The non-HDL-C/HDL-C ratio is a strong and independent predictor of the no-reflow phenomenon in patients with ST-elevation myocardial infarction

BACKGROUND

No-reflow (NR) is the inability to achieve adequate myocardial perfusion despite successful restoration of attegrade blood flow in the infarct-related artery after primary percutaneous coronary intervention. The non-HDL-C/HDL-C ratio has been shown to be superior to conventional lipid markers in predicting most cardiovascular diseases. In this study, we wanted to reveal the predictive value of the NR by comparing the Non-HDL-C/HDL-C ratio with traditional and non-traditional lipid markers in patients who underwent primary percutaneous coronary intervention (pPCI) due to ST-elevation myocardial infarction (STEMI).

METHODS

A total of 1284 consecutive patients who underwent pPCI for STEMI were included in this study. Traditional lipid profiles were detected and non-traditional lipid indices were calculated. Patients were classified as groups with and without NR and compared in terms of lipid profiles.

RESULTS

No-reflow was seen in 18.8% of the patients. SYNTAX score, maximal stent length, high thrombus burden, atherogenic index of plasma and non-HDL-C/HDL-C ratio were determined as independent predictors for NR (p < 0.05, for all). The non-HDL-C/HDL-C ratio predicts the development of NR in STEMI patients with 71% sensitivity and 67% specificity at the best cut-off value. In ROC curve analysis, the non-HDL-C/HDL-C ratio was superior to traditional and non-traditional lipid markers in predicting NR (p < 0.05, for all).

CONCLUSION

The non-HDL-C/HDL-C ratio can be a strong and independent predictor of NR in STEMI patients and and therefore non-HDL-C/HDL-C ratio may be a useful lipid-based biomarker that can be used in clinical practice to improve the accuracy of risk assessment in patients with STEMI.

Comparison of the effect of uric acid/albumin ratio on coronary slow flow with other inflammation-based markers

Background: Many inflammation-based markers (IBMs) have been shown to be closely related to coronary slow flow (CSF), but the effect of the uric acid/albumin ratio (UAR) on CSF and its relationship with other IBMs are not clearly known. In this study, we aimed to compare the effects of UAR and other IBMs on CSF. Methods: After the exclusion criteria, 126 patients with CSF detected on coronary angiography and 126 subjects with normal coronary flow as the control group were included in the study. Results: UAR was determined as an independent predictor for CSF. In addition, the UAR was superior to other IBMs in detecting CSF (p < 0.05 for all). Conclusion: This study is the first to investigate the effect of UAR on CSF in comparison with other IBMs.

Comparison of the effect of uric acid/albumin ratio on coronary colleteral circulation with other inflammation-based markers in stable coronary artery disease patients

BACKGROUND

The Uric acid/Albumin ratio (UAR) has recently been identified as a prominent marker in cardiovascular diseases. In this study, we aimed to reveal the effect of UAR on coronary collateral circulation (CCC) in patients with stable coronary artery disease (CAD) patients by comparing it with conventional inflammation-based markers.

METHODS

In this study, 415 consecutive patients who underwent coronary angiography for stable angina pectoris and were found to have chronic total occlusion in at least one coronary artery were retrospectively included. The study population was divided into two groups as good CCC (Rentrop 2-3) and poor CCC (Rentrop 0-1) according to the Rentrop classification, and the groups were compared in terms of UAR and other traditional inflammation-based markers.

RESULTS

In the poor CCC group, C-reactive protein/albumin ratio (CAR), monocyte/high-density lipoprotein cholesterol ratio (MHR), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), systemic immune-inflammation index (SII) and UAR were found to be significantly high (p < .05, for all). UAR negatively correlated with rentrop classification (r = -0.383, p < .001). In multivariate regression analysis, MHR, NLR, SII and UAR were determined as independent predictors for poor CCC (p < .05, for all). The ability of UAR to predict poor CCC was superior to uric acid and albumin alone (p < .0001, for both). In addition, UAR was found to be superior to other inflammation-based markers in predicting poor CCC (p < .005, for all).

CONCLUSION

UAR was identified as a strong and independent predictor of CCC. In this context, UAR may be a useful biomarker in the risk prediction of patients with stable CAD.

The effects of melatonin and thymoquinone on doxorubicin-induced cardiotoxicity in rats

OBJECTIVES

This study aims to investigate the protective effects of thymoquinone and melatonin on the heart against doxorubicin-induced cardiotoxicity in rats.

BACKGROUND

Melatonin and thymoquinone may play an important role in cardiotoxicity.

METHODS

The subjects were divided into four groups: Control (physiological serum on 5th day), Doxorubicin (DXR), Doxorubicin+Melatonin (DXR+MEL, 10 mg/kg melatonin, intraperitoneally), and Doxorubicin+Thymoquinone (DXR+TQ, 50 mg/kg thymoquinone, orally). On the 5th day of the experiment, all groups were injected with 45 mg/kg DXR into the tail vein. On the 8th day of the experiment, ECG recordings were performed under anaesthesia.

RESULTS

Thymoquinone reduced the PR, QRS and QTc intervals, which were increased by DXR, while melatonin only reduced the QTc interval. Melatonin had a protective effect against the histopathological changes induced by DXR, while TQ did not demonstrate such an effect. DXR increased CK-MB, IL-6, MDA, IL-1, IL-18 levels and decreased SOD in the cardiac tissue. MEL reduced the levels of CK-MB, MDA, NO, SOD, IL-1, IL-6, IL-18. Meanwhile, TQ only reduced CK-MB, IL-1 and IL-18.

CONCLUSION

Our study showed that DXR induces cardiac injury and that melatonin improves biochemical parameters and offers histological protection; while thymoquinone improves ECG parameters and causes partial recovery of biochemical parameters (Tab. 4, Fig. 2, Ref. 41).

Usefulness of CHA2DS2-VASc Score to predict clinical outcomes of patients undergoing carotid artery stenting

The CHA₂DS₂-VASc score predicts stroke and mortality risk in several cardiovascular diseases regardless of atrial fibrillation. In this study, we aimed to investigate the ability of CHA₂DS₂-VASc score to predict in-hospital and long-term outcomes in patients undergoing carotid artery stenting (CAS). The study population included 558 patients undergoing CAS. The patients were stratified into three groups based on their CHA₂DS₂-VASc scores [low (≤ 2, n = 123), moderate (3-5, n = 355) and high (6-8, n = 80)]. In-hospital and 3-year outcomes were compared between the groups. In-hospital rates of ipsilateral and major strokes and death were significantly different between the groups (1.6% vs. 3.9% vs. 16.2%; 1.6% vs. 4.5% vs. 16.2%; 0.8% vs. 3.1% vs. 13.8%, p < 0.001 for all, respectively). At 3 years of follow-up, rates of ipsilateral and major strokes and death were significantly increased in patients with highscore compared to those with moderate and low scores (1.6% vs. 5.8% vs. 13%, p = 0.005; 0.8% vs. 5.2% vs. 13%, p = 0.001; 1.6% vs. 8.4% vs. 15.9%; p = 0.002, respectively). After adjusting for multi-model Cox regression analysis, CHA₂DS₂-VASc score persisted as an independent prognostic factor for mortality and major stroke in patients undergoing CAS. Higher CHA₂DS₂-VASc score predicted increased risk of in-hospital and 3- year stroke and mortality in patients undergoing CAS.

Epicardial fat thickness is associated with severity of disease in patients with chronic obstructive pulmonary disease

OBJECTIVE

Cardiovascular diseases (CVD) are common in patients with chronic obstructive pulmonary disease (COPD) and the BODE index is an important tool for the prognostic assessment of COPD patients. It is well known that epicardial fat thickness (EFT) is related to CVD. However, there are very few data about the relationship between EFT and BODE index. The aim of this study is to investigate the relationship between EFT and BODE index in patients with COPD.

PATIENTS AND METHODS

We prospectively included 157 patients with COPD and 45 controls in the present study. All patients underwent pulmonary function tests and six-minute walking test. EFT and other echocardiographic parameters were measured using transthoracic echocardiography on admission. Patients were divided into four quartiles according to the BODE index scores (Quartile-1 (Q1): 0-2 points; Quartile-2 (Q2): 3-4 points; Quartile-3 (Q3): 5-6 points; Quartile-4 (Q4): 7-10 points). High sensitive C-reactive protein (Hs-CRP) and other biochemical parameters were measured in all participants.

RESULTS

COPD patients had higher EFT values compared with control group (p<0.05). When COPD patients were classified according to BODE index quartiles, the highest EFT values were observed in Q1 compared with other quartiles (p<0.05, for all). EFT values showed a decreasing trend from Q1 to Q4. Furthermore, EFT was independently associated with BODE index (β=0.405, p<0.001), Hs-CRP (β=0.300, p<0.001) and diabetes (β=0.338, p<0.001) in multivariate linear regression analysis.

CONCLUSIONS

Our findings suggested that EFT is independently and negatively associated with the severity of disease as indicated by BODE index in patients with COPD.

Biventricular Myocardial Performance Is Impaired in Proportion to Severity of Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is an independent risk factor for cardiovascular morbidity and death. Little information is available regarding the relationship between the severity of OSA and myocardial performance in OSA patients who have normal ejection fractions. We prospectively investigated this relationship, using the tissue-Doppler myocardial performance index (TD-MPI). We conducted overnight, full-laboratory polysomnographic examinations of 116 patients, and calculated the left and right ventricular TD-MPIs. Patients were classified into 3 groups in accordance with their apnea-hypopnea index (AHI) levels: AHImild (≥5 to <15), AHImoderate (≥15 to <30), and AHIsevere (≥30). Left and right ventricular TD-MPI values were higher in the AHIsevere group than in the AHImild and AHImoderate groups (all P <0.05). In addition, right ventricular TD-MPI values in the AHImoderate group were higher than those in the AHImild group (P <0.05). Right ventricular TD-MPI was significantly associated with AHI (β=0.468, P <0.001), left ventricular TD-MPI, and right ventricular early-to-late filling velocities (E/A ratio) in multiple linear regression analysis. On the other hand, left ventricular TD-MPI was significantly associated with right ventricular TD-MPI and left ventricular E/A ratio (both P <0.05). Our results show that OSA severity, determined by means of AHI, is independently associated with impaired right and left ventricular function as indicated by TD-MPI in patients who have OSA and normal ejection fractions.

Mean platelet volume is associated with disease severity in patients with obstructive sleep apnea syndrome

OBJECTIVE

Obstructive sleep apnea syndrome is associated with cardiovascular diseases and thromboembolic events. The mean platelet volume (MPV) is a predictor of cardiovascular thromboembolic events. The aim of the present study is to investigate the association between the MPV and disease severity in patients with obstructive sleep apnea syndrome.

METHODS

We prospectively included 194 obstructive sleep apnea syndrome patients without cardiovascular disease (mean age 56.5±12.5 years) who were undergoing sleep tests. An overnight full laboratory polisomnography examination was conducted on each patient. The patients were divided into 3 groups according to the apnea-hypopnea index (AHI): (1) AHIlow group: 5≤AHI<15, (2) AHImid group: 1530.

RESULTS

The highest MPV values were found in the AHIhigh group compared with other groups (p<0.05 for all). Multiple linear regression analysis indicated that the MPV was associated with the AHI (β=0.500, p<0.001) and the high sensitivity C-reactive protein (hs-CRP) level (β=0.194, p=0.010).

CONCLUSION

The MPV is independently associated with both disease severity and inflammation in patients with obstructive sleep apnea syndrome.

Perioperative evaluation for the patients with obstructive sleep apnea syndrome

Obstructive sleep apnea syndrome, that has been more frequently diagnosed lately and whose importance has been gradually understood better, is a widespread health problem. This syndrome has been accompanied by obesity frequently. In the obstructive sleep apnea syndrome, it has been known that hypoxia and sometimes hypercarbia additionally has been observed, nevertheless cardiovascular problems have been observed more frequently in the aforementioned patient group in comparison with other individuals. Anesthetic substituents applied during the invasive operations and some medicine used for analgesia may cause the increase of the aforesaid hypoxia and cardiovascular problems in the obstructive sleep apnea syndrome. Nowadays, with the improvements in accessing to health agencies and consequently with the increase in the number of surgical applications, this review has been prepared with the thought of helping to clinicians about the approach and the pre-anesthetic and post-anesthetic precautions required to be taken within the mentioned patient group.

Aortic stiffness increases in proportion to the severity of apnoea-hypopnea index in patients with obstructive sleep apnoea syndrome

BACKGROUND AND AIMS

Obstructive sleep apnoea syndrome (OSA) and aortic stiffness are associated with an increased risk of cardiovascular morbidity and mortality. Although aortic stiffness increased in patients with OSA, the relationship between severity of OSA indicated with apnoea-hypopnea index (AHI) and aortic stiffness was not investigated in previous studies. The aim of this study is to investigate the relationship between the severity of OSA and aortic stiffness.

METHODS

In the present study, 90 consecutive OSA patients definite diagnosed with sleep test were prospectively included (mean age 54.5 ± 11.6 years). Aortic pulse wave velocity (PWV) and augmentation index (AIx) were calculated using the single-point method via the Mobil-O-Graph® ARCsolver algorithm. Aortic distensibility (AD) was calculated from the echocardiographically derived ascending aorta diameters and haemodynamic pressure measurements. Overnight full-laboratory polysomnography examination was conducted on each subject. Patients were classified into two groups according to their median AHI values (AHIlow and AHIhigh groups).

RESULTS

PWV values were higher and AD values were lower in AHIhigh group compared with AHIlow group (P < 0.05, for all). AHI was associated with body mass index (BMI), systolic blood pressure, pulse pressure, aortic diameter, AD, AIx and PWV in bivariate analysis (P < 0.05, for all). Multivariate linear regression analysis showed that AHI was independently associated with BMI (β = 0.175, P = 0.047), PWV (β = 0.521, P < 0.001) and aortic distensibility (β = -0.223, P = 0.020).

CONCLUSIONS

Aortic stiffness is associated both with the presence and the severity of OSA.

Gamma Glutamyl Transferase Activity is Associated With Both Paraoxonase Activity and Aortic Stiffness in Hypertensive Patients

BACKGROUND

We aimed to investigate relationship between gamma glutamyl transferase (GGT) activity with paraoxonase 1 (PON1) activity and aortic stiffness (AS) parameters such as pulse wave velocity (PWV) and augmentation index (AIx).

METHODS

Measurements were obtained from 324 patients with newly diagnosed essential hypertension (mean age: 55.0 ± 8.2 years). The patients were divided into two groups according to their median GGT values. PWV and AIx were calculated using the single-point method via the Mobil-O-Graph® ARCsolver algorithm.

RESULTS

PWV, Aix, and high-sensitive C-reactive protein (hs-CRP) values were higher and PON1 activity values were lower in GGThigh group compared with GGTlow group (P < 0.05, for all). Multiple linear regression analysis showed that GGT activity was independently associated with PWV (β = 0.496, P < 0.001) and PON1 activity (β = -0.343, P < 0.001) as well as hs-CRP (β = 0.334, P < 0.001).

CONCLUSION

These results may support that increased GGT activity would be associated with both impaired antioxidant system and increased AS in hypertensive patients.

Serum 25-hydroxyvitamin D level and extent and complexity of coronary artery disease

BACKGROUND

There are limited number of studies about relationship between serum vitamin D level and presence and severity of coronary artery disease (CAD). We assessed the relationship between the extent and complexity of CAD assessed by SYNTAX score and 25-hydroxyvitamin D level in patients with stable CAD.

METHODS

In the study, 209 consecutive patients with stable CAD (age: 63.1 ± 10.0 years) and 102 healthy control subjects (age 61.3 ± 13.7 years) were included. Serum 25-hydroxyvitamin D was measured using a direct competitive chemiluminescent immunoassay and other biochemical markers were measured in all subjects. All subjects underwent coronary angiography and SS was calculated.

RESULTS

The mean serum 25-hydroxyvitamin D level of CAD group was lower than the control group (P < 0,001). Multivariate regression analysis showed that serum 25-hydroxyvitamin D level was independently associated with SYNTAX score (β = -0.396, P < 0.001), hypertension (β = -0.183, P = 0.003), high sensitive C-reactive protein (β = -0.141, P = 0.014), and body mass index (β = -0.135, P = 0.023) in patient group.

CONCLUSION

25-Hydroxyvitamin D level was associated with extent and complexity of CAD. 25-Hydroxyvitamin D may play a role in pathogenesis and severity of coronary atherosclerosis.

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 (β = 0.304, p = 0.003) and LVMI (β = 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 is associated with SYNTAX score and aortic distensibility in patients with stable CAD

OBJECTIVE

A high N-terminal pro-brain natriuretic peptide (NT-proBNP) level provides significant prognostic information on patients with coronary artery disease (CAD). It is unclear whether aortic distensibility (AD), which reflects the aortic stiffness, and the extent and complexity of CAD, assessed with the SYNTAX score (SS), affect the secretion of NT-proBNP in stable CAD. We aimed to investigate the relationship between NT-proBNP levels and AD as well as with the extent and complexity of CAD in stable CAD patients.

METHODS

The study included 411 patients with stable CAD (mean age = 61.7 ± 9.9 years, male/female = 247/164). 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). AD was calculated from the echocardiographically derived ascending aorta diameters and hemodynamic pressure measurements. Coronary angiography was performed and SS was determined in all patients. NT-proBNP and other biochemical markers were measured in all subjects.

RESULTS

The AD and ejection fraction values of the NT-proBNPhigh group were lower and their SS levels were higher compared with those from the NT-proBNPlow group (p < 0.05, for all). The NT-proBNP level was independently associated with AD (β = -0.378, p < 0.001), SS (β = 0.262, p < 0.001), and ejection fraction (β = - 0.295, p < 0.001) on multiple linear regression analysis.

CONCLUSION

NT-proBNP was independently associated with an impaired elastic property of the aorta and with the extent and complexity of CAD as well as with left ventricular systolic dysfunction.

The anticancer mechanism of caffeic acid phenethyl ester (CAPE): review of melanomas, lung and prostate cancers

BACKGROUND

Caffeic acid phenethyl ester (CAPE), an active component of propolis extract, specifically inhibits NF-κB. It exhibits antioxidant, antiinflammatory, antiproliferative, cytostatic, and most importantly, antineoplastic properties.

AIM

The aim of the present mini-review is to summarize and evaluate the anticancer mechanism of CAPE with examples of several cancer types.

RESULTS

In view of the mechanisms and findings in our laboratory and those of others in literature, we suggest that CAPE possess anticancer and apoptosis inducing activities.

CONCLUSIONS

Further researches are needed regarding the anticancer basis of CAPE in all disciplines of medicine. Also, clinical potential toxicities of CAPE should be revealed if it is going to be used as an anticancer agent.

Relationship between the elastic properties of aorta and QT dispersion in newly diagnosed arterial adult hypertensives

OBJECTIVE

Afterload is increased in hypertensive patients and increased afterload associated with both ventricular repolarization inhomogeneity and impaired elastic properties of aorta. Thus, we investigated whether QT dispersion (QTd), which is a reflection of ventricular repolarization inhomogeneity, is related to aortic elastic properties in patients with hypertension.

METHODS

Overall 113 patients with newly diagnosed hypertension and 25 normal control subjects were included in this cross-sectional case-controlled study. Aortic strain (AS) and aortic distensibility (AD) were calculated echocardiographically from the derived ascending aorta diameters. Electrocardiograms were recorded in all subjects, and QTd and corrected QTd (cQTd) were then calculated.

RESULTS

Patients as compared with control subjects had lower mean AS and AD (p<0.001, for both). The QT interval maximum and corrected QT interval maximum durations, QTd and cQTd were increased in patients compared with control subjects. Multiple linear regression analysis showed that corrected QTd was independently related to age, left ventricular mass index (LVMI), AS and AD (b=0.204, p=0.030, b=0.219, p=0.026, b=-0.238, p=0.021 and b=-0.208, p=0.032 respectively) in hypertensive patients. The QTd was independently related to AS (p=0.043) and AD (p=0.037), as well as age (p=0.003) and LVMI (p=0.008).

CONCLUSION

The QTd and cQTd were increased in hypertensives. Aortic elastic properties may play a role in increased dispersion of QT and cQT intervals.

Relation between P-wave dispersion and left ventricular geometric patterns in newly diagnosed essential hypertension

AIM

P-wave durations and P-wave dispersion (PD) are considered to reflect the heterogeneous conduction in atria. The aim of this study was to investigate PD and P-wave duration in different left ventricle geometric patterns of hypertensive patients.

METHODS

One hundred forty-nine consecutive patients with newly diagnosed essential hypertension and 29 healthy control groups were included in the study. The maximum and minimum P-wave duration (Pmax and Pmin, respectively) and PD were measured from the 12-lead surface electrocardiogram. Echocardiographic examination was also performed in all subjects. Four different geometric patterns were identified in hypertensive patients according to left ventricular mass index (LVMI) and relative wall thickness.

RESULTS

P-wave dispersion was longer in concentric remodeling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH) groups when compared with the control group (P = .009, P < .001, P < .001, respectively). P-wave dispersion of normal left ventricle (NLV) geometric pattern was not different from that of the control group. Patients with NLV geometric pattern had shorter PD than patients who had CH and EH (NLV vs CH, P < .001; NLV vs EH, P = .025). P-wave dispersion of the NLV group was not different from that of the CR group. Patients with CR had also shorter PD than patients who had CH (P = .002). In bivariate analysis, there was a significant correlation between PD with left ventricle geometry, body surface area, LVMI, and relative wall thickness. In multiple linear regression analysis, PD was independently correlated only with LVMI (beta = .425, P < .001).

CONCLUSIONS

P-wave dispersion is independently associated with LVMI rather than left ventricle geometry and relative wall thickness in hypertensive patients. Thus, it is increased particularly in patients with CH and EH.

Spontaneous bilateral femoral neck fractures in a young adult with chronic renal failure

Pathologic femoral neck fracture due to renal osteodystrophy is rare. We report the case of a young adult patient with chronic renal failure who presented with bilateral spontaneous femoral neck fractures due to renal osteodystrophy. The pathophysiology of renal osteodystrophy and the treatment of hip fractures in patients with renal failure is discussed.

Delirium associated with the combination of a neuroleptic, an SSRI, and benztropine

BACKGROUND

On the basis of recent findings, the increased use of serotonin selective reuptake inhibitors (SSRIs) in combination with antipsychotics and concomitant benztropine is likely.

METHOD

Five patients who developed delirium while receiving a neuroleptic, an SSRI, and benztropine are described.

RESULTS

The timing of the delirium in relation to drug administration suggests the delirium was the result of an interaction of the SSRI and benztropine.

CONCLUSION

Possible mechanisms are explored. Clinicians should be aware that patients receiving this combination may be at increased risk for delirium.