Relationship between carotid intima-media thickness and coronary angiographic findings: a prospective study

<p>Abstract</p> <p>Background</p> <p>Since cardiovascular diseases are associated with high mortality and generally undiagnosed before the onset of clinical findings, there is a need for a reliable tool for early diagnosis. Carotid intima-media thickness (CIMT) is a non-invasive marker of coronary artery disease (CAD) and is widely used in practice as an inexpensive, reliable, and reproducible method. In the current study, we aimed to investigate prospectively the relationship of CIMT with the presence and extent of significant coronary artery narrowing in patients evaluated by coronary angiography for stable angina pectoris.</p> <p>Methods</p> <p>One hundred consecutive patients with stable angina pectoris and documented ischemia on a stress test were included in the study. The patients were divided into two groups according to the result of the coronary angiography: group 1 (39 patients) without a noncritical coronary lesion, and group 2 (61 patients) having at least one lesion more than 50% within the main branches of the coronary arteries. All of the patients underwent carotid Doppler ultrasound examination for measurement of the CIMT by a radiologist blinded to the angiographic data.</p> <p>Results</p> <p>The mean CIMT was 0.78 ± 0.21 mm in Group 1, while it was 1.48 ± 0.28 mm in Group 2 (p = 0.001). The mean CIMT in patients with single vessel disease, multi-vessel disease, and left main coronary artery disease were significantly higher compared to Group 1 (1.2 ± 0.34 mm, p = 0.02; 1.6 ± 0.32 mm, p = 0.001; and 1.8 ± 0.31 mm, p = 0.0001, respectively). Logistic regression analysis identified CIMT (OR 4.3, p < 0.001) and hypertension (OR 2.4, p = 0.04) as the most important factors for predicting CAD.</p> <p>Conclusions</p> <p>The findings of this study show that increase in CIMT is associated with the presence and extent of CAD. In conclusion, we demonstrated the usefulness of carotid intima-media thickness in predicting coronary artery disease but large-scale studies are required to define its role in clinical practice.</p

Evaluation of renal function in non-hypertensive patients with obstructive sleep apnea [Obstrüktif uyku apne sendromu olan normotansif hastalarda böbrek fonksiyonlari{dotless}ni{dotless}n degerlendirilmesi]

Objective: Obstructive sleep apnea syndrome (OSAS) is one of the most common sleep disorders in society. The presence of hypertension is shown in 30-60% of OSAS patients. Creatinine clearance (CC) in hypertensive OSAS patients was found to be lower than non-hypertensive OSAS patients. In our study, we aimed to determine CC in non- hypertensive OSAS patients comparing with the control group and determine that CC is affected by the severity of OSAS. Material and Methods: Ninety-three patients with complaints of snoring who were diagnosed as obstructive sleep apnea syndrome with polysomnography were examined in the study between March 2009-November 2010. Renal function tests were performed in these patients and creatinine clearance was calculated. Results: According to the OSAS severity, 30 patients were in the mild, 32 in moderate and 31 in severe OSAS group.There were no statistically significant differences in the demograpic data, systolic and diastolic blood pressure and CC between OSAS and control groups There was no corelation between severity of disease and CC. Conclusion: Due to the pathophysiologic features of OSAS, chronic kidney disease can develop in these patients, although hypertension has not yet developed. Therefore it must be considered that, hypertension may develop in patients with OSAS; blood pressure monitoring, evaluation and monitoring of renal function should not be neglected. © 2012 by Erciyes University School of Medicine

Determination of subclinical atherosclerosis in obstructive sleep apnea syndrome patients without traditional risk factors for atherosclerosis [Ateroskleroti·k ri·sk faktörleri· olmayan obstrükti·f uyku apne sendromlu hastalarda subkli·ni·k aterosklerozun saptanmasi]

Objective: Obstructive sleep apnea-hypopnea syndrome (OSAS) is associated with high cardiovascular morbidity and mortality. Recent studies have suggested a pathophysiological link between OSAS and atherosclerosis; for which carotid intima-media thickness (CIMT) and pulse wave velocity (PWV) has been considered as an early marker. The aim of this study was to assess the presence of early signs of atherosclerosis and cardiovascular effects of OSAS depending on its severity, in patients without clinically diagnosed cardiovascular disease and any coincident risk factors for atherosclerosis. Material and Method: Thirty one healthy subjects without any systemic disease and OSAS, and patients with OSAS without known atherosclerosis and also without any risk factors for atherosclerosis were examined in the study. According to the severity, 30 patients were in mild OSAS, 32 were in moderate OSAS and 31 patients were in severe OSAS group. Bilateral CIMT assesment and PWV analysis were performed in patients and controls. Results: Significant differences existed between control subjects and patients with mild, moderate and severe OSAS in PWV (5.70±0.48, 6.76±0.61, 7.72±0.82, 8.94±1.72 m/sec respecitively; p&lt;0.0001) and CIMT (0.712±0.040, 0.812±0.037, 0.900±0.056, 0.971±0.74 mm respectively; p&lt;0.0001). AHI and TST% were positively correlated with the following; the PWV (p&lt;0.001- r=0.67 / p&lt;0.001- r=0,70 respectively), the maximal CIMT (p&lt;0.001- r=0.79 / p&lt;0.001- r=0.74 respectively), The minimal SaO2 values were negatively correlated with the following; the PWV (p&lt;0.001, r=-0.66), the maximal CIMT (p&lt;0.001, r=-0.68). Conclusion: OSAS patients have tendency to atherosclerosis development, and this process increases proportionally with the severity of the disease

Are thyroid function tests necessary in patients with obstructive sleep apnea?

Amaç: Obstrüktif uyku apne sendromu (OUAS) toplumda sık görülen ve hipotiroidi ile %1,2-11 arasında değişen oranlarda birlikte görülebilen bir hastalıktır. OUAS’ın semptomatoloji spektrumu oldukça geniştir. Bu semptomlar OUAS’a yönelmemizi sağlarlar ancak hepsi tanı koydurucu özelliğe sahip değildir. OUAS’lu hastalar gün boyu sersemlik, horlama, apati ve letarji gibi hepsi hipotiroidide de gorülebilen semptomlarla karşı karşıyadır. Etyolojik nedenler arasında sayılan endokrin bozukluklardan tiroid hormonlarının azalması kolaylıkla tespit edilebilir. Serum tiroid hormon düzeylerinin tesbitinin maliyeti düşüktür ve tedavi planlanmasında yol gostericidir. Bu noktadan hareketle polisomnografi (PSG) ile OUAS tanısı alan hastalarda tiroid hormon düzeylerine baktık ve hipotiroidinin OUAS’taki sıklığını araştırdık. Materyal ve Metod: Çalışmaya Mart 2009 – Ekim 2010 tarihleri arasında Akdeniz Üniversitesi Tıp Fakültesi Hastanesi Göğüs Hastalıkları Polikliniğine horlama şikayeti ile başvuran ve PSG ile OUAS tanısı konulan 93 hasta alındı. Hastalardan tiroid fonksiyon testleri istendi. Bulgular: Hastaların 30’unun hafif dereceli, 32’sinin orta dereceli, 31’inin ise ciddi dereceli OUAS olduğu görüldü. Hastaların 5’inde (%5,37) hipotiroidi saptandı. Hipotiroidi saptanan hastalardan 2’sinde klinik hipotiroidi, 3’ünde ise subklinik hipotiroidi olduğu görüldü. Sonuç: Çalışmamızda OUAS ile hipotiroidi sıklığı literatür verileri ile benzer oranda bulundu. Yapılan çalışmalarda hipotiroidisi olan OUAS’lu hastalarda tiroid hormon tedavisi ile apne hipopne indeksinde ve semptomlarda azalma olduğu dikkate alınarak OUAS şüphesi ile tetkik edilen hastalarda hipotirodi taraması yapılmalıdır.Aim: Obstructive sleep apnea syndrome (OSAS) is common in society, and hypothyroidism is a disease that can be seen along with rates ranging from 1.2 to 11%. Symptomatology spectrum of OSAS is very wide. These symptoms suggest OSAS but these symptoms are not definitive diagnostic feature. Patients with OSAS have symptoms such as throughout the day drowsiness, obesity, snoring, apathy and lethargy, that can be seen in all of them are faced with hypothyroidism. Regarded among the etiological causes in endocrine disorders, reduction of thyroid hormones can be easily detected. Measurement of serum levels of thyroid hormone is inexpensive and it is guidance for treatment planning. We investigate thyroid hormone levels in patients who were diagnosed as OSAS with polysomnography (PSG) and determine the prevalence of hypothyroidism in patients with OSAS. Material and Method: Ninety-three patients with complaints of snoring who were diagnosed as OSAS with PSG were examined in the study between March 2009-November 2010. Thyroid function tests were performed in these patients. Results: According to the severity, 30 patients were in mild, 32 patients were in moderate and 31 patients were in severe OSAS group. Hypothyroidism was detected in 5 of those 93 OSAS patients (5,37%). Two of these patients had clinical hypothyroidism and three of these patients had subclinical hypothyroidism. Conclusion: In our study, the prevalence of hypothyroidism and OSAS was found compatible with the literature. Reduction in symptoms and apnea hypopnea index with thyroid hormone therapy in OSAS patients with hypothyroidism is considering and hypothyroidism screening tests should be made with the suspicion of OSAS

Obstrüktif uyku apne sendromu olan normotansif hastalarda böbrek fonksiyonlarının değerlendirilmesi

Amaç: Obstrüktif uyku apne sendromu toplumda en sık karşılaşılan uyku bozukluklarından birisidir. OUAS’lu hastaların %30-60’ında hipertansiyonun varlığı gösterilmiştir. Hipertansif OUAS’lu hastalarda kreatinin klirensinin (KK) hipertansif olmayanlara göre daha düşük olduğu saptanmıştır. Çalışmamızda hipertansiyon gelişmemiş olan OUAS’lu hastalarda KK’ni kontrol grubu ile kıyaslayarak, OUAS’da KK’nde azalma olup olmadığı ve OUAS’nun ciddiyet derecesinden etkilenip etkilenmediğini saptamayı amaçladık. Gereç ve Yöntemler: Çalışmaya Mart 2009–Ekim 2010 tarihleri arasında Akdeniz Üniversitesi Tıp Fakültesi Hastanesi Göğüs Hastalıkları Polikliniğine horlama şikayeti ile başvuran ve polisomnografi ile OUAS tanısı konulan 93 hasta alındı. Hastalardan böbrek fonksiyon testleri istendi ve KK hesaplandı. Bulgular: Hastaların 30’unun hafif, 32’sinin orta, 31’inin ise ciddi dereceli OUAS olduğu görüldü. Hasta grupları ve kontrol grubunun demografik verilerinde, sistolik ve diyastolik kan basıncı ve KK değerlerinde istatistiksel anlamlı farklılık saptanmadı. OUAS’nun şiddeti ile KK arasında bir ilişki bulunmadı. Sonuç: Hipertansiyon gelişmemiş olsa bile OUAS’nun patofizyolojik özelliklerinden dolayı bu hastalarda kronik böbrek hastalığı gelişebileceği bildirilmektedir. Bu yüzden OUAS’lu hastalarda hipertansiyon gelişebileceği göz önünde bulundurulmalı; tansiyon takibi,böbrek fonksiyonlarının değerlendirilmesi ve takibi ihmal edilmemelidir.Objective: Obstructive sleep apnea syndrome (OSAS) is one of the most common sleep disorders in society. The presence of hypertension is shown in 30-60% of OSAS patients. Creatinine clearance (CC) in hypertensive OSAS patients was found to be lower than non-hypertensive OSAS patients. In our study, we aimed to determine CC in non- hypertensive OSAS patients comparing with the control group and determine that CC is affected by the severity of OSAS. Material and Methods: Ninety-three patients with complaints of snoring who were diagnosed as obstructive sleep apnea syndrome with polysomnography were examined in the study between March 2009-November 2010. Renal function tests were performed in these patients and creatinine clearance was calculated. Results: According to the OSAS severity, 30 patients were in the mild, 32 in moderate and 31 in severe OSAS group.There were no statistically significant differences in the demograpic data, systolic and diastolic blood pressure and CC between OSAS and control groups There was no corelation between severity of disease and CC. Conclusion: Due to the pathophysiologic features of OSAS, chronic kidney disease can develop in these patients, although hypertension has not yet developed. Therefore it must be considered that, hypertension may develop in patients with OSAS; blood pressure monitoring, evaluation and monitoring of renal function should not be neglected

Right heart thrombus entrapped in patent foramen ovale with pulmonary embolism in a patient with primary hypercoagulable state

Thromboembolic disease is a potentially severe pathology.When its clinical feature implies a massive occlusionof the arterial pulmonary tree and a cardiac failure is ensued,it can be seriously life threatening even for youngpatients. Less frequent features as right or left atriumthrombosis could increase morbidity and mortality of thisdisease.We report a case of massive right pulmonary embolism(PE) with entrapped thrombus in patent foramen ovaleand right heart failure in a 32- year-old man. Transthoracicechocardiography showed a right atrial thrombusattached to the inter-atrial septum. Following the diagnosisof right heart thrombosis with massive PE, infusion oftissue type plasminogen activator (100 mg in two hours)was administered. Echocardiography performed two daysafter thrombolysis showed a significant decrease in theright ventricular size and complete lysis of the thrombusin the right heart. By genetic examination, he proved tohave factor V ’Leiden’ gene and two thrombophilia genes,all of which were positive in the heterozygous state. Hehad also a high serum homocysteine.Key words: pulmonary embolism, hypercoagulable state,thrombolytic therapy, patent foramen oval

Ischemic preconditioning attenuates lipid peroxidation and apoptosis in the cecal ligation and puncture model of sepsis

Sepsis and septic shock are are among the major causes of mortality in intensive care units. The lung and kidney are the organs most affected by sepsis. Evidence exists that lipid peroxidation and apoptosis may be responsible for the high mortality due to sepsis. Ischemic preconditioning (IP) is a method for the protection of tissues and organs against ischemia/reperfusion injury by reducing reactive oxygen species levels, lipid peroxidation and apoptosis. In the present study, the effects of IP were investigated in cecal ligation and puncture (CLP)-induced sepsis in rats. The three groups of animals used in the present controlled study were the sham-operated group (sham, n=7), which only underwent a laparotomy; the sepsis group (sepsis, n=7), which underwent cecal ligation and perforation; and the IP + sepsis group (IP+sepsis, n=7), which underwent CLP immediately prior to the application of three cycles of IP to the hind limb. The study was terminated at 6 h after the induction of CLP. Blood, kidney and lung tissue samples were collected for the determination of serum creatinine, blood urea nitrogen (BUN), neutrophil gelatinase-associated lipocalin (NGAL) and lung tissue malondialdehyde (MDA) levels, as well as histological examination. The serum creatinine, plasma NGAL and lung tissue MDA levels in the sepsis group were significantly increased compared with those in the sham and the IP+sepsis groups (P<0.05). Alveolar macrophage counts, histological kidney and lung injury scores, kidney (caspase 3) and lung tissue immuonreactivity (M30) scores in the sepsis group were also significantly increased compared with those in the sham and IP+sepsis groups (P<0.05). The alveolar macrophage count in the IP+sepsis group was increased compared with that in the sham group (P<0.05). In conclusion, IP inhibits lipid peroxidation and attenuates histological injury and apoptosis in the lung and kidney during sepsis