Plasma osteopontin concentration is elevated in patients with coronary bare metal stent restenosis.

OBJECTIVE: Osteopontin is a component of atherosclerotic lesions, secreted by monocytes, macrophages and endothelial and vascular smooth muscle cells, which together are responsible for neointimal proliferation. We examined whether elevated plasma osteopontin concentration was associated with in-stent restenosis in patients with coronary artery disease. SUBJECTS AND METHODS: We enrolled 91 patients who underwent coronary artery stenting, and 60 control patients with normal findings on coronary angiography, between June 2012 and September 2013. For patients with stents, we measured plasma osteopontin concentration at the first follow-up coronary angiogram. For controls, plasma osteopontin concentration was measured at the time of angiography. RESULTS: Of the 91 patients who had undergone coronary artery stenting, 31 (34.1%) had developed in-stent restenosis and the mean time passed to control coronary angiography was 36.7 months (±SD 35.1 months). Mean plasma osteopontin concentration in this group was 2721.4 ± 1787.8 pg/ml, significantly higher than the 60 patients (65.9%) with no in-stent restenosis (1770.4 ± 1208.2 pg/ml, p = .011) and the 60 patients with a normal coronary angiogram (1572.4 ± 904.8 pg/ml, p = .002). There was no significant difference in mean osteopontin concentration between the patients with no in-stent restenosis and the control group (p = .312). CONCLUSIONS: Elevated plasma osteopontin concentration is associated with in-stent stenosis in patients with coronary artery disease. Further studies will be needed to establish whether osteopontin can predict in-stent restenosis and guide clinical management strategies.

Use of alpha-lipoic acid in prevention of contrast-induced nephropathy in diabetic patients.

In this prospective study, we aimed to determine the protective antioxidant role of alpha-lipoic acid (ALA) on development of contrast-induced nephropathy (CIN) in diabetic patients undergoing coronary angiography. Seventy-eight diabetic patients undergoing coronary angiography were included. Thirty-nine patients were randomized to control group and 39 patients to ALA group. Both groups were hydrated on the day of angiography, and the ALA group had also received three doses of "Thioctacid 600 mg HR, MEDA Manufacturing GmbH" in pill form. Serum creatinine clearance, cystatin C, and urinary neutrophil gelatinase-associated lipocalin (NGAL) were studied before and after angiography. We defined CIN as either ≥25% or ≥0.5 mg/dL increase in serum creatinine at 48th hour after angiography. Baseline clinical characteristics were similar in both groups. Mehran risk score and creatinine clearance were comparable in control and therapy groups (5.59 ± 1.96 vs. 5.49 ± 1.73, p = 0.54 and 89 ± 21 vs. 96 ± 24, p = 0.13, respectively). The volumes of contrast media (median values of 80 mL vs. 75 mL) and hydration with saline (2862 ± 447 mL vs. 2637 ± 592 mL) were also similar (p > 0.05). The incidence of CIN was the same (8%) in both the groups. Alterations in serum creatinine, cystatin C, and urinary NGAL levels before and after the procedure were comparable between the ALA and control groups (group p-values were >0.05 in two-way repeated measures analysis of variance). We presented for the first time that ALA therapy added to hydration does not decrease the risk of CIN development in diabetic patients undergoing coronary angiography.

Association of epicardial adipose tissue thickness by echocardiography and hypertension.

OBJECTIVES: Epicardial adipose tissue (EAT) is a component of visceral adiposity with endocrine and paracrine effects. It is also associated with metabolic syndrome (MetS). In this study, we investigated the relationship between EAT thickness and hypertension that is a component of MetS. STUDY DESIGN: Enrolled in this study were 140 hypertensive patients and 60 age- and sex-similar normotensive controls. EAT thickness was measured using 2-D echocardiography from the parasternal long- and short-axis views. EAT thicknesses were compared between patients with hypertension and controls. The effects of hypertension on EAT thickness were evaluated like other components of MetS. RESULTS: EAT thickness was increased in hypertensive patients compared to normotensive controls (6.3 ± 1.7 mm vs. 5.3 ± 1.6 mm; p<0.001). EAT thickness correlated with systolic and diastolic blood pressures (r=0.233, p=0.001; r=0.144, p=0.047, respectively). EAT thickness was further increased in patients with uncontrolled hypertension than in those with controlled hypertension (6.6 ± 1.7 mm vs. 5.9 ± 1.8 mm, p=0.046). When linear regression analysis was performed to assess the effect of hypertension on EAT thickness like the other components of MetS, hypertension (p=0.009, 95% CI 0.236-1.619), waist circumference (p=0.003, 95%CI 0.339-1.640), HDL-cholesterol (p=0.046, 95% CI, -0.054 - 0.001) and blood glucose levels (p=0.007, 95% CI, 0.003-0.002) were found to be independent correlates of EAT thickness. CONCLUSION: EAT thickness is associated with hypertension. Hypertension could be contributing factor for the development of EAT thickness like the other components of MetS.

Assessment and Evaluation of Cardiology Residency Training in Türkiye: A National Survey.

BACKGROUND: Workplace-based assessment methods are essential in the assessment and evaluation of competency-based cardiology residency training. This study aims to determine the assessment and evaluation methods used in cardiology residency training in Türkiye and to reach the opinions of the institutions on the applicability of the workplace-based assessments. METHODS: In this descriptive study, a Google Survey was sent to the heads/trainers of residency educational centers and their opinions about the currently used assessment and evaluation methods, applicability of cardiology competency exams, and the workplace-based assessments were asked. RESULTS: Responses were received from 65 (76.5%) of 85 training centers. Of the centers, 89.2% reported using resident report cards, 78.5% case-based discussion, 78.5% direct observation of procedural skills, 69.2% multiple-choice questions, 60% traditional oral exams, and less commonly other exam types. About 74% of responders gave a positive opinion on the requirement of being successful in the Turkish Cardiology Competency knowledge exam before specialty. Case-based discussion was the most common work-place-based assessments that the centers think could be applied as suggested by the current literature. A common idea was the adaptation of workplace-based assessments based on international standards and our national norms. The trainers supported a nationwide examination for all training centers to ensure standardization. CONCLUSION: In Türkiye, it was promising to see that the trainers are positive about the applicability of workplace-based assessments, but they commonly thought that the proposed workplace-based assessments should be adapted before nationwide applicability. Medical educators and field experts need to work together on this issue.

Association between cardiac functional capacity and parameters of tissue Doppler imaging in patients with normal ejection fraction.

OBJECTIVE: Patients with normal ejection fraction (EF) by conventional echocardiography may present with symptoms and findings of decreased cardiac functional capacity. We aimed to investigate the association between cardiac functional capacity determined by cardiopulmonary exercise test (CPET) and parameters of tissue Doppler (TD) imaging in patients with normal EF. METHODS: In all, 52 patients with normal EF were included. Conventional and TD imaging were performed. Peak systolic (S), early (E') and late (A') diastolic velocities were obtained from septal and lateral mitral annulus and tricuspid annulus by pulsed-wave TD. CPET was performed. Exercise time, peak oxygen consumption (peak VO2), anaerobic threshold (AT), metabolic equivalents (MET) values were determined and were compared with TD imaging parameters. RESULTS: We did not find any association between conventional echocardiographic measurements and cardiac functional capacity. However, peak S, E' and A velocity from the septal and tricuspid annulus and E' velocity from the lateral annulus correlated with exercise time, peak VO2, AT and MET (all P < 0.05). E/E' from the left ventricle correlated inversely with exercise time, peak VO2, AT and MET (all P < 0.05). S, E, A' velocities from septal and tricuspid annulus, E' velocity from lateral annulus were lower in patients with MET < or = 7 than in patients with MET > 7 (all P < 0.05). CONCLUSION: Systolic and diastolic velocities measured byTD imaging correlated with cardiac functional capacity as determined by CPET in patients with normal EF by conventional echocardiography. TD imaging could be more susceptible to determine cardiac functional capacity in these patients.

[Fistula between the left internal mammary artery and pulmonary artery: a rare cause of recurrent angina after coronary bypass grafting]. / Koroner baypas sonrasi tekrarlayan anginal yakinmalarin nadir bir nedeni: Sol internal mamaryan arter grefti ile pulmoner arter arasinda fistül olusumu.

Left internal mammary artery (LIMA) to pulmonary vasculature fistula is a rare complication after coronary artery bypass surgery. In most cases, the duration between bypass grafting and fistula formation ranges from 2 to 5 years. We present a 62-year-old man who presented with anginal symptoms five years after bypass surgery. On coronary angiography, selective catheterization of the LIMA showed fistula formation to the pulmonary artery, which probably led to coronary steal syndrome and myocardial ischemia. He underwent surgery and the connection between the LIMA and pulmonary artery was terminated. After surgery, his anginal complaints improved and echocardiography showed improvement in the wall motion abnormality detected before surgery.

[Serum gamma-glutamyltransferase activity: a new marker for coronary artery bypass graft disease]. / Serum gama-glutamiltransferaz aktivitesi: Koroner arter baypas greft hastaligi için yeni bir belirteç

OBJECTIVES: Serum gamma-glutamyltransferase (GGT) activity has been shown to be related to the development of atherosclerosis and cardiovascular events. We evaluated the association between GGT and severe graft disease in patients undergoing coronary artery bypass graft (CABG) surgery. STUDY DESIGN: We evaluated 113 patients (mean age 62±9 years; range 21 to 81 years) who underwent control coronary angiography after a mean of 39 months (range 18 to 84 months) following CABG surgery. A graft was considered patent if there was <70% stenosis or severely diseased if there was ≥70% stenosis on coronary angiography. Preoperative serum GGT levels were measured in all the patients and none had severe systemic or hepatobiliary disease. The association between serum GGT level and severe graft disease was investigated. The grafts were also evaluated separately. RESULTS: Coronary angiography showed severe graft disease involving at least one graft in 65 patients (57.5%). Serum GGT level was significantly higher in patients with severe graft disease (p=0.001). ROC curve analysis yielded a cut-off value of 29.5 U/l for serum GGT level to predict severe graft disease (area under the curve: 0.69) with 48% sensitivity and 82% specificity. While GGT levels were similar for internal mammary artery grafts (p>0.05), radial artery grafts and saphenous vein grafts (SVG) with severe graft disease were associated with significantly higher GGT levels (p=0.003 and p<0.001, respectively). In multivariate analysis, family history of coronary artery disease at a young age (OR 2.46, 95% CI 1.08-5.61, p=0.03) and serum GGT (OR 1.03, 95% CI 1.00-1.07, p=0.05) were independent predictors of severe graft disease. Separate analysis based on the graft types showed that GGT was an independent predictor of severe graft disease for only SVG (OR 1.02, 95% CI 1.00-1.04, p=0.03). CONCLUSION: Serum GGT level may be an independent marker for the development of severe SVG disease in patients undergoing CABG surgery.

Increased serum gamma-glutamyltransferase activity in patients with metabolic syndrome.

OBJECTIVES: Accumulating data indicate that serum gamma-glutamyltransferase (GGT) activity represents a true marker of atherosclerotic cardiovascular disease and has prognostic importance. In this study, we sought to evaluate serum GGT activity in patients with metabolic syndrome (MetS). STUDY DESIGN: We enrolled 232 patients (mean age 60.4 years) from our outpatient cardiology clinic, 117 with and 115 without MetS (control group) as defined by the ATP-III criteria. The results of serum liver function tests including serum GGT and C-reactive protein (CRP) levels were compared between the two groups. RESULTS: The two groups were similar with regard to age, sex, smoking, and family history of coronary artery disease (p>0.05). The prevalences of hypertension and dyslipidemia were significantly higher in patients with MetS. Compared with controls, patients with MetS had significantly higher serum GGT [(median 21, interquartile range (16-33) vs. 19 (14-26) U/l; p=0.008] and C-reactive protein levels [6.2 (3.6-9.4) vs. 5.0 (3.1-7.0) U/l; p=0.044]. A high GGT activity (>40 U/l) was determined in 14.5% of the patients with MetS and in 4.4% of the control subjects (p=0.012). Serum GGT level showed significant correlations with MetS (r=0.24, p=0.001), CRP (r=0.20, p=0.003), triglyceride (r=0.18, p=0.006), HDL cholesterol (r=-0.19, p=0.004), aspartate aminotransferase (r=0.15, p=0.02), alanine aminotransferase (r=0.32, p=0.001), and alkaline phosphatase (r=0.16, p=0.01). This significant association continued only for MetS (ß=-0.25, p=0.03), HDL cholesterol (ß=-0.18, p=0.03), and alkaline phosphatase (ß=0.17, p=0.01) in multivariate regression analysis. CONCLUSION: Our findings suggest that patients with MetS have higher serum GGT and CRP levels compared with controls. This increased GGT level might be a marker of increased oxidative stress and premature atherosclerosis.

[Postmenopausal hormone replacement therapy and the cardiovascular system]. / Postmenopozal hormon replasman (yerine koyma) tedavisi ve kardiyovasküler sistem.

Women suffer from cardiovascular diseases 10 years later than men, therefore female sex has been considered to be a 'protective factor'. However, the risk in women increases rapidly after menopause and the declining levels of endogenous estrogen is thought to be responsible. Postmenopausal hormone replacement therapy (HRT) decreases the severity and intensity of menopausal symptoms and improves women's quality of life. Until the last 10 years, based on the results of observational studies, postmenopausal HRT was thought to protect women against cardiovascular events and decrease the risk of coronary artery disease by 35-50%. However, recent randomized primary and secondary prevention trials did not support the cardioprotective effect of HRT. The different results of observational and randomized controlled trials are discussed to be related to the differences in the study population. The study population in observational and prospective cohort studies included relatively young women at the earlier stages of menopause, whereas studies showing neutral or negative effects of HRT included women older than 50 years old at least 10 years in menopause. Furthermore, the effects of estrogen depend on the state of vascular pathology. In relatively healthy vessels with no or early signs of atherosclerosis, estrogen prevent the development or progression of atherosclerotic lesions, whereas in the presence of established atherosclerotic lesions, estrogen promotes atherosclerosis or may even trigger acute events. Therefore, it is critically important to predict which women can safely receive HRT and which are at increased risk from HRT. Under the light of current knowledge, HRT should not be used for prevention from cardiovascular disease in postmenopausal women and the many other preventive strategies, (diet, exercise, blood pressure or cholesterol control) that are proven to be effective but underused, should be kept in mind.

The frequency of silent myocardial ischemia associated with femoral sheath removal and hemostasis after percutaneous coronary intervention: evaluation with 12-lead ST-segment monitoring.

OBJECTIVES: Silent myocardial ischemia (SMI) is the objective documentation of ischemia in the absence of angina or anginal symptoms. We aimed to determine the frequency of SMI before and after sheath removal (SR) following elective percutaneous coronary interventions (PCI). STUDY DESIGN: Sixty-six patients (51 men, 15 women; mean age 59.5±10.3 years) were prospectively monitored with 12-lead ST monitoring after elective PCI for six hours. Transient ischemic episode was defined as the detection of transient ST-segment shift of at least 1 mm and lasting for at least 1 min in any lead. The monitoring period was divided into three intervals: two hours before and after SR, and the last two hours. The number of SMI episodes and maximal ST-segment changes were calculated for each interval. RESULTS: Throughout monitoring, SMI was detected in 32 patients (48.5%), during which 44, 121, and 65 SMI episodes were recorded and 11 (16.7%), 20 (30.3%), and 1 (1.5%) patients exhibited de novo SMI episodes in two hours before and after SR, and the last two hours, respectively. The number of patients with SMI was significantly greater in the first two hours after SR compared to two hours before SR (p<0.001) and the last two hours (p=0.022). Moreover, the number of SMI episodes per patient was significantly greater in this period (1.8±3.8) compared to the period before SR (0.7±2.4, p<0.001) and the last period (1.0±3.0, p<0.001). Maximum ST-segment shifts were significantly greater in both the first and second two hours after SR compared to the period before SR (0.82±0.30 mm and 0.77±0.36 mm vs. 0.68±0.32 mm; p<0.001 and p=0.008, respectively). CONCLUSION: Our data indicate that SMI occurs more frequently during the early hours after SR in patients undergoing elective PCI.

Platelet function analysis with two different doses of aspirin.

OBJECTIVES: We aimed to compare the level of platelet inhibition using the platelet function analyzer (PFA)-100 in patients receiving low and medium doses of aspirin. STUDY DESIGN: On a prospective basis, 159 cardiology outpatients (83 men, 76 women; mean age 60.9 ± 9.9 years) taking 100 mg/day or 300 mg/day aspirin at least for the previous 15 days were included. Of these, 79 patients (50%) were on 100 mg and 80 patients (50.3%) were on 300 mg aspirin treatment. Blood samples were collected between 09:30 and 11:00 hours in the morning. Platelet reactivity was measured with the PFA-100 system. Incomplete platelet inhibition was defined as a normal collagen/epinephrine closure time (< 165 sec) despite aspirin treatment. RESULTS: Baseline clinical and laboratory characteristics of the patient groups taking 100 mg or 300 mg aspirin were similar. The overall prevalence of incomplete platelet inhibition was 22% (35 patients). The prevalence of incomplete platelet inhibition was significantly higher in patients treated with 100 mg of aspirin (n = 24/79, 30.4%) compared with those treated with 300 mg of aspirin (n = 11/80, 13.8%) (p = 0.013). In univariate analysis, female sex (p = 0.002) and aspirin dose (p = 0.013) were significantly correlated with incomplete platelet inhibition. In multivariate analysis, female sex (OR: 0.99; 95% CI 0.9913-0.9994; p = 0.025) and aspirin dose (OR: 3.38; 95% CI 1.4774-7.7469; p = 0.003) were found as independent factors predictive of incomplete platelet inhibition. CONCLUSION: Our findings suggest that treatment with higher doses of aspirin can reduce incomplete platelet inhibition especially in female patients.

Acute effects of smoking light cigarettes on coronary microvascular functions.

BACKGROUND: To date, there has been no study comparing the possible acute effects on coronary microvascular functions of smoking light cigarettes (those with low tar and nicotine yield) and regular cigarettes. METHODS: Twenty healthy volunteers (8 women and 12 men; mean age, 25.8 +/- 5.8 years) were included in a single-blind, open-label, cross-over study to compare the effects of smoking light cigarettes (containing 0.6 mg nicotine, 8 mg tar, 9 mg carbon monoxide) and smoking regular cigarettes (containing 0.9 mg nicotine, 12 mg tar, 12 mg carbon monoxide) on coronary flow reserve (CFR). For each participant, CFR values were measured at baseline, after smoking 2 regular or light cigarettes, and 15 days later after smoking 2 cigarettes of the other kind. RESULTS: After smoking 2 cigarettes, CFR values declined from 2.8 +/- 0.56 (baseline) to 2.31 +/- 0.51 after smoking light cigarettes (P = .003), and from 2.8 +/- 0.56 (baseline) to 2.21 +/- 0.45 after smoking regular cigarettes (P < .001). After smoking light and regular cigarettes, CFR values were similar (P = .678). CONCLUSIONS: Light cigarette smoking has similar acute detrimental effects on coronary microvascular function and CFR as does regular cigarette smoking.

Serum levels of C-reactive protein and uric acid in patients with cardiac syndrome X.

OBJECTIVES: Angina-like chest pain, a positive result from a stress test, and normal coronary arteries are characteristics of patients with cardiac syndrome X (CSX). Serum levels of C-reactive protein (CRP), which is a marker of a systemic inflammatory state, are associated with coronary atherosclerosis and endothelial dysfunction. Serum uric acid (UA) levels have also been implicated in the development of atherosclerotic cardiovascular disease. However, little is known about the association of serum UA and CRP levels with CSX. METHODS: In all, 250 subjects (100 patients with CSX, 100 with coronary artery disease (CAD), and 50 control subjects) were enrolled in the study. Coronary arteries were evaluated by conventional coronary angiography in the CSX and CAD groups. All patients underwent a noninvasive stress test. To determine whether they are potential risk factors for CSX, serum CRP and UA levels were compared among the 3 groups. RESULTS: Serum levels of CRP were higher in patients with CSX or CAD than in the control subjects (4.4 +/- 3.1 and 4.5 +/- 2.9 mg/L, respectively, vs. 1.9 +/- 1.6 mg/L; P < 0.001), but those levels were similar in patients with CSX or CAD. Uric acid levels were higher in patients with CSX or CAD than in the control subjects (5.5 +/- 1.1 mg/dl and 5.9 +/- 1.4 mg/dl, respectively, vs. 4.4 +/- 1.2 mg/dl; P < 0.00 1), but those levels were also similar in patients with CSX or CAD. CONCLUSIONS: In patients with CSX, serum CRP and UA levels were as high as those in patients with CAD. Elevated serum CRP and UA levels may contribute to the development of CSX.

Mitral valve aneurysm associated with aortic valve regurgitation.

Mitral valve aneurysm (MVA) is uncommon and occurs most commonly in association with infective endocarditis involving the aortic valve. A 66-year-old man with anterior MVA is presented. Two-dimensional transthoracic echocardiography and transesophageal echocardiography revealed a saccular structure in the anterior mitral leaflet that bulged into the left atrium throughout the cardiac cycle, a localized aneurysmal lesion of the aortic valve, and severe mitral and aortic regurgitation. There were neither vegetations nor atrial thrombi and his medical record was not suggestive of any episode of infective endocarditis. The mitral and aortic valves were replaced with mechanical protheses. Pathologic examination of the excised valves showed inflammation and cultures were negative. The postoperative course was uneventful, and the patient was discharged on the fifth postoperative day. In this case, MVA is likely to result from previous infective endocarditis of the aortic valve leading to aneurysm formation and severe aortic regurgitation.

Mentholated cigarette smoking and brachial artery, carotid artery, and aortic vascular function.

OBJECTIVES: We investigated possible acute effects of mentholated versus nonmentholated cigarette smoking on vascular functions and left ventricular diastolic functions in otherwise healthy young smokers. STUDY DESIGN: The study included 20 otherwise healthy smokers (6 women, 14 men; mean age 25.6 years) and 22 healthy nonsmokers (12 women, 10 men; mean age 25.1 years). Ultrasound and echocardiographic examinations were performed to determine baseline characteristics for the brachial artery, aorta, and carotid artery, including brachial flow-mediated dilation (FMD), aortic and carotid stiffness index (SI), distensibility, and elastic modulus (EM). On day 2, each subject smoked either two mentholated or nonmentholated cigarettes and ultrasound and echocardiographic examinations were repeated. The procedure was repeated 15 days later with each subject smoking the other type of cigarette. RESULTS: From the baseline level of 14.0+/-9.0%, FMD decreased significantly to 8.3+/-3.2% (p=0.012) and to 9.8+/-5.5% (p=0.025) after smoking mentholated and nonmentholated cigarettes, respectively. Increase in systolic blood pressure was significant only with mentholated cigarettes (p=0.003). Increases in heart rate and rate-pressure product were significant in both groups, being more prominent with mentholated cigarettes. Both types of cigarettes resulted in significant prolongation of mitral E deceleration time and decrease in mitral E/A ratio. Changes in aortic SI and EM were significant only with mentholated cigarettes, while changes in carotid SI and EM were significant in both groups. Menthol-associated changes in systolic blood pressure, heart rate, rate-pressure product, carotid strain, and carotid SI parameters differed significantly from those seen after nonmentholated cigarette smoking (p=0.027, p<0.001, p<0.001, p=0.037, and p<0.001, respectively). CONCLUSION: Our findings show that mentholated cigarettes are not safer than nonmentholated cigarettes and that menthol-associated acute impairment is more severe in many parameters of elasticity and stiffness.

Platelet Membrane Γ-Glutamyl Transferase-Specific Activity and the Clinical Course of Acute Coronary Syndrome.

γ-Glutamyl transferase (GGT) participates in oxidative and inflammatory reactions inside the atheroma plaque and platelets. We evaluated whether platelet membrane γ-glutamyl transferase (Plt-GGT) activity is a predictor of major adverse cardiac events (MACEs) during 3 months follow-up of patients with acute coronary syndrome (ACS; MACE-3M). We included 105 patients who were hospitalized consecutively with the diagnosis of ACS. Patients with an MACE-3M were older, more likely to have hypertension, hyperlipidemia, family history of coronary artery disease(CAD), thrombolysis in myocardial infarction (TIMI) risk score >4, higher Plt-GGT and serum GGT activities, serum C-reactive protein level, and lower left ventricular ejection fraction (LVEF) when compared to those without MACE-3M (all P values ≤.05). By receiver-operator characteristic (ROC) curve analysis, 265 mU/mg for Plt-GGT, 30 U/L for serum GGT, and 45% for LVEF were determined as cutoff values to discriminate MACEs. Platelet GGT activity >265 mU/mg, TIMI risk score >4, and family history of CAD were independent predictors of MACE-3M (all P values <.05). Platelet GGT activity was as an independent predictor for MACEs in patients with ACS during the 3 months follow-up.

Serum gamma-glutamyl transferase activity: new high-risk criteria in acute coronary syndrome patients?

In acute coronary syndromes (ACS), oxidation and inflammation have very important roles and in-vitro studies have demonstrated that gamma-glutamyl transferase (GGT) participates in such oxidative and inflammatory reactions. We aimed to evaluate the prognostic value of baseline serum GGT activity on the development of major adverse cardiac event (MACE) in the follow-up of the patients with ACS in coronary care unit (CCU), after 1 and 6 month periods. We included 117 patients (mean age: 61.2+/-11.3 years, 93 males) hospitalized in CCU with the diagnosis of ACS. All had baseline serum GGT activity and were free of systemic and hepatobiliary disease. MACE was defined as the composite of mortality from cardiac causes, recurrent hospitalization with ACS and nonfatal recurrent myocardial infarction diagnoses, to need for coronary revascularization during CCU, over 1 and 6 month follow-up periods. During the follow-up of CCU, MACE occurred in 17 (14.5%) patients (two died). Serum GGT activity was significantly higher in the patients with MACE than those free of MACE (P=0.001) and GGT was found as the independent predictor of the development of MACE-CCU [relative hazard: 1.05, 95% confidence interval (CI): 1.01-1.09, P=0.007]. During the follow-up of 1 month, MACE occurred in 23 (20.0%) patients (five died). Serum GGT activity was significantly higher in patients with MACE than those free of MACE (P=0.021) and GGT was found as the independent predictor of the development of MACE-1 month (relative hazard: 1.04, 95% CI: 1.01-1.08, P=0.039). During the follow-up of 6 months, MACE occurred in 24 (21.8%) patients (two died). Again, GGT was significantly higher in patients who developed MACE than those free of MACE (P=0.001) and GGT was found as the independent predictor of the development of MACE-6 months (relative hazard 1.06, 95% CI: 1.03-1.10, P<0.001). Serum GGT activity was found to be an independent predictor of the development of MACE in the patients with ACS during CCU, over 1 and 6 month follow-up periods.

Echocardiographic diagnosis of left ventricular-right atrial communication (Gerbode-type defect) in an adult with chronic renal failure: a case report.

Left ventricular-right atrial communication, known as a Gerbode-type defect, is a rare form of ventricular septal defect. It is usually congenital, but rarely acquired. Clinical presentation is associated with the volume of the shunt. Transthoracic echocardiography is the most useful diagnostic method. We present a 63-year-old man with chronic renal failure and left ventricular-right atrial shunt.