[Show abstract][Hide abstract] ABSTRACT: Objectives: We aimed to investigate the role of oxidative
stress related with ischemia- reperfusion damage on the pathogenesis
of atrial fibrillation (AF) developing after coronary artery
bypass graft (CABG) surgery.
Study design: In our prospective, single-center study, 118 patients
who underwent elective isolated on-pump CABG surgery
were included. Patients were divided into two groups according
to the development of postoperative atrial fibrillation (POAF) as
Group 1: Patients who developed POAF, and Group 2: Patients
who remained in sinus rhythm. In addition to preoperative demographic,
laboratory, echocardiographic, intraoperative, and
postoperative clinical characteristics, levels of plasma total
oxidative status (TOS) after placement and removal of aortic
cross clamp (ACC) were compared between the two groups.
Predictors of POAF were also investigated by multivariate logistic
Results: A comparison of preoperative demographic, laboratory,
echocardiographic, and postoperative clinical characteristics
between the two groups showed that patients in Group 1
were significantly older (65.6±7.20 vs. 59.6±9.07, p<0.001), had
a lower hematocrit level (37.5±5.16 vs. 39.7±5.28; p=0.034),
and an enlarged left atrium diameter (39±0.45 vs. 3.6±0.48;
p=0.006). Changes in plasma TOS levels after placement and
removal of ACC were statistically significant in Group 1 [13 (8.6-
23), 30 (18.1-47.3); p=0.001 vs. 14 (8.8-22.2), 24 (21.4-42.7);
p=0.060]. Length of stay in the intensive care unit [3 (2-14) vs.
2 (1-58); p=0.001] and length of stay in hospital [7 (6-85) vs.
7 (5-58); p=0.001] were prolonged in Group 1. In multivariate
logistic regression analysis, aging (odds ratio (OR): 1.088, 95%
confidence interval (CI): 1.005-1.177; p=0.036), hematocrit level
(OR: 0.718, 95% CI: 0.538-0.958; p=0.025), pump temperature
(OR: 1.445, 95% CI: 1.059-1.972; p=0.020), and plasma TOS
level (OR: 1.040, 95% CI: 1.020-1.050; p=0.040) were found to
be independent predictors of POAF.
Conclusion: Ischemia-reperfusion damage related with ACC
placement may be an important factor on the pathogenesis of
POAF. Minimizing the oxidative stress occurring intraoperatively
should be targeted for preventing mortality and morbidity
Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir 07/2014; 2014;(42)5:419-425.
[Show abstract][Hide abstract] ABSTRACT: We determined the effect of 6-month rosuvastatin treatment on blood lipids, oxidative parameters, apolipoproteins, high-sensitivity C-reactive protein, lipoprotein(a), homocysteine, and glycated hemoglobin (HbA1c) in patients with metabolic syndrome (MetS). Healthy individuals (men aged >40 years and postmenopausal women) with a body mass index ≥30 (n = 100) who fulfilled the National Cholesterol Education Program Adult Treatment Panel III diagnostic criteria for MetS were included. Total cholesterol and low-density lipoprotein cholesterol (LDL-C) levels decreased (P < .0001). The change in LDL 1 to 3 subgroups was significant (P = .0007, P < .0001, and P = .006, respectively). Changes in LDL 4 to 7 subgroups were not significant. There was a beneficial effect on oxidized LDL, fibrinogen, homocysteine, and HbA1c. Rosuvastatin significantly increased high-density lipoprotein levels (P = .0003). The oxidant/antioxidant status and subclinical inflammatory state were also beneficially changed. Rosuvastatin had a significant beneficial effect on atherogenic dyslipidemia as well as on oxidative stress and inflammatory biomarkers in patients with MetS.
[Show abstract][Hide abstract] ABSTRACT: Resistin, which is derived from the gene of RSTN, belongs to a family of cysteine-rich secretory proteins called resistin-like molecules (RELMs). Increased serum resistin levels are associated with coronary artery disease (CAD) and the risk of cardiovascular death. Patients (n = 214) with an initial diagnosis of stable angina pectoris, unstable angina pectoris, and myocardial infarction without ST-segment elevation and referred to catheter laboratory for coronary angiography were enrolled in the study. We aimed to investigate the relationship between increased serum resistin level and CAD. The severity of CAD was calculated by the Gensini scoring system. In conclusion, we established a significant correlation between serum resistin levels and CAD (P = .010). Also, serum resistin levels correlated with the Gensini score that represents the severity of CAD angiographically (P = .010).
[Show abstract][Hide abstract] ABSTRACT: Background: Postoperative atrial fibrillation (AF) following cardiac surgery is associated with an increased risk of stroke, prolonged hospitalization, and increased costs. Statin therapy is associated with a lower incidence of postoperative AF. We aimed to compare the preventive effects of rosuvastatin and atorvastatin on postoperative AF.
Methods: This study included 168 patients undergoing elective cardiac surgery with cardiopulmonary bypass. Patients were divided into 2 groups according to treatment of statin. Group 1 (n = 96) was patients receiving atorvastatin, and group 2 (n = 72) was patients receiving rosuvastatin. Postoperative electrocardiographs (ECGs) and telemetry strips were examined for AF within postoperative period during hospitalization.
Results: The incidences of postoperative AF were 17.9% (n = 17) in group 1 and 22.2% (n = 16) in group 2 (P = .48). Left ventricular end-diastolic diameter (LVEDD) and ejection fraction (EF) were not different between groups. Incidence of diabetes, hypertension, hyperlipidemia, smoking, myocardial infarction in past medical history, family history of atherosclerosis, male sex, drug use, and perioperative features were similar between groups.
Conclusions: The present study revealed that preoperative rosuvastatin or atorvastatin treatment did not have a different effect in preventing postoperative AF.
Postoperative atrial fibrillation (AF) is a frequent complication after cardiac surgery, occurring in 20% to 30% of patients [Frost 1992], and is associated with increased mortality, significant morbidity, and increased length of hospital stay and costs [Almassi 1997; Mathew 2004]. Although the exact pathophysiologic mechanism causing AF after cardiac surgery is not well defined, a number of clinical and perioperative factors have been shown to be associated with this arrhytmia [Aranki 1996; Almassi 1997]. Recent studies found that atrial fibrillation after cardiac surgery may be associated with inflammatory response, and statins have been shown to inhibit such inflammatory response and reduce the incidence of AF after cardiac surgery [Young-Xu 2003; Boos 2006]. Rosuvastatin is a new generation statin with a highly effective lipid lowering and antiatherosclerotic activity. Its pharmacologic action has been shown at lower doses, but only few data are available about its advantageous anti-inflamatory properties [Resch 2006]. Previous studies have suggested that preoperative atorvastatin treatment significantly reduces postoperative AF [Patti 2006; Song 2008]. The aim of the present study was to compare the effects of 2 widely used statins—atorvastatin and rosuvastatin—on prevention of postoperative AF.
The Heart Surgery Forum 06/2013; · 0.46 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Acute pancreatitis is an inflammatory syndrome with unpredictable progression to systemic inflammation
and multi-organ dysfunction. As in our case rarely, acute pancreatitis can be presented
with the coexistance of acute coronary syndrome. To prevent a misdiagnosis of acute
situation presented with chest or abdominal pain, physicians must be aware for coexisting pathophysiologies
and take into account the differential diagnosis of all life-threatening causes such
as cardiac ischemia or acute abdominal situations.
[Show abstract][Hide abstract] ABSTRACT: To evaluate the percentage of hypertensive patients who could achieve target blood pressure (TBP) according to the guidelines in the context of recommended measures and the factors responsible for failure. A total of 589 hypertensive patients (59.0% female; mean age: 57.7 ± 10.4 years) were assessed twice for TBP achievement based on 2007 ESH/ESC guidelines and the investigators' view, in addition to the recommended measures and possible causes of failure in hypertension management in this national multi-center (n = 99), non-interventional observational study. Only 29.5% of the patients at the first visit and 46.8% at the second visit achieved the TBP levels specified by the guidelines. However, the investigators' evaluation indicated a higher achievement rate at the first (43.5%) as well as the second (69.1%) visit when compared with the guideline-based assessments (P < 0.001). The primary reasons identified by the investigators for the failure to reach TBP were non-compliance with dietary recommendations (61.6%) at the first visit and non-compliance with treatment (63.92%) at the second visit. Recommendations for lifestyle were the most commonly identified treatment plan by the investigators at both visits (62.9% and 66.1%, respectively). Although more patients achieved the TBP levels specified by the guidelines for the second visit compared with the first, effective blood pressure control was achieved only in 29.5% of our patients. Interestingly, the investigators had a more optimistic view about their patients' control of hypertension, which may have contributed to a poor achievement of TBP.
Hypertension Research 02/2012; 35(6):624-32. · 2.79 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Although cardiac troponins play a central role in the diagnosis and
risk stratification of patients with acute coronary syndrome and are
frequently used to determine whether a patient with chest pain has
had cardiac damage, a false positive value can result in unnecessary
hospitalization and enrollment of potentially invasive tests. Clinicians
should be aware of the possibility of false positive troponin levels,
especially when the results are not consistent with clinical
presentation of the patient
[Show abstract][Hide abstract] ABSTRACT: To determine whether elevated N-terminal pro-BNP (NT pro-BNP) predicts pulmonary artery systolic pressure increase on exercise stress echocardiography in asymptomatic or mildly symptomatic patients with moderate to severe mitral stenosis.
Forty-one asymptomatic or mildly symptomatic patients with moderate to severe mitral stenosis and 21 age- and sex-matched healthy subjects. Transthoracic echocardiography was performed in all patients to assess the severity of the valve disease and to measure pulmonary artery pressure before and immediately after treadmill exercise. Blood samples for NT pro-BNP were also collected before and immediately after treadmill exercise at the time of echocardiographic examination. The plasma concentrations of NT pro-BNP levels were significantly higher in patients with mitral stenosis than in control subjects before and after exercise (P < 0.001). Patients with atrial fibrillation had significantly higher NT pro-BNP levels compared to those with sinus rhythm (P < 0.001). Pre- and postexercise NT pro-BNP levels correlated statistically significantly with the left atrial (LA) dimension, right ventricle enddiastolic diameter, exercise duration, heart rate, rest, and exercise pulmonary artery systolic pressure, after exercise mitral valve mean gradient. Area under the receiver-operating characteristic curve for NT pro-BNP as an exercise induced augmentation of pulmonary artery pressure was 0.78. Using an optimized cutoff value of 251 pg/mL for NT pro-BNP, sensitivity was 89.47%. The independent determinants of higher pulmonary artery pressure were LA diameter and pretest NT pro-BNP levels in multivariante analysis.
NT pro-BNP levels correlate with functional class and echocardiographic findings in patients with mitral stenosis and indicate exercise induced augmentation of peak PAP > 60 mmHg. (Echocardiography 2011;28:8-14).
[Show abstract][Hide abstract] ABSTRACT: Metabolic syndrome is associated with cardiovascular disease and oxidative stress. The aim of this study was to investigate the differences of novel oxidative stress parameters and lipid profiles in men and women with metabolic syndrome.
The study population included 88 patients with metabolic syndrome, consisting of 48 postmenauposal women (group I) and 40 men (group II). Premenauposal women were excluded. Plasma levels of total antioxidant status (TAS) and total oxidative status (TOS) were determined by using the Erel automated measurement method, and oxidative stress index (OSI) was calculated. To perform the calculation, the resulting unit of TAS, mmol Trolox equivalent/L, was converted to micromol equivalent/L and the OSI value was calculated as: OSI = [(TOS, micromol/L)/(TAS, mmol Trolox equivalent/L) x 100]. The Student t-test, Mann-Whitney-U test, and chi-squared test were used for statistical analysis; the Pearson correlation coefficient and Spearman rank test were used for correlation analysis. P < or = 0.05 was considered to be statistically significant.
Both women and men had similar properties regarding demographic characteristics and biochemical work up. Group II had significantly lower levels of antioxidant levels of TAS and lower levels of TOS and OSI compared with group I (P = 0.0001, P = 0.0035, and P = 0,0001). Apolipoprotein A (ApoA) levels were significantly higher in group I compared with group II.
Our findings indicate that women with metabolic syndrome have a better antioxidant status and higher ApoA levels compared with men. Our findings suggest the existence of a higher oxidative stress index in men with metabolic syndrome. Considering the higher risk of atherosclerosis associated with men, these novel oxidative stress parameters may be valuable in the evaluation of patients with metabolic sydrome.
Metabolic syndrome and related disorders 12/2009; 8(1):53-8.
[Show abstract][Hide abstract] ABSTRACT: Respiratory and clinical outcomes after coronary artery bypass surgery in male patients below and over 70 years of age Yetmiş yaş altı ve üstü erkek hastalarda koroner arter bypass cerrahisinden sonra solunumsal ve klinik sonuçlar Amaç: Geriye yönelik olarak planlanan bu çalışmada 70 yaş altı ve üstü erkek hastalarda koroner arter bypass cerrahisi (KABC) sonrası solunum fonksiyonları ve klinik sonuçları değerlendi-rildi. Ça lış mapla nı:Ocak 2002-Eylül 2006 tarihleri arasında KABC uygulanan 918 hastanın dosyası incelendi. Çalışmaya alınma kriterlerine yönelik hiçbir eksik bilgisi olmayan 112 erkek hasta 70 yaş altı veya üstü olarak iki gruba ayrıldı (genç grup: 89 hasta; ort. yaş 57.9±5.3 yıl; yaşlı grup: 23 hasta; ort. yaş 71.6±2.3) ve çalışmaya alındı. Her iki grubun ameliyat öncesi ve sonrası solunum fonksiyonları, solunum kas kuvveti ve kli-nik sonuçları karşılaştırıldı ve parametreler aralarındaki ilişki araştırıldı. Bul gu lar: Ameliyat öncesi vital kapasite (VC; p=0.0006), zorlu vital kapasite (FVC; p=0.0005), 1. sn'deki zorlu ekspira-tuvar volüm (FEV1; p<0.0001), FEV1/FVC % (p=0.02), zorlu ekspiratuvar ortası akış (FMF; p<0.0001), zorlu ekspiratuvar akış (FEF; p=0.0005), maksimal inspiratuvar basınç (PImaks; p<0.0001) ve maksimal ekspiratuvar basınç (PEmaks; p=0.02) gençlerle karşılaştırıldığında, yaşlı hastalarda anlamlı olarak düşüktü. Ameliyat sonrası pulmoner fonksiyonlar, solunum kas kuvvetindeki azalma ve komplikasyon oranları iki grupta da benzerdi. Yaşlı hastalarda genç hastalara göre kardiyopulmoner bypass süreleri (p=0.03), entübasyon süreleri (p=0.0004), yoğun bakımda kalış günleri (p=0.001) ve ameliyat sonrası hastanede kalış süreleri (p<0.0001) daha uzundu. So nuç:Ameliyat sonrası klinik toparlanma gençlere göre yaş-lılarda daha uzun olmasına rağmen yine de diğer çalışmaların sonuçlarına göre daha iyi bulundu. Bu nedenle 70 yaş üstü erkek hastalar sadece yaşlarından dolayı KABC'den alıkonul-mamalıdır. Anah tar söz cük ler: Koroner arter bypass cerrahisi; solunum fonksiyon testi; solunum kas kuvveti, klinik sonuç. Background: This retrospective study was planned to evaluate respiratory functions and clinical outcomes in male patients below and over 70 years of age after coronary artery bypass surgery (CABS).
Turkish Journal of Thoracic and Cardiovascular Surgery 01/2009; 17(4):254-260. · 0.13 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Atrial fibrillation (AF) is a very common cardiac arrhythmia, and is associated with an increased mortality in patients with hypertension. Whether the best therapeutic approach for these patients is to restore sinus rhythm (SR) or to adequately control the ventricular rate is still controversial. The aim of this study is to compare both strategies in patients with hypertension.
Two hundred and twenty-one patients with hypertension and AF of duration >48 h were randomly assigned to either the rhythm (n=155) or rate (n=66) control group. Exercise capacity was improved in the rhythm control group in the 1st year of the study (p<0.0001). There were no statistically significant differences in the embolic event rate and the total mortality between the 2 groups at the end of the study (p=NS).
Although restoring and maintaining SR had a beneficial effect on exercise capacity in patients with hypertension and AF, no significant difference was found in terms of the total mortality and the embolic event rates. Thus, rate control is an acceptable primary strategy in patients with AF and hypertension.
[Show abstract][Hide abstract] ABSTRACT: The aim of our study was to evaluate the factors leading to embolization in patients with left atrial thrombi (LAT). With this purpose, we retrospectively analyzed clinical, transthoracic, transesophageal echocardiographic data of patients with LAT in the transesophageal echocardiographic evaluation.
One hundred ninety-two patients with LAT not on anticoagulant therapy were divided into two groups according to the presence of prior ischemic stroke. The group with ischemic stroke included more patients with sinus rhythm and less patients with mitral stenosis. They had smaller left atrial diameter, more left atrial appendage spontaneous echo-contrast, higher appendage ejection fraction, and emptying velocity.
Once the thrombus has been formed, cerebral embolization seems to be higher in patients with relatively preserved appendage ejection fraction and emptying velocity. Presence of atrial appendage spontaneous echo-contrast also favor embolization. Factors leading to embolization seem to differ in some respects from the causes of thrombus formation.