Is adiponectin elevation associated with left atrial remodeling and impaired mechanical functions? (a speckle tracking study)

Objectives Recent studies demonstrated that elevated adiponectin levels predicted an increased risk of atrial fibrillation (AF) and stroke; however, a causal relationship is yet to be unknown. Reduced left atrium (LA) functions detected by two-dimensional echocardiographic speckle tracking (2D-STE) can predict AF development. We aimed to investigate the relationship between adiponectin level and LA functions in hypertensive and diabetic patients at high risk for incident AF. Material and methods The study consisted of 80 hypertensive diabetic patients. All patients underwent echocardiography, and venous blood samples were taken. The relationship between adiponectin levels and LA functions was analyzed. Results We divided patients into two groups according to the mean adiponectin level (13.63 ng/ml). In the high adiponectin group, the mean age (p=0.001) and high-density lipoprotein (HDL) cholesterol (p=0.015) were higher, whereas estimated glomerular filtration rate (eGFR) (p=0.036) and hemoglobin (p=0.014) levels were lower. Although LA maximum volume, LA minimum volume, and LA pre-A volume were higher in the group with high adiponectin levels, they did not reach a statistical significance. Peak early diastolic LA strain (S-LAe) (p=0.048) and strain rate (SR-LAe) (p=0.017) were lower in this group. Multivariate logistic regression analysis demonstrated that age (p=0.003) and hemoglobin (p=0.006) were predictors of elevated adiponectin levels. On the contrary, S-LAe, HDL cholesterol, and eGFR lost their statistical significance. Conclusion In patients with HT and DM, elevated adiponectin level is associated with impaired LA mechanical functions. Increased age and hemoglobin level are independent predictors of elevated adiponectin levels

Is metabolic syndrome related with coronary artery disease severity and complexity: An observational study about IDF and AHA/NHLBI metabolic syndrome definitions

Background: The aim of the present study was to assess the relation between metabolic syndrome (MS) and coronary artery disease (CAD) complexity, assessed by Syntax score (SS), and severity in non-diabetic patients with stable CAD who underwent coronary angiography, and to evaluate whether the MS defined by different definitions, including International Diabetes Federation (IDF) and American Heart Association/National Heart Lung Blood Institute (AHA/NHLBI) guidelines, similarly correlated with SS.Methods: The present study is cross sectional and observational with prospective inclusion of 248 consecutive patients (157 male) who underwent coronary angiography due to stable CAD.Results: The prevalence of MS was 54.4% according to IDF definition and 50.4% according to AHA/NHLBI definition. MS score according to IDF definitions (r = 0.446, p < 0.001), MS score according to AHA/NHLBI definitions (r = 0.341, p < 0.001) were moderately correlated with SS. In Fisher r to z transformation test the correlations of the presence of MS according to IDF and AHA/NHLBI definitions with SS were not statistically significant (p = 0.168, z = –1.38). The systolic blood pressure (p < 0.001, B = 0.354, 95% CI = –0.308 to 0.228), diastolic blood pressure (p = 0.006, B = –0.194, 95% CI = –0.333 to –0.056), age (p = 0.014, B = 0.147, 95% CI = 0.029 to 0.264), left ventricular ejection fraction (p = 0.031, B = –0.150, 95% CI= –0.286 to –0.014), waist/hip circumference (p < 0.001, B = 45.713, 95% CI = 23.235 to 68.1919) and log10 high density lipoprotein (p < 0.001, B = –22.209, 95% CI = –33.298 to–11.119) were the independent predictors of SS in linear regression analysis.Conclusions: MS is associated with the presence and complexity of CAD. Besides the presence of discrepancy in the limits of waist circumference, both IDF and AHA/NHLBI criteria were similarly correlated with CAD complexity

Exercise-based cardiac rehabilitation has a strong relationship with mean platelet volume reduction

Background: Mean platelet volume (MPV), which is a simple measure of platelet activation, has recently become an interesting topic in cardiovascular research. Exercise-based cardiac rehabilitation (CR) is a comprehensive intervention that decreases mortality-morbidity in patients with coronary artery disease (CAD). Studies on the effects of exercise on platelet activation have yielded conflicting results. Objective: The purpose of this study was to determine the effect of an exercise-based CR programs on MPV in patients with stable CAD. Methods: The sample was composed of 300 consecutive stable CAD patients. The patients were divided into two groups: CR group (n = 97) and non-CR group (n = 203). Blood analysis was performed. Point-Biserial correlation measures were performed to show correlation between MPV change and CR. A p value of <0.05 was considered statistically significant. Results: The decrease in MPV was greater in the CR group than in the non-CR group [(-1.10(-1.40-(-0.90)) vs. (-0.10 (-2.00-0.00)); p< 0.001]. Delta MPV had a positive correlation with Delta neutrophil (r = 0.326, p < 0.001), Delta TG (r = 0.439, p < 0.001), Delta LDL-c (r = 0.478, p < 0.001), Delta WBC (r = 0.412, p < 0.001), and Delta CRP (r = 0.572, p < 0.001). A significant correlation was found between Delta MPV% and CR (r=0.750, p<0.001). Conclusions: We were able to show that exercise-based CR has a strong relationship with MPV reduction in patients with CAD. We consider that decreased platelet activation with exercise-based CR might play an important role in reducing thrombotic risk in patients with stable CAD

Paradoxical association between lipoprotein cholesterol levels and left atrial function in hypertensive diabetic patients: A speckle tracking study

Background Studies have shown that subclinical left atrial (LA) dysfunction can be diagnosed with two-dimensional speckle tracking echocardiography (2D-STE). Although low-density lipoprotein cholesterol (LDL-C) is a risk factor for cardiovascular diseases, recent studies have reported a paradoxical relationship between LDL-C level and atrial fibrillation. In this study, we investigated the relationship between LDL-C levels and LA function. Methods In 168 patients with the diagnosis of hypertension and diabetes, transthoracic echocardiography with LA 2D-STE was performed. The patients were then divided into two groups: normal LA-strain (n = 94) or impaired LA-strain (n = 74). The relationship between LDL-C and LA function was analyzed. Results Patients with impaired LA-strain had higher body mass index (BMI) (p = 0.029), higher statin usage (p = 0.003), and lower LDL-C levels (p = 0.001) than patients with normal LA-strain. They also had lower left ventricle ejection fraction (LVEF) (p = 0.047) and higher E-wave velocity (mitral e, m/s) (p = 0.020). Multivariate logistic regression analysis showed that lower LDL-C (p = 0.034), higher BMI (p = 0.004), lower LVEF (p = 0.004), and higher E-wave velocity (p = 0.003) values were independently associated with impaired LA-strain. The area under the receiver operating curve of LDL-C in predicting impaired LA-strain was 0.645 (0.564-0.730, p < 0.05). LDL-C <= 112.5 mg/dl was found to be the optimal cut-off value with 74.5% sensitivity and 51.2% specificity in predicting impaired LA strain. Conclusion In patients with hypertension and diabetes, LDC-C levels are moderately but independently and paradoxically associated with impaired LA function assessed by 2D-STE

Blood urea nitrogen to left ventricular ejection fraction ratio is associated with long-term mortality in the stable angina pectoris patients

OBJECTIVE: Left ventricle (LV) dysfunction remains a significant cause of morbidity and mortality in patients with stable angina pectoris (SAP) and has prognostic significance. However, new prognostic indicators may be more useful in clinical practice. There is a growing interest in the role of blood urea nitrogen (BUN) in cardiovascular diseases. Blood urea nitrogen is an indicator of cardiac dysfunction and neurohormonal activation. We aimed to determine the relationship of BUN/LV ejection fraction ratio (BUNLVEFr) with long-term mortality and de novo decompensated heart failure (HF) in SAP patients. PATIENTS AND METHODS: The study comprised 603 consecutive SAP patients who underwent coronary angiography. The median duration of the follow-up period was 112.6±17.8 months. All-cause mortality and de novo decompensated HF were determined as the endpoints. RESULTS: Adverse cardiac events were observed in 141 patients (23.3%), including mortality in 103 (17.1%) and decompensated HF in 38 (6.3%) of them during the follow-up period. Age (p=0.027), BUNLVEFr (p=0.001), glucose (p=0.043), hemoglobin (p=0.035), and Gensini score (p=0.012) were found as independent predictors of mortality and decompensated HF. BUNLVEFr was superior to BUN alone (BUNLVEFr vs. BUN: Z=5.715, p<0.001) and LVEF alone (BUNLVEFr vs. LVEF: Z=4.075, p[removed]29 predicted all-cause mortality/ decompensated HF with high sensitivity (78%) and low specificity (68%). CONCLUSIONS: BUNLVEFr may provide better prognostic information than either BUN or EF can give alone in determining therapeutic strategies for SAP patients

FEV1 is independently related with impaired left atrial strain in chronic obstructive pulmonary disease patients: A speckle tracking study

Background Atrial fibrillation (AF) is common in chronic obstructive pulmonary disease (COPD) patients. It is known that impaired forced expiratory volume in 1 s (FEV1) is one of the risk factors of cardiovascular disease. Two-dimensional speckle tracking echocardiography (2D-STE) can detect deterioration of left atrial mechanical functions in the subclinical stage. We hypothesized that reduced lung functions, measured by FEV1 in COPD patients, may be associated with impaired left atrial (LA) mechanical functions. Objectives Present study included 127 consecutive COPD patients. We divided study population into two groups: patients with normal LA strain (n = 20) or with impaired LA strain (n = 107). Results In univariate logistic regression analysis, age (p: 0.001), FEV1% (p < 0.001), FEV1 (p < 0.001), FEV1/forced vital capacity (FVC) (p: 0.014), white blood cell (p: 0.012), LA Max vol (p: 0.026), C-reactive protein (p :0.001), arterial oxygen pressure (PaO2) (p: 0.019), arterial oxygen saturation (SO2) (p: 0.021), left ventricle ejection fraction (LVEF) (p: 0.042), and mitral A-wave velocity (p: 0.017) were associated with impaired LA-strain. In multivariate logistic regression analysis, age (p: 0.043), FEV1 (p < 0.001), LA Max vol (p: 0.004), and LVEF (p: 0.004) were independently associated with impaired LA strain. Conclusion FEV1 is associated with impaired left atrial strain independently of arterial blood gas and left ventricular diastolic dysfunction parameters in COPD patients with preserved left ventricular systolic function

The effect of statin treatment on inflammation in patients with metabolic syndrome

Amaç: Metabolik sendromun (MS) patogenezinde inflamasyon önemli rol oynamaktadır. Bu çalışmada, MS’li hastalarda fluvastatin tedavisinin inflamatuvar belirteçler üzerine etkisi araştırıldı. Ça lış ma pla nı: Çalışmaya MS tanılı 47 hasta (36 kadın, 11 erkek; ort. yaş 55±8) alındı. Metabolik sendrom tanısı NCEP ATP III ölçütlerinden en az üçünün varlığıyla kondu. Bütün hastalara altı hafta boyunca 80 mg fluvastatin tedavisi uygulandı. Tedavi öncesi ve sonrasında laboratuvar parametreleri ölçüldü; periferik kan lökositleri akım sitometri yöntemiyle değerlendirildi. Hasta grubunun verileri, yaş ve cinsiyet uyumlu 47 sağlıklı bireyden (33 kadın, 14 erkek; ort. yaş 52±8) oluşan kontrol grubuyla karşılaştırıldı. Bul gu lar: Tedavi sonrasında total kolesterol, LDL-kolesterol ve trigliserid düzeylerinde (p0.05). So nuç: Bulgularımız metabolik sendrom patogenezinde inflamasyonun önemli rol oynayabileceğini ve statin tedavisi ile bu etkinin kontrol altına alınabileceğini göstermektedir.Objectives: Inflammation plays an important role in the pathogenesis of metabolic syndrome (MS). We investigated the effect of fluvastatin treatment on inflammatory markers in patients with MS. Study design: The study included 47 patients (36 females; 11 males; mean age 55±8 years) with MS. The diagnosis of MS was based on the presence of at least three criteria of the NCEP ATP III guidelines. All the patients received 80 mg fluvastatin treatment for six weeks. Laboratory parameters were measured before and after treatment, and flow cytometric analysis of peripheral blood leukocytes was performed. The results were compared with those of 47 age- and sexmatched healthy controls (33 females, 14 males; mean age 52±8 years). Results: Fluvastatin treatment resulted in significant decreases in levels of total cholesterol, LDL cholesterol, triglyceride (p0.05). Conclusion: Our data demonstrate that inflammation may have a significant role in the pathogenesis of MS and that this effect can be controlled with statin treatment

Serum osteoprotegerin level is independently related to subclinical left atrial mechanical function in patients with hypertension and diabetes

Cetin, Mustafa/0000-0001-6342-436X; KALAYCIOGLU, EZGI/0000-0003-2122-1817WOS: 000556232600001PubMed: 32462219Objectives Previous studies showed that subclinical abnormal left atrial (LA) function could be diagnosed with LA speckle tracking evaluation long before chamber enlargement. Osteoprotegerin (OPG) is a member of the tumor necrosis factor (TNF) receptor superfamily and was recently found to be an indicator for adverse cardiovascular outcomes and a risk factor for new onset atrial fibrillation. the authors hypothesized that OPG values could predict LA mechanical dysfunction and LA remodeling assessed by two-dimensional speckle tracking echocardiography (2D-STE) in patients with hypertension (HT) and diabetes mellitus (DM). Methods A single center study was conducted including consecutive patients presenting to the authors' outpatient clinic. Enrolled patients needed to have been treated for HT and DM for at least 1 year. Results the study included 80 patients (mean age, 57.5 +/- 8.3 years). Patients in the impaired LA strain group were older (p = 0.035), had lower low density lipoprotein (LDL) cholesterol (mg/dl) (p = 0.021), and higher OPG (pmol/l) (p = 0.004) values than patients in the normal LA strain group. Univariate logistic regression analysis demonstrated that age (p = 0.039), LDL cholesterol (mg/dl) (p = 0.025), and OPG (pmol/l) (p = 0.008) values were associated with impaired LA strain. Backward multivariate logistic regression analysis showed that LDL cholesterol (mg/dl) (OR: 0.982, CI 95% 0.964-0.999,p = 0.049) and OPG (pmol/l) (OR: 1.438, CI 95% 1.043-1.983,p = 0.027) were independently associated with impaired LA strain. Conclusion in hypertensive and diabetic patients, higher OPG values were associated with impaired LA function assessed by 2D-STE. in this high-risk patient group, serum OPG can be used as a risk predictor for LA mechanical dysfunction

Epicardial adipose tissue is associated with increased systolic pulmonary artery pressure in patients with chronic obstructive pulmonary disease

Objectives: Pulmonary hypertension (PHT) is one of the essential predictors of mortality in chronic obstructive pulmonary disease (COPD). It is thought that PHT is due to vasoconstriction secondary to hypoxia caused by airway obstruction in COPD patients; however, loss of capillary bed with emphysema, inflammation, and endothelial dysfunction may also play a role in the development of PHT. Epicardial adipose tissue (EAT) has a role as a metabolically active endocrine organ and secretes various proinflammatory cytokines. We hypothesized that EAT thickness in COPD patients might be associated with the systolic pulmonary arterial pressure (PAPs) level, and we aimed to test it. Methods: The present study included 129 consecutive patients with the diagnosis of COPD. All patients underwent transthoracic echocardiographic evaluation. The relationship between PAPs and EAT thickness was evaluated. Results: Positive correlations with PAPs were reported with age, EAT, white blood cell (WBC) and GOLD grade score (range 0.197-0.275, P values 0.026 to 0.002), negative correlations with body-mass index (BMI), hyperlipidemia, FEV1 (% predicted) and pO2 (range −0.216 to −0.340, P values.014 to <.001). In stepwise linear regression analysis, BMI (P =.003), EAT (P =.002), WBC (P =.001), and FEV1 (% predicted) (P =.010), were independently associated with PAPs. Conclusion: EAT thickness in COPD patients with preserved left ventricular systolic function is associated with increased PAPs, and this association is independent of the parameters indicating the severity of COPD

Impact of valvular heart disease on oral anticoagulant therapy in non-valvular atrial fibrillation: results from the RAMSES study

PubMed ID: 27848065The definition of non-valvular atrial fibrillation (NVAF) is controversial. We aimed to assess the impact of valvular heart disease on stroke prevention strategies in NVAF patients. The RAMSES study was a multicenter and cross-sectional study conducted on NVAF patients (ClinicalTrials.gov identifier NCT02344901). The study population was divided into patients with significant valvular disease (SVD) and non-significant valvular disease (NSVD), whether they had at least one moderate valvular disease or not. Patients with a mechanical prosthetic valve and mitral stenosis were excluded. Baseline characteristics and oral anticoagulant (OAC) therapies were compared. In 5987 patients with NVAF, there were 3929 (66%) NSVD and 2058 (34%) SVD patients. The predominant valvular disease was mitral regurgitation (58.1%), followed by aortic regurgitation (24.1%) and aortic stenosis (17.8%). Patients with SVD had higher CHA2DS2VASc [3.0 (2.0; 4.0) vs. 4.0 (2.0; 5.0), p &lt; 0.001] and HAS-BLED [2.0 (1.0; 2.0) vs. 2.0 (1.0; 2.0), p = 0.004] scores compared to patients with NSVD. Overall, 2763 (71.2%) of NSVD and 1515 (73.8%) of SVD patients were on OAC therapy (p = 0.035). When the patients with SVD were analyzed separately, the mean CHA2DS2VASc and HAS-BLED scores were higher in patients with mitral regurgitation compared to patients with aortic regurgitation and aortic stenosis [4.0 (3.0; 5.0), 3.0 (2.0; 4.0), 3.0 (2.0; 4.0) p &lt; 0.001 and 2.0 (1.0; 3.0), 1.0 (1.0; 2.0), 1.0 (0.0; 2.0) p &lt; 0.001, respectively]. In patients with SVD, 65.7% of mitral regurgitation, 82.6% of aortic regurgitation and 88.0% of aortic stenosis patients were on OAC therapy. One out of three NVAF patients had at least one moderate valvular heart disease with the predominance of mitral regurgitation. Patients with SVD were at greater risk of stroke and bleeding compared to patients with NSVD. Although patients with mitral regurgitation should be given more aggressive anticoagulant therapy due to their higher risk of stroke, they are undertreated compared to patients with aortic valve diseases. © 2016, Springer Science+Business Media New York