PrevAleNce and Associated factors of inappropriaTe dosing of direct Oral anticoaguLants In pAtients with Atrial Fibrillation: the ANATOLIA-AF Study

PURPOSE

Inappropriate dosing of direct oral anticoagulants is associated with an increased risk of stroke, systemic embolism, major bleeding, cardiovascular hospitalization, and death in patients with atrial fibrillation. The main goal of the study was to determine the prevalence and associated factors of inappropriate dosing of direct oral anticoagulants in real-life settings.

METHODS

This study was a multicenter, cross-sectional, observational study that included 2004 patients with atrial fibrillation. The study population was recruited from 41 cardiology outpatient clinics between January and May 2021. The main criteria for inappropriate direct oral anticoagulant dosing were defined according to the recommendations of the European Heart Rhythm Association.

RESULTS

The median age of the study population was 72 years and 58% were women. Nine-hundred and eighty-seven patients were prescribed rivaroxaban, 658 apixaban, 239 edoxaban, and 120 dabigatran. A total of 498 patients (24.9%) did not receive the appropriate dose of direct oral anticoagulants. In a logistic regression model, advanced age, presence of chronic kidney disease and permanent atrial fibrillation, prescription of reduced doses of direct oral anticoagulants or edoxaban treatment, concomitant use of amiodarone treatment, and non-use of statin treatment were significantly associated with potentially inappropriate dosing of direct oral anticoagulants.

CONCLUSION

The study demonstrated that the prevalence of inappropriate direct oral anticoagulant dosing according to the European Heart Rhythm Association recommendations was 24.9% in patients with atrial fibrillation. Several demographic and clinical factors were associated with the inappropriate prescription of direct oral anticoagulants.

Evaluation of systemic immune-inflammation index for predicting severity of lower extremity arterial disease

OBJECTIVE

Predictive value of systemic immune-inflammation index (SII) has been shown in clinical outcomes and complexity of coronary artery disease, acute coronary syndrome, and heart failure. We sight to evaluate value of SII in patients with lower extremity arterial disease (LEAD).

METHODS

A total of 271 patients diagnosed with LEAD were included to our study. Blood samples of the patients were collected and analyzed for biochemical variables and complete blood count parameters. SII value of each patient was calculated. The complexity of atherosclerotic disease was classified according to Trans-Atlantic Inter-Society Consensus (TASC II) classification.

RESULTS

Patients with TASC C-D were older than patients in TASC A-B group (63.06 ± 9.24 years and 60.85 ± 8.75 years, respectively). Other co-morbidities were comparable in both groups. Hemoglobin level and lymphocyte count were significantly lower, neutrophil, platelet counts, and SII values were significantly higher in patients with TASC C-D disease compared to that of patients with TASC A-B disease. SII showed significant correlation with the severity of LEAD (r = 0.363, p < .001). SII value of 664.24 predicted TASC C-D disease with a sensitivity and specificity of 60.8% and 73.3%, respectively. Results of multivariate logistic regression analysis showed that SII had higher odds ratio compared to platelet, neutrophil, and lymphocyte counts.

CONCLUSION

Higher SII may indicate probability of more complex LEAD. This relationship seems plausible in terms of similar pathophysiology of coronary artery disease and peripheral artery disease.

Predictive value of triglyceride/glucose index for cardiac outcomes in non-diabetic renal transplant recipients

OBJECTIVES

Insulin resistance (IR) is associated with an increased risk of adverse cardiovascular outcomes. The triglyceride-glucose index (TyG index) is a reliable marker of IR. No study has examined the impact of the TyG index on major adverse cardiac and cerebrovascular events (MACCEs) in RTRs. Therefore, this study aimed to investigate the predictive value of the TyG index for MACCEs in RTRs.

MATERIALS AND METHODS

Non-diabetic patients undergoing renal transplantation were retrospectively enrolled. The patients were divided into two groups according to MACCE development. The cut-off value of the TyG index for MACCE was conducted.

RESULTS

The mean age of 522 patients was 41 (31-51) years, and 349 (66.9%) were male. During the 5.4-year follow-up, 84 (16%) MACCE were recorded. TyG index was significantly higher in the group that developed MACCE (p < 0,001). Cox regression analysis revealed that TyG index [HR: 3.297 (1.228-8.855), p = 0.018], left ventricle ejection fraction [HR: 0.934 (0.900-0.968), p < 0.001], cadaveric transplantation [HR: 8.886 (4.764-16.576), p < 0.001], graft survey [HR: 0.608 (0.542-0.682), p < 0.001)], and smoking [HR: 1.965 (1.117-3.456), p = 0.019] were independent predictors of MACCEs in nondiabetic RTRs.

CONCLUSION

TyG index is an independent predictor of MACCEs in non-diabetic RTRs. The widespread use of the TyG index may positively affect long-term treatment costs and survival.

Relationship between uric acid albumin ratio and peripheral artery disease complexity

OBJECTIVE

Uric acid to albumin ratio (UAR) reflects inflammatory activity and its predictive value has been shown in various diseases. In this study, we sought to evaluate the value of uric acid to albumin ratio in patients with peripheral arterial disease (PAD).

PATIENTS AND METHODS

Two hundred forty-three PAD patients were divided into TransAtlantic Inter-Society Consensus-II (TASC-II) A-B and TASC-II C-D groups, according to their TASC-II classification. Biochemical variables of the patients were recorded, and the UAR of each patient was calculated.

RESULTS

Patients who had TASC-II A-B disease were younger than the patients who had TASC-II C-D disease (60.7±8.71 vs. 63.28±8.8 years, p=0.024). Quade ANCOVA results showed that patients with TASC-II C-D disease had higher values of UAR when age was used as a covariate (t=-5.045, p<0.001). Lymphocyte count was significantly lower, and UAR was significantly higher in patients with TASC-II C-D disease (p=0.035 and p<0.001, respectively). UAR and lymphocyte count showed a significant positive correlation and a negative correlation with the TASC-II class of the disease (r=0.403, and r=-0.299, p<0.001 for both). A UAR of 1.54 predicted TASC-II C-D disease with a sensitivity and specificity of 57.9% and 78.8%, respectively. UAR predicted severe PAD with an OR of 3.723.

CONCLUSIONS

UAR was a better tool for predicting TASC-II C-D disease compared to uric acid and albumin levels. UAR is an easily calculable parameter that can be used in clinical practice.

The Definition of Sarcomeric and Non-Sarcomeric Gene Mutations in Hypertrophic Cardiomyopathy Patients: A Multicenter Diagnostic Study Across Türkiye

BACKGROUND

Hypertrophic cardiomyopathy is a common genetic heart disease and up to 40%-60% of patients have mutations in cardiac sarcomere protein genes. This genetic diagnosis study aimed to detect pathogenic or likely pathogenic sarcomeric and non-sarcomeric gene mutations and to confirm a final molecular diagnosis in patients diagnosed with hypertrophic cardiomyopathy.

METHODS

A total of 392 patients with hypertrophic cardiomyopathy were included in this nationwide multicenter study conducted at 23 centers across Türkiye. All samples were analyzed with a 17-gene hypertrophic cardiomyopathy panel using next-generation sequencing technology. The gene panel includes ACTC1, DES, FLNC, GLA, LAMP2, MYBPC3, MYH7, MYL2, MYL3, PLN, PRKAG2, PTPN11, TNNC1, TNNI3, TNNT2, TPM1, and TTR genes.

RESULTS

The next-generation sequencing panel identified positive genetic variants (variants of unknown significance, likely pathogenic or pathogenic) in 12 genes for 121 of 392 samples, including sarcomeric gene mutations in 30.4% (119/392) of samples tested, galactosidase alpha variants in 0.5% (2/392) of samples and TTR variant in 0.025% (1/392). The likely pathogenic or pathogenic variants identified in 69 (57.0%) of 121 positive samples yielded a confirmed molecular diagnosis. The diagnostic yield was 17.1% (15.8% for hypertrophic cardiomyopathy variants) for hypertrophic cardiomyopathy and hypertrophic cardiomyopathy phenocopies and 0.5% for Fabry disease.

CONCLUSIONS

Our study showed that the distribution of genetic mutations, the prevalence of Fabry disease, and TTR amyloidosis in the Turkish population diagnosed with hypertrophic cardiomyopathy were similar to the other populations, but the percentage of sarcomeric gene mutations was slightly lower.

Value of systemic inflammation-response index in predicting contrast-induced nephropathy in patients with ST-elevation myocardial infarction

BACKGROUND

Contrast induced nephropathy (CIN) is one of the feared complications of contrast medium-using procedures. Present study was conducted in order to evaluate the value of systemic inflammatory-response index (SIRI) for development of CIN among patients who underwent primary percutaneous intervention.

METHODS

Six hundred seventy-six patients with the diagnosis of ST elevation myocardial infarction were included. The patients were divided into two groups according to the presence of CIN. Patients without (n = 530) and with (n = 146) CIN constituted group 0 and group 1, respectively. Clinical and biochemical features of the patients were recorded. Calculation of SIRI was made for each patient.

RESULT

CIN patients were older, had higher prevalence of hyperlipidaemia, higher values of pre- and post-procedural creatinine levels, neutrophil and monocyte counts, neutrophil/lymphocyte ratio (NLR) and monocyte/lymphocyte ratio (MLR) and SIRI. They had lower values of left ventricular ejection fraction (LVEF), haemoglobin and high-density lipoprotein-cholesterol levels. SIRI had the highest area under the curve (AUC) for prediction of CIN. Pairwise analyses of the AUC's demonstrated that SIRI had statistically significantly higher AUC compared to NLR and MLR. Multivariate logistic regression analysis showed that besides from LVEF and pre-procedural creatinine, NLR and SIRI were the independent predictors of CIN. SIRI had a higher odds ratio compared to NLR.

CONCLUSION

SIRI had greater diagnostic power than NLR and MLR and it can easily be used by physicians for the identification of high-risk patients for the occurrence of CIN.

The Definition of Sarcomeric and Non-Sarcomeric Gene Mutations in Hypertrophic Cardiomyopathy Patients: A Multicenter Diagnostic Study Across Türkiye

BACKGROUND

Hypertrophic cardiomyopathy is a common genetic heart disease and up to 40%-60% of patients have mutations in cardiac sarcomere protein genes. This genetic diagnosis study aimed to detect pathogenic or likely pathogenic sarcomeric and non-sarcomeric gene mutations and to confirm a final molecular diagnosis in patients diagnosed with hypertrophic cardiomyopathy.

METHODS

A total of 392 patients with hypertrophic cardiomyopathy were included in this nationwide multicenter study conducted at 23 centers across Türkiye. All samples were analyzed with a 17-gene hypertrophic cardiomyopathy panel using next-generation sequencing technology. The gene panel includes ACTC1, DES, FLNC, GLA, LAMP2, MYBPC3, MYH7, MYL2, MYL3, PLN, PRKAG2, PTPN11, TNNC1, TNNI3, TNNT2, TPM1, and TTR genes.

RESULTS

The next-generation sequencing panel identified positive genetic variants (variants of unknown significance, likely pathogenic or pathogenic) in 12 genes for 121 of 392 samples, including sarcomeric gene mutations in 30.4% (119/392) of samples tested, galactosidase alpha variants in 0.5% (2/392) of samples and TTR variant in 0.025% (1/392). The likely pathogenic or pathogenic variants identified in 69 (57.0%) of 121 positive samples yielded a confirmed molecular diagnosis. The diagnostic yield was 17.1% (15.8% for hypertrophic cardiomyopathy variants) for hypertrophic cardiomyopathy and hypertrophic cardiomyopathy phenocopies and 0.5% for Fabry disease.

CONCLUSIONS

Our study showed that the distribution of genetic mutations, the prevalence of Fabry disease, and TTR amyloidosis in the Turkish population diagnosed with hypertrophic cardiomyopathy were similar to the other populations, but the percentage of sarcomeric gene mutations was slightly lower.

Awareness and Knowledge of Pneumococcal Vaccination in Cardiology Outpatient Clinics and the Impact of Physicians’ Recommendations on Vaccination Rates

Aim: We aimed to evaluate the awareness of pneumococcal vaccination (PCV13, PPSV23) in general cardiology outpatient clinics and impact of physicians’ recommendations on vaccination rates. Methods: This was a multicenter, observational, prospective cohort study. Patients over the age of 18 from 40 hospitals in different regions of Turkey who applied to the cardiology outpatient clinic between September 2022 and August 2021 participated. The vaccination rates were calculated within three months of follow-up from the admitting of the patient to cardiology clinics. Results: The 403 (18.2%) patients with previous pneumococcal vaccination were excluded from the study. The mean age of study population (n = 1808) was 61.9 ± 12.1 years and 55.4% were male. The 58.7% had coronary artery disease, hypertension (74.1%) was the most common risk factor, and 32.7% of the patients had never been vaccinated although they had information about vaccination before. The main differences between vaccinated and unvaccinated patients were related to education level and ejection fraction. The physicians’ recommendations were positively correlated with vaccination intention and behavior in our participants. Multivariate logistic regression analysis showed a significant correlation between vaccination and female sex [OR = 1.55 (95% CI = 1.25–1.92), p < 0.001], higher education level [OR = 1.49 (95% CI = 1.15–1.92), p = 0.002] patients’ knowledge [OR = 1.93 (95% CI = 1.56–2.40), p < 0.001], and their physician’s recommendation [OR = 5.12 (95% CI = 1.92–13.68), p = 0.001]. Conclusion: To increase adult immunization rates, especially among those with or at risk of cardiovascular disease (CVD), it is essential to understand each of these factors. Even if during COVID-19 pandemic, there is an increased awareness about vaccination, the vaccine acceptance level is not enough, still. Further studies and interventions are needed to improve public vaccination rates.

Real-World Evaluation of Anticoagulant Treatment Patterns in Patients with Atrial Fibrillation: Data from Multicenter ROTA Study

OBJECTIVE

Oral anticoagulant therapy is the cornerstone of atrial fibrillation management to prevent stroke and systemic embolism. However, there is limited real-world information regarding stroke and systemic embolism prevention strategies in patients with atrial fibrillation. The aim of the ROTA study is to obtain the real-world data of anticoagulant treatment patterns in patients with atrial fibrillation.

METHODS

The ROTA study is a prospective, multicenter, and observational study that included 2597 patients with atrial fibrillation. The study population was recruited from 41 cardiology outpatient clinics between January 2021 and May 2021.

RESULTS

The median age of the study population was 72 years (range: 22-98 years) and 57.4% were female. The median CHA2DS2-VASc and HAS-BLED scores were 4 (range: 0-9) and 1 (range: 0-6), respectively. Vitamin K antagonists and direct oral anticoagulants were used in 15.9% and 79.4% of patients, respectively. The mean time in therapeutic range was 52.9% for patients receiving vitamin K antagonists, and 76% of those patients had an inadequate time in therapeutic range with <70%. The most common prescribed direct oral anticoagulants were rivaroxaban (38.1%), apixaban (25.5%), and edoxaban (11.2%). The rate of overuse of vitamin K antagonists and direct oral anticoagulants was high (76.1%) in patients with low stroke risk, and more than one-fourth of patients on direct oral anticoagulant therapy were receiving a reduced dose of direct oral anticoagulants. Among patients who were on direct oral anticoagulant treatment, patients with apixaban treatment were older, had higher CHA2DS2-VASc and HAS-BLED scores, and had lower creatinine clearance than the patients receiving other direct oral anticoagulants.

CONCLUSIONS

The ROTA study provides important real-world information about anticoagulant treatment patterns in patients with atrial fibrillation.time in therapeutic range with <70%.

Evaluation of demographic, clinical, and aetiological data of patients admitted to cardiology clinics and diagnosed with left ventricular hypertrophy in Turkish population (LVH-TR)

BACKGROUND

Left ventricular hypertrophy (LVH) is potentially modifiable cardiovascular risk factor often overlooked in clinical practice. For this reason, we planned to LVH-TR (Left Ventricular Hypertrophy in Turkish Population) trial to determine the aetiological causes and demographic characteristics of LVH patients.

METHODS

Our study was a multicentre, national, observational study and included 886 patients who applied to the cardiology clinics in 22 centres between February 2020 and August 2021. In the initial evaluation, the Fabry disease (FD) and cardiac amyloidosis (CA) algorithm was followed in patients whose definitive etiologic cause(s) could not be identified.

RESULTS

The most common aetiological causes of LVH in our study were hypertension with a rate of 56.6%, heart valve disease with 8.2%, and hypertrophic cardiomyopathy with 7.5%. Athlete's heart was detected in eight patients, LV non-compaction was detected in four patients. The rate of LVH of unknown cause was 18.8%. FD was suspected in 143 patients, and CA was suspected in 16 patients. There were 43 (4.85%) patients with low α-galactosidase A enzyme levels. GLA gene mutation analysis was positive in 1.58% of all patients, and these patients were diagnosed with FD, and 15 (1.69%) patients were diagnosed with CA by endomyocardial biopsy method.

CONCLUSION

In the aetiology of LVH, the rate of LVH of unknown cause was high. FD and CA should be considered primarily in this patient group. Early diagnosis of the disease by following the schemes leading to FD and CA was essential in starting treatment before the progression of the disease.

Is the revascularisation strategy and outcome different in patients with acute coronary syndrome in COVID-19 pandemic era: a tertiary centre experience

BACKGROUND

In this study, we aimed to compare the management and clinical outcomes of patients with acute coronary syndrome (ACS) before and during pandemic.

METHODS

A total of 239 patients with ACS were enrolled into the study. Patients who were admitted during pandemic were compared with pre-pandemic patients according to their demographic, biochemical, angiographic features, revascularisation strategies and clinical outcomes.

RESULTS

During the pandemic period, we observed an increase in total number of patient with ST elevation myocardial infarction patients compared to the pre-pandemic period. Initial high sensitive troponin and CK-MB levels were statistically higher in the pandemic group patients (1953 pg/ml versus 259 pg/ml for troponin I and 14 ng/ml versus 6 ng/ml for CK-MB p < 0.0001, p = 0.02, respectively). Type 4a myocardial infarction due to stent thrombosis was more frequent in pandemic group relative to the pre-pandemic group (10 versus 0, p = 0.003). Post-procedural TIMI flow grade was lower in the pandemic group and distal embolisation and TIMI thrombus score were significantly higher in the pandemic group compared to the pre-pandemic group (p = 0.001, p = 0.02, and p = 0.002, respectively). The number of patients who underwent bypass surgery was much lower compared to pre-pandemic period (27 versus 8, p < 0.0001). There was no statistically significant difference in hospital mortality and short-term all-cause mortality among groups (p > 0.05).

CONCLUSION

Although clinical, laboratory, and angiographic features were worse in ACS patients during pandemic, the mortality rate of ACS was similar in both pre-pandemic and pandemic era. It is important to keep coronary intensive care units and catheter labs open and fully-functioning during the pandemic.

Assessment of right ventricular functions in acromegaly: comparison of active disease with remission

Aim    Cardiac involvement in acromegaly is defined as acromegalic cardiomyopathy, an insidious and chronic disease. Previous research on acromegalic cardiomyopathy was largely focused on morphological and functional assessment of the left heart. Since the literature data regarding right heart function in acromegalic patients are limited, we aimed to evaluate the structure and function of the right heart in such patients.Material and Methods    We included 43 adult participants as the acromegaly group and 42 individuals as the control group. All patients underwent echocardiographic evaluation. The results were compared between acromegaly and control groups and between active and controlled acromegaly groups.Results    The acromegaly group had increased interventricular septum thickness, right ventricular (RV) free wall thickness, right atrium (RA) minor diameter, RV basal and longitudinal diameters, RV end-diastolic and end-systolic areas, E / E' ratio, isovolumetric relaxation time, and RV ejection time. The E / A ratio and E' velocity were reduced. GH and IGF-1 were positively correlated with RV longitudinal diameter, indexed RA minor-axis dimension, and indexed RV end-diastolic area. Patients with active acromegaly had increased RV index of myocardial performance (RVIMP) and isovolumetric contraction time and shortened RV ejection time compared to patients in remission. A RVIMP value of 0.435 predicted active acromegaly with a sensitivity and specificity of 0.83 and 0.64, respectively (p=0.002).Conclusions    Increases in the size and diameters of the right heart chambers along with RV free wall thickness may be attributed to acromegalic cardiomyopathy. RVIMP, isovolumetric contraction time, and ejection time are parameters that can be used in the evaluation of active acromegaly disease.

Periprocedural, Short-Term, and Long-Term Outcomes of Alcohol Septal Ablation in Patients with Hypertrophic Obstructive Cardiomyopathy: A 20-Year Single-Center Experience

Background

: Alcohol septal ablation is recommended for hypertrophic obstructive cardiomyopathy patients who had refractory symptoms despite optimal medical treatment. We compared the periprocedural, short-, and long-term clinical outcomes and mortality predictors in hypertrophic obstructive cardiomyopathy patients who underwent alcohol septal ablation.

Methods

Hypertrophic obstructive cardiomyopathy patients aged ≥18 years (63 females and 71 males) who underwent alcohol septal ablation were included. The primary endpoint was all-cause mortality.

Results

The mean patient age was 60.0 (standard deviation 13.7) years. The median follow-up time was 13 (7.6-18.5) years. During the procedure, 9, 2, and 1 patients developed ventricular fibrillation, remote site myocardial infarction, and pericardial tamponade, respectively, but none died. One patient died during hospitalization. During the long-term follow-up, 17, 5, 20, and 8 patients developed heart failure, myocardial infarction, chronic atrial fibrillation, and non-fatal stroke, respectively, and 24 died. There was no significant difference between the sexes (all P > .05). Age (hazard ratio = 0.69, 95% CI = 0.61‒0.78, P < .001), body mass index (hazard ratio = 1.20, 95% CI = 1.04-1.40, P = .01), age at diagnosis (hazard ratio = 1.57, 95% CI = 1.34-1.78, P < .001), and time from diagnosis to ablation (hazard ratio = 1.57, 95% CI = 1.35-1.84, P < .001) predicted all-cause mortality. In Kaplan‒Meier curves, long-term all-cause mortality was similar in men and women (P[log-rank] = .43).

Conclusion

Alcohol septal ablation has similar short- and long-term outcomes for both sexes in hypertrophic obstructive cardiomyopathy patients. Risk factors for long-term mortality were age, body mass index, diagnosis age, and time delay to operation. Therefore, alcohol septal ablation timing is essential for better clinical outcomes. Our findings may contribute to the increased performance of alcohol septal ablation in hypertrophic obstructive cardiomyopathy patients in our country.

Does coexistence of fragmented QRS and cardiovascular disease have the ability to predict the mortality in hospitalized, critically ill patients with COVID-19?

OBJECTIVE

In this study, we aimed to investigate the prognostic accuracy of the presence of fragmented QRS (fQRS) on baseline electrocardiogram on the adverse outcome in critical patients with coronavirus disease 2019 (COVID-19) with cardiovascular disease (CVD).

METHODS

The current study was retrospective designed and included 169 patients who were critically ill with COVID-19 and CVD (mean age of 62±15 years). The patients were grouped into those who died (non-survivor group) and those who survived (survivor group).

RESULTS

The non-survivors were older and more often had CVD (p=0.009), hypertension (p=0.046), diabetes (p=0.048), cancer (p=0.023), and chronic renal failure (p=0.001). Although the presence of fQRS on the basal electrocardiogram was more common in patients who died, this was not statistically significant (p=0.059). Furthermore, non-survivors had more frequent the coexistence of CVD and fQRS (p=0.029). In Model 1 multivariate regression analysis, CVD alone was not a predictor of mortality (p=0.078), whereas coexistence of CVD and fQRS was found to be an independent predictor of mortality in Model 2 analysis [hazard ratio (HR): 2.243; p=0.003]. Furthermore, older age (HR: 1.022; p=0.006 and HR: 1.023; p=0.005), cancer (HR: 1.912; p=0.021 and HR: 1.858; p=0.031), high SOFA score (HR: 1.177; p=0.003 and HR: 1.215; p<0.001), and increased CRP level (HR: 1.003; p=0.039 and HR: 1.003; p=0.027) independently predicted the mortality in both multivariate analysis models, respectively.

CONCLUSION

fQRS may be a useful and handy risk-stratification tool for clinical outcomes by identifying high-risk individuals, especially among those with CVD.

Evaluation by different mechanisms of the protective effects of vitamin B12 on methotrexate nephrotoxicity

Methotrexate is used for cure of many cancer types. It has many side effects. For this reason, obtaining a nephroprotective agent is obligatory. In the study, our aim is to determine probable effects of Vitamin B12 on MTX caused kidney damages in rats. Rats were randomly divided into 4 groups, including 8 animals in each group. Control group, VitB12 group (3 μg-kg-ip B12 throughout 15 days), MTX group (at the 8th day of experiment, a single dose of 20 mg-kg-ip MTX), Vit B12 + MTX group (3 μg-kg-ip B12 throughout 15 days and at the 8th day of experiment, a single dose of 20 mg-kg-ip MTX) Animals were anesthetized and kidney tissues were removed to evaluate biochemically, immunohistochemically and histopathologycally. There were histopathological deteriorations, rises of apoptotic cells, expressions of heat shock proteins, endoplasmic reticulum stress and inflammation markers in the MTX group. In the MTX group, Superoxide Dismutase (SOD), Total Antioxidant Status (TAS) and Catalase (CAT) levels decreased, but Total Oxidant Status TOS, Malondialdehyde (MDA) and interleukin-6 (IL6) levels increased. In addition, there was amelioration in kidney tissue in Vit B12 + MTX group compared to the MTX group. We suggest that Vit B12 can be used to reduce the toxic effects of MTX.

Effect of Sacubitril/Valsartan Combined with Dapagliflozin on Long-Term Cardiac Mortality in Heart Failure with Reduced Ejection Fraction

The angiotensin receptor-neprilysin inhibitor (ARNI) sacubitril/valsartan and sodium-glucose cotransporter-2 (SGLT-2) inhibitor dapagliflozin have been shown to reduce rehospitalization and cardiac mortality in patients with heart failure (HF) with reduced ejection fraction (HFrEF). We aimed to compare the long-term cardiac and all-cause mortality of ARNI and dapagliflozin combination therapy against ARNI monotherapy in patients with HFrEF. This retrospective study involved 244 patients with HF with New York Heart Association (NYHA) class II-IV symptoms and ejection fraction ≤40%. The patients were divided into 2 groups: ARNI monotherapy and ARNI+dapagliflozin. Median follow-up was 2.5 (.16-3.72) years. One hundred and seventy-five (71.7%) patients were male, and the mean age was 65.9 (SD, 10.2) years. Long-term cardiac mortality rates were significantly lower in the ARNI+dapagliflozin group (7.4%) than in the ARNI monotherapy group (19.5%) (P = .01). Dapagliflozin [Hazard Ratio (HR) [95% Confidence Interval (CI)] = .29 [.10-.77]; P = .014] and left ventricular ejection fraction (LVEF) [HR (95% CI) = .89 (.85-.93); P < .001] were found to be independent predictors of cardiac mortality. Our study showed a significant reduction in cardiac mortality with ARNI and dapagliflozin combination therapy compared with ARNI monotherapy.

Human neutrophil peptides 1-3 level in patients with acute myocardial infarction and its relation with coronary artery disease severity

OBJECTIVE

Inflammation plays a crucial role in the pathogenesis and clinical outcome of atherosclerosis. Among the various inflammatory factors, antimicrobial peptides, such as alpha-defensins, seem to contribute to the development and progression of atherosclerosis. The aim of this study was to evaluate the plasma levels of human neutrophil peptide-1, -2, and -3 (HNP1-3) in patients with acute myocardial infarction (AMI) and to assess its relationship with the severity of coronary artery disease.

METHODS

lasma HNP1-3 levels in patients with AMI and controls with angiographically normal coronary arteries were measured by solid-phase enzyme-linked immunosorbent assay. In the patient group, coronary artery disease severity was assessed using the SYNergy between percutaneous intervention with TAXus and cardiac surgery score (SS).

RESULTS

HNP1-3 levels were significantly higher in the group with AMI than in the controls (6.5±5.8 ng/mL vs. 2.8±2.5 ng/mL, p<0.001). The receiver operator characteristic (ROC) analysis yielded a cut-off value of 3.13 ng/mL for differentiating patients with AMI from the controls (area under the curve: 0.739, 95% confidence interval: 0.629-0.831, p<0.001). HNP1-3 levels in the high SS tertile (≥33) were slightly but statistically nonsignificantly higher than that in the low (≤22) and intermediate SS tertiles (high SS: 7.0±6.1 ng/mL, intermediate SS: 5.9±6.2 ng/mL, low SS: 5.3±3.8 ng/mL; p=0.639).

CONCLUSION

Patients with AMI had higher plasma HNP1-3 levels than the controls, but this did not show a significant correlation with angiographic disease severity. The nonsignificant trend toward higher SS in patients with higher HNP1-3 levels warrants future studies on larger populations.

Thymoquinone is a protective agent that reduces the negative effects of doxorubicin in rat testis

BACKGROUND

Doxorubicin (DOX) is used for treatment of many cancer types. Thymoquinone (THQ) is a powerful antioxidant agent used for reducing side effects of several drugs. The aim of this study is to determine possible therapeutic effects of THQ on doxorubicin-induced testicular toxicity in rats.

METHODS

Rats were divided into five groups (n = 8): control, THQ, olive oil, DOX (a single dose of 15 mg/kg intraperitoneally (i.p.) on seventh day of the experiment), and DOX + THQ (10 mg/kg THQ per day and 15 mg/kg DOX i.p. on seventh day). Animals were euthanized, and testis tissues were evaluated histopathologically. Caspase 3 and HSP90 immunostaining were performed to determine the expression levels of these proteins among groups. Terminal deoxynucleotidyl transferase 2'-deoxyuridine, 5'-triphosphate nick-end labeling method was used for evaluation of apoptotic index. Moreover, serum testosterone levels and total antioxidant status (TAS) and total oxidant status (TOS) in testicular tissue were measured by ELISA assay.

RESULTS

The DOX group had histopathological deterioration compared to the control group. There was an increase in apoptotic index, caspase 3 and HSP90 expressions in the DOX group. While TAS level of the DOX group decreased, TOS level increased when compared with the other groups. Serum testosterone levels in the DOX group decreased compared to the control group. However, there was improvement in testicular tissue in DOX + THQ group compared to the DOX group. There was a decrease in apoptotic index, caspase 3, and HSP90 expressions in DOX + THQ group compared to the DOX group. Testosterone level of DOX + THQ significantly increased compared to the DOX group.

CONCLUSION

We suggest that THQ can be used as a protective agent to reduce the toxic effects of DOX.

Alterations in the immunoreactivity of laminin, type IV collagen and α3β1 integrin in diabetic rat ovarian follicles

AIM

In order to determine the possible effects of diabetes, we aimed to investigate the expression of extracellular matrix proteins in the theca and granulosa layers in different follicular stages.

METHODS

Thirty-two adult Wistar albino male rats were divided into 4 groups as control and sampled groups. Four, eight and twelve weeks after inducing diabetes with an intraperitoneal injection of streptozotocin (40 mg/kg), the expressions of laminin, type IV collagen and α3β1 integrin in ovarian tissues were evaluated by immunohistochemical method.

RESULTS

In our study, in the first month of diabetes, a significant increase was observed in laminin, type IV collagen and α3β1 integrin expressions in all follicle types compared to the control group in both the theca and granulosa layers. Laminin and type IV collagen immunoreactivity tended to increase in D2 and D3 groups also. Integrin expression did not change in the newly formed follicles in the D2 and D3 groups, however, it tended to change and increase in the developing follicles.

CONCLUSIONS

The changes in the expression of laminin, type IV collagen and α3β1 integrin, which are the extracellular matrix proteins in the follicle, along with diabetes, show that diabetes plays a role in the regulation of follicular development (Tab. 4, Fig. 36, Ref. 29).

The association between CHA2DS2-VASc score and erectile dysfunction: a cross-sectional study

PURPOSE

This study aims to assess the association between CHA2DS2-VASc score and erectile dysfunction in patients who were admitted to cardiology outpatient clinics.

MATERIALS AND METHODS

One hundred and two male patients who were admitted to the cardiology outpatient clinic were included to the study. Erectile dysfunction was evaluated in the urology outpatient clinic in the same hospital and scored using Turkish Version of The International Index of Erectile Function. CHA2DS2-VASc score was calculated for every patient using the current associated guidelines.

RESULTS

There was a negative correlation between The International Index of Erectile Function score and CHA2DS2-VASc score, age, hypertension, heart failure, diabetes mellitus, stroke respectively. Smoking and dislipidemia were not correlated with The International Index of Erectile Function score (p>0.05).

CONCLUSION

CHA2DS2-VASc score can be used to detect Erectile dysfunction in patients who are admitted to the cardiology outpatient clinics.

Is there any association between rs1303 (Pi*M3) variant of alpha-1 antitrypsin gene and atrial septal aneurysm development?

AIM

Atrial septal aneurysm (ASA) is one of the congenital heart defects. The underlying pathophysiology of ASA has not been fully understood yet. Alpha-1 antitrypsin (A1AT) is a serine protease inhibitor glycoprotein, which is held responsible from tissue wall proteolysis if it is deficient in the body. The aim of this study was to investigate A1AT serum levels and the rs1303 (Pi*M3) variant in A1AT gene in patients with ASA.

MATERIAL AND METHODS

Thirty patients (7 male and 23 female) with isolated ASA and 33 patients (11 male and 22 female) with normal atrial septum on echocardiography were included in this study. A1AT serum levels of study patients were measured quantitatively by the enzyme-linked immune sorbent assay (ELISA) method. The A1AT gene mutation rs1303 was analyzed by genotyping, which is performed on genomic DNA extracted from circulating mononuclear blood cells. Single-nucleotide polymorphism was evaluated on polymerase chain reaction using commercial kits.

RESULTS

A1AT serum levels were not statistically different among patients with and without ASA (9.52 ± 4.33 µg/mL vs 9.83 ± 5.27 µg/mL, respectively, P = .80). A1AT homozygote mutation (PiM3M3) was significantly higher in the ASA group than the control group (21 vs 11, OR (95% CI): 6.68 [2.09-21.40], P = .001). A1AT serum levels were similar among patients with normal A1AT allele (PiMM), homozygote variant (PiM3M3), and heterozygote variant (PiMM3) (P = .79).

CONCLUSION

This preliminary study revealed that homozygote A1AT rs1303 (PiM3M3) variant is significantly higher in patients with isolated ASA and may be associated with ASA development. Large scale comprehensive studies are needed to validate these results.

Effect of age and gender differences on high-sensitive troponin T measurement in the diagnosis of acute myocardial infarction

Background

Cardiac troponins are the recommended markers for the detection of acute myocardial infarction (AMI). There is a controversy regarding their decision limits. In this study, our objective was to reveal the cut-off values of high-sensitive troponin T (hsTnT) for AMI diagnosis in our population and to examine the effect of age and gender on hsTnT cut-off values.

Methods

Patients who presented to the emergency department (ED) with chest pain were selected, and only those patients admitted during the first 3–6 h of symptom onset were included in the study.

Results

A total of 484 men and 182 women were included. A total of 355 (279 men/76 women) patients were diagnosed with AMI. The cut-off values of hsTnT were found to be 17 ng/L and 16 ng/L, for males and females, respectively. The cut-off values of hsTnT were detected to be significantly higher in men over 40 years of age (24 ng/L) than in men less than 40 years of age (10 ng/L).

Conclusions

The cut-off value for the hsTnT test for AMI was slightly lower in females than in males. The cut-off levels of hsTnT for the diagnosis of AMI were found to be significantly higher in men over 40 years of age than in men less than 40 years of age.

Intraperitoneal Administration of Low Dose Aluminium in The Rat: How Good is It to Produce a Model for Alzheimer Disease

Since neurotoxicity of aluminium (Al) resembles the progressive neurodegeneration observed in Alzheimer Disease (AD), Al administration in several ways has been used to produce AD model. Intraperitoneal (ip) low dose (4.2 mg/ kg) Al injection in rats for long periods is the preferred method by some researchers. In this paper, the efficiency of this method for producing an AD model was evaluated. In this study, we looked at the neuropathology of Al and the characteristic lesions of AD by histological and immunohistochemical techniques and determined oxidative stress markers in the brains of Al-treated and control rats. We also made electrophysiological recordings at the hippocampus and evaluated possible behavioural changes by Morris water maze test. However, no pathologic changes occurred in the animals except for an impairment in long-term potentiation (LTP) in the hippocampus (e.g. the LTPs of population spike (PS) amplitude at 15 min post-tetanus were measured as 217±27% in Al-treated rats and as 240±42% in sham-treated rats, of baseline PS amplitude). According to the findings of the present study, low dose of ip Al in rats is not sufficient to produce a good AD model. Higher doses (≥10 mg/kg) should be used.