Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Handgrip stres testinin kalp yetersizliği olan olgularda silazapril tedavisi öncesi ve sonrasında hemodinamik parametreler üzerine etkileri

Amaç: Konjestif kalp yetmezliği olan hastalarda handgrip egzersiz testi ile oluşan hemodinamik değişiklikler üzerine silazapril tedavisinin etkilerini incelemek amacı ile planlandı. Yöntem: Çalışmaya 30 hasta alındı (ortalama yaş 65$pm$18 yıl, 14'ü kadın).Handgrip egzersiz testinin hemodinamik parametreler üzerine etkilerini araştırmal için doppler ekokardiyografi ve sağ kalp kateterizasyonu yapıldı. Bulgular:Handgrip egzersiz testi sonunda , kalp hızı ve ortalama arter basıncı istatistiksel olarak anlamlı düzeyde yüksek bulundu.(95$pm$6 dan 101$pm$12'ye, 109$pm$15 den 118$pm$19'a,p0.05).Pulmoner arter sistolik ve diyastolik basıncı, sağ ventrikül diyastolik basıncı,ortalama arter basıncı ve kalp hızı cilazapril tedavisinden sonra anlamlı olarak azaldı. Pulmoner kapiller saplama basıncı ve kalp debi indeksi, sol ventrikül ejeksiyon fraksiyonu, sağ ventrikül ejeksiyon farksiyonu tedavi sonrası değişmedi(p>0.05) Sonuç:Silazapril'in handgrip stres testi sırasında, hemodinamik parametreler üzerine olumlu etkileri vardır. Bu olumlu etkilerini sempatik aktivasyon , renin-anjiyotensin sistemi ve vasküler tonus üzerinden yapmaktadır.Objective: To assess the effect of cilazapril treatment on several hemodynamic parameters during handgrip maneuvers in patients with congestive heart failure. Cilazapril, an ACE inhibitor with high affinity, has been shown to be highly effective against a variety of vascular disorders. The effectiveness of isometric handgrip exercise on changes of cardiovascular hemodynamic parameters before and after cilazapril treatment in patients with congestive heart failure is unknown. Methods: The study population included 30 patients (16 male, 14 female) with mean age of 65&plusmn;18 years. The effects of handgrip maneuver on hemodynamic parameters were studied by right heart catheterization and Doppler echocardiography. Results: Heart rate (HR) and mean arterial pressures (MAP) increased significantly after handgrip maneuver (from 95&plusmn;6 beats/min to 101&plusmn;12 beats/min; from 109&plusmn;15 mm Hg to 118&plusmn;19 mm Hg, p&lt;0.05 respectively). Pulmonary capillary wedge pressure (PCWP), pulmonary artery systolic (s) and diastolic (d) pressures (PAP), cardiac index (CI), right ventricular systolic and diastolic pressures (RVPs and RVPd), left ventricular ejection fraction (LVEF), right ventricular ejection fraction (RVEF) did not change after handgrip maneuvers (p&gt;0.05). On the other hand, PAPs and PAPd , RVPs and RVPd, MAP and HR (p&lt;0.05) decreased significantly during handgrip maneuvers after cilazapril treatment. However PCWP and CI, LVEF, RVEF did not change after treatment (p&gt;0.05). Conclusion: Cardiovascular response to handgrip maneuver may be a marker of failure to respond to compensatory mechanisms. Cilazapril treatment was associated with significant improvement in hemodynamic parameters during handgrip stress test, the mechanisms of which are increased sympathetic and renin-angiotensin system activation, and altered vascular tonus

Effect of physiologic maneuvers on diastolic function in patients with mitral regurgitation

Bu çalışmada mitral yetmezliği olan 32 hastada, Doppler ekokardiyografi kullanılarak, valsalva, handgrip, ayakta duruş ve ayakları kaldırma egzersizi sırasında diyastolik fonksiyon parametreleri incelendi. Valsalva manevrası sırasında E-dalgası (%12, p0.05). El A oranı anlamlı olarak değişti. (%13, p0.05).In this study, we observed diastolic Junction by using Doppler echocardiography during Valsalva, handgrip, standing and leg elevation maneuvers in patients with mitral regurgitation (MR). Patients population consisted of 32 patients with MR . Valsalva maneuver decreased E-velocity (%J2, p&lt;0.05), A velocity (%8, p&lt;0.05) but did not change E/A ratio (p&gt;0.05). During the handgrip test, peak E and A velocity and E/A ratio did not change (p&gt;0.05). During the leg elevation, E and A velocity were not changed (p&lt;0.05), but E/A ratio was changed (%13, p&lt;0.05). Standing decreased E-velocity (%11, p&lt;0.05) and E/A ratio (%7, p&lt;0.05) but did not changed A velocity (p&gt;0.05)

SENKOP VE ANGİNAL YAKINMALARI OLAN SAĞ KORONER ARTERİ SOL KORONER SİNÜSTEN ÇIKAN BİR KORONER ARTER ANOMALİSİ

Koroner arter anomalilerinde, anomalili arterin çıkış açısı ve kıvrımlı seyri nedeniyle aterosklerotik lezyonların daha sık görülmesi ve bazı olgularda ani ölümlerin bildirilmesi, koroner arter anomalilerine olan ilgiyi arttırmıştır

Cardiovascular risk factors and noninvasive assessment of arterial structure and function in obese Turkish children

Obesity is associated with a number of risk factors, such as hyperlipidemia, hyperinsulinemia, hypertension, and early atherosclerosis. Evidence indicates that atherosclerosis begins in childhood and progresses over decades. In this work, we examined the relationship between cardiovascular risk factors and ultrasonographic signs of subclinical atherosclerosis in 77 obese children and adolescents compared to 40 non-obese healthy peers. Carotis intima media thickness (cIMT), carotid artery compliance (CAC), brachial artery flow-mediated dilatation (FMD), and established cardiovascular risk factors were studied. In the obese patients, cIMT was significantly increased (0.57 mm vs 0.45 mm, p < 0.001) whereas CAC (1.84% vs 3.29%, p < 0.001) and FMD (9.67 % vs 14.81%, p < 0.001) were significantly decreased. In multiple linear regression analysis, a relation was observed between cIMT, CAC, brachial FMD on one hand, and body mass index (BMI) on the other. Among the lipid anomalies, only hypertriglyceridemia was found to be positively correlated with cIMT. Additionally, we found a significant association between waist circumference (WC) and FMD. These findings indicate that obesity in children is associated with arterial wall alterations and endothelial dysfunction. In hyperlipidemic situations, only hypertriglyceridemia was found to be positively correlated with cIMT. This finding has consistently indicated TG to be a risk factor for the development of atherosclerosis. To our knowledge this is the first study to determine the relation between FMD and WC, which is used as a parameter of obesity in childhood

Comparison of floating wire and single wire techniques in right coronary ostial lesions in terms of procedural features and one-year clinical follow-up results

Objective: The floating wire technique is a special technique for solving interventional problems in aorta-ostial lesions. There are no long-term data in the literature for the floating wire technique in right aorto-ostial lesions

Comparison of floating wire and single wire techniques in right coronary ostial lesions in terms of procedural features and one-year clinical follow-up results

Objective: The floating wire technique is a special technique for solving interventional problems in aorta-ostial lesions. There are no long-term data in the literature for the floating wire technique in right aorto-ostial lesions