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ABSTRACT: We sought to investigate whether serum choline levels are increased across the spectrum of coronary artery disease (CAD) manifestations and correlate with the severity of coronary stenosis.
A total of 36 patients with acute coronary syndrome (ACS) [22 patients with non-ST-segment elevation ACS and 14 patients with ST-segment elevation acute myocardial infarction (STEMI)], 22 patients with stable angina pectoris (SAP), and 18 controls were recruited for the study. In ACS patients, serum choline levels were measured on admission, and at 24 and 48 h thereafter, using high-performance liquid chromatography. The severity of CAD was assessed using the Gensini score.
Serum choline levels on admission were significantly higher in the entire group of patients with ACS than in controls. The highest level of choline was observed in the STEMI group, followed by the SAP, and the non-ST-segment elevation ACS groups. Serum choline levels decreased gradually in patients with STEMI over the 48-h period. Serum choline levels on admission, and at 24 or 48 h thereafter, did not correlate with the presence of CAD neither in patients with ACS (P=0.78, 0.98 and 0.98, respectively) nor in those with SAP (P=0.92).
Our results suggest that serum choline levels are increased in ACS patients. However, there was no clear correlation between levels of choline and the severity and extent of CAD in this patient group.
Coronary artery disease 10/2010; 21(8):466-71. · 1.56 Impact Factor
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ABSTRACT: Reduced arterial elasticity is an important mediator of accelerated atherogenesis and consequent increased cardiovascular morbidity in obstructive sleep apnea (OSA). The aim of our study was to investigate whether continuous positive airway pressure (CPAP) therapy may improve arterial elasticity in subjects with OSA.
In 44 subjects with OSA, we measured arterial elasticity by applanation tonometry before and after 6 months of treatment with CPAP. Nine OSA+ subjects withdrew from the study.
The 35 patients with OSA who completed the 6-month CPAP treatment showed a marked reduction in both the large artery (LAEI, P=0.001) and small artery (SAEI, P=0.009) elasticity indices, independent of potential confounders. In OSA+ subjects who withdrew from the study, SAEI and LAEI did not change significantly over time.
Six months of CPAP therapy improves arterial elasticity in subjects with OSA.
Respiratory medicine 10/2010; 104(10):1571-6. · 2.33 Impact Factor
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ABSTRACT: Growing evidence has indicated the potential clinical usefulness of measuring different forms of cytokeratin 18 in patient sera (M30 antigen for apoptosis and M65 antigen for necrosis) for distinguishing different forms of cell death. Preliminary data have reported altered levels of cytokeratin 18 fragments in patients with acute coronary syndrome (ACS) and ischemic heart disease. In this study, serum levels of M30 and M65 were measured in 74 patients with ACS [including 17 cases with unstable angina and 57 patients with acute myocardial infarction (AMI)], 25 patients with stable angina, and 23 controls.
In patients with ACS, serial measurements of M30 and M65 were obtained, and for each patient, the following values were determined: (i) values at admission, (ii) values obtained 24 h after symptom onset, and (iii) values obtained at 48 h after symptom onset. The severity of coronary atherosclerosis was expressed using the Gensini score.
On admission, M30 and M65 levels in ACS patients were similar to those observed in stable angina patients and control participants. In AMI patients, serum levels of M30 peaked at 24 h and declined thereafter at 48 h. Notably, serum levels of M30 measured at 24 h correlated significantly and positively with the extent of coronary artery disease as measured by the Gensini score in AMI patients (r = 0.253, P<0.05).
Serum levels of the apoptotic marker M30 peak at 24 h after AMI and reflects the extent of coronary artery disease in this patient group.
Coronary artery disease 09/2009; 20(8):494-8. · 1.56 Impact Factor
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Anadolu kardiyoloji dergisi: AKD = the Anatolian journal of cardiology 07/2009; 9(3):E7-8. · 0.44 Impact Factor
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ABSTRACT: To examined whether serum paraoxonase (PON1) and arylesterase (ARE) activities are correlated with inflammatory biomarkers (procalcitonin and high sensitivity C-reactive protein (hs-CRP) in patients with acute coronary syndrome (ACS).
This cross-sectional study was conducted at the Departments of Cardiology and Biochemistry, Uludag University School of Medicine, Bursa, Turkey, from April 2007 to December 2007. Seventy-eight consecutive patients with ACS and 39 healthy controls were investigated. Acute coronary syndrome patients were divided into 3 groups according to their clinical presentation: unstable angina pectoris (UAP) (Braunwald III-B, n=25), non-ST elevation myocardial infarction (NSTEMI) (n=18), and ST-elevation myocardial infarction (STEMI) (n=35). Serum PON1/ARE activities were measured spectrophotometrically. Levels of procalcitonin and hs-CRP were measured by immunoassay.
Paraoxonase/ARE activities were significantly lower in all patient groups compared to controls. No correlation between PON1/ARE activities and high-density-cholesterol levels was seen. Among ACS patients, serum ARE activity correlated inversely with baseline and 48-hour procalcitonin (r=-0.577, p=0.009, and r=-0.642, p=0.019) and hs-CRP levels (r=-0.614, p=0.03, and r=-0.719, p=0.044).
Serum ARE activity is reduced in ACS patients and inversely correlated with inflammatory markers.
Saudi medical journal 04/2009; 30(3):334-9. · 0.52 Impact Factor
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ABSTRACT: Aortic distensibility is an elasticity index of the aorta, and reflects aortic stiffness. Coronary artery disease has been found to be substantially associated with increased aortic stiffness. In this study we aimed to retrospectively analyze the association of angiographically determined aortic distensibility with the patency rates of coronary bypass grafts
The study was conducted in the Cardiology department of the Applied Research Centre for Health of Uludağ University. The coronary angiograms of 53 consecutive coronary bypass patients were analysed retrospectively. Aortic distensibility was calculated using the formula: 2 x (change in aortic diameter)/(diastolic aortic diameter) x (change in aortic pressure). The number of stenosed and patent bypass grafts and the patient characteristics like age, risk factors were noted.
There were 44 male (83%) and 9 female (17%) cases. Eighteen cases had only one saphenous vein grafting. The number of cases with two, three and four saphenous grafting were 18, 11 and 1; respectively. In the control angiograms the number of cases with one, two, three and four saphenous vein graft obstruction were 15 (31.3%), 7 (14.6%), 1 (2.1%) and 1 (2.1%) respectively. The aortic distensibility did not differ in cases with and without saphenous graft occlusion (p > 0.05). Also left internal mammary artery (LIMA) graft patency was not related to the distensibility of the aorta (p > 0.05). We also evaluated the data for cut-off values of 50 and 70 mmHg of pulse pressure and did not see any significant difference between the groups in terms of saphenous or LIMA grafts.
In this study we failed to show association of angiographically determined aortic distensibility with coronary bypass graft patency in consecutive 53 patients with coronary artery bypass graft surgery (CABG).
Journal of Cardiothoracic Surgery 04/2009; 4:14. · 1.19 Impact Factor
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Anadolu kardiyoloji dergisi: AKD = the Anatolian journal of cardiology 03/2009; 9(1):69. · 0.44 Impact Factor
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ABSTRACT: We have investigated the relationship between silent cardiac autonomic neuropathy (CAN), one of the most important causes of mortality in diabetic patients, and the Tei index, which is an indicator of global ventricular function.
Among the patients with type 2 diabetes mellitus, 15 without autonomic neuropathy (Ewing score < 1) were accepted as CAN (-) and 18 with autonomic neuropathy (Ewing score > or =1) were accepted as CAN (+).Twelve healthy individuals were included in the control group. Diastolic dysfunction and Tei index were evaluated by means of 2-D and Doppler echocardiographic examination.
Not only Doppler mitral, but also tricuspid inflow parameters showed a significant decrease in E/A ratio, an increase in A wave amplitude and deceleration time with CAN (+) patients. Left ventricular Tei index and Ewing score were found to be positively correlated (P < 0.001, r = 0.55). Likewise to the correlation in the left ventricle, a positive correlation was also detected between right ventricular Tei index and Ewing score (P = 0.004, r = 0.43).
We have shown that in patients with type II diabetes, CAN is related with left and right ventricular diastolic dysfunction.We also have determined that the Tei index is in correlation with CAN (Ewing score), which is a complication of diabetes.
Acta cardiologica 10/2008; 63(5):629-33. · 0.61 Impact Factor
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ABSTRACT: Reduced arterial compliance is an independent predictor of cardiovascular mortality and is commonly encountered in patients with coronary artery disease. Statins may produce cholesterol-independent effects which can result at least in part from direct improvement of the arterial function. In this study, we sought to determine the effect of intensive statin therapy according to the Adult Treatment Panel III guidelines on arterial compliance in dyslipidaemic patients with angiographically-proven CAD selected for medical treatment.
Patients (n = 33) received atorvastatin 40 mg/day for 6 months. Large arterial compliance and small arterial compliance were measured at baseline and after 6 months of atorvastatin treatment.
After treatment, the large artery elasticity index (LAEI) increased from 11.85 +/- 3.46 to 13.80 +/- 3.95 ml/mm Hg x 100 (P < 0.001) and the small artery elasticity index (SAEI) increased from 3.84 +/- 1.97 to 4.97 +/- 1.98 ml/mm Hg (P = 0.03). There was no correlation between the change in either LAEI or SAEI and other baseline variables or changes in lipid levels.
Our findings suggest that intensive statin therapy according to the Adult Treatment Panel III guidelines improves arterial elasticity in CAD patients selected for medical treatment. The beneficial vascular effect of atorvastatin on arterial elasticity was independent of lipid parameters.
Acta cardiologica 09/2008; 63(4):467-71. · 0.61 Impact Factor
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ABSTRACT: We sought to investigate serum paraoxonase/arylesterase activities in patients with acute coronary syndromes (ACS) and their correlations with the severity and extent of coronary artery disease (CAD).
Three groups of patients were investigated: 89 patients with ACS, 54 patients with normal coronary angiograms (no-CAD group), and 27 healthy comparison subjects. ACS patients were divided into three groups according to their clinical presentation: unstable angina pectoris (UAP, Braunwald III-B, n = 31), non-ST elevation myocardial infarction (NSTEMI) (n = 27), and ST-elevation myocardial infarction (STEMI) (n = 31). Serum paraoxonase/arylesterase activities were measured spectrophotometrically. Angiographic CAD extent was expressed both by the number of vessels diseased and by the Gensini scoring system. Results showed that serum paraoxonase/ arylesterase activities and the paraoxonase/high density lipoprotein-cholesterol (HDL-C) ratio were significantly lower in the STEMI, NSTEMI, UAP groups than in no-CAD and control groups. Serum paraoxonase/arylesterase activities and paraoxonase/HDL-C ratio were reduced in patients with 2-vessel disease (VD) and 3-VD compared to the I-VD and no-CAD group (P < 0.001). In patients with ACS, the Gensini score correlated inversely with serum paraoxonase (r = -0.419, P < 0.001), arylesterase (r = -0.492, P < 0.0001), and the paraoxonase/HDL-C ratio (r = -0.377, P < 0.001). Serum arylesterase (r = 0.161, P = 0.03) and paraoxonase (r = 0.135, P = 0.002) activities were positively correlated with HDL-C levels. Serum arylesterase activity (P < 0.0001), gender (P = 0.0037), diabetes mellitus (P = 0.005) and LDL-C levels (P = 0.03) were independent predictors of CAD presence.
Serum paraoxonase/arylesterase activities are reduced in ACS patients and inversely correlated with the severity of CAD.
Acta cardiologica 07/2008; 63(3):361-7. · 0.61 Impact Factor
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ABSTRACT: Contrast-induced nephropathy (CIN) is a complication that is underestimated in clinical practice after cardiac catheterization. Recently, the value of interleukin (IL)-18 as a novel biomarker for the detection of acute renal failure has been highlighted. In the present study, we sought to investigate whether urine IL-18 may be an early diagnostic marker of CIN.
We performed a nested case-control study using a hospital based cohort of all patients (n=157) admitted for elective PCI for stable angina to the Uludag University School of Medicine between February 2007 and June 2007. We identified 15 patients (9.5%) with CIN. Controls were matched with cases at an attempted 2.5:1 ratio by age and gender. Urinary IL-18 values were measured before as well as 24 and 72 h after the PCI.
No statistically significant differences in urine IL-18 were detected between cases (n=15) and controls (n=36) or between the patient samples obtained before PCI and after the invasive procedure in both study groups.
These findings argue against the hypothesis that urine IL-18 may be clinically useful as a biomarker of CIN after radiological procedures requiring intravascular administration of iodinated contrast media. Further studies with larger sample sizes are needed to validate our findings.
Clinical biochemistry 06/2008; 41(7-8):544-7. · 2.02 Impact Factor
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ABSTRACT: Arterial elasticity has been previously linked to atherosclerotic vascular disease states. Serum uric acid level has been recently associated with increased arterial stiffness, but to what extent serum uric acid reflects angiographic coronary artery status and vessel compliance remains to be established. In this study we aimed to evaluate the association of arterial elasticity indexes, serum uric acid and the presence and extent of angiographic coronary artery disease (CAD) in patients with chronic stable angina.
One hundred and eight consecutive patients attending for elective coronary angiography were investigated. The severity of CAD was expressed using the Gensini score. Quantitative analysis of the arterial elasticity was performed by applanation tonometry. Serum uric acid was measured in all participants. Stepwise multiple linear regression analysis was used to identify the independent correlates of the Gensini score.
After adjustment for age, gender, common cardiac risk factors and cardiovascular drugs, small artery elasticity index (SAEI) (p<0.001) and serum uric acid (p<0.001) were independently correlated with the severity of CAD. Stepwise multiple linear regression analysis was also used to identify independent correlates of the SAEI. Serum uric acid emerged as the only independent correlate of SAEI (p<0.001).
SAEI independently reflects the extent of CAD in patients with chronic stable angina. This relationship is chiefly mediated by serum uric acid. Our data add to the growing evidence that serum uric acid may be a marker of arterial stiffness and atherosclerotic burden.
Atherosclerosis 05/2008; 202(1):200-4. · 3.79 Impact Factor
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ABSTRACT: Arterial calcification is frequently encountered in mammography. The frequency of breast arterial calcification (BAC) increases with increasing age. Studies have shown that BAC is seen more frequently among the people who are under the risk of coronary artery diseases (CAD) such as diabetes and hypertension. The objective of this study is to investigate the relationship between the arterial calcification detected in mammography and the CAD.
Screening mammography was performed in 123 women above the age of 40 years who had been examined with coronary angiography for the evaluation of CAD. The presence of BAC, number of affected vessels, and the distribution of calcification in the vessel wall were evaluated in the mammography. Subjects were questioned in terms of the cardiovasculary risk factors. The severity of CAD was evaluated according to the Gensini scoring. In addition, the number of blood vessels with stenosis of more than 50% was used as the vascular score. The correlation between Gensini and the vascular scores, and BAC was statistically evaluated using Mann-Whitney U and Kruskal-Wallis tests.
Eighty (65%) of 123 patients had CAD. BAC was detected in the mammography of 49 (39.8%) subjects. The ages and duration of menopause of the cases with BAC were significantly higher than those without BAC (p<0.001). There was an almost significant correlation between the BAC and Gensini scores (p=0.059). There was a significant increase in the frequency of BAC among subjects with more than two vessels with stenosis (p=0.033).
Frequency of BAC increases with increasing age. BAC is also frequently seen in subjects having severe coronary artery disease. Although increasing age may be a factor increasing the frequency of BAC, BAC may also be an indicator of CAD. Therefore, the mentioning of arterial calcification in mammography reports may be important in warning the clinician in terms of CAD.
European Journal of Radiology 09/2007; 63(3):391-5. · 2.61 Impact Factor
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ABSTRACT: The aim of this study is to determine the relation of high-sensitive serum C-reactive protein (hsCRP) and procalcitonin with presence and severity of coronary artery disease and early prognosis in patients with acute coronary syndrome (ACS).
Procalcitonin and hsCRP levels were measured at admission and after 48 hours in 50 patients (41 men, 9 women) with ACS. The patients were assigned to three groups according to their clinical diagnosis: unstable angina pectoris (UAP) (Braunwald III-B), non-ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI). Incidences of adverse cardiac events were recorded in a 3-month follow-up. Coronary angiography was performed to evaluate presence and severity of coronary artery disease. In the groups of STEMI, NSTEMI and UAP, procalcitonin (P = 0.01 3, P = 0.045 and P = 0.000 1, respectively) and hsCRP (P = 0.000 1, P = 0.01 and P = 0.00 1, respectively) levels were significantly increased. No significant correlation was found between these markers and the presence and severity of coronary artery disease. There was no correlation between procalcitonin and hsCRP levels at admission and after 48 hours and primary end points after 3 months except in the group of UAP with revascularization procedure. In the group of UAP, hsCRP levels at 48 hours were found higher in the patients with a revascularization procedure (P = 0.04).
In conclusion, levels of hsCRP and procalcitonin are increased in patients with ACS but failed to correlate with severity of coronary disease and early prognosis.
Acta cardiologica 05/2007; 62(2):135-41. · 0.61 Impact Factor
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ABSTRACT: Reperfusion treatment modalities used in the routine treatment protocols of acute myocardial infarction (AMI) were found to be ineffective in establishing the nutritional cellular reperfusion in the microvascular environment even they succeed to open the infarct related artery. Glucose-insulin-potassium (GIK) solution, which is presumed to stimulate the glycolytic pathway, is experimentally proven to be the most efficacious substrate for the preservation of energy production and therefore the myocardial viability, in the setting of acute ischemia.
We compared, 54 patients who suffered AMI and received GIK solution (300 g glucose+50 IU crystallized insulin+80 mEq potassium chloride in one liter solution) in addition to conventional treatment (GIK group) with 27 patients who were traditionally treated (control group) for in-hospital and early-term (1 month) cardiac morbidity. We also compared the two groups in terms of heart rate variability (HRV).
Eight patients in the control group developed new-onset symptomatic congestive heart failure whereas only 5 patients in GIK group were found to have such a cardiac morbidity (p=0.01). Reduced HRV (<50 ms) was found in 3 patients of control group whereas no patient in GIK group had abnormal HRV (p=0.01).
The GIK solution decreased the incidence of new-onset symptomatic congestive heart failure and low HRV after myocardial infarction. Larger multicenter trials need to resolve the questions on the efficiency of metabolic intervention with GIK solution in acute myocardial infarction.
Anadolu kardiyoloji dergisi: AKD = the Anatolian journal of cardiology 07/2005; 5(2):90-4. · 0.44 Impact Factor
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ABSTRACT: Coronary artery anomalies are found in 0.6% to 1.5% of coronary angiograms. Angiographic recognition of these vessels is important because of their clinical significance and importance in patients undergoing coronary angioplasty or cardiac surgery. We reviewed the database of the Cardiac Catheterization Laboratory of Uludag Medical University in Bursa, Turkey. All patients who were subjected to coronary angiography from 1994 to 2001 were included. The study included 12,059 patients who underwent diagnostic coronary arteriography during the 8 year period. One hundred patients had primary congenital coronary anomalies. Ninty-five (95%) of the patients had anomalies of origin and distribution while five (5%) had coronary artery fistulae. The left main coronary artery (LMCA) was the most common anomalous vessel involved (forty-eight (48%) of the patients). An LMCA distribution anomaly was observed in these 48 patients. An anomalous right coronary artery (RCA) was the second most common anomaly, seen in twenty-two (22%) of the patients. An anomalous circumflex artery (Cx) was the third most common anomaly, seen in seventeen. Five patients had a coronary artery fistulae. The fistulae in our series were small without significant shunt circulation. Primary congenital coronary anomalies are isolated lesions and generally have no relation with other congenital heart diseases. They do not appear to be associated with an increased risk for development of coronary atherosclerosis. Angiographic recognition of these vessels is important because of their clinical significance and importance in patients undergoing coronary angioplasty or cardiac surgery.
International Heart Journal 02/2005; 46(1):97-103. · 1.16 Impact Factor
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Anadolu kardiyoloji dergisi: AKD = the Anatolian journal of cardiology 10/2004; 4(3):276. · 0.44 Impact Factor
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ABSTRACT: Neurocardiogenic syncope is the most common type of syncope. Head-up tilt testing is the investigation of choice for diagnosis of patients with neurocardiogenic syncope. In this study, we aimed to findout any association between heart rate variability parameters and type of tilt-test response in patients with syncope.
Forty-nine cases with unexplained syncopal attacks were enrolled into our study and were grouped according to the tilt-test responses. Tilt test was performed in all patients after excluding other causes of syncope. In case of a negative basal tilt-testing, pharmacological tilt testing was performed after 30 min of 5 mg sublingual isosorbide dinitrate. Holter monitoring was done from the beginning of tilt testing upto two hours post-procedure. The heart rate variability parameters analyzed were the mean of all coupling intervals between normal beats, the standard deviation about the mean of all coupling intervals between normal beats, the mean of all 5-min standard deviations of mean of all coupling intervals between normal beats, the proportion of adjacent normal R-R intervals differing by > 50 ms, the root mean square of the difference between successive RRs, and the standard deviation of 5-min mean of all coupling intervals between normal beats and ratio between low and high frequencies.
In 35 patients, the tilt-test was positive, 16 were cardioinhibitor type (Group 1), four cases had a vasodepressor type response (Group 2) and 15 were mixed type (Group 3). Fourteen patients had a negative test result. The heart rate variability measures did not significantly differ among the study groups. The heart rate variability measures were compared between the tilt-test negative (Group 4) and the tilt-test positive groups (Groups 1, 2 and 3) and no statistically significant difference was found.
Indian heart journal 56(3):229-31.
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ABSTRACT: Isoproterenol tilt-table testing provides a diagnosis of neurocardiogenic syncope in patients with syncope or near-syncope. Although acute beta-blockade may prevent the development of syncope during isoproterenol tilt-table testing, the use of beta-blockers for chronic prophylaxis may not be effective for some patients who show a positive response to isoproterenol tilt-table testing. We evaluated whether the efficacy of intravenous metoprolol in preventing symptoms during repeated tests would be helpful in selecting patients suitable for long-term therapy.
We studied 55 patients (35 females, 20 males; mean age 36+/-11 years) who had been chosen from a group referred to our institute with a history of unexplained syncope (> or = 2 syncopal episodes) and a positive response to isoproterenol tilt-table testing. After a positive response to isoproterenol tilt-table testing, 5 mg metoprolol was infused intravenously as a bolus and the test repeated. Thirty-five patients (group 1) showed a positive response again and 20 (group 2) showed a negative response. We started 50 mg metoprolol once a day for patients in group 1 while group 2 was divided into 2 subgroups: the first subgroup (group 2a, 12 patients) was started on 50 mg sertraline or 20 mg paroxetine once a day and the second subgroup (group 2b, 8 patients) was started on 5 mg midodrine orally once a day. Two months later, isoproterenol tilt-table testing was repeated. In group 1, 13 of 35 patients (37%) were positive on isoproterenol tilt-table testing while in group 2, 8 of 20 patients (40%) were positive on isoproterenol tilt-table testing (p not statistically significant). The therapies of the two groups were then interchanged. Two months later (4 months from the beginning of the study), the isoproterenol tilt-table test was repeated. Eleven patients in group 1 (31%) and 6 in group 2 (30%, p not statistically significant) showed a positive response again.
We conclude that acute beta-blockade response to positive isoproterenol tilt-table testing is not a useful predictor for the assessment of chronic prophylaxis for neurocardiogenic syncope.
Indian heart journal 55(1):40-3.
