Assessment of the left atrial volume index and plasma NT-proANP level in patients with acute ST-elevation myocardial infarction

OBJECTIVES: Acute ST-elevation myocardial infarction is associated with ventricular dysfunction due to ischemia-induced progressive myocardial damage. The decrease in ventricular compliance causes left atrial dilatation and stretching of the atrial myocardium, which are the main stimuli for the secretion of atrial natriuretic peptide. The aim of this study was to evaluate left atrial dimensions and atrial natriuretic peptide levels in patients early after their first acute ST-elevation myocardial infarction and assess the probable interaction between coronary lesions and these measurements. METHODS: A total of 110 patients with acute myocardial infarction and 50 controls were studied. Plasma atrial natriuretic peptide was measured at admission. Left ventricular function, diameter, and volume index were evaluated using transthoracic echocardiography. Gensini and vessel scores of the patients who underwent coronary angiography were calculated. RESULTS: Plasma atrial natriuretic peptide in the patients with myocardial infarction was increased compared with that in controls (3.90±3.75 vs. 1.35±0.72 nmol/L,

Plasma concentrations of soluble CD40 ligand in smokers with acute myocardial infarction: a pilot study

Coronary artery disease (CAD) is believed to be the single leading cause of death in both men and women in the world. Smoking is the most important risk factor for CAD. Smoking increases platelet aggregation and thrombus formation. CD40 ligand (CD40L) is a transmembrane glycoprotein derived from activated platelets. It participates in thrombus formation during the acute phase of acute myocardial infarction (MI). Elevation of CD40L identifies the patients who are at highest risk for cardiac events and who are likely to benefit from treatment with the glycoprotein IIb/IIIa (GPIIb/IIIa) receptor antagonists. The purpose of this study was to evaluate levels of CD40L in smokers with acute MI. Fifty-seven patients with acute MI were enrolled in this study. Thirty-one smokers were compared with 26 non-smokers. Soluble CD40L level in the plasma was determined by a standard enzyme-linked immunosorbent assay. Circulating levels of CD40L were higher in the smokers’ group. Smokers with acute MI may have increased risk for thrombotic complications during acute MI, and optimal antiaggregant therapy should be administered

Korelacja odsetka hemoglobiny glikowanej z ciężkością choroby wieńcowej występująca u młodych osób niezależnie od tradycyjnych czynników ryzyka

Introduction: In this study, we aimed to investigate the relationship between glycated haemoglobin (HbA1c) levels and the severity of coronary artery disease (CAD) in < 40 years old patients. Material and methods: The study population consisted of 211 premature coronary atherosclerotic patients (pCAP) (aged 36.4 &#177; 2.5 years) and 160 control subjects (36.4 &#177; 2.4 years). The severity of CAD was evaluated by the Gensini scoring system. HbA1c levels and the other basic biochemical parameters were analysed, and relations with severity of CAD were evaluated. Results: There were statistically significant differences in serum HbA1c levels between the two groups (pCAP = 6.1 &#177; 1.8%, control = 4.7 &#177; 1.2%, p < 0.001). HbA1c levels significantly positively correlated with the Gensini score in pCAP (r = 0.662, p < 0.001). In linear multivariate regression analysis (including age, sex, HbA1c, smoking, diabetes mellitus and hypertension as dependent parameters), only HbA1c was found to be an independent risk factor for the presence of severe CAD (Beta = 0.374, p < 0.001). In ROC curve analysis, the optimal cut-off value of HbA1c to predict severe CAD was 6.52%, with 74.4% sensitivity and 75.1% specificity (area under the curve 0.781, 95% confidence interval 0.661 to 0.901, p < 0.001). Conclusions: HbA1c levels were found to be correlated with the Gensini score in pCAP with and without diabetes. In this respect, glucose metabolism abnormalities, indicated by HbA1c, may play an important role in premature CAD. (Endokrynol Pol 2012; 63 (5): 367-371)Wstęp: Niniejsze badanie przeprowadzono w celu oceny zależności między odsetkiem hemoglobiny glikowanej (HbA1c) a ciężkością choroby wieńcowej (CAD) u chorych w wieku < 40 lat. Materiał i metody: Badana populacja składała się z 211 chorych z przedwczesną miażdżycą tętnic wieńcowych (pCAP) (w wieku 36,4 &#177; 2,5 roku) i 160 osób stanowiących grupę kontrolną (36,4 &#177; 2,4 roku). Ciężkość CAD określano na podstawie wartości wskaźnika Gensiniego. Przeanalizowano odsetek HbA1c oraz inne wyjściowe parametry biochemiczne i oceniono ich zależności z ciężkością CAD. Wyniki: Stwierdzono statystycznie istotne różnice między grupami w zakresie stężeń HbA1c w surowicy (pCAP = 6,1 &#177; 1,8%, grupa kontrolna = 4,7 &#177; 1,2%; p < 0,001). Wartości HbA1c były istotnie skorelowane z wartościami wskaźnika Gensiniego u chorych z pCAP (r = 0,662; p < 0,001). W wieloczynnikowej analizie regresji liniowej (w której uwzględniono wiek, płeć, stężenie HbA1c, palenie tytoniu, cukrzycę i nadciśnienie tętnicze jako zmienne zależne) jedynie stężenie HbA1c okazało się niezależnym czynnikiem ryzyka wskazującym na występowanie ciężkiej CAD (Beta = 0,374; p < 0,001). Jak wykazano w analizie krzywych ROC, optymalny punkt odcięcia wartości HbA1c pozwalający prognozować ciężką CAD wynosi 6,52%, przy czułości metody 74,4% i swoistości 75,1% (pole pod krzywą 0,781, 95-proc. przedział ufności 0,661&#8211;0,901; p < 0,001). Wnioski: U osób z pCAP, zarówno chorych na cukrzycę, jak i bez tej choroby, stwierdzono korelacje między wartościami HbA1c i wskaźnikiem Gensiniego. Jak wynika z powyższych obserwacji, zaburzenia metabolizmu glukozy, których wyznacznikiem jest odsetek HbA1c, mogą odgrywać ważną rolę w rozwoju przedwczesnej CAD. (Endokrynol Pol 2012; 63 (5): 367-371

The evaluation of doxorubicin-induced cardiotoxicity: Comparison of Doppler and tissue Doppler-derived myocardial performance index

Background: Doxorubicin is a chemotherapeutic agent used in a wide spectrum of cancers. However, cardiotoxic effects have limited its clinical use. The early detection of doxorubicin-induced cardiotoxicity is crucial. The purpose of our study was to assess values of Doppler and tissue Doppler imaging (TDI)-derived myocardial performance index (MPI) in adult cancer patients receiving doxorubicin treatment. Methods: A total of 45 patients underwent echocardiographic examinations before any doxorubicin had been administered and then after doxorubicin. Doppler and TDI-derived MPI of left ventricular (LV) were determined in the evaluation of cardiotoxicity. Additionally, TDI-derived MPI of right ventricular (RV) was determined. Results: All patients underwent control echocardiographic examination after mean 5 &#177; 1.7 months. The LV MPI obtained by both Doppler and TDI were increased after doxorubicin treatment (0.56 &#177; 0.11, 0.61 &#177; 0.10, p = 0,005 vs 0.51 &#177; 0.09, 0.59 &#177; 0.09, p = 0.001, respectively). There was no correlation between Doppler-derived MPI and cumulative doxorubicin dose (coefficient of correlation 0.11, p = 0.6). TDI-derived MPI was correlated with cumulative doxorubicin dose (coefficient of correlation 0.35, p = 0.015), but this correlation is weak (r = 0.38). The study population was divided into two groups according to doxorubicin dose (below and above 300 mg level). There was a moderate correlation between TDI-derived MPI and less than 300 mg of doxorubicin dose (coefficient of correlation 0.51, p = 0.028). However, Doppler-derived MPI was not correlated with less than 300 mg of doxorubicin dose (coefficient of correlation 0.38, p = 0.123). Also, there was no significant change in the TDI-derived RV-MPI (0.49 &#177; 0.14, 0.50 &#177; 0.12, p = 0.56). Conclusions: TDI-derived MPI is a useful parameter and an early indicator compared with Doppler-derived MPI in the detection of cardiotoxicity during the early stages. Also, doxorubicin administration does not affect RV function

Real-world efficacy and safety of Ledipasvir plus Sofosbuvir and Ombitasvir/Paritaprevir/Ritonavir +/- Dasabuvir combination therapies for chronic hepatitis C: A Turkish experience

Background/Aims: This study aimed to evaluate the real-life efficacy and tolerability of direct-acting antiviral treatments for patients with chronic hepatitis C (CHC) with/without cirrhosis in the Turkish population.Material and Methods: A total of 4,352 patients with CHC from 36 different institutions in Turkey were enrolled. They received ledipasvir (LDV) and sofosbuvir (SOF)+/- ribavirin (RBV) ombitasvir/paritaprevir/ritonavir +/- dasabuvir (PrOD)+/- RBV for 12 or 24 weeks. Sustained virologic response (SVR) rates, factors affecting SVR, safety profile, and hepatocellular cancer (HCC) occurrence were analyzed.Results: SVR12 was achieved in 92.8% of the patients (4,040/4,352) according to intention-to-treat and in 98.3% of the patients (4,040/4,108) according to per-protocol analysis. The SVR12 rates were similar between the treatment regimens (97.2%-100%) and genotypes (95.6%-100%). Patients achieving SVR showed a significant decrease in the mean serum alanine transaminase (ALT) levels (50.90 +/- 54.60 U/L to 17.00 +/- 14.50 U/L) and model for end-stage liver disease (MELD) scores (7.51 +/- 4.54 to 7.32 +/- 3.40) (p<0.05). Of the patients, 2 were diagnosed with HCC during the treatment and 14 were diagnosed with HCC 37.0 +/- 16.0 weeks post-treatment. Higher initial MELD score (odds ratio [OR]: 1.92, 95% confidence interval [CI]: 1.22-2.38; p=0.023]), higher hepatitis C virus (HCV) RNA levels (OR: 1.44, 95% CI: 1.31-2.28; p=0.038), and higher serum ALT levels (OR: 1.38, 95% CI: 1.21-1.83; p=0.042) were associated with poor SVR12. The most common adverse events were fatigue (12.6%), pruritis (7.3%), increased serum ALT (4.7%) and bilirubin (3.8%) levels, and anemia (3.1%).Conclusion: LDV/SOF or PrOD +/- RBV were effective and tolerable treatments for patients with CHC and with or without advanced liver disease before and after liver transplantation. Although HCV eradication improves the liver function, there is a risk of developing HCC.Turkish Association for the Study of The Liver (TASL

Evaluation of the cardiac effects of doxorubicin therapy by current echocardiography parameters

Doksorubisin kemoterapisinin, sol ventrikül (SV) ve sağ ventrikül (RV) fonksiyonlarına etkisini prospektif olarak değerlendirmek amacıyla bu çalışma planlandı.Metod: Doksorubisin kemoterapisi alan 45 hasta (erkek-kadın oranı, 8:37; ortalama yaş, 50,1±13,6 yıl) çalışmaya kaydedildi. Doksorubisin kemoterapisi almadan önce ve tedavi tamamlandıktan sonra ortalama 5. ayında klinik ve ekokardiyografik değerlendirmeler yapıldı. Bütün hastalara konvansiyonel ekokardiyografi ve kardiyak fonksiyonlardaki minimal değişiklikleri saptamada hassas bir teknik olan doku Doppler görüntüleme uygulandı. Ortalama kümülatif doksorubisin dozu 268,3 ± 49,9 mg/m2 bulundu (doz aralığı, 150-360 mg/m2). Ayrıca ventrikül fonksiyonlarını değerlendirmede konvansiyonel ekokardiyografi ile elde edilen miyokardiyal performans indeksi (MPİ) ve doku Doppler ile elde edilen MPİ (DDMPİ) parametreleri kullanıldı.Bulgular: Doksobusinin ortalama 268 mg/m2 dozu ile SV fonksiyonlarında aşağıdaki değişiklikler oluştu: izovolumetrik relaksasyon zamanında uzama olurken E hızı, E/A oranında azalma ve doku Doppler tekniği ile ölçülen hem Sm ve Em hızlarında hem de Em/Am oranında azalma oldu. Sol ventrikül ejeksiyon fraksiyonunda önemli bir değişiklik gözlenmedi. Sol ventrikülün konvansiyonel MPİ'si arttı (0,51± 0,09; 0,59±0,0, p= 0.00) fakat bu artış kümülatif doksorubisin dozuyla korele değildi (r= 0.11 p= 0.6). Doku Doppler ile elde edilen SV DDMPİ de artış gösterdi (0,51± 0,09; 0,59±0,09, p= 0.00). Bu artışın kümülatif doksorubisin dozuyla korele olduğu tespit edildi (r= 0.35 p= 0.015). Doku Doppler ile elde edilen RV DDMPİ' de önemli bir değişiklik meydana gelmedi (0,49 ± 0,14; 0,50 ± 0,12, p=0.56).Sonuç: Elde ettiğimiz veriler: (a) potansiyel olarak zararlı olduğu bilinen doksorubisin dozlarının altındaki seviyelerde gizli kardiyak hasarın görülebileceğini ve (b) düşük doz doksorubisinin SV fonksiyonlarını olumsuz olarak etkileyebileceğini fakat RV fonksiyonlarını etkilemediğini düşündürmektedir.Anahtar kelimeler: Doksorubisin, ekokardiyografi, MPİThis study was designed to prospectively assess the effect of doxorubicin based chemotherapy on the left ventricular (LV) and right ventricular (RV) functions.Methods: Forty-five consecutive patients (male-to-female ratio, 8:37; mean age, 50,1±13,6 years) requiring doxorubicin-containing chemotherapy were enrolled. Clinical and echocardiographic assessments performed before were given doxorubicin and fifth months after completion of their chemotherapy. All patients underwent conventional echocardiography and tissue Doppler imaging (TDI), a very accurate technique for detecting minimal changes in cardiac function. The mean cumulative doxorubicin dose was 268,3 ± 49,9 mg/m2 (range, 150 to 360 mg/m2). In addition, the Myocardial Performance Index (MPI) obtained by conventional echocardiography and the MPI obtained by TDI were used to evaluate the ventricular functions.Results: The following significant changes in LV function occurred only after 268 mg/m2 of doxorubicin dose: a decrease in conventional early diastolic (E) velocities, E/A ratio, whereas isovolumetric relaxation time was prolonged and a reduction in both the Sm, Em velocities and in the Em/Am ratio as measured using the TDI technique. No significant changes in LV ejection fraction were observed. The LV MPI obtained by conventional echocardiography increased (0,51± 0,09 vs 0,59±0,0, p= 0.00) but did not correlate with cumulative doxorubicin dose (r= 0.11 p= 0.6). The MPI obtained by TDI also increased (0,51± 0,09 vs 0,59±0,09, p= 0.00). This rise correlated with cumulative doxorubicin dose (r= 0.35 p= 0.015). There was no significant change in the RV MPI obtained by TDI (0,49 ± 0,14 vs 0,50 ± 0,12, p=0.56).Conclusions: Our data suggest that: (a) subtle cardiac injury may be seen by the doxorubicin doses below the level known to be potentially carditoxic and (b) the low-dose doxorubicin may be poorly effect on LV function but does not affect RV function.Keywords: Doxorubicin, echocardiography, MP