Evaluation of serum apelin-13 and apelin-36 concentrations in preeclamptic pregnancies.

AIM: Recent studies suggest that apelin can be a novel potential therapeutic mediator to improve the diagnosis, and treatment of preeclampsia. This study aimed to investigate the association of serum apelin-13 and apelin-36 with preeclampsia and to detect their relationship with preeclampsia-associated perinatal morbidity. METHODS: Forty-four women with preeclampsia were included as the study group. Forty-four healthy pregnant women, at similar gestational week with similar gravidity, formed the control group. The clinical findings, biochemical indicators, maternal and perinatal outcomes, and the serum concentrations of apelin-36 and apelin-13 were evaluated. The levels of apelin-13 and apelin-36 were determined with commercial kits using a competition-based enzyme-linked immunosorbent assay method. RESULTS: The mean gestational age at sampling was 35.77 ± 2.515 weeks in the preeclamptic group, 36.45 ± 2.057 weeks in the control group (P = 0.270). Maternal serum apelin-36 and apelin-13 concentrations were significantly lower in patients with preeclampsia compared to the individuals in the control group (P = 0.030 and P = 0.005, respectively). The optimal cut-off points of apelin-36 and apelin-13 measurements for discriminating between preeclampsia and controls were evaluated by the receiver-operator curve analysis. The results showed that apelin-13 and apelin-36 are moderately successful markers to differentiate subjects with preeclampsia from healthy pregnant women. The concentrations of apelin-13 and apelin-36 in both groups were not statistically different in cases with and without adverse fetal/neonatal outcomes. CONCLUSION: In conclusion, we investigated serum apelin-13 and apelin-36 concentrations in preeclamptic patients and demonstrated markedly lower maternal concentrations compared to healthy pregnant women.

Relationship of fragmented QRS with prognostic markers and long-term major adverse cardiac events in patients undergoing coronary artery bypass graft surgery.

BACKGROUND: Fragmented QRS (fQRS) complex is associated with increased sudden cardiac death, recurrent cardiovascular events, morbidity and mortality. However, the prognostic role of fQRS has not been comprehensively studied in patients undergoing coronary artery bypass graft (CABG) surgery. In this study, we planned to investigate the relationship of fQRS with prognostic markers and long-term major adverse cardiovascular events (MACEs) following isolated CABG surgery. METHODS: Two hundred and thirteen patients who underwent CABG surgery at our institution were enrolled consecutively. MACE was defined as cardiac death, recurrent myocardial infarction, decompensated heart failure and re-hospitalization. The patients were followed up for a mean duration of 26 ±â€Š10 months for MACE. RESULTS: Patients with fQRS had a higher rate of Q wave on ECG (30 vs. 10%, P < 0.001), more prolonged QRS time (99 ±â€Š11 vs. 88 ±â€Š13 ms, P < 0.001), higher EUROSCORE (4.0 ±â€Š1.9 vs. 2.7 ±â€Š1.5, P < 0.001) and lower left ventricular ejection fraction (44 ±â€Š12 vs. 56 ±â€Š12, P < 0.001) in comparison with patients with non-fQRS. In addition, patients with fQRS had increased short-term and long-term MACE (17 vs. 4%, P = 0.002; 23 vs. 6%, P < 0.001, respectively) after discharge. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of fQRS for predicting MACE were 67, 71, 23, 94 and 70%, respectively. fQRS [odds ratio (OR) 3.110, 95% confidence interval (CI) 1.157-8.362, P = 0.025] and prolonged QRS duration (>100 ms) (OR 3.898, 95% CI 1.463-10.39, P = 0.007) were the only independent predictors of long-term MACE in multivariate logistic regression analysis. However, QRS duration had a better association with MACE than the presence of fQRS. CONCLUSION: fQRS and prolonged QRS duration may have an additional value in predicting cardiac status and long-term prognosis. Fragmentations on admission ECG and prolonged QRS duration may be useful for identifying patients with higher long-term risk who will need more intense treatment and close follow-up after CABG surgery.

The independent relationship of epicardial adipose tissue with carotid intima-media thickness and endothelial functions: the association of pulse wave velocity with the active facilitated arterial conduction concept.

BACKGROUND: Hypertension, identifiable by elevated blood pressure (BP), is a heterogeneous multifactorial disorder. Epicardial adipose tissue (EAT), a special fat depot that is related to visceral fat rather than total adiposity, shares the same microcirculation with myocardial tissue and coronary vessels. Recent studies have identified EAT as an active organ, which secretes several mediators, called adipokines, affecting the vascular system. The aim of this study was to evaluate the potential association between EAT and BP, endothelial function, carotid intima-media thickness (CIMT), and pulse wave velocity (PWV) independent of conventional and novel metabolic risk factors in patients with previously untreated hypertension. PATIENTS AND METHODS: Our study, which has a cross-sectional design, included 107 consecutive untreated hypertensive patients. Vascular status and functions were evaluated using CIMT, PWV, and flow-mediated dilation (FMD) of the brachial artery. The values of BP were obtained both by the traditional auscultatory method using a sphygmomanometer in an office and by ambulatory BP measurement. RESULTS: When we stratified the patients into three groups according to increased EAT values, CIMT (P<0.001), presence of carotid plaque (P=0.026), and BP values (P=0.001) were increased in the higher tertile compared with the lower tertile. FMD of the brachial artery decreased significantly with increasing EAT thickness (P<0.001). There was a significant, strong, and negative association between CIMT and FMD (r=-0.604, P<0.001). CIMT correlated positively to age (r=0.404, P<0.001), EAT (r=0.517, P<0.001), office systolic BP (r=0.241, P=0.016), ambulatory systolic BP (r=0.419, P<0.001), and diastolic BP (r=0.360, P=0.002). FMD correlated negatively to age (r=-0.390, P<0.001), EAT (r=-0.495, P<0.001), ambulatory systolic (r=-0.338, P=0.006), and diastolic BP (r=-0.281, P=0.024). Multivariate linear regression analyses, carried out to identify predictors of CIMT and FMD, showed only age, EAT, and mean ambulatory BP as independent predictors of both CIMT and FMD. CONCLUSION: Our study showed that EAT is an independent factor of adverse changes in CIMT, FMD, and PWV. Future studies, investigating the vascular influence of EAT at the molecular level, may provide therapeutic options to prevent its adverse vascular interactions.