The Effects of Niacin on Inflammation in Patients with Non-ST Elevated Acute Coronary Syndrome.

BACKGROUND: In this study, we aimed to evaluate the effects of niacin on high sensitivity C reactive protein (hs-CRP) and cholesterol levels in non-ST elevated acute coronary syndrome (NSTE-ACS) patients. METHODS: In this prospective, open label study, 48 NSTE-ACS were randomized to niacin or control group. Patients continued their optimal medical therapy in the control group. In the niacin group patients were assigned to receive extended-release niacin 500 mg/day. Patients were contacted 1 month later to assess compliance and side effects. Blood samples for hs-CRP were obtained upon admittance to the coronary care unit, in the third day and in the first month of the treatment. Fasting blood samples for cholesterol levels were obtained before and 30 days after the treatment. The primary end point of the study was to evaluate changes in hs-CRP, cholesterol levels, short-term cardiovascular events, and the safety of niacin in NSTE-ACS. RESULTS: Baseline demographic, clinical and laboratory characteristics were similar between the two groups. Logarithmic transformation of baseline and 3(rd) day hs-CRP levels were similar between the groups; but 1 month later, logarithmic transformation of hs-CRP level was significantly lower in the niacin group (0.43 ± 0.39 to 0.83 ± 0.91, p = 0.04). HDL-C level was significantly increased in the niacin group during follow-up. Drug related side effects were seen in 7 patients in the niacin group but no patients discontinued niacin. CONCLUSIONS: Our findings demonstrate that lower dose extended release niacin can be used safely and decreases hs-CRP and lipid parameters successfully in NSTE-ACS patients. KEY WORDS: Acute coronary syndrome; hs-CRP; Inflammation; Niacin.

[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.

Effects of right ventricular dysfunction on exercise capacity and quality of life and associations with serum NT-proBNP levels in COPD: an observational study.

OBJECTIVE: During the course of chronic obstructive pulmonary disease (COPD), pulmonary hypertension (PH) and right ventricular (RV) failure may develop due to elevated afterload of the RV. In those patients, exercise capacity is reduced due to pulmonary and cardiac limitations. We investigated relationships between serum N-terminal of proB-type natriuretic peptide (NT-proBNP) and RV functions with exercise capacity and quality of life in patients COPD. METHODS: An observational case-control study was conducted. We enrolled 31 moderate and severe COPD patients, and 20 subjects without chronic diseases as control group. Parameters reflecting the right ventricular diastolic and systolic functions by echocardiography along with serum NT-proBNP levels were assessed. Cardiopulmonary exercise testing and Short Form-36 (SF-36) were applied. RESULTS: Serum NT-proBNP levels were higher in COPD patients than control group (p=0.003). Serum NT-proBNP level was found to be related with pulmonary arterial pressure. Serum NT-proBNP levels were negatively correlated with anaerobic threshold oxygen uptake (AT VO2) and peak oxygen uptake (PVO2) values. Early ventricular filling velocity (Em) was lower in COPD patients. Em wave was significantly correlated with O2 pulse. There was a positive relationship between tricuspid E/A ratio and VO2 value at AT. SF-36 domains of physical functioning, general health and role limitation due to physical disorder were significantly correlated with AT VO2, PVO2 and O2 pulse. CONCLUSION: Exercise limitation may be predicted by assessment of right ventricule functions and NT-proBNP levels and exercise limitation impairs quality of life in COPD patients.

Flow in the left anterior descending coronary artery in patients with migraine headache.

Migraine is a common neurovascular disorder characterized by attacks of severe headache, autonomic and neurologic symptoms. Migraine can affect many systems in the body, yet its effects on cardiovascular system are unclear. We hypothesized that migraine and coronary microvascular angina may be manifestations of a common systemic microvascular dysfunction and clinically associated. Forty patients with migraine and 35 healthy volunteers were included into the study. Using transthoracic Doppler echocardiography, coronary flow was visualized in the middle or distal part of the left anterior descending artery. Coronary diastolic peak flow velocities were measured with pulse wave Doppler at baseline and after dipyridamole infusion (0.56 mg/kg/4 min). Coronary flow reserve of <2 was considered normal. In addition, thorough 2-dimensional and Doppler echocardiographic examinations were also performed. Fifty-two women and 23 men were included. Coronary flow reserve was significantly lesser in the migraine group than in the control group (1.99 ± 0.3 vs 2.90 ± 0.5, p <0.05). In addition, mitral annular velocities were lower and the ratio of early mitral inflow velocity to early mitral annular velocity (E/E' lateral and E/E' septal) was higher in migraineurs than in the control group (p <0.05 for all), indicating diastolic function abnormalities in the migraine group. In conclusion, these findings suggest that there is an association between coronary microvascular dysfunction and migraine independently of the metabolic state of the patients. A common pathophysiologic pathway of impaired endothelial vasodilatation, vasomotor dysfunction, and increased systemic inflammatory factors may play a role in these 2 clinical conditions and could be the underlying cause of subclinical systolic and diastolic left ventricular dysfunction in migraineurs.

[The frequency of embolic risk factors and adequacy of anti-embolic treatment in patients with atrial fibrillation: a single tertiary center experience]. / Atriyal fibrilasyon hastalarinda emboli risk faktörleri sikligi ve emboli önleyici tedavilerin uygunlugunun arastirilmasi: Tek üçüncül bir merkez deneyimi.

OBJECTIVE: Though atrial fibrillation (AF) is the most common sustained arrhythmia permanently; there is not enough data about the prevalence, frequency of risk factors, and adequacy of anticoagulant therapy. We aimed to investigate the prevalence of AF, the frequency of risk factors, adequacy of anticoagulant therapy in patients who were admitted to our outpatient tertiary cardiology clinic according to current guidelines. METHODS: Patients, admitted to our Cardiology outpatient clinic between January - June 2010 and had a history of AF were included to the study retrospectively. Patients' demographic findings, clinical AF classification, CHA2DS2VASC scores, treatments the measured INR values in last 12 months retrospectively and the success of anticoagulant therapy were evaluated. RESULTS: Overall, 432 (9.1%) of 4721 patients had AF. Among them 253 (58.5%) patients were female, mean age was 70.4 years. Permanent AF was the most common type. The most common risk factor was hypertension (71.9%). CHA2DS2VASC score was ≥ 2 in 377 patients (87.2%) and 254 (67.3%) of those patients had absolutely indicated for anticoagulation therapy, were taking warfarin. Sixteen of 37 patients with one risk factor, and 10 of 18 patients without risk factors were also receiving warfarin. Although warfarin was indicated in 123 patients, 36 patients had contraindications, 13 patients refused anticoagulation, and warfarin was stopped in 5 patients because of noncompliance with treatment. 15.9% of patients were not on warfarin although anticoagulation was indicated and no contraindication. 83.5% patients INR levels were between therapeutic ranges. CONCLUSION: Anticoagulation is applied successfully among an important part of AF patients in our tertiary center, but in a substantial group of patients the guidelines are still not implemented. New, cost-effective, safe, accessible treatments are needed for warfarin contraindicated patients.