Is Low-free Triiodothyronine (fT3) Associated with Increased Morbidity in Patients Admitted to Coronary Care Units?

BACKGROUND

The effects of thyroid hormone on patients hospitalized in coronary intensive care units are still controversial.

Objective

We retrospectively examined thyroid hormone levels and their impact on cardiovascular morbidity in patients admitted to coronary intensive care units.

METHODS

A total of 208 (Female/Male; 46.6%/53.4%) patients without any history of thyroid disease were enrolled and screened. Patients with specific heart disease and existing thyroid hormone parameters were included in the study. Low triiodothyronine syndrome is characterized by reduced serum total or free T3 (fT3) concentrations in normal free T4 (fT4) and TSH levels.

RESULTS

The common diagnosis of the patients in the coronary care unit is acute coronary syndrome (n=59, 28.2 %) and heart failure (n=46, 23.3%). Patients were divided into two groups according to left ventricular ejection fraction percentages (LVEF ≤39% vs LVEF ≥40%). Plasma fT3 levels were significantly correlated with low LVEF (≤39%) (p =0.002). fT3 (r=-0.183, p =0.013) and hospitalization etiology (r=-0.161, p =0.023) were also the most critical parameters affecting the length of hospitalization.

CONCLUSION

Low fT3 was associated with reduced ejection fraction and prolonged hospitalization, which may lead to potential morbidities in HF patients and may be useful in risk stratification and treatment strategies.

Comparison of 24-Hour Electrocardiogram Parameters in Patients with Graves' Disease Before and After Anti-Thyroid Therapy

BACKGROUND

We aimed prospectively to investigate the laboratory and electrocardiographic parameters (heart rate, QRS, QT, QTc, Tpe, Tpe/QTc, and arrhythmia prevalence) in patients with Graves' disease before and after antithyroid therapy.

METHODS

Seventy-one patients (48 female, and 23 male), of age between 18-50 years (mean±SD: 36.48±12.20) with GD were included in the study. Patients were treated with antithyroid therapy (thioamides and/or surgical therapy) to maintain euthyroid status. Patients were examined in terms of electrocardiographic parameters before and after the treatment.

RESULTS

Mean TSH, free thyroxin (fT4), and tri-iodothyrionine (fT₃) levels of all patients were 0.005±0.21, 3.27± 1.81, 11.42±7.44, respectively. While 9 patients (group 2) underwent surgical therapy, had suspicious malignant nodule or large goiter, and unresponsiveness to medical treatment; the other patients (n=62, group 1) were treated with medical therapy. Patients with surgical therapy had more increased serum fT4 (p=0.045), anti-thyroglobulin value (p=0.018) and more severe graves orbitopathy (n=0.051) before treatment when compared to a medical therapy group. Baseline Tpe duration and baseline Tpe/QTc ratio and frequency of supraventricular ectopic beats were found to be significantly higher in group 2 when compared to group 1 (p=0.00, p=0.005). Otherwise, the baseline mean heart rate, QRS duration, QTc values of both groups were similar. Although the patients came at their euthyroid status, group 2 patients still suffered from more sustained supraventricular ectopics beats than group 1.

CONCLUSION

Distinct from the medical treatment group, surgical treatment group with euthyroidism for at least 3 months still suffered from an arrhythmia (Tpe, Tpe/QTc, supraventricular and ventricular ectopic beats).

The relationship between visible thrombus aspiration material with no-reflow and in-hospital mortality ratio in patients with anterior ST-elevation myocardial infarction treated with primary percutaneous coronary intervention

OBJECTIVE

The benefit of intracoronary thrombus aspiration (TA) during primary percutaneous coronary intervention (pPCI) in patients with ST-segment elevation myocardial infarction (STEMI) is not yet fully clear. The aim of this study was to investigate the clinical impact of visible thrombus aspiration (VTA) material.

METHODS

A total of 295 patients with a Thrombolysis in Myocardial Infarction (TIMI) flow score of 0 or 1 after an anterior STEMI were included in the study. Manual TA devices were used before performing PCI. The patients were divided into 2 groups: (1) visible thrombus aspiration (VTA) group and (2) non-visible thrombus aspiration (non-VTA) group. No-reflow was defined as TIMI grade 0, 1, or 2 flow, or TIMI grade 3 with a myocardial blush of grade 0 or 1. The primary endpoint was the occurrence of no-reflow.

RESULTS

VTA was retrieved in 178 (60.3%) of the patients. A no-reflow determination was significantly less frequent in the VTA group (p<0.001). The ejection fraction and ST-segment resolution values were higher, and the in-hospital mortality, Killip class II-IV rating, and post-pPCI TIMI frame count were lower in the VTA group (p<0.05 for each).

CONCLUSION

VTA predicted a lower rate of in-hospital mortality and no-reflow in patients with anterior STEMI who underwent pPCI.

The Possible Effects of Dapagliflozin on 12-derived Electrocardiogram in Patients with Type 2 Diabetes Mellitus

BACKGROUND

Dapagliflozin, sodium glucose cotransporter 2 inhibitor, has potential side effects on electrolyte imbalance as it has diuretic effects which include decreasing glucose reabsorption, increasing glucosuria and natriuresis. We aimed to determine the possible effects of dapagliflozin on electrocardiogram (ECG) in patients with type 2 DM.

MATERIAL AND METHODS

This retrospective study consisted of 49 patients (25 female, 24 male). Patients who had inadequate glycemic control besides using several oral antidiabetics, subsequently endorsed with dapagliflozin, were included in the current study.

RESULTS

Meantime interval from treatment initiation to control was 10.5 ± 5.03 weeks. Body mass index, glucose, HbA1C, eGFR, LDL-C, heart rate, systolic and diastolic blood pressures were found to be significantly lower at control admission (p<0.05). Creatinine and QT interval were significantly higher at control admission (p<0.05). Baseline Tpe duration and baseline Tpe/QT ratio were found to be significantly correlated with Tpe/QT difference (p<0.05). In linear regression analysis, baseline Tpe/QT ratio was found to be the sole independent predictor of Tpe/QT difference (p<0.05).

CONCLUSION

Initiation of dapagliflozin treatment seems to be safe, up to several months, in terms of serum electrolytes and ECG findings in patients with type 2 DM with a probable improvement.

The relationship between low thiol levels and major adverse cardiovascular events after primary percutaneous coronary intervention in patients with STEMI

OBJECTIVE

The aim of this study was to investigate whether low thiol levels are associated with peri-procedural factors during primary percutaneous coronary intervention (pPCI) upon admission with ST-segment elevation myocardial infarction (STEMI), and the prognostic value at 6-month follow-up.

METHODS

A total of 241 consecutive acute STEMI patients who underwent pPCI and a control group of 67 individuals with a normal coronary angiography were enrolled in the study.

RESULTS

While age, contrast-induced nephropathy, N-terminal prohormone of brain natriuretic peptide (NT-proBNP), stent length, and creatinine were related to native thiol, NT-proBNP, contrast-induced nephropathy, and creatinine were related to total thiol. NT-proBNP was also related to the disulphide level. The left ventricular ejection fraction (LVEF) and the levels of native thiol, total thiol, low-density lipoprotein, and serum albumin were found to be independent predictors of major adverse cardiovascular events (MACEs) during 6 months of follow-up.

CONCLUSION

Initial lower native thiol, total thiol, LVEF, LDL, and serum albumin may be used to identify patients with an increased long-term risk of unfavorable cardiac events in case of STEMI.

Impact of 25(OH)D3 on spontaneous reperfusion and SYNTAX score in patients with ST-elevation myocardial infarction

OBJECTIVE

The aim of this study was to evaluate the potential relationship between 25-hydroxyvitamin D3 (25[OH]D3), the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score, and spontaneous reperfusion (SR) in patients with ST-elevation myocardial infarction (STEMI).

METHODS

A total of 148 consecutive patients with acute STEMI who underwent primary percutaneous coronary intervention were retrospectively enrolled in the study.

RESULTS

In all, 36 patients with a TIMI 3 flow score (spontaneous reperfusion [SR]) before coronary intervention constituted Group 1, and 112 patients with a TIMI flow score of 0-2 served as Group 2. The SYNTAX score and the in-hospital major adverse cardiovascular event (MACE) rate were significantly higher in Group 2 (p<0.001, p=0.012, respectively). The mean 25(OH)D3 level was significantly higher in Group 1 (p=0.003). Age, Killip class, left ventricular ejection fraction, and N-terminal pro-B-type natriuretic peptide were correlated with the SYNTAX score, and 25(OH)D3, troponin-I, C-reactive protein, and creatinine were weakly correlated with the SYNTAX score. Multilogistic regression analysis indicated that the SYNTAX score (p<0.001), Rentrop collateral (p=0.049), and troponin-I (p=0.004) were significantly effective at predicting SR, and 25(OH)D3 (p=0.079) and high-density lipoprotein (p=0.055) were borderline effective.

CONCLUSION

A lower level of 25(OH)D3 may be associated with the absence of SR, increased disease severity, and inhospital MACE rates in patients with STEMI.

Thiol/disulphide homeostasis in thoracic aortic aneurysm and acute aortic syndrome

AIM

The aim of this study was to evaluate whether ranging values of thiol and disulphide herald a dilatation or impending acute aortic syndrome at thoracic aorta. Results/methodology: Study population consisted of patients with aortic aneurysm (n = 58), with acute aortic syndrome (n = 32) and without aortic aneurysm (control group; n = 61). A spectrophotometric method was used to determine thiol and disulphide. Native and total thiol levels were moderately correlated with maximal aortic diameter. At the end of 6 months, there was statistically significant increase in native, total thiol levels and decrease in disulfide and disulphide/native thiol ratio in operated group.

DISCUSSION/CONCLUSION

Lower thiol levels may be associated with the higher risk of aortic aneurysm development and may increase after surgical therapy.

The influence of plasma 25-(OH) vitamin D levels in acute ST elevation myocardial infarction

BACKGROUND

The preventive role of acute occurring of collateral circulation (AOCC) to infarct related artery (IRA) in patients presenting with acute ST-segment elevation myocardial infarction (STEMI) is well known. Therefore, we aimed to investigate whether there is an association between admission plasma 25-hydroxyvitamin D (25(OH)D3) levels and grade of collateralization in patients with STEMI.

METHODS

We prospectively included 369 STEMI patients within the first 12 h of symptoms onset. Patients were divided into two groups according to their Rentrop collateralization grade to IRA: poorly developed collateral (PDC) group (Rentrop grade ≤ 1, 272 patients) and well developed collateral (WDC) group (Rentrop grade ≥ 2, 97 patients).

RESULTS

We observed that AOCC grade to IRA was negatively correlated with high sensitive C-reactive protein (hs-CRP), N terminal pro-B-type natriuretic peptide (NT-proBNP), as well as peak troponin T levels, yet positively correlated with admission plasma 25(OH)D3 level (p < 0.05, for all). In multi¬variate analysis, 25(OH)D3 levels (OR 1.246, 95% CI 1.185-1.310, p < 0.001), together with hs-CRP, NT-proBNP, and peak troponin T levels were found independent predictors of AOCC to IRA in patients with acute STEMI.

CONCLUSIONS

Admission level of plasma 25(OH)D3 levels together with cardiac risk biomarkers (troponin T, NT-proBNP, hs-CRP) are associated with collateralization grade to IRA in acute STEMI patients. In addition, 25(OH)D3 may be a promoter of AOCC in patients with acute STEMI.

Acute myocardial infarction in a patient with sickle cell trait

Presently described is the rare complication of sickle cell trait (HbAS) with acute inferior myocardial infarction in a young adult patient. Angiogram revealed microemboli in the distal thin segment of the circumflex (Cx) artery. Anticoagulant and anti-aggregant therapies were initiated to restore Cx artery flow. HbAS was detected as an underlying pathology. ST segments returned to the isoelectric line and the patient became asymptomatic.

Association of P wave dispersion and left ventricular diastolic dysfunction in non-dipper and dipper hypertensive patients

OBJECTIVE

Objective of this study was to investigate the correlation between P wave dispersion and left ventricular diastolic function, which are associated with the increased cardiovascular events in patients with dipper and non-dipper hypertensive (HT).

METHODS

Eighty sex and age matched patients with dipper and non-dipper HT, and 40 control subject were included in this observational cross-sectional study. P wave dispersion was measured through electrocardiography obtained during the admission. The left ventricular LV ejection fraction was measured using the modified Simpson's rule by echocardiography. In addition, diastolic parameters including E/A rate, deceleration time (DT) and isovolumetric relaxation time (IVRT) were recorded. Independent samples Bonferroni, Scheffe and Tamhane tests and correlation test (Spearman and Pearson) were used for statistical analysis.

RESULTS

P wave dispersion was found to be significantly increased in the non-dipper than in the dipper group (56.0±5.6 vs. 49.1±5.3, p<0.001). Pmax duration was found significantly higher (115.1±5.6 vs. 111.1±5.8, p=0.003) and Pmin duration significantly lower (59.0±5.6 vs. 62.3±5.3, p=0.009) in the non-dippers. Correlation analysis demonstrated presence of moderate but significant correlation between P-wave dispersion and left ventricular mass index (r=0.412, p=0.011), IVRT (r=0.290 p=0.009), DT (r=0.210, p=0.052) and interventricular septum thickness (r=0.230 p=0.04).

CONCLUSION

P wave dispersion and P Max were found to be significantly increased and P min significantly decreased in the non-dipper HT patients compared to the dipper HT patients. P-wave dispersion is associated with left ventricular dysfunction in non-dipper and dipper HT.

Arterial stiffness and pulse wave reflection in young adult heterozygous sickle cell carriers

Objective: Pulse wave velocity (PWV) and aortic augmentation index (AI) are indicators of arterial stiffness. Pulse wave reflection and arterial stiffness are related to cardiovascular events and sickle cell disease. However, the effect of these parameters on the heterozygous sickle cell trait (HbAS) is unknown. The aim of this study is to evaluate the arterial stiffness and wave reflection in young adult heterozygous sickle cell carriers.

Materials and Methods: We enrolled 40 volunteers (20 HbAS cases, 20 hemoglobin AA [HbAA] cases) aged between 18 and 40 years. AI and PWV values were measured by arteriography.

Results: Aortic blood pressure, aortic AI, and brachial AI values were significantly higher in HbAS cases compared to the control group (HbAA) (p=0.033, 0.011, and 0.011, respectively). A statistically significant positive correlation was found between aortic pulse wave velocity and mean arterial pressure, age, aortic AI, brachial AI, weight, and low-density lipoprotein levels (p=0.000, 0.017, 0.000, 0.000, 0.034, and 0.05, respectively) in the whole study population. Aortic AI and age were also significantly correlated (p=0.026). In addition, a positive correlation between aortic PWV and systolic blood pressure and a positive correlation between aortic AI and mean arterial pressure (p=0.027 and 0.009, respectively) were found in HbAS individuals. Our study reveals that mean arterial pressure and heart rate are independent determinants for the aortic AI. Mean arterial pressure and age are independent determinants for aortic PWV.

Conclusion: Arterial stiffness measurement is an easy, cheap, and reliable method in the early diagnosis of cardiovascular disease in heterozygous sickle cell carriers. These results may depend on the amount of hemoglobin S in red blood cells. Further studies are required to investigate the blood pressure changes and its effects on arterial stiffness in order to explain the vascular aging mechanism in the HbAS trait population.

Conflict of interest:None declared.

Assessment of mineral density and atomic content of fracture callus by quantitative computerized tomography

The mineral density and atomic numbers of elements in the periosteal callus and the cortex area of a healing fracture were measured by quantitative computerized tomography (QCT) to obtain accurate information on the mineralization process in rabbit tibia. The mineral density of the periosteal callus was highest on day 15 and decreased gradually throughout the experiment. This was initially detected by QCT, but not with conventional radiography. An apparent decrease in cortical bone density on days 28 and 42 after fracture was observed. Atomic numbers of elements in the cortex remained stable, indicating a possible homeostatic mechanism of mineral preservation at the fracture callus and involved cortical area. QCT may predict density alterations in the fracture callus more accurately than conventional X-ray. Further studies are essential to predict a relationship between mineral density, atomic numbers, and mechanical stability.

Biomechanical analysis of the effects of single high-dose vitamin D3 on fracture healing in a healthy rabbit model

In a previous ultrastructural study, the benefit of a single high dose of vitamin D3 on fracture healing in a healthy animal model was demonstrated. This study examined the biomechanical consequences of applying a single high dose of vitamin D3 in a healthy rabbit model subsequent to femoral fracture. The fracture load, the values of energy absorbed until fracture and the flexural rigidity values of the vitamin D group were significantly higher than the corresponding ones of the control group in the case of fracture. On the other hand, for intact bones, those values did not differ significantly between the two groups. It was concluded that single high-dose vitamin D3 application had positive effects on fracture healing in a healthy animal model, as far as the parameters related to mechanical strength are concerned.

Anaesthetic management in maple syrup urine disease

Two children with maple syrup urine disease undergoing emergency and elective surgery are reported. The administration of ketamine to a 12-month-old boy without neurological problems and propofol infusion to a 5-year-old girl with a history of convulsions, was uneventful. We believe that a full knowledge of the pathophysiology of maple syrup urine disease and potential peri-operative problems associated with the disease are essential, so that patients are not subjected to unnecessary risks.