Pheochromocytoma: An overlooked reversible cause of heart failure with reduced ejection fraction

Pheochromocytoma is a rare, benign tumor of adrenal medulla, and its clinical symptoms are related to catecholamine production. Clinical presentation may vary in a broad spectrum. Dilated or hypertrophied cardiomyopathies are the possible clinical outcomes of pheochromocytoma. Pheochromocytoma should be kept in mind in the differential diagnosis where resistant hypertension, palpitations, headache, and sweating accompany cardiomyopathy. Excessive adrenergic stimulation causing catecholamine discharge can trigger hypertension crisis, pulmonary edema, and myocardial necrosis. Here in this report, we aimed to present the case of a patient with pheochromocytoma related cardiomyopathy who was totally recovered after surgical excision of the tumor

Esansiyel hiperyansiyon hastalarında yeni başlanan karvedilol ve nebivolol tedavisinin insülin direnci ve Lipid profiline etkisi

Beta blokerler, hipertansiyon tedavisinde kullanılan önemli ilaç sınıflarından biri olmasına rağmen, son kılavuzların çoğunda 1. sıra antihipertansif ajan olarak önerilmemektedir. Bu olumsuz görüş, geleneksel beta blokerlerin hemodinamik ve metabolik parametrelerdeki yan etkilerinden kaynaklanmaktadır. Yeni kuşak vazodilator beta blokerlerin, özellikle metabolik parametrelerde, geleneksel beta blokerlere üstünlükleri bilinmektedir. Bu çalışmada her ikisi de yeni kuşak beta bloker olan karvedilol ve nebivololün, esansiyel hipertansiyonlu hastalarda insülin direnci ve lipid profili üzerine etkilerinin karşılaştırılması amaçlandı. Çalışma prospektif, randomize, açık uçlu, klinik bir çalışmadır. Çalışmaya, kardiyoloji polikliniğine başvurarak esansiyel hipertansiyon tanısı konulan, diyabetes mellitusu olmayan 107 hasta alındı. Hastalar 2 gruba randomize edilerek, bir gruba karvedilol 25 mg (p.o.), diğer gruba nebivolol 5 mg (p.o.) dozu titre edilerek başlandı. Tüm hastalara yaşam tarzı değişiklikleri önerildi. İlk başvuruda ve tedaviye başladıktan 4 ay sonra açlık kan şekeri, insülin, lipid profili [yüksek yoğunluklu lipoprotein (HDL), düşük yoğunluklu lipoprotein (LDL), total kolesterol, trigliserid, apolipoprotein A-I, apolipoprotein B] değerleri ölçüldü ve HOMA indeksi (açlık kan şekeri x açlık insülini / 405) ile insülin direnci hesaplandı. Randomize edilen 107 hastanın 27’ si takipte çalışma dışı kaldı ve çalışma karvedilol grubundan 40 ve nebivolol grubundan 40 hasta olmak üzere toplam 80 hasta ile tamamlanarak verileri analiz edildi. Karvedilol ve nebivolol tedavisi ile sistolik ve diyastolik kan basıncında ve kalp hızında tedavi öncesine göre istatistiksel olarak anlamlı azalma izlendi (p<0.001) ve azalma gruplar arası benzerdi (p=AD). Hem karvedilol hem nebivolol grubunda, tedavi ile glukoz (p<0.001), insülin (p<0.01), HOMA-IR (p<0.01), HDL (p<0.001), LDL (p<0.001), total kolesterol (p<0.001) ve apolipoprotein B (p<0.05) değerlerinde anlamlı azalma gözlendi, bu değerlerdeki değişim ilaçlar arasında benzerdi (p=AD). Her iki grupta, trigliserid ve apolipoprotein A-I değerlerinde anlamlı değişiklik gözlenmedi (p=AD). Vücut kitle indeksi (p<0.05) ve bel çevresi (p<0.001) her iki grupta anlamlı azalma gösterdi, azalma her iki grupta benzerdi (p=AD). Bu çalışma ile karvedilol ve nebivololün yeni tanı hipertansiyon hastalarında etkin ve benzer kan basıncı düşüşü yaparken, insülin direnci ve lipid profili üzerine olumlu etki gösterdikleri saptandı. Bu veriler doğrultusunda, yeni kuşak beta blokerlerden karvedilol ve nebivololün, metabolik yönden olumsuz etkilere yol açmadan esansiyel hipertansiyon tedavisinde kullanımının uygun olabileceğini ve bu bulguların değişik ilaç gruplarının karşılaştırıldığı plasebo-kontrollü büyük randomize çalışmalarla desteklenmesi gerektiğini düşünmekteyiz

Total serum protein predicted mortality in patients with st-elevation myocardial ınfarction who underwent primary percutaneous coronary ıntervention: Results of 8-year follow-up

Objectives: ST-elevation myocardial infarction (STEMI) is globally one of the leading causes of mortality. Determining modifiable mortality predictors to improve outcomes is critical. Total serum protein (TSP) is a composite indicator of immunity, nutrition, and inflammation and it plays a vital role in biological pathways contributing to cardiovascular diseases. TSP level has not been evaluated in patients with STEMI in the prediction of mortality previously. Materials and Methods: The patients diagnosed with STEMI between March 2007 and May 2009 were included in the study. TSP was obtained at admission to the hospital. Follow-up period of the study was 8 years and primary endpoint was all-cause mortality. Participants were separated according to the presence of mortality and clinical parameters compared between these two groups. Results: The mean age of the total 99 patients was 61±12.4 years and 82 (82.8%) of them were male. While left ventricular ejection fraction (LVEF) (p=0.001), serum albumin (p=0.014), and TSP (p<0.001) were lower, serum creatinine was higher (p=0.003) in the mortality group. Diabetes mellitus (p=0.007), increased age (p=0.027), LVEF (p=0.006), serum creatinine level (p=0.023), and TSP (hazard ratio: 0.159, 95% confidence interval: 0.062-0.408, p<0.001) predicted mortality independently. Conclusion: TSP level predicted all-cause mortality independently in STEMI patients who underwent primary percutaneous coronary intervention during 8-year follow-u

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 Glasgow prognostic score a predictor of mortality in infective endocarditis?

Objectives: The inflammation-based Glasgow prognostic score (GPS), which comprises elevated serum Creactive protein (CRP) and decreased albumin concentration, is the most valid inflammatory risk score in cancer. New prognostic markers are needed to predict high-risk infective endocarditis (IE) patients. In the present study, we investigated the in-hospital mortality estimation of GPS in infective endocarditis patients. Methods: The retrospectively designed study included 53 IE patients diagnosed according to Duke criteria. Demographic and clinical data of the patients were recorded and GPS levels were measured. Patients were divided into two groups according to in-hospital mortality outcomes. Glasgow prognostic score was rated as 0, 1, or 2 points based on serum albumin and C-reactive protein levels. Results: The nonsurvivor group was older and the number of patients with kidney failure or diabetes was higher in this group. Glasgow prognostic score was higher in the nonsurvivor group, while albumin levels were lower. Thirty-four patients died during intensive care unit follow-up, and the mean follow-up period was 24.1 ± 18.6 days. ROC analysis showed that the Glasgow prognostic score had a sensitivity of 82.4% and a specificity of 36.8% at a cut-off value of ≥ 1.5 in predicting in-hospital mortality. Chronic renal failure (OR: 6.720; 95% CI: 1.907-23.684; p = 0.003) and age (OR: 1.040; 95% CI: 1.001-1.081; p = 0.044) were the independent variables of the mortality prediction in univariate logistic regression analysis. In multivariate logistic regression analysis, only chronic renal failure (OR: 0.153; 95% CI: 0.036-0.653; p = 0.011) was found to be a significant predictor of mortality. Kaplan–Meier survival analysis revealed that long-term survival was reduced in patients with a high GPS (Log-rank: p = 0.003). Conclusions: Glasgow prognostic score level is associated with increased in-hospital mortality in IE patients. Chronic renal failure and GPS are the independent predictors of mortalit

Myocardial injury in COVID-19 patients is associated with the thickness of epicardial adipose tissue

Aim High sensitive troponin (hs-TnI) levels may increase secondary to Coronavirus disease-2019 (COVID-19), and this increase is associated with cardiovascular mortality in COVID-19 patients. Epicardial adipose tissue (EAT) is associated with myocardial injury directly as a reservoir tissue for coronavirus, and indirectly through mediators it secretes as an apocrine gland. We aimed to evaluate the relationship between myocardial injury secondary to COVID-19 infection and EAT thickness. Material and methods Thoracic computed tomography (CT) was performed in 73 consecutive patients diagnosed with COVID-19. EAT thickness and volume were calculated by two radiologists blind to the study data. We formed two groups according to hs-TnI concentrations, patients with myocardial damage (hs-TnI >= 11.6 ng/l) and without myocardial damage (hs-TnI<11.6 ng/dl). Results A total of 46 patients were women (63.0%). The mean age was 66.4 +/- 12.3 yrs in the myocardial injury group and 55.9 +/- 9.7 yrs in the group without myocardial injury (p<0.001). There were 20 hypertensive patients (68.9%) in the injury group, while there were 12 hypertensive patients (27.3%) in the group without injury (p=0.001). Glucose, C-reactive protein, D-dimer, white blood cell count, neutrophil, and neutrophil/lymphocyte ratio were higher in the injury group (p<0.05, for all variables). The mean EAT thickness was 5.6 +/- 1.6 mm in the injury group, whereas it was 4.8 +/- 1.8 mm in the group without injury (p=0.031). EAT thickness of 4.85 mm and above was associated with the myocardial injury with 65% sensitivity and 39% specificity (AUC=0.65, 95% CI: 0.52-078, p=0.031). Conclusion In patients with COVID-19 infection, higher rates of myocardial injury were observed as the EAT thickness increased. Epicardial adipose tissue, contributes to cytokine-mediated myocardial injury either directly or indirectly by acting as a reservoir for coronavirus. Increased EAT thickness is associated with myocardial injury in COVID-19 patients

Serum apelin levels and cardiovascular diseases

Apelin is a G protein-linked receptor endogenous ligand, synthesized as a 77-amino acid pre-propeptide. Increased expression of apelin is present in many cardiovascular (CV) tissues, including cardiomyocytes. It is a peripheral vasodilator and one of the most potent stimulants of ventricular contraction. Apelin may be a valuable therapeutic for both blood pressure regulation and myocardial performance. More information is needed for the CV pathophysiology of apelin. We will discuss the importance of apelin level in CV diseases in this review

The association of new atherosclerosis markers with coronary collaterals in chronic total occlusion patients

Objectives: In the present study, we investigated the relationship between mentioned markers and chronic total occlusion collateral development. Patients and methods: A total of 243 patients (210 males, 33 females; mean age: 63.3±11.5; range, 51 to 76 years) who underwent coronary angiography due to typical chest pain or myocardial ischemia detected in noninvasive stress tests and diagnosed with ≥1 major coronary artery occlusion between January and September 2020 were included in the cross-sectional observational study. The angiographic collateral index was determined according to the Cohen-Rentrop classification. The patients were divided into two groups according to the sufficiency of collateral development: the well-developed collaterals group (n=155) and the poor-developed collaterals group (n=88). Results: Statistically significant parameters in univariate logistic regression analysis were evaluated with multivariate (stepwise) logistic regression analysis; as a result, presence of chronic total occlusion in left anterior descending artery (odds ratio [OR]=2.447; 95% confidence interval [CI], 1.160-5.162; p=0.019), total number of occlusions (OR=3.503; 95% CI, 1.445-8.494; p=0.006), left ventricular ejection fraction (OR=1.056; 95% CI, 1.022-1.091; p=0.001), and the atherogenic index of plasma (OR=0.017; 95% CI, 1.022-1.091; p<0.001) were independently associated with well-developed collaterals. Although the triglyceride-glucose index had statistical significance in the univariate analysis, it was not detected as an independent variable in the multivariate analysis. The monocyte-lymphocyte ratio was not significant in the univariate analysis. Conclusion: Of the new atherosclerosis markers, only the atherogenic index of plasma had an independent association with poor collateral developmen

Epicardial fat thickness is associated with retinopathy in patients with newly diagnosed hypertension

OBJECTIVE: Hypertensive retinopathy develops based on endothelial dysfunction, inflammation, and atherosclerosis. Epicardial fat secretes various cytokines associated with endothelial dysfunction, oxidative stress, inflammation, and atherosclerosis. We aimed to evaluate whether epicardial adipose tissue (EAT) thickness is a marker for retinopathy in newly diagnosed hypertensive patients. METHODS: A total of 73 newly diagnosed hypertension (HT) patients were included in the study. Transthoracic echocardiography (TTE) was used to measure EAT thickness. To evaluate the presence of retinopathy in HT patients, hypertensive retinopathy staging was performed by ophthalmologists, according to Scheie classification. RESULTS: Retinopathy was detected in 27 (37.0%) of 73 patients. EAT thickness in HT patients with retinopathy was higher than the group without retinopathy (5.07 +/- 1.45 mm vs. 4.19 +/- 1.20 mm, p=0.007). Low-density lipoprotein cholesterol (LDL-C) levels in HT patients with retinopathy were higher than the group without retinopathy (162.4 +/- 41.2 mg/dl vs. 138.1 +/- 35.6 mg/dl, p=0.010). As a result of the regression analysis, LDL-C (OR=1.016, 95% CI 1.001-1.031, p=0.043) and EAT thickness (OR=1.674, 95% CI 1.069-2.626, p=0.043) were the independent predictors of retinopathy. CONCLUSION: Increased EAT thickness is associated with the presence of retinopathy in hypertensive patients

The effect of ısolated coronary artery ectasia on mortality in long-term follow-up in patients with stable angina pectoris

Amaç: Koroner arter ektazisi koroner anjiyografi ile tespit edilen bir koroner anomalidir. Koroner arter ektazisinin klinik ve progrostik öne‐ mi hala daha aydınlatılabilmiş değildir. Çalışmamızda izole koroner arter ektazisinin uzun süreli takip sonucunda normal koroner ar ter li hasta grubuna göre ölüm gelişimi ile ilişkili olup olmadığını değerlendirerek bu alandaki çelişkili sonuçlara cevap vermeyi amaç la dık. Gereç ve Yöntem: Çalışmaya göğüs ağrısı ve/veya eşdeğeri semptomlarla hastaneye başvuran, koşu bandı egzersiz testi ile iskemi lehi‐ ne bulgu izlenen, stabil anjina pektoris tanılı hastalar alındı. Koroner anjiyografi işlemi sonucunda koroner darlık oluşturan lezyonu ol‐ mayan, izole koroner arter ektazisi ve normal koroner arterli 262 hasta ile çalışmaya devam edildi ve hastalar ortalama 8.2 yıl boyunca takip edildi. Takip sürecinde ölüm gelişen hastalar belirlenerek analiz edildi. Bulgular: Çalışma takip süresince 35 hastada ölüm gerçekleşti. Takip süresi içerisinde koroner arter ektazili ve normal koroner arterli hasta grupları arasında ölüm oranları açısından istatistiki olarak anlamlı farklılık izlenmedi (p=0,179). İzole koroner arter ektazisinin ile‐ ri yaş (p<0,001), erkek cinsiyet (p<0,001), diabetus mellitus (p=0,011), serum kreatinin düzeyi yüksekliği (p=0,036) ve dislipidemi (p=0,006) ile normal koroner arterli gruba göre daha yakından ilişkili olduğu izlendi. Sonuç: İzole koroner arter ektazisinin, uzun süreli takip sonucunda normal koroner arterlere göre ölüm oranlarında artışa neden olma‐ dığı gösterilmiştirObjective: Coronary artery ectasia is a common coronary anomaly detected by coronary angiography. The clinical and prognostic significance of coronary artery ectasia is still unclear. We compared isolated coronary artery ectasia patients to the patients with normal coronary arteries in terms of mortality during long‐term following. Material and Method: Stable angina pectoris patients who were admitted to the hospital with chest pain or equivalent symptoms and diag‐ nosed as ischemia with treadmill exercise test were included in the study. As a result of coronary angiography, 262 patients with isolated co‐ ronary artery ectasia or normal coronary artery without coronary stenosis were included, and patients were followed for an average of 8.2 years. We identified and analyzed patients in terms of mortality during the follow‐up period. Results: A total of 35 patients died during follow‐up. There was no statistical difference between the normal coronary artery group and the iso‐ lated coronary artery ectasia group in terms of mortality (p=0.179). Age (p<0.001), male gender (p<0.001), serum creatinine level (p=0.036), diabetes mellitus (p=0.011), and dyslipidemia (p=0.006) were more closely related to coronary artery ectasia than normal coronaries. Conclusion: Isolated coronary artery ectasia cause no increase in mortality rates compared to normal coronary arteries after long‐term following