[Show abstract][Hide abstract] ABSTRACT: Platelets and inflammatory cells are vital elements of acute coronary syndromes (ACS). Recent studies have shown that the platelet-to-lymphocyte ratio (PLR) is associated with several malignancies; however, there are not enough data in cardiovascular diseases. Therefore, the aim of this study was to explore the association between PLR and in-hospital mortality in patients with ACS.
We retrospectively collected patients with ACS undergoing coronary angiography. Total and differential leukocyte counts were measured by an automated hematology analyzer.
This study is single-centered and observational. In total, 587 patients with a mean age of 61.8±13.1 years (68.4% male) were enrolled in the study. Patients were divided into 3 tertiles based on PLR levels. In-hospital mortality was significantly higher among patients in the upper PLR tertile when compared with the middle and lower PLR tertile groups [29 (14.8%) vs. 17 (8.7%) and 2 (1.0%); p<0.001]. In the multiple logistic regression analysis, a high level of PLR was an independent predictor of in-hospital mortality, together with age, total leukocyte count, and creatinine. Using a cutoff point of 142, the PLR predicted in-hospital mortality with a sensitivity of 69% and specificity of 63%.
Different from other inflammatory markers and assays, PLR is an inexpensive and readily available biomarker that may be useful for cardiac risk stratification in patients with ACS.
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to determine the long-term prognostic implications of incidental pleural effusion (PE) detected during echocardiographic examination and its relationship with concomitant diseases.
The study hypothesis is to test whether incidental pleural PE detected during echocardiographic examination be used as a prognostic marker.
The study was performed by evaluating patient records (N = 251) in whom PE was incidentally detected during echocardiographic examination in a tertiary hospital between 1999 and 2012. The patients were classified into 4 major groups according to the concomitant primary disease: malignancy, and cardiovascular, renal, and pulmonary diseases. The total survival time was obtained from hospital records for patients who died during the hospital stay and social security institution records for patients with out-of-hospital death.
One-year and 5-year life expectancies of PE cases concomitant with different disorders were as follows; heart failure (n = 151), 81% and 70%; malignancies (n = 45), 53% and 44%; pulmonary diseases (n = 37), 89% and 78%; renal diseases (n = 18), 100% and 83%; respectively. PE associated with heart failure, renal disease, and pulmonary disease had similar (P > 0.05 for all) and favorable outcomes compared to PE associated with malignancies (P < 0.001).
The prognosis of incidental PE was the worst in patients with concomitant malignancies; however, PE associated with nonmalignant diseases including heart failure, pulmonary disease, and renal disease have similar and favorable outcomes.
[Show abstract][Hide abstract] ABSTRACT: The predictors for the development of cardiovascular diseases and peripheral arterial diseases in patients with systemic sclerosis (SSc) were not clearly established, and there is no specific study conducted to investigate the mean platelet volume (MPV) levels in SSc patients. Therefore, this study evaluates the MPV levels in SSc and possible relationship between SSc, its clinical features and activity/severity scores, and MPV. In total, 76 SSc patients (67 women and 9 men, mean age 50.44 ± 13.21 years) diagnosed according to the classification criteria of the American College of Rheumatology and 45 healthy volunteers were enrolled into study. Data relating to anamnesis, physical examination, MPV, erythrocyte sedimentation rate, C-reactive protein levels, electrocardiography, echocardiography, high-resolution computerized tomography findings, complaints, and treatment processes were recorded into the database. Of the total cases, 17 had (22.3 %) cardiac involvement, 45 had gastrointestinal involvement (59.2 %), 47 had (61.8 %) lung involvement, 31 (32 %) had finger flexion deformity, and 27 (35.5 %) had digital ulcers at the fingertips. The mean MPV levels of SSc patients were significantly higher than those of the control group (p = 0.008). The mean MPV levels of SSc patients with cardiac involvement, digital ulcers, and gangrene presence were significantly high, and lower in Ilomedin-receiving patients than in the Ilomedin naives (p < 0.05). A negative relationship was discovered between the mean MPV levels, Valentini score, and Disease Severity Index of the patients with systemic sclerosis (p = 0.006, r = -0.310; p = 0.047, r = -0.229). MPV levels were significantly elevated in SSc patients and they were negatively correlated with disease activity scores. Increased MPV levels would be a predictive marker in the diagnosis of macrovascular and microvascular disease involvement in SSc patients.
[Show abstract][Hide abstract] ABSTRACT: We aimed to investigate the relationship between PCOS and epicardial fat thickness with transthoracic echocardiography.
PCOS patients were divided into two groups according to the lean or obesity status: PCOS patients with lean 34 subjects (BMI: 23.3±2.8; mean age: 25.5±4), PCOS patients with obese16 subjects (BMI: 32.3±7.6; mean age: 27.2±3.7) were compared with control healthy lean subjects (BMI: 23.5±1.7; mean age: 25.9±2.2).
There was increased epicardial thickness in obese PCOS subjects compared to lean PCOS subjects (6.3±0.9 mm, 4.7±0.5, respectively, p < 0.001). However, epicardial fat thickness between lean PCOS subjects and lean healthy control groups were not significantly varied (4.7±0.5 mm, 4.5±0.5, respectively, p = 0.6). There was increased epicardial thickness in obese PCOS subjects compared to lean healthy control subjects (6.3±0.9 mm, 4.5±0.5, respectively, p < 0.001). This sudy showed for the first time that increased epicardial fat thickness measured using transthoracic echocardiography is associated with increased BMI in PCOS subjects.
Epicardial fat thickness between lean PCOS subjects and lean healty control group were similar which indicate the importance of obesity in PCOS subjects.
European review for medical and pharmacological sciences 08/2013; 17(15):2111-3. · 1.09 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Like any other foreign bodies, implanted cardiac devices can become infected. Staphylococcus aureus and coagulase-negative Staphilococci are the most common causes of infections of pacemaker and defibrillator systems. In this case an implantable cardioverter defibrillator pocket infection caused by an extremely rare microorganism, Klebsiella pneumonia, is presented.
[Show abstract][Hide abstract] ABSTRACT: Aspirin reduces the odds of an arterial thrombotic event in high-risk patients. However, 10%-20% of patients with an arterial thrombotic event who are treated with aspirin have a recurrent arterial thrombotic event during long-term followup. Aspirin resistance has been described in some patient populations such as those with an acute coronary syndrome, ischemic stroke, percutaneous coronary intervention with drug-eluting stent, stent re-stenosis, and diabetes mellitus (DM). The aim of this study was to assess aspirin resistance and to compare it to the use of oral anti-diabetic drugs and insulin in patients with diabetes.
Platelet aggregation was measured after aspirin treatment in 101 diabetic patients undergoing percutaneous coronary intervention. Two patient populations were included in the investigation: use of insulin (group 1) and use of oral anti-diabetic agents (OAD) (group 2) in diabetic patients. Platelet aggregation was determined using a multichannel Multiplate analyzer. Among group 1 patients, 4.7% were aspirin non-responders and among group 2 patients, 8.6% were aspirin non-responders. Statistical differences were not found between the groups (p = 0.359).
This study demonstrated that there was no significant difference in aspirin resistance between type 2 diabetes mellitus patients on insulin treatment and type 2 diabetes mellitus patients on OAD treatment.
European review for medical and pharmacological sciences 05/2012; 16(5):617-21. · 1.09 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Epicardial fat has been proposed as a new cardiometabolic risk factor. Although epicardial fat thickness (EFT) is associated with hypertension, the relationship between diurnal blood pressure profiles and EFT is still unknown. The purpose of this study is to investigate the association between the echocardiographic EFT and diurnal blood pressure profiles in hypertensive patients.
After the ambulatory blood pressures of 123 patients were monitored, they were divided into three groups according to the clinical diagnoses: 41 patients (33.3%) were in the normotensive group, 40 patients (32.5%) were in the dipper hypertensive group and 42 patients (34.1%) were in the non-dipper hypertensive group. All participants underwent transthoracic echocardiography and ambulatory blood pressure monitoring to measure the EFT and blood pressure responses.
The mean EFT measurements of the dipper group were significantly higher than the normotensive group (6.5 ± 0.6 vs 5.8 ± 0.6; p < 0.0001). On the other hand, the mean EFTs of the non-dipper group were also significantly higher than the dipper group (7.4 ± 0.7 vs 6.5 ± 0.6, p < 0.0001). An EFT of ≥ 7 mm predicted the non-dipper profile in hypertensive patients with 74% sensitivity and 71% specificity (receiving operator characteristic area under the curve: 0.826, 95% CI 0.738-0.913; p < 0.0001). EFT was associated with both dipper (OR 8.9, 95% CI 3.03-26.3; p < 0.0001) and non-dipper blood pressure profiles (OR 12.3, 95% CI 1.75-86.31; p < 0.0001), and this relationship was also independent from all the risk factors.
Echocardiographic EFT assessment is independently associated with impaired diurnal blood pressure profiles in the hypertensive individuals. Thus, the echocardiographic assessment of the EFT may be helpful in cardiometabolic risk stratification and therapeutic interventions.
[Show abstract][Hide abstract] ABSTRACT: The mean platelet volume (MPV) values reflect platelet size and are accepted as marker of platelet activation. We sought to test the hypothesis that platelet activation occurs independently from presence or absence of thrombus in prosthetic mitral valve. A total of 168 patients were included in the study. Study participants were divided in three groups: group 1 (n = 62) - patients with normal prosthetic mitral valve; group 2 (n = 37) - patients with prosthetic mitral valve thrombosis; and group 3 (n = 69) - healthy individuals. MPV values were significantly higher in normal and thrombotic prosthetic mitral valve patients than in healthy individuals (P = 0.008 and P = 0.01, respectively). MPV values were not different between normal prosthetic mitral valve and thrombotic prosthetic mitral valve. This is the first study indicating that increased MPV is present in normal and thrombotic prosthetic mitral valve, implying that platelet reactivity occurs in prosthetic mitral valve irrespective of development of thrombus formation.
Blood coagulation & fibrinolysis: an international journal in haemostasis and thrombosis 01/2012; 23(1):91-3. · 1.25 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Mean platelet volume (MPV) is a marker of platelet activation. An increased MPV is associated with acute myocardial infarction (AMI) and long-term mortality. The aim of this study was to compare MPV in patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI). Also, we investigated the value of MPV on in-hospital mortality and long-term prognosis of patients with STEMI and NSTEMI. We studied 429 patients with AMI (70.4% male, 61.9 ± 12.4 years; 279 patients with STEMI, 150 patients with NSTEMI). MPV and platelet count were similar in both groups. Elevated MPV increased the risk of death by 3.1-fold (p < 0.001) in STEMI group during the hospitalization. However, increased MPV was not associated with in-hospital mortality in NSTEMI group. The area under the receiver operating characteristic curve of MPV was 0.868 (95% CI, 0.830-0.907) for predicting two-year mortality. A cut-off point of 11.1 fL showed a sensitivity of 81% and a specifity of 77% for prediction of two-year mortality. Kaplan-Meier survival curve showed two-year mortality rate of 12.5% in patients with MPV >11.1 fL versus 9.9% in patients with MPV <11.1 fL (p < 0.001). Cox regression analysis showed MPV to be an independent predictor of two-year mortality (Hazard ratio 1.7; 95% CI 1.5-1.9; p < 0.001). An increased MPV is an independent predictor of in-hospital mortality in patients with STEMI. However, elevated levels of MPV did not predict in hospital mortality in NSTEMI group. The increase in MPV values was independently correlated with two-year mortality in all study patients.
Scandinavian journal of clinical and laboratory investigation 08/2011; 71(7):613-9. · 1.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Diabetes mellitus (DM) is accepted as coronary heart disease equivalent even in the presence of normal coronary artery on coronary angiography. We aimed to evaluate microvascular circulation with novel angiographic perfusion indexes "myocardial blush grade" (MBG) and "myocardial filling time" (MFT) in patients with uncomplicated DM.
Among 4563 angiographic studies performed between November 2001 and May 2004, 70 subjects with DM who were normotensive, non-smokers and with normal lipid profiles were recruited into the study. Patients were divided into 2 groups according to angiographic results. DM-1: diabetic normotensive and normolipidemic subjects with normal coronary angiography (n: 30) and DM-2: diabetic subjects with lesions in the left anterior descending artery (LAD) less than 50% (n: 40). Non-diabetic, normotensive and normolipidemic 60 subjects were assigned as the control group. Control group was also divided into 2 groups according to angiographic results Control-1: subjects with normal coronary angiography (n: 30) and ; Control-2: subjects with lesions in the left anterior descending artery (LAD) less than 50% (n: 30). MBG was defined between 0 and 3 according to myocardial dyeing density and wash-out speed with 0 as the least and 3 as the most. MFT was calculated by conversion of the frame count, from the beginning of myocardial blushing till the time with the highest amount of contrast, to milliseconds.
MFT was longer in the group DM-2 when compared with other groups (p<0.0001). MFT was similar in Control-2 and DM-1. MFT was shorter in Control-1 when compared with DM-1 and DM-2 (p<0.0001). MBG was lower in DM-2 when compared with Control-1 and Control-2 (p=0.001). However MBG was similar in DM-1 when compared with Control-1 and Control-2.
Microvascular function is worse in subjects with both diabetes and coronary artery disease than in non-diabetic subjects with coronary artery disease. The most impressive result of our study is diabetic patients with normal coronary angiography have similar MBG and MFT results with non-diabetic coronary artery disease patients. DM causes microvascular dysfunction even one has normal coronary angiography and this put them in the same risk group with non-diabetic coronary artery patients.
International journal of cardiology 08/2008; 127(2):262-5. · 6.18 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Left ventricular mobile thrombi carry high risk of embolism and need early treatment in which the appropriate treatment is still controversial. Because most patients with mobile thrombi have low ejection fraction and also accompanying heart failure symptoms, decision of surgical treatment is not always easy and thus effective medical treatment is crucial.
In this paper we present, treatment and follow-up of seven patients with mobile thrombi who underwent fibrinolytic treatment between 2002 and 2006.
In four cases, mobile thrombi disappeared completely while echocardiographically regressed to lower size with decreased mobility in the other three patients. On 6th month follow-up, complete lysis of the thrombi in six patients was observed with warfarin treatment. No major complications were seen in the patients.
In case of mobile left ventricular thrombi with concomitant low ejection fraction and heart failure fibrinolytic treatment might be a therapeutic option.
Journal of Thrombosis and Thrombolysis 07/2008; 25(3):293-6. · 1.99 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Double right coronary artery (RCA) is a very rare coronary anomaly. So far, the number of reported cases of double RCA is not so much. Nevertheless, there have been several reports of double RCA in the literature, particularly in the last decade. We aimed to report two cases with double RCA and review the literature in this issue. In brackets, we searched the words - double right coronary artery - in medline (www.ncbi.nlm.nih.gov) and limit the search into the title. According to the results, so far double RCA have been reported 18 times and in 20 cases. Here in this case report and minireview we discussed the characteristics of the previous 20 and the present 2 cases with double RCA. The age of diagnosis of double RCA was in the fifth decade on average. Of the 22 cases reported, 19 were male. 14 of them originated from single ostia whereas 8 from separate ostia. 7 of 22 cases were complicated with atherosclerosis and 4 had associated anomalies. In conclusion, although controversy exists about definition of double RCA and generally considered as a benign entity, it might be atherosclerotic and can cause acute coronary syndromes including myocardial infarction and be associated with other anomalies. It is predominantly seen in males and might origin from either single or separate ostia. Although coronary angiography is the most widely used diagnostic modality, multidetector computed tomography might also be helpful.
International journal of cardiology 02/2008; 130(2):e74-7. · 6.18 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A 62-year-old female underwent percutaneous coronary stent implantation of the left anterior descending artery without any complications except for a small haematoma in the right inguinal region where femoral artery puncture was performed. Forty days after discharge, she presented to the emergency department with a deep ulcerative wound in the femoral artery puncture site. The wound-site culture revealed methicillin-sensitive Staphylococcus aureus. After appropriate antibiotic treatment and wound care, the deep inguinal infection healed with proper epithelisation and without any complications. This case underscores the importance of prevention and management of access site haematoma during percutaneous procedures.
The New Zealand medical journal 02/2008; 121(1269):68-70.
[Show abstract][Hide abstract] ABSTRACT: Thrombus formation in a morphologically normal a aorta is a very rare event. A 50-year-old man with a history of chronic obstructive pulmonary disease, presented to the emergency department with pulmonary edema. Transthoracic and transesophageal echocardiography revealed a highly mobile, pedunculated floating thrombus in the descending thoracic aorta 3-4 cm distal to the origin of the left subclavian artery. The original lumen of the aorta was almost obliterated by the thrombus. The aortic wall was free of any atheroma. Thrombolytic treatment was administered, but 3 hours after starting streptokinase, he developed sudden and severe low-back pain accompanied by loss of lower-extremity pulses which were patent on admission. Cardiopulmonary arrest developed within an hour and the patient died despite resuscitation. The potential causes of aortic thrombus, the clinical spectrum that the patients may present, diagnostic methods, and therapeutic options are discussed.
Clinical and Applied Thrombosis/Hemostasis 01/2008; 14(4):486-8. · 1.58 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: There is increasing evidence that nuts have protective effects against coronary artery disease by improving lipid profile and inhibiting lipid oxidation. However, data about pistachio nuts are limited, and to our knowledge, there is no study investigating the effects of pistachio intake on lipid oxidation and serum antioxidant levels. This study, therefore, sought to determine the effects of pistachio intake on serum lipids and determine whether consumption of pistachio would alter serum antioxidant levels. Rats were randomly divided into three groups (n=12 for each): control group fed basic diet for 10 weeks and treated groups fed basic diet plus pistachio which constituted 20% and 40% of daily caloric intake, respectively. Consumption of pistachio as 20% of daily caloric intake increased high-density lipoprotein (HDL) levels and decreased total cholesterol (TC)/HDL ratio, compared with those not taking pistachio. However, TC, low-density lipoprotein (LDL) cholesterol and triglyceride levels were unaffected by pistachio consumption. Consumption of pistachio as 20% of daily caloric intake increased serum paraoxonase activity by 35% and arylesterase activity by 60%, which are known to inhibit LDL cholesterol oxidation, compared with the control group. However, increased antioxidant activity was blunted when pistachio intake was increased to 40% of daily caloric intake. In conclusion, the present results show that consumption of pistachio as 20% of daily caloric intake leads to significant improvement in HDL and TC/HDL ratio and inhibits LDL cholesterol oxidation. These results suggest that pistachio may be beneficial for both prevention and treatment of coronary artery disease.
The Tohoku Journal of Experimental Medicine 06/2007; 212(1):43-8. · 1.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Adiponectin is a novel polypeptide that modulates endothelial function. Association between high serum adiponectin level and stimulation of new blood vessel formation have been reported in two experimental studies, however, data in humans are lacking. We sought to determine relationship between serum adiponectin and collateral vessel development in patients with coronary artery disease. We included 89 patients with stable angina pectoris and angiographically documented total occlusion in one of the major coronary arteries. Coronary collateral circulation was graded according to Rentrop scoring method in which collateralisation was graded between 0 and 3 from the poorest to the best. Adiponectin was determined by the ELISA method. High serum adiponectin level were significantly associated with increased new collateralisation (p = 0.001). With the increase of body mass index and waist circumference, the collateral development decreased (p = 0.001, p = 0.002; respectively). Presence of the diabetes mellitus (DM) was more frequent in those with poor collateral group than in those with good collateral group. DM was associated with poor collateral development (p = 0.002). In multiple stepwise logistic regression analysis, low level of serum adiponectin (p = 0.0001), waist circumference (p = 0.001), and presence of DM (p = 0.003) were found to be significant independent predictors of poor collateral formation. In conclusion, we have shown for the first time that elevated levels of serum adiponectin are associated with coronary collateral development in patients with coronary artery disease and additionally, the present study confirms many of the metabolic associations reported previously with adiponectin.
The Tohoku Journal of Experimental Medicine 05/2007; 211(4):347-52. · 1.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Hypertension is an increasingly important medical and public health issue. Appropriate diagnosis and treatment of hypertension is very important in both reducing the morbidity, mortality, and cost related to it. Interrupted aortic arch (IAA) is an uncommon and usually lethal congenital malformation. It is very rarely encountered in adult patients who generally present with nonspecific symptoms and hypertension. Substantial collateral circulation must be present to maintain blood flow to tissues below the aortic interruption and thus to enable survival. A 40-year-old man presented with general malaise, frequent headaches, weakness in his legs, and hypertension. He had suffered from effort intolerance since childhood. Physical examination revealed upper limb hypertension. Lower-limb pulses were not palpable. Transthoracic echocardiography, aortography, and gadolinium contrast-enhanced magnetic resonance angiography revealed complete interruption of the aortic arch just distal to the origin of the left subclavian artery. The present case describes an unusual case of IAA, in which the diagnosis was delayed until the age of 40 years. A complete physical examination would have ensured the correct diagnosis was made much earlier. As our case implies, physical examination maintains its pivotal role in the diagnosis of some forms of secondary hypertension, although various high-tech diagnostic tools are needed for confirmation.
The New Zealand medical journal 02/2007; 120(1258):U2635.