Association between syndecan-4 and subclinical atherosclerosis in ankylosing spondylitis

BACKGROUND

Despite advances in the diagnosis and treatment of ankylosing spondylitis (AS), the risk of cardiovascular complications in AS patients is still higher than in the general population. Macrophages are at the intersection of the basic pathogenetic processes of AS and atherosclerosis. Although syndecan-4 (SDC4) mediates a variety of biological processes, the role of SDC4 in macrophage-mediated atherogenesis in AS patients remains unclear. Herein, we aimed to investigate the role of SDC4 in subclinical atherosclerosis in AS patients.

METHODS

Subjects were selected from eligible AS patients and control subjects without a prior history of AS who were referred to the rheumatology outpatient clinics. All participants' past medical records and clinical, and demographic characteristics were scanned. In addition, carotid intima-media thickness (CIMT) measurement and disease activity index measurement were applied to all patients.

RESULTS

According to our data, serum SDC4 level was significantly higher among AS patients compared with the control group (6.7 [1.5-35.0] ng/mL vs 5.1 [0.1-12.5] ng/mL, P < .001). The calculated CIMT was also significantly higher in AS patients than in the control group (0.6 [0.3-0.9] mm vs 0.4 (0.2-0.7), P < .001]. Additionally, serum C-reactive protein level and SDC4 level were independent predictors of AS and strongly associated with CIMT. Linear regression analysis showed that serum SDC4 level was the best predictor of CIMT (P = .004).

CONCLUSION

Our data indicate that serum SDC4 levels provide comprehensive information about the clinical activity of the disease and subclinical atherosclerosis in AS patients.

NEW BIOMARKERS TO PREDICT CARDIOVASCULAR RISK IN PATIENTS WITH ADRENAL INCIDENTALOMA; IRISIN AND NESFATIN-1

OBJECTIVE

In our study, we aimed to investigate the levels of irisin, nesfatin-1 and the relationship between levels of these relatively new molecules with cardiometabolic risk markers; carotid intima-media thickness (CIMT), epicardial adipose tissue (EAT) thickness in patients with nonfunctional adrenal incidentaloma (NFAI).

MATERIALS AND METHODS

Patients with NFAI (n=59) and age, sex and body mass index-matched healthy control subjects (n=59) were enrolled in this study. Serum glucose, insulin, C-reactive protein (CRP), lipid, irisin and nesfatin-1 levels and echocardiographic CIMT and EAT thickness measurements were performed in patients and controls.

RESULTS

The irisin level was 17.58 ± 4.38 pg/mL in the NFAI group, significantly higher (p<0.001) than 14.03 ± 4.03 pg/mL in the control group. Nesfatin-1 level was significantly lower in the NFAI group 194.98 ± 119.15 pg/mL ((p < 0.001)) versus 303.48 ± 200.78 pg/mL in the control group. A positive correlation was found between irisin and nesfatin-1 levels and CIMT and EAT thickness in the NFAI group.

CONCLUSIONS

In our study, we found that irisin level was higher and nesfatin-1 level was lower in patients with NFAI, and both irisin and nesfatin-1 levels were associated with CIMT and EAT thickness in NFAI patients.

Arterial stiffness, carotid intima-media thickness, endocan and A disintegrin-like and metalloprotease with thrombospondin type I motif 9 levels and their relationship with disease activity in acromegaly patients with and without cardiovascular risk factors

OBJECTIVE

Cardiovascular complications such as cardiomyopathy and endothelial dysfunction, which are frequently seen in patients with acromegaly, are among the most important causes of morbidity and mortality. In this study, we aimed to investigate arterial stiffness, carotid intima-media thickness, endocan and A disintegrin-like and metalloprotease with thrombospondin type I motif 9 (ADAMTS9) levels and their relationship with disease activity in acromegaly patients with and without cardiovascular risk factors.

DESIGN

A total of 60 patients with acromegaly, 25 with active disease, 26 with well-controlled disease, and 9 newly diagnosed, and 60 age-, sex- and body mass index (BMI)-matched healthy control subjects were enrolled in this study. All subjects' height, weight, BMI, systolic blood pressure (SBP), distolic blood pressure (DBP), fasting plasma glucose (FPG), insulin, hemoglobin A1c (HbA1c), C-reactive protein (CRP), lipid, endocan, ADAMTS9, pulse wave velocity (PWV) and carotid intima-media thickness (CIMT) measurements were performed.

RESULTS

SBP, DBP, FPG, HbA1c and PWV levels of the acromegaly group were higher than the control group. In acromegaly patients with cardiovascular disease (CVD) risk factors, PWV was higher than the control group, and in acromegaly patients without CVD risk factor, PWV was similar to the control group. In the correlation analysis, a positive correlation was found between PWV and age, BMI, SBP, DBP, FPG and HbA1c levels in the acromegaly group.

CONCLUSIONS

In our study, we found that arterial stiffness increased in acromegaly patients with CVD risk factors, and that increased arterial stiffness was associated with hemodynamic (SBP, DBP) and metabolic (BMI, FPG, HBA1C) parameters.

Association between SYNTAX II Score and late saphenous vein graft failure in patients undergoing isolated coronary artery bypass graft surgery

OBJECTIVE

Coronary artery bypass graft (CABG) surgery is a well-established treatment modality for patients with multivessel coronary artery disease (CAD). Syntax II Score has been established as novel scoring system with better prediction of postprocedural outcomes. This study aimed to investigate the prognostic value of SYNTAX II Score for predicting late saphenous vein graft (SVG) failure in patients undergoing isolated CABG.

METHODS

The records of 1,875 consecutive patients who underwent isolated CABG with at least one SVG were investigated. Those who underwent coronary angiography and SVGs angiography at least 1 year after the CABG were included. Patients were divided into two groups based on the presence or absence of SVG failure. For each group, predictors of late SVG failure and subsequent clinical outcomes were analyzed.

RESULTS

According to this study, the presence of hypertension, higher rates of repeat revascularization, and higher SYNTAX II Scores were found to be independent predictors of late SVG failure. In addition, the prognostic value of SYNTAX II Score was found to be significantly higher than anatomical SYNTAX Score in terms of predicting late SVG failure and major adverse cardiovascular and cerebrovascular event.

CONCLUSIONS

There was a strong association between SYNTAX II Score and late SVG failure in patients undergoing isolated CABG.

Prognostic nutritional index and the risk of acute kidney injury in patients with acute coronary syndrome

OBJECTIVE

Recent studies have linked malnutrition with undesirable outcomes in cardiovascular diseases. However, the underlying mechanism is unknown. Contrast-induced acute kidney injury (CI-AKI) increased cardiovascular mortality after percutaneous coronary intervention (PCI). This study hypothesizes that prognostic nutritional index (PNI) plays a role in the development of CI-AKI in patients with acute coronary syndrome undergoing emergency PCI.

METHODS

This study enrolled 551 patients. PNI was determined as 10× serum albumin (g/dL)+0.005×total lymphocyte count (mm3). CI-AKI was characterized as the increase in serum creatinine ≥0.3 mg/dL level within 48 h after PCI. Patients were classified as either CI-AKI (+) or CI-AKI (-).

RESULTS

CI-AKI has occurred in 72 of 551 patients (13.1%). PNI was significantly lower in the CI-AKI (+) group than in the CI-AKI (-) group (44.4±6.6 versus 47.2±5.8, p<0.001, respectively). Multivariate logistic regression analysis showed that PNI [odds ratio, OR: 1.631, 95% confidence interval (CI): 1.168-2.308, p=0.02] and estimated glomerular filtration rate (OR: 3.26, 95%CI 1.733-6.143, p<0.001) were independent risk factors for CI-AKI.

CONCLUSIONS

PNI is an independent risk factor for CI-AKI. The development of CI-AKI may be the mechanism responsible for the relationship between poor nutritional status and adverse cardiac events.

The Impact of SARS-CoV-2 Transmission Fear and the COVID-19 Pandemic on the Mental Health of Patients with Primary Immunodeficiency Disorders and Severe Asthma, and Other High-Risk Groups

ABSTRACT Objective: The effect of the COVID-19 pandemic on mental health in the long term is unclear. We evaluated severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)–related transmission fear and mental-health disorders in populations at high risk for COVID-19. Materials and Methods: Healthcare workers and patients with primary immunodeficiency disorders (PIDs), severe asthma, malignancy, cardiovascular disease, hypertension, and diabetes mellitus were included in the study. The hospital anxiety and depression scale (HADS) and Fear of Illness and Virus Evaluation (FIVE) scales were applied during face-to-face interviews. Results: There was a total of 560 participants, 80 per group; 306 (55%) were female. The FIVE and HADS-A scale scores of health care workers were significantly higher than the other groups (p = 0.001 and 0.006). The second-highest scores were in patients with PID. There was no significant difference between the groups in HADS-D scores (p = 0.07). There was a significant positive correlation between FIVE scale scores and anxiety (r = 0.828; p < 0.001) and depression (r = 0.660; p < 0.001). The FIVE scale had significant discriminatory power for anxiety (AUC = 0.870, 95% confidence interval [CI] = 0.836–0.904; p < 0.0001) and depression (area under the curve = 0.760, 95% CI = 0.717–0.803; p < 0.0001). Conclusion: During the COVID-19 pandemic, mental-health disorders may develop in patients with comorbidities, especially healthcare workers. They should be referred to mental-health centers. Keywords: Asthma, COVID-19, fear of virus transmission, mental health, primary immunodeficiency

Effects of oral colchicine administration as first-line adjunct therapy in myopericarditis

BACKGROUND

Although current guidelines recommend routine use of oral colchicine as a first-line adjunct therapy to aspirin/nonsteroidal anti-inflammatory drugs (NSAIDs) for acute and recurrent pericarditis, there are insufficient data to recommend routine use of colchicine for the initial management of myopericarditis.

METHODS

The records of 194 patients who were admitted for myopericarditis were investigated retrospectively. Patients receiving oral colchicine (n = 33) as an adjunct to aspirin/NSAIDs comprised the study group and patients who received conventional therapy (n = 31) formed the control group. Plasma C‑reactive protein (CRP) levels, cardiac biomarkers, and several electrocardiographic parameters of atrial activation were evaluated before the start of treatment and at the 6‑month follow-up.

RESULTS

Assessments before and after treatment with regard to cardiac biomarkers and plasma CRP levels showed improvements in both groups (p > 0.05). There were statistically significant improvements in P wave indices including P wave duration, PR interval length, P wave dispersion, P terminal force, and isoelectric interval in the colchicine therapy group compared with the control group (p < 0.01).

CONCLUSION

Routine use of colchicine for the initial management of myopericarditis as a first-line adjunct therapy to aspirin/NSAIDs in patients with myopericarditis has favorable effects on electrocardiographic indices of atrial activation parameters.

Time delays in each step from symptom onset to treatment in acute myocardial infarction: Results from a nation-wide TURKMI registry

OBJECTIVE

In this study, we aimed to analyze the TURKMI registry to identify the factors associated with delays from symptom onset to treatment that would be the focus of improvement efforts in patients with acute myocardial infarction (AMI) in Turkey.

METHODS

The TURKMI study is a nation-wide registry that was conducted in 50 centers capable of 24/7 primary percutaneous coronary intervention (PCI). All consecutive patients (n=1930) with AMI admitted to coronary care units within 48 hours of symptom onset were prospectively enrolled during a predefined 2-week period between November 1, 2018, and November 16, 2018. All the patients were examined in detail with regard to the time elapsed at each step from symptom onset to initiation of treatment, including door-to-balloon time (D2B) and total ischemic time (TIT).

RESULTS

After excluding patients who suffered an AMI within the hospital (2.6%), the analysis was conducted for 1879 patients. Most of the patients (49.5%) arrived by self-transport, 11.8% by emergency medical service (EMS) ambulance, and 38.6% were transferred from another EMS without PCI capability. The median time delay from symptom-onset to EMS call was 52.5 (15-180) min and from EMS call to EMS arrival 15 (10-20) min. In ST-segment elevation myocardial infarction (STEMI), the median D2B time was 36.5 (25-63) min, and median TIT was 195 (115-330) min. TIT was significantly prolonged from 151 (90-285) min to 250 (165-372) min in patients transferred from non-PCI centers. The major significant factors associated with time delay were patient-related delay and the mode of hospital arrival, both in STEMI and non-STEMI.

CONCLUSION

The baseline evaluation of the TURKMI study revealed that an important proportion of patients presenting with AMI within 48 hours of symptom onset reach the PCI treatment center later than the time proposed in the guidelines, and the use of EMS for admission to hospital is extremely low in Turkey. Patient-related factors and the mode of hospital admission were the major factors associated with the time delay to treatment.

Dynamic changes in aortic stiffness after substantial weight loss by laparoscopic sleeve gastrectomy in patients with obesity: a 1-year follow-up study

Arterial stiffness has been identified as a powerful and independent risk factor for cardiovascular disease. Obesity is associated with an increased risk of aortic stiffness (AS) and adverse cardiovascular events. Herein, we aimed to evaluate the effects of weight loss after laparoscopic sleeve gastrectomy (LSG) on AS in individuals with morbid obesity by using the transthoracic echocardiography (TTE).A total of 53 patients with obesity (17 males, 36 females) who underwent LSG and did not have any known heart disease were included in the study. The AS parameters were measured with TTE. The demographic and echocardiographic data of the patients were studied before, at 1 month and 12 months after surgery.The mean age of the study group was 34.41±11.62, 68% of whom were female. There were no significant differences in terms of the standard echocardiography and Doppler measurements as compared with preoperative values (all p>0.05). When the elastic parameters of the aorta were compared, no significant differences were detected regarding aortic strain (%) ((16.28±4.11) vs (16.68±4.56), p=(0.998)), distensibility (cm²/dyn) ((6.74±1.78) vs (7.03±2.31), p=(0.997)) and Aortic Stiffness Index values ((10.73±3.84) vs (10.63±3.34), p=0.998) between baseline and first month after surgery. In the 12-month follow-up, it was determined that the aortic strain ((16.28±4.11) vs (22.74±5.79), p≤0.001) and distensibility ((6.74±1.78) vs (10.34±3.059), p<0.001)) values increased at significant levels.Weight loss by LSG improves arterial stiffness parameters in patients with obesity over a 1-year follow-up.

Favorable electrocardiographic changes after substantial weight loss in patients with morbid obesity : Results of a prospective study

BACKGROUND

Obese patients have an increased risk of arrhythmias and sudden death, even in the absence of structural heart disease and cardiac dysfunction. This study aimed to determine whether weight loss by bariatric surgery has an effect on arrhythmia-related electrocardiographic (ECG) variables in morbidly obese patients.

METHODS

In this prospective study, the data of 48 patients were analyzed. All ECG variables that have the potential to predict ventricular arrhythmia were evaluated before surgery, and were compared with the 1‑month and 6‑month follow-up results.

RESULTS

The mean body mass index was 45.74 ± 5.60 kg/m² before surgery. There was a statistically significant decline in body mass index in the first and sixth month after surgery (39.26 ± 5.00 kg/m² and 31.71 ± 4.49 kg/m², respectively; p < 0.001). Furthermore, notable reduction was found in terms of heart rate measurements-QTc‑d, JTc, JTc‑d, Tp‑e, TP-e/QT, TP-e/QTc-in the first month and sixth month compared with baseline (p < 0.001 for all comparisons). Several ECG variables, such as heart rate (r = 0.369, p = 0.001), QTc‑d (r = 0.449, p = 0.001), JTc‑d (r = 0.324, p = 0.002), Tp‑e (r = 0.592, p = 0.001), Tp-e/QTc (r = 0.543, p = 0.001), Tp-e/JTc (r = 0.515, p = 0.001), exhibited a positive and significant correlation with weigh loss. Moreover, a negative and weakly significant correlation was found between the index of cardiac electrophysiological balance (r = -0.239, p = 0.004) and body mass index.

CONCLUSION

Substantial weight loss following laparoscopic sleeve gastrectomy in obese patients is accompanied by a significant improvement in ventricular repolarization. Therefore, this effect may lead to a decrease in the incidence of lethal ventricular arrhythmia and sudden cardiac death.

Index of cardiac-electrophysiological balance and the effects of thrombolytic therapy on the electrocardiogram of patients with pulmonary embolism

OBJECTIVE

Different parameters on electrocardiograms (ECG) have been investigated to predict arrhythmia and mortality in patients with acute pulmonary embolism (APE). The acute effect of thrombolytic therapy (TT) on these parameters has not been investigated yet.

METHODS

We examined the data of 83 patients who were evaluated as high-risk APE and discharged from the hospital after TT. First, the high-risk APE patients' ECGs were compared with healthy control subjects (n = 55). After their admission and 24 hours later, the ECGs of patients with APE were compared. Heart rate, P-wave morphology, QRS duration, QT distance, Tp-e, and the index of cardiac electrophysiological balance (iCEB) were analyzed.

RESULTS

Although P maximum was not different between the groups' ECGs, heart rate, QT, QTc (corrected QT) interval, Tp-e intervals, Tp-e/QT ratio, and P wave dispersion were significantly higher in the APE group ( P values < 0.031). iCEB or iCEBc (corrected iCEB) values were lower in APE group ( P < 0.001). After TT, we determined a decrease in heart rate, Tp-e interval, and Tp-e/QT ratio ( P < 0.001). Although we detected a decrease in the QT and QTc interval and QT dispersion (QTd), QTd had no statistical significance (respectively P -value 0.013, 0.029, and 0.096). The iCEB and iCEBc levels were lower after TT ( P -value was 0.035 and 0.044 respectively).

CONCLUSION

The QT, QTc, Tp-e interval, Tp-e/QTc ratio, iCEB, and iCEBc values significantly decreased after TT. It may be thought that effective TT causes partial improvement in ventricular repolarization in an early period.

Prolonged pulmonary pulse transit time is associated with symptoms in patients with significant mitral stenosis and sinus rhythm

INTRODUCTION

Pulmonary pulse transit time (pPTT) is a novel noninvasive echocardiographic measure to assess pulmonary arterial hemodynamics. It has been shown to be shorter in precapillary pulmonary hypertension (PHT). Mitral stenosis (MS) is one of the causes of postcapillary PHT. We aimed to investigate pPTT in patients with MS and its relationship with symptoms.

METHODS

We included 51 patients with MS (25 were asymptomatic, NYHA I, and 26 were symptomatic, NHYA II or III), and 50 controls, and evaluated their demographic characteristics and echocardiographic variables, including pPTT.

RESULTS

Baseline characteristics, including age, sex, body mass index, and cardiovascular risk factors, were similar between the MS and the control group. The pPTT was longer in the MS group than in the control group (0.21 ± 0.08 vs 0.15 ± 0.05, P < .001). Patients with symptomatic MS had longer pPTT than asymptomatic patients (P = .005). The pPTT was positively correlated with left atrial volume index and systolic pulmonary artery pressure, and negatively with tricuspid annular plane systolic excursion (r = .432; P < .001, r = .319; P = .001, r = -.293; and P = .003, respectively).

CONCLUSION

The measurement of pPTT appears clinically relevant in patients with PHT. Further studies evaluating whether it is useful in distinguishing precapillary from postcapillary PHT are required.

Short- and mid-term effects of sleeve gastrectomy on left ventricular function with two-dimensional speckle tracking echocardiography in obese patients

AIM

This study aimed to investigate left ventricular functions of obese patients with no known heart disease who underwent laparoscopic sleeve gastrectomy by speckle tracking echocardiography in their early and medium-term postoperative follow-up.

PATIENTS AND METHOD

Thirty-seven obese patients (10 M, 27 F) without coronary artery disease or heart failure who had undergone LSG were included in the study. Apical four-, three-, and two-chamber images were analyzed longitudinally by conventional methods and speckle tracking echocardiography (STE) for left ventricle functions preoperatively, at the postoperative Month 1 and at the postoperative Month 6 (QLAB 6.0), using current software.

RESULTS

No difference was found between standard echocardiography and Doppler parameters in terms of the 1-month versus 6-month follow-up values compared to baseline. Left ventricular STE longitudinal measurements demonstrated significantly higher longitudinal strain and strain velocity parameters in the follow-up values at Month 6 compared to the values at Month 1 and at baseline. Global longitudinal strain (GLS) was -17.48 ± 1.09% in 6-month follow-up, -16.16 ± 1.26% in 1-month follow-up, and -16.06 ± 1.25% at baseline (P < .001). A significant correlation was found between delta GLS, which represents patients' GLS change in 6 months, and delta weight, which represents patients' body weight change in 6 months.

CONCLUSION

Obese patients who had undergone LSG were observed to have improved left ventricular function in the mid-term.

Association between depression and anxiety scores and inflammation in patients with isolated coronary artery ectasia

OBJECTIVE

Depression and anxiety disorders are frequently found in combination with obstructive coronary artery disease. Coronary artery ectasia (CAE) is an atypical form of coronary artery disease, the etiology of which has not yet been clearly defined. The aim of this study was to assess the existence of a relationship between anxiety/depression and CAE.

METHODS

A CAE group (n=41; mean age: 58.9±9.0 years) and a control group (n=42; mean age: 58.0±9.6 years) were compared. The anxiety and depression status of patients was evaluated using the Hospital Anxiety and Depression Scale (HADS) questionnaire.

RESULTS

Age, sex, ejection fraction, and cardiovascular risk factor data were similar in both groups. The serum Creactive protein (CRP) and uric acid levels as well as the leukocyte count were significantly higher in the CAE group (p<0.05). The HADS anxiety score was higher in the CAE group, but without statistical significance (p=0.23). The HADS depression score and total HADS score was significantly higher in the CAE group (p<0.001 and p<0.001). The total HADS score and the HADS depression score were correlated with the serum CRP level (r=0.489; p<0.001 and r=0.543; p<0.001, respectively), whereas the anxiety score was not correlated with CRP (r=0.85; p=0.23).

CONCLUSION

The depression score, CRP, and uric acid levels were greater in patients with isolated CAE compared with those of patients with normal coronaries. The anxiety score did not demonstrate a relationship to CAE; however, there was an association between the depression score and CRP, which is an inflammatory marker.

Electrocardiographic alterations in patients consuming synthetic cannabinoids

INTRODUCTION

The aim of this study was to investigate the electrocardiographic parameters in patients consuming synthetic cannabinoids.

METHODS

Thirty-five patients who were consuming synthetic cannabinoids were enrolled to the study, prospectively. The control group included 35 healthy age and sex-matched volunteers. The standard 12-lead surface electrocardiograms of the study population were recorded. P maximum (P_max), P minimum (P_min), P wave dispersion, interatrial duration, P wave area in D2 derivation, abnormal P terminal force in V1 derivation, heart rate, QT interval, corrected QT, QT dispersion, PR interval duration and macrovolt T-wave alternans were evaluated by two experienced cardiologists. The intra-observer and inter-observer variations for all measurements were non-significant.

RESULTS

P_max and P_min duration was not different between the groups ( p=0.96, p=0.15, respectively). However, P wave dispersion was higher in the patient group compared to control group (34±9.4, 29.5±6.6, p=0.02, respectively). QT interval was significantly higher in the patient group than the control group (380.3±25, 365.6±22.8, p=0.01, respectively). Besides, corrected QT was higher in the patient group compared to control group (415±36.8, 392±15.5, p=0.001, respectively). QT dispersion was also higher in the patient group than the control group (39.8±10.0, 29.2±5.4, p<0.001, respectively).

CONCLUSION

Altered electrocardiography parameters linked with atrial and ventricular arrhythmia development may be observed in patients consuming synthetic cannabinoids. These patients should be evaluated regularly for cardiovascular disease and arrhythmia development. The electrocardiogram, which is a cheap and easy test to apply, can be used to determine the pro-arrythmic risk in patients consuming synthetic cannabinoids.

Quadricuspid Aortic Valve Associated with Aortic Regurgitation, Mitral Regurgitation, and Aortic Dilatation

The quadricuspid aortic valve (QAV) is a very uncommon congenital malformation with an estimated incidence of 0.003% to 0.043% of all congenital heart diseases. Combinations of QAV with several different congenital malformations have been described. The case is reported of a type A QAV associated with moderate aortic regurgitation, mild mitral regurgitation, and ascending aorta dilatation. This interesting case was referred for close follow up.

The Relationship between Pre-Infarction Angina and Serum Sphingosine-1-Phosphate Levels

BACKGROUND

Pre-infarction angina reduces myocardial infarct size by preventing the myocardium from being subjected to ischemia reperfusion (I/R) injury. Ischemic preconditioning is the proposed mechanism for this effect. Sphingosine 1 phosphate (S1P) activates ischemic preconditioning pathways and may play a role in the presence of cardioprotective effects of pre-infarction angina. Therefore, we evaluated the relationship between pre-infarction angina and serum S1P levels.

METHODS

Between May 2011 and January 2012, 79 patients with acute myocardial infarction were included in the study. In addition to taking routine medical histories, all of the patients were questioned as to whether or not they had pre-infarction angina. We determined patients serum levels of S1P at admission and discharge, and peak creatine kinase MB and troponin levels were also measured in the pre-infarction angina positive and negative groups.

RESULTS

Of the 79 patients included in the study, 36 had pre-infarction angina and 43 had not. Baseline characteristics were similar between the groups. The median level of serum S1P in patients with pre-infarction angina was significantly higher than in those without pre-infarction angina both at admission and discharge [0.54 (0.14-1.35) vs. 0.26 (0.12-0.62) p = 0.014/0.51 (0.20-1.81) vs. 0.30 (0.13-0.68) p = 0.010]. Serum high sensitive troponin levels were significantly lower in patients with pre-infarction angina [0.97 (0.39-3.07) vs. 2.56 (0.9-6.51) p = 0.034]. Serum S1P levels both at admission and discharge tended to be higher in patients with more angina episodes, but the differences between these subgroups were not statistically significant.

CONCLUSIONS

Patients who experienced pre-infarction angina had higher serum S1P levels than patients without pre-infarction angina. This study supported our hypothesis that the cardioprotective effects of pre-infarction angina may in part be mediated by S1P.

KEY WORDS

Ischemic preconditioning; Pre-infarction angina; Sphingosine 1 phosphate.

Predictability and Outcome of Vascular Complications after Transfemoral Transcatheter Aortic Valve Implantation

BACKGROUND

Although the efficacy and safety of transfemoral transcatheter aortic valve implantation (TAVI) have been improved with new devices, careful patient selection is essential and awkward complications associated with the procedure persist. Despite a gradual reduction in the delivery system size and the development of access site arterial closure devices, vascular complications remain one of the main challenges of TAVI. The aim of this single-center study was to prospectively evaluate the incidence and predictors of vascular complications in transfemoral TAVI.

METHODS

A total of 211 patients (mean age 77.98 ± 8.20 years) who underwent transfemoral TAVI between 2011 and 2014 at the authors' institution, using two different commercially available devices, was included in the study. Technical success, vascular complications, predictors of vascular complications and mortality were each assessed. Vascular complications were defined by the current Valve Academic Research Consortium-2 (VARC-2) criteria.

RESULTS

The mean logistic EuroSCORE of the patients was 21.04 ± 7.51. An Edwards SAPIEN XT valve was used in 69.7% of cases, and a Medtronic CoreValve in 30.3%. Completely percutaneous transfemoral TAVI was successful in 81.6% of patients. Procedural and 30-day mortalities were 1.4% and 8.5%, respectively. Vascular complications occurred in 16.1% of patients (minor 10.4%, major 5.7%), and necessitated surgical repair in 25 cases (11.8%). Major vascular complications were predictive of 30-day mortality (58.3% versus 5.6% (p = 0.000). Predicted major vascular complications (by multivariate analysis) were female gender (hazard ratio (HR) 5.45; 95% confidence interval (CI) 0.91-32.5, p = 0.063), arterial calcification (HR 2,88; 95% CI 1.14-7.30, p = 0.025) and sheath to iliofemoral artery ratio (SIFAR) (HR 1.91, 95% CI 1.27-2.87, p = 0.001).

CONCLUSIONS

Although vascular preclosure devices have revolutionized transfemoral TAVI, and offer a simple but effective percutaneous procedure, vascular complications are still observed in a considerable number of patients. The major vascular complications were predictive of 30-day mortality, and included female gender, iliofemoral calcification and SIFAR. Further technological and procedural developments are required to reduce vascular complication rates and related mortality.

An Extreme Case of CoreValve Bioprosthesis Embolization into the Abdominal Aorta and of the Delivery Catheter Cone into the Right Internal Iliac Artery

Transcatheter aortic valve implantation (TAVI) is a new and hopefully therapeutic option in patients with symptomatic severe calcific aortic valve stenosis and multiple comorbidities who are not eligible for open-heart surgery due to unacceptable conventional surgical risks. Herein is reported the case of a patient who underwent TAVI in whom an unusual CoreValve bioprosthesis embolization occurred into the abdominal aorta. While attempting to retrieve the whole system, the conical tip of the catheter delivery system also became embolized into the right iliac artery. Importantly, this case demonstrated a rare complication of CoreValve bioprosthesis embolization which was managed without surgical intervention. Video 1: Peripheral angiography demonstrating the embolized CoreValve bioprosthesis. Video 2: Fluoroscopy demonstrating completely opened CoreValve bioprosthesis at a level above the iliac artery bifurcation and the mobile conical tip in the valve system. Video 3: Peripheral angiography demonstrating prosthetic valve without any flow limitation and embolized conical tip into the right internal iliac artery. Video 4: Peripheral angiography demonstrating prosthetic valve without any flow limitation and embolized conical tip into the right internal iliac artery. Video 5: Aortography demonstrating the successfully implanted second CoreValve bioprosthesis in an optimal aortic position, with no paravalvular leak. Video 6: Peripheral angiography demonstrating the embolized conical tip into the right iliac artery with a normal external iliac artery flow. Video 7: Peripheral angiography demonstrating the embolized conical tip into the right iliac artery with a normal external iliac artery flow.

Relationship between serum vitamin D levels and angiographic severity and extent of coronary artery disease

BACKGROUND

Vitamin D is known for its effect in calcium and bone homeostasis. There is an increasing evidence for health benefits accomplished by activated vitamin D that go beyond these classical functions. Previous studies have suggested that lower vitamin D levels are associated with increased cardiovascular disease risk. Therefore, we aimed to evaluate relationship between vitamin D levels and extent and severity of coronary artery disease.

MATERIALS AND METHODS

A total of 746 patients in whom coronary angiography was performed between August 2012 and July 2013 were enrolled in this study. Serum vitamin D levels were measured, and patients were grouped according to their serum vitamin D levels (vitamin D <20 ng/mL (n = 602) Group 1 versus >20 ng/dL (n = 144) Group 2). Gensini score system was used to evaluate the association between serum vitamin D levels and severity and extent of coronary artery disease.

RESULTS

There was no significant difference between the groups in terms of baseline characteristics and demographic characteristics. Mean serum vitamin D levels of all patient cohort was 15.54 ± 7.46 ng/mL. Group 1 and Group 2 had an average serum vitamin D levels of 12.6 ± 3.3 ng/mL and 27.5 ± 7.8 ng/mL, respectively. Gensini score for all cohort was 26.25 ± 34.32. Group 1 had an average Gensini score of 26.4 ± 35.7; on the other hand, Gensini score was 25.5 ± 27.5 in Group 2 (P = 0.097).

CONCLUSIONS

This study failed to demonstrate significant relationship between serum vitamin D levels and the severity and extent of coronary artery disease. Further studies with more participation and homogenous groups with comparable individual and environmental features are needed to evaluate the association of serum vitamin D levels and cardiovascular diseases.

Concurrent Transcatheter Aortic Valve Implantation and Percutaneous Transvenous Mitral Commissurotomy for Totally Percutaneous Treatment of Combined Severe Rheumatic Aortic and Mitral Stenosis

Transcatheter aortic valve implantation (TAVI) is a new promising therapeutic option for patients with symptomatic severe calcific aortic valve stenosis (AS) who are inoperable or at high risk for conventional cardiac surgery. Percutaneous transvenous mitral commissurotomy (PTMC) is performed routinely in patients with severe mitral stenosis (MS) having a favorable anatomy. Although concurrent TAVI and PTMC is a theoretically possible approach in the treatment of patients with severe AS and MS who are unsuitable for conventional surgery, no cases have yet been reported in which this combined technique is used. For patients with severe AS and MS, the standard therapy is replacement of both the mitral and aortic valves. Herein are presented the details of a 52-year-old woman with urethral carcinoma, in whom simultaneous TAVI and PTMC was the chosen technique to treat combined severe rheumatic AS and MS in a single procedure.

Percutaneous Mitral Valve Repair with the MitraClip System in Mitral Regurgitation Due to Mitral Annular Calcification

Percutaneous valve repair with the MitraClip represents a new and promising therapeutic option for patients with severe mitral regurgitation (MR). Mitral valve prolapse and flail leaflet are two major causes of degenerative MR in patients who underwent the MitraClip procedure. Mitral annular calcification (MAC) is also a less-frequent cause of degenerative MR. Among patients with MAC, open surgical treatment or valvular replacement is the treatment of choice for severe MR. Herein we present a case with severe MR secondary to MAC in whom successful percutaneous valve repair was accomplished with the MitraClip system due to the high risk of open-heart surgery.

Association of serum total bilirubin level with severity of coronary atherosclerosis is linked to systemic inflammation

OBJECTIVE

Although cardiovascular protective action of bilirubin has been attributed to its antioxidant effect, there was scarce data regarding the anti-inflammatory properties. Herein, we aimed to assess the relationship between serum total bilirubin level and severity of coronary artery disease (CAD) in association with the direct inflammatory marker such as C-reactive protein (CRP), the other indirect markers included in inflammation process such as neutrophil to lymphocyte ratio (NLR) and red cell distribution width (RDW) in patients with stable CAD.

METHODS

Angiographic data of 1501 patients were analyzed in this retrospective cross-sectional study. Patients were categorized according to Gensini scores as control, mild CAD and severe CAD groups. The association of clinical and laboratory parameters with the severity of CAD were determined by multivariable linear regression analysis.

RESULTS

Total bilirubin level in the control group was significantly higher than those of the other groups. After multivariable linear regression analysis total bilirubin [β=-3.131 (-4.481, -1.782), p<0.001] was significantly associated with the severity of CAD. Futhermore, there was a moderate and significant inverse correlation between serum total bilirubin level and the severity of CAD (r=-0.173, p<0.001), CRP (r=-0.112, p<0.001), NLR (r=-0.070, p=0.026) and RDW (r=-0.074, p=0.027).

CONCLUSION

Serum total bilirubin level was independently and inversely associated with the severity of coronary atherosclerosis in patients with stable CAD. In addition, total bilirubin level was inversely correlated with CRP, NLR and RDW. These results suggest that besides its already known effect on the oxidative stress, higher serum total bilirubin level may exhibit an anti-inflammatory effect in the coronary atherosclerotic process.

Neutrophil-to-lymphocyte ratio is increased in patients with rheumatic mitral valve stenosis?

OBJECTIVE

The role of systemic and chronic inflammatory processes in the pathophysiology of rheumatic heart valve disease is well known. The neutrophil-to-lymphocyte ratio (NLR) was shown to be an indicator of systemic inflammation. In this study, we aimed to investigate relationship between NLR as a marker of systemic inflammation and rheumatic mitral valve stenosis (RMVS).

METHODS

This is a retrospective study. Among patients who underwent transthoracic echocardiography between January 2008-March 2013, 314 patients with RMVS were included retrospectively in the study. The control group included 57 healthy persons who underwent transthoracic echocardiography during the study period. Basal characteristics and NLR were compared between the two groups. Independent predictors of RMVS were determined by logistic regression analysis.

RESULTS

Basal characteristics were similar among the groups (age, 50.2 ± 14.2 vs. 49.2 ± 13.0, p=0.60). The NLR was significantly higher in patients with RMVS [2.9 (0.6-13.0) vs. 2.1 (0.7-5.8), p<0.001]. Besides, C-reactive protein (CRP) was also higher in the RMVS group [5.99 (0.3-23.7) vs. 2.98 (0.6-6.3), p=0.001]. In the regression analysis, NLR (OR: 2.24, p=0.04), CRP (OR: 1.34, p=0.03), and left atrial diameter (OR: 1.21, p=0.001) were independent predictors of RMVS. In the correlation analysis, there was a significant positive correlation between NLR and CRP (r=0.43, p<0.001).

CONCLUSION

We found that NLR was significantly increased in RMVS. Furthermore, NLR was an independent predictor of the presence of RMVS in our study population. According to these findings, NLR can be used as a predictor of RMVS. Since it is an easily available and cheap method, it can easily be used in daily clinical practice. Increased NLR can also be a sign of ongoing chronic inflammation in patients with RMVS.