pg/mL, respectively, p = 0.007). The mean IL-10 levels were found to be significantly lower in migraine patients (3.38 +/- 2.93 pg/mL) than controls (6.76 +/- 1.48 pg/mL) (p = 0.007). There were no differences in TNF-alpha (27.2 +/- 48.1 vs. 15.4 +/- 0.7) and IL-2 (1017 +/- 661 vs. 1153 +/- 228) levels between patients with migraine and healthy controls. Migraine patients had higher concentrations of pro-BNP compared with healthy controls (27.0 +/- 28.0 versus 13.2 +/- 8.6, p = 0.006). CONCLUSIONS: Migraine patients have higher serum IL-1beta and IL-6 levels, and lower IL-10 levels than healthy subjects. These findings support that cytokines may be related to neurogenic inflammation in the pathogenesis of migraine. Also, increased pro-BNP may indicate to preclinical cardiac involvement in patients with migraine.