Korelacje między wskaźnikiem czynności mięśnia sercowego i osoczowym stężeniem peptydu natriuretycznego typu B u chorych na cukrzycę typu 2 lub z nieprawidłową tolerancją glukozy

Background and aim: In this study, we aimed to evaluate myocardial functions in patients with diabetes mellitus (DM) and impaired glucose tolerance (IGT). We also aimed to investigate the relationship between B-type natriuretic peptide (BNP) levels and myocardial performance index (Tei index) in these patients. Methods: A total of 38 patients with DM, 34 patients with IGT, and 40 healthy volunteers were recruited to the study. Basal clinical and laboratory findings were recorded. BNP levels of all individuals were measured. Both conventional transthoracic and tissue Doppler echocardiogaphy were performed to all study participants. Results: B-type natriuretic peptide levels of the diabetic group were greater than in patients with IGT and the control group. BNP levels of the IGT group were also higher than the control group. Myocardial performance index values, measured by both the conventional method and tissue Doppler echocardiography, were significantly higher in the diabetic group than in the control group. There was a significant relationship between myocardial performance index and BNP levels. Conclusions: Myocardial functions are disturbed in patients with DM and also in patients with IGT. BNP and myocardial performance index can be used in diabetic patients and in patients with IGT to define myocardial dysfunction.Wstęp i cel: Niniejsze badanie przeprowadzono w celu oceny czynności mięśnia sercowego u chorych na cukrzycę (DM) i u osób z nieprawidłową tolerancją glukozy (IGT) oraz ustalenia zależności między stężeniem peptydu natriuretycznego typu B (BNP) w osoczu i wskaźnikiem czynności mięśnia sercowego (wskaźnik Tei) u tych chorych. Metody: Do badania włączono 38 chorych na DM, 34 osoby z IGT i 40 zdrowych ochotników. Zgromadzono dane z wyjściowego badania klinicznego i wyniki badań laboratoryjnych. U wszystkich uczestników zmierzono stężenie BNP w osoczu oraz przeprowadzono badanie echokardiograficzne, zarówno konwencjonalne przezklatkowe, jak i z zastosowaniem tkankowego doplera. Wyniki: Stężenie BNP w osoczu było wyższe u chorych na DM niż u osób z IGT i w grupie kontrolnej. Z kolei u osób z IGT stężenie BNP było wyższe niż w grupie kontrolnej. Wartości wskaźnika Tei, oznaczonego zarówno techniką echokardiografii konwencjonalnej, jak i tkankowego doplera, były istotnie wyższe u chorych na DM niż w grupie kontrolnej. Stwierdzono istotną zależność między wskaźnikiem Tei a stężeniem BNP w osoczu. Wnioski: U chorych na DM i u osób z IGT czynność mięśnia sercowego jest upośledzona. Stężenie BNP w osoczu i wskaźnik Tei mogą być przydatne w określeniu zaburzeń czynności miokardium u tych chorych

Relationship of serum HLA-B alleles and TNF-α with rheumatic heart disease

Background/aim: Acute rheumatic fever and rheumatic heart disease are major causes of morbidity and mortality in developing countries. Genetic studies have determined that the immune response in rheumatic heart disease is genetically controlled and that there is a close relationship between the gene of concern and the class II human leukocyte antigen (HLA) gene. The aim of this study was to evaluate the relationship of serum HLA-B alleles and tumor necrosis factor alpha (TNF-alpha) with rheumatic heart disease. Materials and methods: A total of 50 consecutive patients with rheumatic heart disease and 50 controls were enrolled in the study. HLA alleles were analyzed using sequence-specific primer-polymerase chain reaction and nucleotide sequencing. Results: The HLA-B35 allele was significantly more common in patients with rheumatic heart disease than the control group (P = 0.043). The HLA-B44 allele was significantly more common in control patients than in patients with rheumatic heart disease (P = 0.014). There was a significant inverse correlation between high-sensitivity C-reactive protein and mitral valve area (P = 0.001). There was no correlation between TNF-alpha levels and mitral valve area (P = 0.066). Conclusion: Our findings confirmed the association between HLA-B alleles and rheumatic heart disease

Frequency of cardiac troponin-T elevation after successful direct stenting

Direct stenting (stenting without balloon predilation) is a novel approach in percutaneous treatment of coronary artery lesions. This approach may also significantly lower the rate of procedural ischaemic complications by reducing aggression to the vessel wall and immediately sealing the dissections created due to balloon inflation by the endoprosthesis. However, the incidence of minor myocardial infarction after direct stenting is unknown. The purpose of this study was to measure cTnT creatine kinase and its isoform, CK-MB after apparently successful elective stent implantation without balloon predilation. Enzyme levels were measured just before and 16 hours after the procedures. A second-generation commercial ELISA cTnT assay (Boehringer Mannheim Corporation) was used to measure cTnT with a cutoff of 0.1 ng/dl. There was no abnormality in all three enzymes before the procedure. CTnT was elevated in 6 patients (13 6%), CK and CK-MB were elevated in 1 (2.3%) patient at 16 hours after the procedure. Both CK and CK-MB elevation were observed in the patient with side branch occlusion. In all others cTnT measurements in addition to CK-MB measurements are needed to detect this minor myocardial damage. To the best of our knowledge this is the first report evaluating the incidence of myocardial injury after direct stenting. Direct stenting by avoiding balloon-induced complications may decrease procedural myocardial necrosis. Randomized studies with larger patient populations should be conducted to compare this approach with conventional stenting. CTnT measurements in addition to CKMB measurements are essential in detecting this minor myocardial damage

Epicardial adipose tissue thickness and plasma homocysteine in patients with metabolic syndrome and normal coronary arteries

Background: Increased epicardial adipose tissue thickness and plasma homocysteine levels are associated with Metabolic Syndrome (MS) and coronary artery disease. The majority of patients with MS have subclinical or manifest coronary artery disease. The aim of this study was to evaluate the relationship between MS and plasma homocysteine levels and epicardial adipose tissue thickness in subjects without epicardial coronary artery disease. Methods: Patients who underwent coronary angiography due to angina or equivocal symptoms and/or abnormal stress test results and were found to have normal coronary arteries were evaluated for the presence of MS. The study group comprised 75 patients with normal coronary arteries and MS, and the control group included 75 age-gender matched subjects without coronary artery disease or MS. Results: Epicardial adipose tissue thickness (5.8 +/- 1.9 mm vs. 4.3 +/- 1.6 mm, p <0.001) and plasma homocysteine levels (21.6 +/- 6.1 mu mol/L vs. 15.1 +/- 5.8 mu mol/L, p <0.001) were significantly higher in the MS group. Body mass index, triglyceride level, weight, age and waist circumference were positively and HDL cholesterol level were negatively correlated with both epicardial adipose tissue thickness and plasma homocysteine level. Epicardial adipose tissue thickness had the strongest correlation with plasma homocysteine level (r = 0.584, p < 0.001). For each 1 mm increase in epicardial adipose tissue thickness, an increase of 3.51 mu mol/L (95% CI: 2.24-4.79) in plasma homocysteine level was expected. Conclusions: We observed a close relationship between MS and epicardial adipose tissue thickness and plasma homocysteine levels, even in the absence of overt coronary artery disease