Increased Circulating Fetuin-A Levels in Patients with Atrial Fibrillation

Abstract Background Biomarkers related to the pathogenesis of atrial fibrillation (AF) have attracted the attention of experts. One of these recently studied biomarkers is Fetuin-A. Objectives This study aimed to evaluate the relationship between serum Fetuin-A levels and AF. Methods This study used the convenience sampling method, based on inclusion criteria and consent to participate in the study. The Shapiro-Wilk test was used to confirm the normal distribution of all continuous variables. Categorical variables were presented using absolute and relative frequencies. Both groups (48 patients with AF and 47 controls) were compared in terms of biochemical, hematological, and echocardiographic findings and Fetuin-A. the Chi-square or Fisher's exact test were used to compare groups concerning categorical variables. Continuous variables were compared using the independent samples t-test. P<0.05 was considered statistically significant. Results Serum Fetuin-A values increased in AF patients when compared to the controls (544±49 μg/mL versus 484±46 μg/mL, p=0.001). Moreover, Fetuin-A level was independently associated with AF — AOR = 0.978, 95%; confidence interval (CI) 0.969-988, p < 0.001. The cut-off values in Fetuin-A levels in patients with AF were >511.80 μg/mL with a sensitivity of 75% and a specificity of 73% — area under the curve (AUC) = 0.804, 95% CI = 0.715 - 0.892. Conclusions According to this study, there was a relationship between serum Fetuin-A levels and AF, regardless of conventional cardiovascular risk factors. Therefore, Fetuin-A may play a role in the pathophysiology of AF. Prospectively designed cohort studies are necessary to assess whether or not the results can be generalized for other populations.

Glutamine-Driven Metabolic Adaptation to COVID-19 Infection.

Background: COVID-19 is known to be transmitted by direct contact, droplets or feces/orally. There are many factors which determines the clinical progression of the disease. Aminoacid disturbance in viral disease is shown in many studies. In this study we aimed to evaluate the change of aminoacid metabolism especially the aspartate, glutamine and glycine levels which have been associated with an immune defence effect in viral disease. Methods: Blood samples from 35 volunteer patients with COVID-19, concretized diagnosis was made by oropharyngeal from nazofaringeal swab specimens and reverse transcriptase-polymerase chain reaction, and 35 control group were analyzed. The amino acid levels were measured with liquid chromatography-mass spectrometry technology. Two groups were compared by Kolmogorov-Smirnov analysis, Kruskal-Wallis and the Mann-Whitney U. The square test was used to evaluate the tests obtained by counting, and the error level was taken as 0.05. Results: The average age of the patient and control group were 48.5 ± 14.9 and 48.8 ± 14.6 years respectively. The decrease in aspartate (p = 5.5 × 10-9) and glutamine levels (p = 9.0 × 10-17) were significiantly in COVID group, whereas Glycine (p = 0.243) increase was not significiant. Conclusions: Metabolic pathways, are affected in rapidly dividing cells in viral diseases which are important for immun defence. We determined that aspartate, glutamine and glycine levels in Covid 19 patients were affected by the warburg effect, malate aspartate shuttle, glutaminolysis and pentose phosphate pathway. Enteral or parenteral administration of these plasma amino acid levels will correct the duration and pathophysiology of the patients' stay in hospital and intensive care.

Eosinophil Cell Count Predicts Mortality in the Intensive Care Unit after Return of Spontaneous Circulation.

BACKGROUND: Eosinophils constitute 1%-5% of peripheral blood leukocytes, less in the presence of acute infections (referred to as eosinopenia). Studies indicate that eosinopenia can be used as a prognostic predictor for chronic obstructive pulmonary disease exacerbation, sepsis, or acute myocardial infarction disease. There are only a few studies about predicting mortality in emergency departments and intensive care units (ICUs). Prognostic studies about patients in ICUs are generally carried out using different scoring systems. We aimed to analyze if the eosinophil count can estimate the prognosis among non-traumatic patients who underwent cardiopulmonary resuscitation and were hospitalized in ICU thereafter. METHODS: The data were evaluated of 865 non-traumatic adult patients (>18 years of age) who were admitted with cardiopulmonary arrest or developed cardiopulmonary arrest during clinical follow-ups. Admission venous blood sample tests, complete blood count, and biochemical laboratory results were recorded. Arterial blood gas results were also evaluated. The mean results of the recorded laboratory results were compared between the surviving and non-surviving patients groups. RESULTS: There was a significant difference between the two groups in regard to platelet, eosinophil count, pH, PaO2, SaO2, and HCO3- (P<0.001 for all). In the multiple linear regression analysis, eosinophil counts were found to be an independent factor (odds ratio=0.03, 95% confidence interval 0.33-0.56, P<0.001) associated with the mortality after cardiopulmonary resuscitation. CONCLUSION: Because admission eosinophil counts can be measured easily, they are inexpensive biomarkers that can be used for predicting the prognosis among the patients who have return of spontaneous circulation and are treated in ICUs.

Frontal QRS-T angle as a predictive marker for myocardial damage in acute carbon monoxide poisoning.

INTRODUCTION: The present study was undertaken to investigate the prognostic value of the frontal QRS-T angle associated with adverse cardiac outcomes in patients with carbon monoxide (CO) poisoning in early stages in the emergency department. MATERIALS AND METHODS: The data of 212 patients with CO poisoning who were admitted to the ED between January 2010 and May 2020 were retrospectively analyzed. The frontal QRS-T angle was obtained from the automatic reports of the EKG device. RESULTS: Compared to patients without myocardial damage, among patients with myocardial damage, statistically high creatinine, creatine kinase MB, cardiac troponin I, and frontal QRS-T angle values were found (p < 0.001 for all parameters), while the saturation of arterial blood pH and arterial oxygen values were found to be lower (p = 0.002 and p < 0.001, respectively). The frontal QRS-T angle values were correlated with creatine kinase, creatine kinase-MB, cardiac troponin I, and oxygen saturation (SpO2) in arterial blood (r = 0. 232, p = 0.001; r = 0. 253, p = < 0.001; r = 0. 389, p = < 0.001; r = -0. 198, p = 0.004, respectively). The optimum cut-off value of the frontal QRS-T angle was found to be 44.5 (area under the curve: 0.901, 95% confidence interval: 0.814-0.988, sensitivity: 87%, specificity: 84%). CONCLUSIONS: The frontal QRS-T angle, a simple and inexpensive parameter that can be easily obtained from 12-lead surface electrocardiography, can be used as an early indicator in the detection of myocardial damage in patients with CO poisoning.

Venous leg symptoms, ecchymosis, and coldness in patients with peripheral varicose vein: A multicenter assessment and validation study (VEIN-VIOLET study).

OBJECTIVES: We aimed to evaluate peripheral varicose vein symptoms including ecchymosis and coldness by using the Venous Insufficiency Epidemiological and Economic Study-Quality of Life/Symptoms (VEINES-QoL/Sym) questionnaire. METHODS: A total of 1120 patients were enrolled to the analysis after the exclusion of 199 patients who did not match the inclusion criteria. Patients were asked to answer the VEINES-Sym questionnaire and questions about ecchymosis and coldness. Scores of ecchymosis and coldness were calculated similar to VEINES-Sym questionnaire. Classifications of peripheral varicose vein were made according to the clinical part of clinical, etiological, anatomical, and pathophysiological classification system and patients with grade 2 or higher were considered as positive for peripheral varicose vein. RESULTS: Frequency of symptoms present in the VEINES-Sym instrument, ecchymosis and coldness were significantly higher in patients with peripheral varicose vein. Mean score of each symptom was significantly lower in peripheral varicose vein patients including scores of ecchymosis and coldness. Logistic regression analysis revealed that presence of hemorrhoids and all symptoms in VEINES-Sym questionnaire except restless leg were significantly and independently associated with peripheral varicose vein. Besides, ecchymosis (odds ratio: 2.04, 95% confidence interval: 1.34-3.08, p = 0.008) but not coldness was significantly and independently associated with peripheral varicose vein. There was also significant correlation of VEINES-Sym score with ecchymosis (r = 0.43, p < 0.001) and coldness (r = 0.47, p < 0.001). CONCLUSIONS: Venous leg symptoms present in VEINES-Sym questionnaire except restless legs, presence of hemorrhoids and ecchymosis are significantly and independently associated with peripheral varicose vein. Not only ecchymosis but also coldness has shown an independent association with total VEINES-Sym score.

Mean Platelet Volume-to-Platelet Count Ratio, Mean Platelet Volume-to-Lymphocyte Ratio, and Red Blood Cell Distribution Width-Platelet Count Ratio as Markers of Inflammation in Patients with Ascending Thoracic Aortic Aneurysm.

OBJECTIVE: Ascending thoracic aortic aneurysm (ATAA), seen in adults, is an important cause of morbidity and mortality. In this study, we aimed to evaluate the levels of mean platelet volume (MPV), mean platelet volume-to-platelet count ratio (MPVPCR), mean platelet volume-to-lymphocyte ratio (MPVLR), and red cell distribution width platelet count ratio (RDWPCR) in patients with thoracic aortic aneurysm. METHODS: 105 patients admitted to the emergency department were diagnosed with thoracic aortic aneurysm between January and December 2014, and 100 healthy individuals were involved in this retrospective study. MPV, MPVLR, MPVPCR and RDWPCRs were calculated at the time of admission. RESULTS: Platelet and lymphocyte levels were found to be significantly lower in the patient group when compared to the healthy group (P<0.001, P<0.001, respectively), while MPV, MPVPCR, MPVLR and RDWPCR were found to be significantly higher (P<0.001, P<0.001, P<0.001, and P=0.013, respectively). In the patient group, the high-sensitivity C-reactive protein was significantly higher (P<0.001), and the neutrophil (P=0.062) was also higher. In ROC analysis, MPVPCR had the highest sensitivity (80%) and RDWPCR had the highest specificity (72%). CONCLUSION: The results for MPV, MPVPCR, MPVLR and RDWPCR can be evaluated as useful parameters in the emergency clinical approach in the evaluation of inflammatory activity in ATAA patients. More extensive studies are required to address the role of these parameters in determining the severity of the disease.

Mean platelet volume-to-platelet count ratio, mean platelet volume-to-lymphocyte ratio, and red blood cell distribution width-platelet count ratio as markers of inflammation in patients with ascending thoracic aortic aneurysm

Abstract Objective: Ascending thoracic aortic aneurysm (ATAA), seen in adults, is an important cause of morbidity and mortality. In this study, we aimed to evaluate the levels of mean platelet volume (MPV), mean platelet volume-to-platelet count ratio (MPVPCR), mean platelet volume-to-lymphocyte ratio (MPVLR), and red cell distribution width platelet count ratio (RDWPCR) in patients with thoracic aortic aneurysm. Methods: 105 patients admitted to the emergency department were diagnosed with thoracic aortic aneurysm between January and December 2014, and 100 healthy individuals were involved in this retrospective study. MPV, MPVLR, MPVPCR and RDWPCRs were calculated at the time of admission. Results: Platelet and lymphocyte levels were found to be significantly lower in the patient group when compared to the healthy group (P<0.001, P<0.001, respectively), while MPV, MPVPCR, MPVLR and RDWPCR were found to be significantly higher (P<0.001, P<0.001, P<0.001, and P=0.013, respectively). In the patient group, the high-sensitivity C-reactive protein was significantly higher (P<0.001), and the neutrophil (P=0.062) was also higher. In ROC analysis, MPVPCR had the highest sensitivity (80%) and RDWPCR had the highest specificity (72%). Conclusion: The results for MPV, MPVPCR, MPVLR and RDWPCR can be evaluated as useful parameters in the emergency clinical approach in the evaluation of inflammatory activity in ATAA patients. More extensive studies are required to address the role of these parameters in determining the severity of the disease.

Exercise Profile and Diastolic Functions Measured via Tissue Doppler Imaging of Fibromyalgia Patients.

BACKGROUND: Our aim was to evaluate electrocardiographic and echocardiographic properties and exercise response of patients with fibromyalgia (FM). METHODS: The study included 60 women with primary FM and 30 healthy individuals. Resting electrocardiography, echocardiography and exercise treadmill test were used to compare these two groups. At apical four-chamber window, samples of transmitral diastolic inflow and tissue Doppler imaging of left ventricle lateral wall were obtained. Left ventricle ejection fraction was measured via modified Simpson's method. Exercise duration, maximal exercise capacity, maximal heart rate (HR) (bpm), maximal HR (%), rate-pressure product at maximal HR (bpm × mmHg), heart rate recovery 1 (bpm), heart rate recovery 2 (bpm) and chronotropic reserve (%) values were calculated. RESULTS: Resting HR and QTc values were similar in both groups. Echocardiographic measurements in both groups did not reveal statistically significant difference except left ventricle end-diastolic diameter and left atrial diameter. Parameters related to diastolic function of the left ventricle did not differ significantly in both groups. Also, there was not any significant difference between the groups for E/E' ratio and chronotropic reserve. Exercise treadmill test results were statistically similar for both groups. CONCLUSION: Patients with FM presented a normal HR response to exercise and those patients had normal diastolic function similar to their healthy controls.

Anticoagulation in patients with left ventricular systolic dysfunction and sinus rhythm: when?

Left ventricular (LV) systolic dysfunction and chronic systolic heart failure (HF) predispose to intraventricular thrombus formation and embolization resulting in stroke. Current guideline recommends the use of oral anticoagulants in patients with atrial fibrillation and history of previous thromboembolism. However, anticoagulant treatment in patients with LV systolic dysfunction with sinus rhythm and without history of previous thromboembolism is still on debate. Recent epidemiologic date has reported increased stroke rate in patients with systolic HF shortly after diagnosis. This review focuses on the possible causes of increased stroke rate shortly after the diagnosis of HF and subsequently suggests a rationale for the use of oral anticoagulant in these patient groups.

Statins decrease mean platelet volume irrespective of cholesterol lowering effect.

BACKGROUND: Recent clinical observations have demonstrated that the beneficial effects of statins are not limited to LDL lowering effect. They have also favourable effects on platelet activation, endothelial function, inflammation, and coagulation cascade. AIM: To investigate the effects of statins on mean platelet volume (MPV) which is a simple measure of platelet activation volume in patients who have been prescribed statins. Atorvastatin and rosuvastatin were also compared in respect to effects on MPV. METHODS: One hundred and forty five patients were retrospectively included in the study from the outpatient cardiology clinic. Patients who had been given statin treatment were recruited based on the records. Baseline and 4-8 weeks biochemical analysis and haematological measurements and cardiovascular risk factors were recorded. RESULTS: Both statins significantly decreased the MPV. MPV of patients did not show any significant correlation with lipid parameters. Linear regression analysis revealed that there were no statistically significant associations of ∆ MPV with the ∆LDL-cholesterol (beta coefficient = 0.13; p = 0.24), ∆DL-cholesterol (beta coefficient = 0.17; p = 0.18) or ∆triglyceride (beta coefficient = -0.11; p = 0.21) after statin treatment. Both statins had comparable effects on lipid parameters at the end of the one month follow up period. CONCLUSION: Statins significantly reduce MPV irrespective of cholesterol levels, and atorvastatin and rosuvastatin have comparable effects in this regard.

Mean platelet volume in patients with nonvalvular atrial fibrillation.

The procoagulant and prothrombotic states in patients with chronic atrial fibrillation are higher than those in patients with normal sinus rhythm. Mean platelet volume (MPV) which is a marker of platelet function and activation can reflect changes either in the level of platelet stimulation or the rate of platelet production. In this study, we aimed to assess and compare the hematologic parameters of routine complete blood count analysis in elderly patients with nonvalvular atrial fibrillation and control individuals with normal sinus rhythm. One hundred and seven consecutive patients with nonvalvular chronic atrial fibrillation and 112 age and sex-matched control individuals with normal sinus rhythm were retrospectively included in the study from the outpatient cardiology clinic. Hematological variables, including MPV, platelet count, red blood cell and white blood cell count were measured in all patients and control individuals. Presence of coronary artery disease, hypertension, sex, hyperlipidemia, diabetes mellitus, smoking status, hematocrit and platelet count were comparable between two groups (P>0.05 for all). However, MPV and white blood cell count were significantly higher in patients with atrial fibrillation compared to those without atrial fibrillation. Logistic regression analysis revealed that white blood cell count and MPV significantly and independently associated with atrial fibrillation. We have shown that MPV and white blood cell count is independently associated with chronic nonvalvular atrial fibrillation. To improve the clinical utility of MPV and role of inflammation in the pathogenesis of atrial fibrillation, further studies are needed to be carried out.

Serum γ-glutamyltransferase activity in patients with nonvalvular atrial fibrillation.

Procoagulant and prothrombotic states in patients with chronic atrial fibrillation (AF) are higher than those in patients with normal sinus rhythm. We assessed and compared serum γ-glutamyltranferase (GGT) activity in elderly patients with nonvalvular AF and control participants with normal sinus rhythm. Consecutive patients (n = 81) with nonvalvular chronic AF and 210 age- and gender-matched control participants with normal sinus rhythm were retrospectively included in the study from the outpatient cardiology clinic. Presence of coronary artery disease, hypertension, gender, hyperlipidemia, diabetes mellitus, smoking status, glucose, total cholesterol, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and ejection fraction were comparable between the 2 groups (P > .05 for all). However, serum γ-GGT activity was significantly higher (P = .003) in patients with AF compared with those without AF. We have shown that serum γ-GGT activity is independently associated with chronic nonvalvular AF.

Serum uric acid levels are associated with atrial fibrillation in patients with ischemic heart failure.

We evaluated the association between serum uric acid (SUA) and atrial fibrillation (AF) in patients with chronic heart failure (HF). Totally, 363 patients with chronic HF were included in the study. Of all, 78 patients had AF and 285 patients were in normal sinus rhythm. Serum uric acid was significantly increased in patients with AF compared with patients in normal sinus rhythm (P < .05). Comparing patients with AF and normal sinus rhythm, we found that age was significantly higher in patients group with AF. Echocardiographic parameters including ejection fraction, left atrial diameter, left ventricle end-diastolic diameter, and left ventricle end-diastolic volume were also significantly higher in patients with AF compared with patients in normal sinus rhythm. We have shown that patients with AF have significantly higher SUA and this was independently associated with AF in patients with ischemic HF.