Association between Circulating Omentin-1 Levels and Aortic Valve Sclerosis.

Background: Aortic valve sclerosis (AVS) is characterized by thickening of the valve leaflets accompanied by increased echogenicity and calcification without significant limitations in valve movements. Omentin-1 is a glycoprotein of the adiponectin family released from visceral adipose tissue, and it can be used as a biomarker of atherosclerosis, obesity, and metabolic syndrome. No studies have demonstrated any relationship between AVS and omentin-1 in the literature. We aimed to explore the association of serum omentin-1 levels with AVS. Methods: Eighty-six patients with AVS and 92 age- and sex-matched controls were enrolled into the study. The baseline clinical characteristics of the patients were recorded. Conventional 2-dimensional echocardiography was performed. Omentin-1 levels were measured. Results: The mean omentin-1 level was significantly lower in the AVS (+) group compared to the control group (78.16 ± 44.95 vs. 163.57 ± 59.84 ng/mL, p < 0.001). Omentin-1 [odds ratio (OR) = 3.45, 95% confidence interval (CI) = 1.88-5.39, p < 0.001,] and LDL-C (OR = 1.82, 95% CI = 1.33-2.16, p = 0.015) were found to be independent predictors of AVS in multivariate logistic regression analysis. An omentin-1 level of < 92.45 ng/mL had 90.5% sensitivity and 71.4% specificity for the prediction of AVS (area under curve: 0.697, p < 0.001). Conclusions: Our results indicated that a lower omentin-1 level was associated with an increased risk of AVS. We suggest that omentin-1 could be used as a treatment target as well as to predict AVS.

Relationship between atherogenic index of plasma and stent thrombosis in patients with acute coronary syndrome.

OBJECTIVE: Stent thrombosis (ST) is an uncommon but serious complication in patients undergoing percutaneous coronary intervention (PCI). This study aimed to investigate the effect of atherogenic index of plasma (AIP) on ST. METHODS: Among the 10,258 patients who underwent coronary angiography between January 2018 and December 2020, 239 patients who underwent PCI with the diagnosis of acute coronary syndrome (ACS) due to ST were included as the study group (ST group) and 459 patients who underwent percutaneous intervention for ACS and did not have any in-stent lesion as the control group (non-ST group). ST classification was done according to the Academic Research Consortium definition. RESULTS: The mean age of the patients was 63.3±10.6 years (483 male, 69.2%). The groups were similar in terms of characteristic properties, comorbidities, and the drugs being used (p>0.05 for all). Drug eluting stents were used in 86.5% of the patients. In the ST group, the median time from stent implantation to thrombosis was 285 days. Mean AIP and the ratio of triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) were statistically significantly higher in the ST group than in the controls (p<0.001 and p=0.018, respectively), and a positive correlation was observed between time from stent implantation to thrombosis and AIP and TG/HDL-C (rS=0.229, p=0.010 and rS=0.222, p=0.010, respectively). Multivariate logistic regression analysis revealed that stent length, prior ST elevation myocardial infarction, TG/HDL-C, and AIP were independent predictors of ST. CONCLUSION: AIP is an easy calculable biomarker, and the performance of AIP to predict ST is better than TG/HDL-C.

A New Score for Determining Thrombus Burden in STEMI Patients: The MAPH Score.

AIM: to investigate whether the MAPH score, which is a new score that combines blood viscosity biomarkers such as mean platelet volume (MPV), total protein and hematocrit, can be used to predict thrombus burden in ST-segment elevation myocardial infarction (STEMI) patients. METHODS: A total of 473 consecutive patients with STEMI were included in the study. Intracoronary tirofiban/abciximab infusion was applied to patients with thrombus load ≥3 and these patients (n = 71) were defined as the patient group with high thrombus load. MPV, age, hematocrit and total protein values of the patients were recorded. High shear rate (HSR) and low shear rate (LSR) were calculated from total protein and hematocrit values. Cut-off values were determined for high thrombus load by using Youden index, and score was determined as 0 or 1 according to cut-offs. The sum of the scores was calculated as the MAPH score. RESULTS: The mean age of the patients included in the study was 59.6 ± 12.6 (n = 354 male, 74.8%). There was no difference between the groups in terms of gender, HT and DM (P = .127, P = .402 and P = .576, respectively). In the group with high thrombus load; total protein, MPV and hematocrit values were higher (P < .001, P = .001 and P = .03, respectively). Comparison of receiver operating characteristic (ROC) curve analysis revealed that the MAPH score had better performance in predicting higher thrombus load than both other self-containing parameters and HSR and LSR. CONCLUSION: The MAPH score may be a new score that can be used to determine thrombus burden in STEMI patients.

The ATRIA and Modified-ATRIA Scores in Evaluating the Risk of No-Reflow in Patients With STEMI Undergoing Primary Percutaneous Coronary Intervention.

The no-reflow (NR) phenomenon is frequently encountered in acute coronary syndrome. We evaluated the association between anticoagulation and risk factors in atrial fibrillation (ATRIA) and modified ATRIA risk scores and NR in ST-elevation myocardial infarction (STEMI). Consecutive patients (n = 551) who underwent primary percutaneous coronary intervention between December 2019 and June 2020 due to STEMI were included. The mean age of the patients was 60.5 ± 10.8 years (n = 369, 67% male). The ATRIA and modified anticoagulation and risk factors in atrial fibrillation-hyperlipidemia, smoking, male (m-ATRIA-HS) scores were calculated. The NR group had higher frequency of diabetes mellitus (DM), serum creatine kinase-MB (CK-MB) levels, and corrected thrombolysis in myocardial infarction frame count (cTFC) (P = .002, P = .006, and P < .001, respectively). In regression analysis, ATRIA, m-ATRIA-HS, thrombus grade, and cTFC were independent predictors of NR. Age, higher CK-MB, and neutrophil-to-lymphocyte ratio and DM were the other predictors for NR. Pairwise comparison of receiver operating characteristics curve analysis showed that the m-ATRIA-HS (>2, area under curve [AUC]: 0.715) has better performance than ATRIA score (>1, AUC: 0.656), with a P < .022 and z statistics 2.279. In conclusion, ATRIA, especially the m-ATRIA-HS, can be used to evaluate NR risk in STEMI.

Glasgow prognostic score as a marker of mortality after TAVI

Abstract Introduction: The Glasgow prognostic score (GPS) reflects host systemic inflammatory response and has been reported to be significant as a prognostic indicator in cancer-bearing patients. The aim of this study was to evaluate the predictive value of GPS in outcomes of patients with severe aortic stenosis who were treated with transcatheter aortic valve implantation (TAVI). Methods: The study population consisted of 79 patients who underwent TAVI due to severe aortic stenosis between January 2018 and March 2019 in our clinic. Echocardiographic and laboratory data were recorded before the procedure and GPS was scored as 0, 1, or 2, based on serum albumin and C-reactive protein levels. European System for Cardiac Operative Risk Evaluation II scoring system was used for risk stratification. The primary endpoints of the study were postoperative in-hospital mortality, hospitalization due to cardiac causes, or mortality within a year. Results: The 79 patients were classified into two groups according to outcomes. Fifteen patients (19%) reached the primary endpoints at one year of follow-up. Compared to the patients who did not reach the endpoints, these 15 patients were not different in terms of age, preoperative mean gradient, and ejection fraction (P>0.05 for all). GPS was the only laboratory parameter with statistically significant difference between the groups (P=0.008) and multivariate analysis showed that GPS was independent predictor of primary endpoints (P=0.012, odds ratio 4.51, 95% confidence interval 1.39-14.60). Conclusion: GPS is an easy, noninvasive laboratory test which may be used as a predictive biomarker for outcomes in patients undergoing TAVI.

Combined effects of nutritional status on long-term mortality in patients with non-st segment elevation myocardial infarction undergoing percutaneous coronary intervention.

OBJECTIVE: The aim of this study was to investigate the performance of controlling nutritional status (CONUT) index, geriatric nutritional risk index (GNRI), and prognostic nutritional index (PNI) scores in predicting the long-term prognosis of patients with non-ST-elevated myocardial infarction (NSTEMI) who underwent percutaneous coronary intervention (PCI). METHODS: A total of 915 patients with NSTEMI (female: 48.4%; mean age: 73.1±9.0 years) who underwent PCI at Adana Numune Training and Research Hospital, Cardiology Clinic between January 2014 and January 2015 were included in this cross-sectional and retrospective study. CONUT, GNRI, and PNI scores were calculated based on the admission data derived from samples of peripheral venous blood. The mean follow-up duration was 64.5±15.4 months. RESULTS: During follow-up (mean 64.5±15.4 months), 179 patients (19.6%) died. The mean GNRI and PNI scores were significantly lower in the nonsurvivor group; however, the median CONUT score was significantly higher in the nonsurvivor group compared with the survivor group. The receiver operating characteristic (ROC) curve analyses have shown that GNRI score has similar performance to the CONUT score and has better performance than PNI score in predicting 5-year mortality. The Kaplan-Meier curve analysis has shown that patients with lower PNI or GNRI had higher cumulative mortality than the patients with higher PNI or GNRI. Also, the patients with higher CONUT scores had higher cumulative mortality compared with those with lower scores. The multivariate analyses have shown that GNRI (HR: 0.973), PNI (HR: 0.967), CONUT score (HR: 1.527), and body mass index (BMI) (HR: 0.818) were independent predictors of the 5-year mortality in patients with NSTEMI. CONCLUSION: In this study, we have shown that CONUT score, GNRI, and PNI values were associated with the long-term mortality in patients with NSTEMI who underwent PCI, and GNRI yielded similar results to CONUT score but was better than PNI.

Glasgow Prognostic Score as a Marker of Mortality after TAVI.

INTRODUCTION: The Glasgow prognostic score (GPS) reflects host systemic inflammatory response and has been reported to be significant as a prognostic indicator in cancer-bearing patients. The aim of this study was to evaluate the predictive value of GPS in outcomes of patients with severe aortic stenosis who were treated with transcatheter aortic valve implantation (TAVI). METHODS: The study population consisted of 79 patients who underwent TAVI due to severe aortic stenosis between January 2018 and March 2019 in our clinic. Echocardiographic and laboratory data were recorded before the procedure and GPS was scored as 0, 1, or 2, based on serum albumin and C-reactive protein levels. European System for Cardiac Operative Risk Evaluation II scoring system was used for risk stratification. The primary endpoints of the study were postoperative in-hospital mortality, hospitalization due to cardiac causes, or mortality within a year. RESULTS: The 79 patients were classified into two groups according to outcomes. Fifteen patients (19%) reached the primary endpoints at one year of follow-up. Compared to the patients who did not reach the endpoints, these 15 patients were not different in terms of age, preoperative mean gradient, and ejection fraction (P>0.05 for all). GPS was the only laboratory parameter with statistically significant difference between the groups (P=0.008) and multivariate analysis showed that GPS was independent predictor of primary endpoints (P=0.012, odds ratio 4.51, 95% confidence interval 1.39-14.60). CONCLUSION: GPS is an easy, noninvasive laboratory test which may be used as a predictive biomarker for outcomes in patients undergoing TAVI.

Comparison of the ATRIA, CHA2DS2-VASc, and Modified Scores ATRIA-HSV, CHA2DS2-VASc-HS, for the Prediction of Coronary Artery Disease Severity.

Many parameters included in the Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) and CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke, vascular disease, age 65-74 years, sex category) scores also predict coronary artery disease (CAD). We modified the ATRIA score (ATRIA-HSV) by adding hyperlipidemia, smoking, and vascular disease and also male sex instead of female. We evaluated whether the CHA2DS2-VASc, CHA2DS2-VASc-HS, ATRIA, and ATRIA-HSV scores predict severe CAD. Consecutive patients with coronary angiography were prospectively included. A ≥50% stenosis in ≥1epicardial coronary artery (CA) was defined as severe CAD. Patient with normal CA (n = 210) were defined as group 1, with <50% CA stenosis (n = 178) as group 2, and with ≥50% stenosis (n = 297) as group 3. The mean ATRIA, ATRIA-HSV, CHA2DS2-VASc, and CHA2DS2VASc-HS scores increased from group 1 to group 3. A correlation was found between the Synergy between PCI with Taxus and Cardiac Surgery score and ATRIA (r = 0.570), ATRIA-HSV (r = 0.614), CHA2DS2-VASc (r = 0.428), and CHA2DS2-VASc-HS (r = 0.500) scores (Ps < .005). Pairwise comparisons of receiver operating characteristics curves showed that ATRIA-HSV (>3 area under curve [AUC]: 0.874) and ATRIA (>3, AUC: 0.854) have a better performance than CHA2DS2-VASc (>1, AUC: 0.746) and CHA2DS2-VASc-HS (>2, AUC: 0.769). In conclusion, the ATRIA and ATRIA-HSV scores are simple and may be useful to predict severe CAD.

Combined effects of nutritional status on long-term mortality in patients with non-st segment elevation myocardial infarction undergoing percutaneous coronary intervention

SUMMARY OBJECTIVE: The aim of this study was to investigate the performance of controlling nutritional status (CONUT) index, geriatric nutritional risk index (GNRI), and prognostic nutritional index (PNI) scores in predicting the long-term prognosis of patients with non-ST-elevated myocardial infarction (NSTEMI) who underwent percutaneous coronary intervention (PCI). METHODS: A total of 915 patients with NSTEMI (female: 48.4%; mean age: 73.1±9.0 years) who underwent PCI at Adana Numune Training and Research Hospital, Cardiology Clinic between January 2014 and January 2015 were included in this cross-sectional and retrospective study. CONUT, GNRI, and PNI scores were calculated based on the admission data derived from samples of peripheral venous blood. The mean follow-up duration was 64.5±15.4 months. RESULTS: During follow-up (mean 64.5±15.4 months), 179 patients (19.6%) died. The mean GNRI and PNI scores were significantly lower in the nonsurvivor group; however, the median CONUT score was significantly higher in the nonsurvivor group compared with the survivor group. The receiver operating characteristic (ROC) curve analyses have shown that GNRI score has similar performance to the CONUT score and has better performance than PNI score in predicting 5-year mortality. The Kaplan-Meier curve analysis has shown that patients with lower PNI or GNRI had higher cumulative mortality than the patients with higher PNI or GNRI. Also, the patients with higher CONUT scores had higher cumulative mortality compared with those with lower scores. The multivariate analyses have shown that GNRI (HR: 0.973), PNI (HR: 0.967), CONUT score (HR: 1.527), and body mass index (BMI) (HR: 0.818) were independent predictors of the 5-year mortality in patients with NSTEMI. CONCLUSION: In this study, we have shown that CONUT score, GNRI, and PNI values were associated with the long-term mortality in patients with NSTEMI who underwent PCI, and GNRI yielded similar results to CONUT score but was better than PNI.

Association between serum SCUBE1 levels and thrombus burden in patients with ST-segment elevation myocardial infarction.

INTRODUCTION: The signal peptide-CUB-EGF domain-containing protein-1 (SCUBE1) is a recently available biomarker which is expressed by activated and adhered platelets. In present study, we aimed to investigate the association between SCUBE1 levels and thrombus burden in patients with ST elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PPCI). METHODS: A total of 88 patients who were diagnosed with STEMI and underwent PPCI were prospectively included between July 2019 and August 2019. Blood samples were collected for routine biochemistry and serum SCUBE1 levels before PPCI and antiplatelet therapy. Angiographic coronary thrombus burden was classified based on thrombolysis in myocardial infarction (TIMI) thrombus grades. We formed two groups based on the thrombus grade: 37 (42%) patients had high thrombus burden whereas 51 (58%) patients had low thrombus burden. RESULTS: The mean age of study population was 58.2 ± 11.8 years (34% female). The mean peak troponin I level, SCUBE1 level, SYNTAX score, and pain-to-balloon time were significantly higher in the high thrombus burden group compared to the low thrombus burden group (p < .05, for all). In ROC analysis, SCUBE1 level >65.63 ng/dL had a sensitivity of 91.9% and a specificity of 76.6% to predict high thrombus burden (AUC: 0.9256; p < .001). In multivariate analysis, SCUBE1 level (HR: 1.133, p = .004) and troponin (HR: 1.002; 95% CI 1.001-1.004, p = .003) were independent predictors of high thrombus burden. CONCLUSION: In the present study, we showed that SCUBE1, a novel platelet-endothelial adhesion molecule and a marker of platelet activation, is an independent predictor of high thrombus burden in patients with STEMI.

Serum 25-Hydroxyvitamin D Level and Aortic Intima-Media Thickness in Patients Without Clinical Manifestation of Atherosclerotic Cardiovascular Disease.

OBJECTIVES: Existing evidence suggests that impaired vitamin D metabolism contribute to the development of atherosclerosis. Aortic intima-media thickness (IMT) is an earlier marker than carotid IMT of preclinical atherosclerosis. However, there is a lack of researches on direct investigation of relevance between serum 25-hydroxyvitamin D (25(OH)D) and thoracic aortic IMT. In this study, we aimed to assess the relationship between thoracic aortic IMT and 25(OH)D. METHODS: We studied 117 patients (mean age: 45.5 ± 8.4 years) who underwent transesophageal echocardiography (TEE) for various indications. Serum 25(OH)D was measured using a direct competitive chemiluminescent immunoassay. The patients were divided into three groups according to the their serum 25(OH)D levels (VitDdeficiency , VitDinsufficient and VitDnormal groups). TEE was performed in all subjects. High sensitive C-reactive protein (hsCRP) and other biochemical markers were measured using an automated chemistry analyzer. RESULTS: Only 24.8% (29 patients) of patients had normal levels of 25(OH)D. The highest aortic IMT values were observed in VitDdeficiency group compared with VitDinsufficient and VitDnormal groups (P < 0.05, for all). Also aortic IMT values of VitDinsufficient group were higher than VitDnormal group (P < 0.05). 25(OH)D was independently associated with hs-CRP (ß = -0.442, P < 0.001) and aortic IMT (ß = -0.499, P < 0.001). CONCLUSIONS: The lower 25(OH)D level was independently associated with higher aortic IMT values. Therefore, hypovitaminosis D may have a role on pathogenesis of subclinical thoracic atherosclerosis.

Paraoxonase (PON1) activity in patients with subclinical thoracic aortic atherosclerosis.

High density lipoprotein (HDL), a powerful antioxidant, protects low density lipoprotein (LDL) particles against oxidative stress. By limiting LDL oxidation, HDL plays an important role in preventing atherosclerosis (AS). The antioxidant effect of HDL is mostly associated with the paraoxonase (PON1) activity. It has been known that increased aortic intima-media thickness (IMT) is an earlier marker AS than carotid IMT. We aimed to investigate the association between thoracic aortic IMT and serum PON1 activity. We studied 133 patients (mean age: 46.3 ± 8 years) who underwent transesophageal echocardiography (TEE) for various indications. The measurements of thoracic aortic IMT by TEE are classified into four grades (1, 2, 3 and 4). Serum PON1 activity was measured spectrophotometrically. Oxidative and anti-oxidative status was evaluated by measuring serum lipid hydroperoxide (LOOH), total anti-oxidant status (TAS). Serum PON1 activity was progressively decreasing from grade 1 IMT to grade 4 IMT (p < 0.001). However, serum LOOH was significantly lower and TAS was significantly higher in patients with grade 1 when compared with other grades. In multiple linear regression analysis, IMT was independently correlated with PON1 activity (ß = -0.495, p < 0.001), TAS level (ß = -196, p < 0.009), age (ß = 0.145, p = 0.029) and LDL cholesterol level (ß = 0.169, p = 0.009). Decreased PON1 activity was independently associated with the extent of thoracic AS. PON1 activity may play a role in pathogenesis of thoracic AS besides age, TAS and LDL cholesterol levels.

Serum bilirubin level and aortic intima-media thickness in patients without clinical manifestation of atherosclerotic cardiovascular disease.

We investigated the association between serum bilirubin level and thoracic aortic intima-media thickness (IMT). The study population consisted of 417 patients without coronary artery disease, who underwent transesophageal echocardiography examination for various indications. The highest aortic IMT values were observed in the bilirubinlow group compared with the bilirubinhigh group (P < .001). Serum bilirubin level was associated with high-density lipoprotein cholesterol level (r = .162, P = .001), high-sensitivity C-reactive protein (hsCRP; r = -.265, P < .001), and aortic IMT (r = -.551, P < .001) in bivariate analysis. Multivariate linear regression analysis showed that serum bilirubin level was independently and negatively associated with hsCRP (ß = -.095, P = .028) and aortic IMT (ß = -.513, P < .001). Serum bilirubin level may be an independent predictor of the extent of subclinical aortic atherosclerosis assessed by thoracic aortic IMT.

Mean platelet volume associated with aortic distensibility, chronic inflammation, and diabetes in patients with stable coronary artery disease.

We aimed to assess the effective factors on high mean platelet volume (MPV) in patients with stable coronary artery disease (CAD). A total of 411 patients (247 males and 164 females; mean age: 61.7 ± 9.9 years) with angiographically proven CAD were included. The patients were divided into 2 groups according to the median MPV value (MPVlow group <9.5 fL and MPVhigh group ≥9.5 fL). The SYNTAX score, high sensitive C-reactive protein (hsCRP) levels, and frequencies of diabetes and hypertension were higher in MPVhigh group compared to MPVlow group. Aortic distensibility (AD) and platelet count of patients in MPVhigh group were lower than patients in MPVlow group (P < .05, for all). Multivariate linear regression analysis showed that MPV was independently related with diabetes (ß = 0.135, P = .007), hsCRP (ß = 0.259, P < .001), platelet count (ß = -0.144, P < .001), and AD (ß = -0.425, P < .001). High MPV value is independently related to AD, as well as diabetes, hsCRP, and platelet count in patients with stable CAD.

Mean platelet volume is independently associated with renal dysfunction in stable coronary artery disease.

It has been suggested that athero-thrombotic risk progressively increases as the glomerular filtration rate (GFR) declines. Mean platelet volume (MPV) is the most commonly used measure of platelet size, and higher MPV value is independent risk factor for athero-thrombotic disease such as myocardial infarction. We aimed to evaluate the association between estimated GFR and MPV in patients with stable coronary artery disease showing normal to mildly impaired renal function. A total of 471 patients (288 males and 183 females; mean age: 62.5+9.5 years) with angiographically proven CAD were included. The patients were divided into two groups according to the estimated GFR value (GFRlow group: GFR <60 ml/minute per 1.73 m(2) and GFRhigh group: GFR ≥ 60, ml/min per 1.73 m(2)). Estimated GFR was calculated according to the Cockcroft-Gault formula. MPV, high-sensitive C-reactive protein (hsCRP) and other biochemical markers were measured in all patients. Prevalent of CAD was determined by the SYNTAX score. Patients with GFRlow group were of older age, had higher incidence of female gender, current smoker, diabetes, hypertension and hyperlipidemia, lower values of total cholesterol, LDL cholesterol, hemoglobin and platelet count and higher values of BMI, SYNTAX score, hs-CRP and MPV compared with patients with GFRhigh group. Multivariate linear regression analysis showed that the MPV was independently related with diabetes (ß=0.189, p<0.001), eGFR (ß=-0.267, p<0.001), hs-CRP level (ß=0.158, p<0.001) and platelet count (ß=-0.116, p=0.002). In conclusion, MPV is independently associated with GFR as well as hsCRP, platelet count and diabetes. These findings may explain, in part, the increase in athero-thrombotic risk with slightly impaired renal function.

N-terminal pro-brain natriuretic peptide levels and abnormal geometric patterns of left ventricle in untreated hypertensive patients.

N-terminal pro-brain natriuretic peptide (NT-proBNP) predicts cardiovascular events and mortality in hypertensive patients. Relationship between NT-proBNP level and left ventricular (LV) hypertrophy is well known in hypertensive patients. However, the studies investigating relationship between LV geometric patterns and serum NT-proBNP level have conflicting results and are in a limited number. The goal of the present study is to investigate relation between NT-proBNP and abnormal LV geometric patterns in untreated hypertensive patients. Measurements were obtained from 273 patients with untreated essential hypertension (mean age = 51.7 ± 5.8 years) and 44 healthy control subjects (mean age; 51.3 ± 4.7). Four different geometric patterns (NG: normal geometry; CR: concentric remodelling; EH: eccentric hypertrophy; CH: concentric hypertrophy) were determined according to LV mass index (LVMI) and relative wall thickness. NT-proBNP and other biochemical markers were measured in all subjects. The highest NT-proBNP levels were determined in the CH group compared with the control group and other geometric patterns (p < 0.05). NT-proBNP levels of all geometric patterns were higher than the control group (p < 0.05, for all). NT-proBNP levels were similar between CR and NG groups (p > 0.05). NT-proBNP was independently associated with LV geometry (ß = 0.304, p = 0.003) and LVMI (ß = 0.266, p = 0.007) in multiple linear regression analysis. Serum NT-proBNP level was independently associated with LVMI and LV geometry in untreated hypertensive patients with preserved ejection fraction.

NT-proBNP predicts impaired myocardial function in newly diagnosed hypertensive patients with preserved ejection fraction.

N-terminal pro-brain natriuretic peptide (NT-proBNP) is an excellent biomarker to diagnose left ventricular (LV) dysfunction. LV myocardial performance index (MPI-Tei index) is commonly used as a measure of combined systolic and diastolic function. We aimed to investigate the relationship between NT-proBNP and tissue Doppler derived MPI in newly diagnosed hypertensive patients with preserved LV ejection fraction (LVEF). We studied 236 patients with newly diagnosed HT (mean age; 52.9 ± 5.2 years). Echocardiographic examination was performed in all patients. LV mass index (LVMI) was calculated. Conventional Doppler indices (E and A waves) were recorded. The MPI value was obtained from the tissue Doppler derived ejection time, isovolumic contraction and relaxation times. The patients were divided into two groups according to the median NT-proBNP value (NT-proBNPlow group <114 pg/ml and NT-proBNPhigh group ≥114 pg/ml). Patients with NT-proBNPhigh were older and had higher levels of glucose and creatinine, lower E/A ratio and higher LVMI and MPI values than patients with NT-proBNPlow. However, LVEF were similar among the groups. Multiple linear regression analysis showed that NT-proBNP was independently associated with age, LVMI, MPI and E/A ratio. Increased NT-proBNP level was independently associated with impaired myocardial performance index in newly diagnosed hypertensive patients with preserved LVEF.

High-sensitivity cardiac troponin T levels in newly diagnosed hypertensive patients with different left ventricle geometry.

BACKGROUND: The high-sensitivity cardiac troponin T (hs-cTnT) assay provides important prognostic information on cardiovascular diseases. Although hs-cTnT is associated with left ventricle (LV) hypertrophy (LVH), it has not been investigated in different LV geometric patterns incorporating normal LV structure and concentric remodeling in addition to LVH. OBJECTIVES: We aimed to investigate the possible association between hs-cTnT and LV geometric patterns in newly diagnosed hypertensive patients. METHODS: We studied 306 patients with newly diagnosed hypertension (HT; mean age 51.7 ± 5.6 years) and 44 healthy control subjects (mean age 51.3 ± 4.7 years). Echocardiographic examination was performed in all subjects. Four different geometric patterns were determined in hypertensive patients according to LV mass index (LVMI) and relative wall thickness (RWth). hs-cTnT and other biochemical markers were measured in all participants. RESULTS: The highest hs-cTnT values were observed in the concentric hypertrophy group compared with the control, normal geometry, concentric remodeling and eccentric hypertrophy groups (p < 0.05, for all). Also, hs-cTnT values of the eccentric hypertrophy group were higher than the control, normal geometry and concentric remodeling groups (p < 0.05, for all). Multivariate regression analysis showed that hs-cTnT was independently associated with LV geometry (ß = 0.326, p = 0.001) as well as LVMI (ß = 0.228, p = 0.010) and creatinine level ß = 0.132, p = 0.012). CONCLUSION: hs-cTnT level is related not only to LVH but also to LV geometry in hypertensive patients. hs-cTnT levels may mediate poorer LV geometric patterns in hypertensive patients.

Serum 25-hydroxyvitamin D level is associated with arterial stiffness, left ventricle hypertrophy, and inflammation in newly diagnosed hypertension.

OBJECTIVES: Vitamin D may modulate vascular inflammation, vascular smooth muscle cell proliferation, the renin-angiotensin system, and cardiomyocyte proliferation, myocardial fibrosis, and proliferation. These mechanisms may play a role on arterial stiffness and left ventricle hypertrophy (LVH) in hypertensive patients. We aimed to evaluate the association between serum vitamin D with arterial stiffness and LVH in patients with hypertension. METHODS: We studied 133 patients with newly diagnosed hypertension [mean (SD) age, 62.9 (10.6) years]. Pulse wave velocity (PWV), which reflects arterial stiffness, was calculated using the single-point method via the Mobil-O-Graph ARCsolver algorithm. Left ventricular mass index (LVMI) was determined according to Deverux formula. The patients were divided into the following 2 groups according to serum vitamin D level: vitamin Dlow group with less than 20 ng/mL and vitamin Dhigh group with greater than or equal to 20 ng/mL. RESULTS: The highest PWV, high-sensitivity C reactive protein, and LVMI values were observed in vitamin Dlow group compared with vitamin Dhigh group. Multiple linear regression analysis showed that vitamin D level was independently associated with LVMI (ß = -0.235, P = 0.002) and PWV (ß = -0.432, P < 0.001). Adjustment for age, sex, parathyroid hormone level, body surface area, and mean blood pressure did not modify these associations. Vitamin D level was also independently associated with high-sensitivity C reactive protein (ß = -0.143, P = 0.047). However, adjustment for parathyroid hormone level or body surface area and mean blood pressure attenuate this association. CONCLUSIONS: Serum 25-hyroxyvitamin D is independently related with arterial stiffness, LVH, and inflammation. Vitamin D may play a role on pathogenesis of arterial stiffness and LVH in patient with newly diagnosed hypertension.

Aortic distensibility and extent and complexity of coronary artery disease in patients with stable hypertensive and nonhypertensive coronary artery disease.

OBJECTIVE: To assess the relationship between aortic distensibility (AD) and the extent and complexity of atherosclerotic lesions assessed with SYNTAX score (SS) in patients with stable coronary artery disease. SUBJECTS AND METHODS: Three hundred and seventy-six consecutive patients (230 males and 146 females; mean age: 61.6 ± 9.9 years) with angiographically proven coronary artery disease were included in the study. The SS was calculated using the SS algorithm on the baseline diagnostic angiogram in the 376 patients. AD was calculated from the echocardiographically derived ascending aorta diameters and hemodynamic pressure measurements in all patients. Frequencies of risk factors, biochemical and hematological data were recorded. The patients were divided into two groups according to the median AD value as AD(low) and AD(high) groups. RESULTS: The SS was higher in the AD(low) group compared with the AD(high) group (18.5 ± 10.2 vs. 8.3 ± 5.9, p < 0.001). The AD was independently related to age (ß = -0.104, p = 0.019), hypertension (ß = -0.202, p < 0.001) and SS (ß = -0.457, p < 0.001) and was more strongly associated with SS in hypertensive patients compared to nonhypertensive patients (r = -0.524 vs. r = -0.414, p < 0.001 for all). CONCLUSION: The findings showed that impaired AD might be an independent predictor for the severity of coronary atherosclerosis, particularly in patients with hypertension.