Aspirin resistance: Where are we now?

Aspirin is an effective antiplatelet drug for preventing thrombo-embolic vascular events. However, clinical and laboratory evidence demonstrates diminished or no response to aspirin in some patients that is called aspirin resistance. This situation has been reported to be independently associated with an increased risk of adverse cardiovascular events. The exact mechanism of aspirin resistance has not been established yet. The clinical, pharmacological and genetic factors may be associated with aspirin resistance. However, there is not currently standardized test to the diagnosis and no proven effective treatment of aspirin resistance. This article summarizes aspirin resistance, discussing its definition, clinical outcomes, laboratory tests, possible causes and therapeutic approaches

Aspirin resistance: Where are we now?

Aspirin is an effective antiplatelet drug for preventing thrombo-embolic vascular events. However, clinical and laboratory evidence demonstrates diminished or no response to aspirin in some patients that is called aspirin resistance. This situation has been reported to be independently associated with an increased risk of adverse cardiovascular events. The exact mechanism of aspirin resistance has not been established yet. The clinical, pharmacological and genetic factors may be associated with aspirin resistance. However, there is not currently standardized test to the diagnosis and no proven effective treatment of aspirin resistance. This article summarizes aspirin resistance, discussing its definition, clinical outcomes, laboratory tests, possible causes and therapeutic approaches

Glomerular filtration rate calculated by modification of diet in renal disease formula can be an indicator of impaired glucose tolerance and diabetes in coronary artery disease

Background: There is an increased risk for coronary artery disease (CAD) at modestly elevated levels of blood glucose which is still below the present threshold for type 2 diabetes mellitus (T2DM). In the present study, we aimed to define impaired glucose tolerance (IGT) and T2DM in patients with stable CAD and observe the relationship between clinical and laboratory findings. Materials and Methods: A total of 132 patients who had stable CAD and who had not been diagnosed as glucose intolerance or diabetes were enrolled. In one of the groups, there were patients with IGT or T2DM results and the other one consisted of patients with normal oral glucose tolerance test (OGTT) results. The Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) was investigated in patients with fasting plasma glucose (FPG) <100 mg/dl. Results: The prevalance of IGT and T2DM was 30.3%. In IGT + T2DM group, waist/hip ratio and creatinin level were significantly higher and estimated glomerular filtration rate (eGFR) was low. Only eGFR calculated by Modification of Diet in Renal Disease (MDRD) formula was a reliable parameter. MDRD eGFR ≤70 ml/dk/m2 independently predicted IGT + T2DM diagnosis with 50% sensitivity but with 82% specificity. Although it is insufficient to use it as an optimal screening test because of lower sensitivity, it can be a reliable indicator of IGT + DM in patients who had eGFR ≤70. Insulin resistance was diagnosed in 29% of patients whose pretest values were FPG <100 mg/dl. Conclusion: MDRD eGFR can be an indicator for IGT + T2DM. OGTT irrespective of FPG level should be used to determine the presence of IGT + T2DM in stable CAD

Unusual electrocardiographic presentation of pacemaker battery depletion with lead failure: pacing spike, artefact or native QRS? A short communication

Herein we report an unusual electrocardiographic presentation of a patient with pacemaker battery depletion and lead insulation failure

Matrix Metalloproteinase-2 and-9 Levels in Patients with Dilated Ascending Aorta and Bicuspid Aortic Valve

Background: Predictors of aortic dilatation are not well-described in patients with bicuspid aortic valve (BAV). Changes in extracellular matrix composition in the aortic wall may play an important role. Our study aimed to examine the relationship between ascending aortic dilatation and biochemical markers for collagen metabolism, such as matrix metalloproteinase-2 (MMP-2) and matrix metalloproteinase-9 (MMP-9) levels in patients with BAV. Methods: All patients underwent cardiac echocardiography using a standard protocol, and aortic measurements were made in end-diastole. One hundred twelve BAV patients with no or mild valvular impairment were recruited and grouped according to the aortic dimensions corrected for body surface area (BSA) and age. There were 54 patients with dilated ascending aorta (Group 1) and 58 patients with nondilated ascending aorta (group 2). The plasma levels of MMP-2 and MMP-9 were determined by ELISA. Results: The mean ascending aorta diameter was 4.49 +/- 0.49mm in group 1 and 3.51 +/- 0.46mm in group 2 (P<0.001). There were no significant difference in gender, BSA, presence of hypertension, diabetes mellitus, hyperlipidemia, and smoking between the 2 groups. Nevertheless, no significant difference was observed in the levels of MMP-2 and MMP-9 between the 2 groups. The ascending aorta diameter correlated significantly with age (r=0.438 P<0.001). No significant correlation was observed between plasma MMP-2 and MMP-9 concentration and ascending aorta diameter, respectively (r=0.005 P=0.58, r=0.106 P=0.07). Multivariate analysis showed that age was independent predictor of aortic dilatation (P0.001). Conclusion: Age was an independent predictor of aortic dilatation in patients with BAV, whereas MMP-2 and 9 levels were not relevant by aortic dilatation

The role of colchicine in preventing contrast-induced acute kidney injury in patients undergoing elective percutaneous coronary intervention

BACKGROUND: Contrast induced acute kidney injury (CI-AKI) is a serious complication of percutaneous coronary interventions (PCI) and is associated with increased morbidity and mortality. The aim of this study was to investigate the preventive role of colchicine on CI-AKI in patients undergoing elective PCI considering to its anti-inflammatory and renoprotective effects