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

Ultrastructural examination of left internal mammary artery under electron microscopy in patients with chronic kidney disease who underwent coronary bypass surgery

Aim: To investigate the vascular damage of internal mammary artery graft with electron microscope secondary to chronic renal failure transmission in patients who underwent coronary artery bypass grafting surgery. Method: A total of 30 patients (10 patients with chronic renal failure and 20 patients without chronic renal failure) who underwent coronary artery bypass graft surgery were included in this prospective study. Left internal mammary artery graft was harvested as conventional fashion with no touch technique. Samples were prepared and then examined with the transmission electron microscope. Every arterial sample was individually examined ultrastructurally, and the changes were recorded. Then the samples of the control group and chronic renal failure group were compared. Results: There were no significant differences between chronic renal failure group and the control group in terms of demographics, comorbidities, intraoperative data and postoperative outcomes, and the groups were statistically similar (p&lt;0.05). Moreover, no statistically significance was detected in terms of structure and ultrastructure between the groups. Conclusion: The results of our study revealed that no ultrastructural changes were observed in the structure of IMA, suggesting that this graft would provide a good graft patency

Our outcomes of aortic valve sparing reimplantation (David procedure) in patients with ascending aortic aneurysm and type A aortic dissection

Aim: To present our outcomes with David procedure in patients with ascending aortic aneurysms (AAA) and type A aortic dissection (AD). Methods: Thirty-six patients, aged between 38-75 years, followed-up in the cardiovascular surgery clinic of our hospital were included in the study. Patients’ demographic data such as age and gender, type of dissection, urea and creatinine values, length of stay in the ICU, duration of hospitalization were recorded. Outcomes of postoperative and long-term ecography were analyzed. Results:  Of the 36 patients included in the study, 26 (72.22%) were male and 10 (22.78%) were female. The mean age of all patients was 60 ± 10 years. Ascending aortic aneurysm (AAA) was found in 20 (55.56%) patients and type A aortic dissection (AD) in 16 (44.44%) patients. In the postoperative echocardiography, 7 (23.33%) patients were normal, while 2 (6.67%) had trace aortic insufficiency, 17 (56.67%) patients had mild aortic insufficiency, 3 (10.00%) patients had moderate aortic insufficiency and 1 (3.33%) severe aortic insufficiency. Echocardiography performed one month after the operation revealed normal pathology in 10 (33.33%) trace aortic sufficiency in 2 (6.67%) patients, mild aortic insufficiency in 17 (56.67%) patients, and moderate aortic insufficiency in 1 (3.33%) patient. Conclusion:  The results of this study indicate that aortic valve-sparing reimplantation (David) procedure can be safely and effectively performed in patients with ascending aortic aneurysm and type A aortic dissection. It eliminates the need for a mechanical prosthesis and its complications

Effects of Coronary Artery Bypass Grafting Surgery on Olfactory and Taste Functions

Conclusion: Our study demonstrated that olfactory function was impaired in patients, who underwent on-pump CABG in the postoperative period, and significant impairment in taste function was present in neither off-pump nor on-pump CABG patients. However, the results of our study should be supported by more comprehensive, prospective, randomized controlled trials with more extensive patient series and by further tests

Akut koroner sendromlu genç hastalarda nötrofil lenfosit oranının değerlendirilmesi

Amaç: Enflamasyonun akut koroner sendrom (AKS) oluşumunda ve ilerlemesinde önemli bir rol oynadığı bilinmektedir. Beyaz kan hücresi ve alt tipleri AKS’li hastalarda enflamasyonun bir göstergesidir. Bu çalışmada, beyaz kan hücresi ve alt tiplerinin 45 yaş genç hastalarda AKS ile ilişkisinin değerlendirilmesi amaçlandı. Çalışma planı: Göğüs ağrısı şikâyetiyle acil servise başvuran ST yükselmesi olmayan AKS’li (STYz-AKS) 84 genç (45 yıl) hastanın (40 ST yükselmesiz miyokart enfarktüslü [STYzME], 44 kararsız anjina pektoris) ve 40 kişilik kontrol grubunun beyaz kan hücresi ve alt tipleri olan nötrofil ve lenfosit oranları geriye dönük olarak incelendi. Bulgular: STYz-AKS’li hastalarda hipertansiyon, diabetes mellitus, sigara kullanımı ve aile öyküsü anlamlı olarak daha yüksekti. Bu grupta ayrıca LDL seviyeleri anlamlı olarak yüksek ve HDL seviyeleri anlamlı olarak düşük bulundu (p0.041 ve p0.009). Gruplar arasında lenfosit oranları anlamlı olarak farklıydı (p0.048). Tüm gruplar arasında ve STYzME’li ile kararsız anjina pektorisli gruplar arasında N/L oranı anlamlı olarak farklı bulundu (p0.001 ve p0.041). Ayrıca, çok değişkenli doğrusal regresyon analizinde hipertansiyonun, nötrofil yüzdesinin ve N/L oranının STYz-AKS için bağımsız öngördürücüler olduğu gösterildi (sırasıyla, beta0.251, %95 GA0.002- 0.523, p0.048; beta0.561, %95 GA0.008-0.137, p0.028 ve beta0.260, %95 GA0.042-0.438, p0.018). Sonuç: N/L oranı, STYz-AKS’li genç hastalarda kontrol grubundan daha yüksek bulunmuştur. Genç STYz-AKS’li hastalarda enflamasyonun beyaz kan hücreleri ve alt tipleri ile değerlendirilmesi daha da önemli rol oynayabilir.Objectives: It is well known that inflammation plays a key role in both initiation and propagation of acute coronary syndrome (ACS). White blood cell (WBC) and its subtypes are an indicator of inflammation in patients with ACS. We aimed to evaluate the WBC and its subtypes in patients aged <45 year with acute coronary syndromes. Study design: We retrospectively analyzed WBC and its subtypes (including neutrophil and lymphocyte) in 84 patients (<45 year) who were admitted to the emergency department for chest pain suggestive of ACS (44 unstable angina pectoris, 40 non-ST-segment elevation myocardial infarction [NSTEMI]), and 40 healthy controls. Results: Hypertension, diabetes mellitus, smoking, and family history were significantly higher in NSTE-ACS patients. Also, LDL levels was significantly higher and HDL levels was significantly lower in NSTE-ACS patients (p0.041 and p0.009). The difference in percent of lymphocytes between the groups was significant (p0.048). N/L ratio was significantly different between all groups and between the NSTEMI and USAP (p<0.001 and p0.041). Our results demonstrated that hypertension, percent of neutrophils, and N/L ratio was a significant independent predictor of NSTE-ACS (Beta0.251, 95% CI0.002-0.523, p0.048; beta0.561, 95% CI0.008-0.137, p0.028 and beta0.260, 95% CI0.042-0.438, p0.018, respectively). Conclusion: N/L was found to be elevated in young patients with NSTE-ACS compared with control group. The inflammation assessed using WBC and its subtypes may be more important in young NSTE-ACS patients

Assessment of the neutrophil to lymphocyte ratio in young patients with acute coronary syndromes

PubMed ID: 23760114Objectives: It is well known that inflammation plays a key role in both initiation and propagation of acute coronary syndrome (ACS). White blood cell (WBC) and its subtypes are an indicator of inflammation in patients with ACS. We aimed to evaluate the WBC and its subtypes in patients aged <45 year with acute coronary syndromes. Study design: We retrospectively analyzed WBC and its subtypes (including neutrophil and lymphocyte) in 84 patients (<45 year) who were admitted to the emergency department for chest pain suggestive of ACS (44 unstable angina pectoris, 40 non-ST-segment elevation myocardial infarction [NSTEMI]), and 40 healthy controls. Results: Hypertension, diabetes mellitus, smoking, and family history were significantly higher in NSTE-ACS patients. Also, LDL levels was significantly higher and HDL levels was significantly lower in NSTE-ACS patients (p=0.041 and p=0.009). The difference in percent of lymphocytes between the groups was significant (p=0.048). N/L ratio was significantly different between all groups and between the NSTEMI and USAP (p<0.001 and p=0.041). Our results demonstrated that hypertension, percent of neutrophils, and N/L ratio was a significant independent predictor of NSTE-ACS (Beta=0.251, 95% CI=0.002-0.523, p=0.048; beta=0.561, 95% CI=0.008-0.137, p=0.028 and beta=0.260, 95% CI=0.042-0.438, p=0.018, respectively). Conclusion: N/L was found to be elevated in young patients with NSTE-ACS compared with control group. The inflammation assessed using WBC and its subtypes may be more important in young NSTE-ACS patients. © 2013 Turkish Society of Cardiology