Factor XIII Val34Leu polymorphism in patients with cardiac syndrome X

Background: The aim of the study was to examine the frequency of factor XIII polymorphism among patients with cardiac syndrome X (CSX).Methods: This study was designed as a cross-sectional and observational study. Forty-eight female patients with CSX and 36 controls matched by age, gender, diabetes, and hypertension were studied. CSX was defined as typical chest pain during rest or effort, abnormal test result for exercise ECG, and presence of angiographically normal epicardial coronary arteries after ruling out inducible spasm. Factor XIII gene polymorphism was investigated by using CVD Strip Assay (ViennaLab Diagnostic GmbH) commercial kit.Results: The frequency of factor XIII (Val/Leu + Leu/Leu) mutation was significantly higher in patients with CSX (43%) than in controls (19%) (p = 0.02). Frequency of the Leu allele was significantly higher in the patient group (23.5% vs. 11.1%, p = 0.04). Factor XIII (Val/Leu + Leu/Leu) mutation (p = 0.01, OR = 3.42; 95% CI 1.22–9.58) and smoking (p = 0.04, OR = 3.33, 95% CI 1.05–10.58) were identified as independent predictors of the disease in multivariate regression analysis.Conclusions: This study indicates that there is an evidence for association between factor XIII Val34Leu polymorphism and CSX

Quantitative assessment of left atrial functions by speckle tracking echocardiography in hypertensive patients with and without retinopathy

Purpose:The association between hypertensive retinopathy and left atrial(LA) impairment is unknown. Accordingly, it was aimed to investigate the possiblerelationship between hypertensive retinopathy and LA phasic functions by means oftwo-dimensional speckle-tracking echocardiography (2D-STE).Methods:A total of 124 hypertensive patients and 27 control subjects were includedin the study. LA reservoir strain (LAS-S), LA conduit strain (LAS-E), and LA boosterstrain (LAS-A) parameters were used to evaluate LA myocardial functions.Results:Hypertensive patients (with and without retinopathy) displayed an obviousreduction in the LA reservoir strain (LAS-S),and LA conduit strain (LAS-E). Moreover,further impairment in LA reservoir and conduit strain was found in patients withhypertensive retinopathy than in the isolated hypertensive patients. There were nosignificant differences in LA booster strain (LAS-A) among the three groups. ImpairedLAS-S(OR: 0.764, CI: 0.657–0.888, andp< 0.001), LAS-E(OR: 0.754, CI: 0.634–0.897,andp=0.001), and hypertension (HT) duration (OR: 2.345, CI: 1.568–3.507, andp< 0.001) were shown to be independent predictors of hypertensive retinopathy.Conclusion:Impaired LA reservoir and conduit strain may be used to predict hyper-tensive patients at higher risk of developing hypertensive retinopathy, and to deter-mine which patients should be followed more closely for hypertensive retinopath

Cardiac Rehabilitation Improves the QRS Fragmentation in Patients With ST Elevatıon Myocardial Infarction

Introduction: We aimed to evaluate the effect of exercise-based cardiac rehabilitation (CR) on the fragmented QRS (fQRS) in patients with ST elevation myocardial infarction (STEMI). Methods: Ninety-seven patients with STEMI participated CR and 81 patients as a control group were included to the study. The trained patients were grouped according to the presence and persistence of QRS fragmentation on the electrocardiogram (ECG) before and after CR. If the fragmentation was present on the ECG at the beginning of the CR but not on the ECG at the end of CR; the transient group, if the fQRS persists after CR; the persistent fQRS group. ECGs obtained from the control group were grouped according to the presence of a fQRS on ECG. Results: Among the trained patients, 45 (46%) did not have a fQRS before CR, whereas 52 (54%) presented a fQRS before CR, which was persistent in 35 patients (the persistent fQRS group) and transient in 17 patients (the transient fQRS group). Among 81 patients included in the control group, fQRS was persistent in 41 patients. Presence of fQRS on the ECG was significantly decreased with CR and it is better in trained group than the control group (P=.034). There were not significant correlations with other characteristics, except hypertension. Conclusion: The existence of the fQRS decreases after CR in patients with STEMI especially in hypertensive individuals, which may be related to improved electrical stability in the myocardium as a predictor of increase in survival and decrease in major cardiac events

Assessment of 25-OH vitamin D levels and abnormal blood pressure response in female patients with cardiac syndrome X

Objective: Vitamin D deficiency is associated with coronary artery disease, hypertension, heart failure, endothelial dysfunction, and metabolic syndrome. The pathophysiology of cardiac syndrome X (CSX) involves many pathways that are influenced by vitamin D levels. This study aimed to investigate the relationship between vitamin D deficiency and abnormal blood pressure response to exercise in patients with CSX. Methods: This was a cross-sectional and observational study. Fifty females with normal epicardial coronary arteries who presented with typical symptoms of rest or effort angina and 41 healthy age-matched female controls, were included. Patients with cardiomyopathy, severe valvular disease, congenital heart disease, and left ventricular hypertrophy were excluded. All patients underwent stress electrocardiography examination and 25-hydroxy (OH) vitamin D level measurements. Results: Levels of 25-OH vitamin D were significantly lower in CSX patients (9.8±7.3 ng/mL vs. 18.1±7.9 ng/mL; p<0.001). Systolic blood pressure (SBP) (188±15 mm Hg vs. 179±17 mm Hg; p=0.013) and diastolic blood pressure (DBP) (98±9 mm Hg vs. 88±9 mm Hg; p<0.001) during peak exercise were higher in CSX patients. Levels of 25-OH vitamin D were negatively correlated with peak SBP (r=–0.310, p=0.004) and peak DBP (r=–0.535, p<0.001) during exercise. To discard the multicollinearity problem, two different models were used for multivariate analyses. In the first model, metabolic equivalents (METs) (p=0.003) and 25-OH vitamin D levels (p=0.001) were independent predictors. METs (p=0.007), 25-OH vitamin D levels (p=0.008), and peak DBP were determined as independent predictors in the second multivariate model. Conclusion: In patients with CSX, 25-OH vitamin D levels were lower than those in controls; moreover, 25-OH vitamin D deficiency was also associated with higher levels of peak DBP during exercise

Prediction of elevated left ventricular filling pressures in patients with preserved ejection fraction using longitudinal deformation indices of the left ventricle

WOS: 000366586000017PubMed ID: 25896356Aims Estimation of left ventricular (LV) filling pressures is a clinical challenge in patients with preserved ejection fraction (EF). In the present study, we investigated whether LV and atrial longitudinal strain and strain rate (SR) parameters derived by speckle tracking echocardiography (STE) could be used to predict invasively measured LV end-diastolic pressure (LVEDP) in this patient population. Methods and results LVEDP was measured before coronary angiography was performed in 65 patients with preserved EF (>= 50%) referred to elective cardiac catheterization; besides, patients enrolled underwent comprehensive echocardiographic examination before the procedure. In addition to conventional echocardiographic parameters used to evaluate diastolic function LV longitudinal strain and SR, as well as peak atrial longitudinal strain during LV systole, measurements were performed using STE. Only log-diastolic blood pressure, systolic SR, early diastolic SR, SR during isovolumetric relaxation (SRIVR), and mitral early diastolic flow velocity/SRIVR significantly correlated with LVEDP. When age-adjusted stepwise linear regression analysis was performed, SRIVRT values (beta = -20.682, t = -3.292; P = 0.002) and log-diastolic blood pressure levels (beta = 21.118, t = 3.784; P < 0.001) were independently correlated with LVEDP. Conclusion When compared with conventional echocardiographic parameters, other longitudinal strain, and SR indices, SRIVRT independently predicted LVEDP in conjunction with log diastolic blood pressure. We suggest that SRIVRT is a valuable parameter to evaluate diastolic function in patients with preserved EF

Adding lipoprotein(a) levels to the GRACE score to predict prognosis in patients with non-ST elevation acute coronary syndrome

WOS: 000322659700006PubMed ID: 23907902Background: High levels of lipoprotein(a) [Lp(a)] are known to be a cardiovascular risk factor associated with premature coronary artery disease. In predicting the long term prognosis in acute coronary syndromes (ACS), the relationship between Lp(a) and risk scoring systems remains unclear. Aim: We investigated whether adding Lp(a) to the GRACE scoring system has an incremental value in predicting prognosis in ACS. Methods: 115 patients (mean age 64 +/- 11 years) with non-ST elevation acute coronary syndromes (NSTE-ACS) were enrolled in this prospective study. Patients were categorised into quartiles according to the Lp(a) levels. Statistically significant variables in the univariate analysis (haemoglobin, creatinine, age, left ventricular ejection fraction, previous myocardial infarction (MI) history, Killip class) were included in the multivariate analysis to determine the independent predictors of cardiovascular outcomes (mortality, rehospitalisation) with and without Lp(a) quartiles for one year follow-up. Results: Previous MI history and Lp(a) quartile were detected as independent predictors of combined cardiovascular events (OR: 2.969 [95% CI 1.413-6.240] and OR: 6.279 [95% CI 1.363-28.927] respectively). Lp(a) quartile also remained as an independent predictor for prognosis when added to a model based on GRACE risk score (OR: 2.589 [95% CI 1.402-4.780]). Serum Lp(a) levels were moderately correlated with GRACE risk score (r = 0.371; p < 0.001). Conclusions: Lipoprotein(a) has an additional prognostic value over GRACE risk score in predicting one-year adverse outcomes in NSTE-ACS. The combination of serum Lp(a) with GRACE risk score could provide enhanced risk stratification in patients with ACS

Factor XIII Val34Leu polymorphism in patients with cardiac syndrome X

WOS: 000334851000002PubMed ID: 23677728Background: The aim of the study was to examine the frequency of factor XIII polymorphism among patients with cardiac syndrome X (CSX). Methods: This study was designed as a cross-sectional and observational study. Forty-eight female patients with CSX and 36 controls matched by age, gender, diabetes, and hypertension were studied. CSX was defined as typical chest pain during rest or effort, abnormal test result for exercise ECG, and presence of angiographically normal epicardial coronary arteries after ruling out inducible spasm. Factor XIII gene polymorphism was investigated by using CVD Strip Assay (ViennaLab Diagnostic GmbH) commercial kit. Results: The frequency of factor XIII (Val/Leu + Leu/Leu) mutation was significantly higher in patients with CSX (43%) than in controls (19%) (p = 0.02). Frequency of the Leu allele was significantly higher in the patient group (23.5% vs. 11.1%, p = 0.04). Factor XIII (Val//Leu + Leu/Leu) mutation (p = 0.01, OR = 3.42; 95% CI 1.22-9.58) and smoking (p = 0.04, OR = 3.33, 95% CI 1.05-10.58) were identified as independent predictors of the disease in multivariate regression analysis. Conclusions: This study indicates that there is an evidence for association between factor XIII Val34Leu polymorphism and CSX

Biküspit aort kapaklı hastalarda pulmoner arter ve sağ ventrikül fonksiyonları

Objective: Bicuspid aortic valve (BAV) is a complex developmental anomaly caused by abnormal aortic leaflet formation during valvulogenesis. The present study is an assessment of the effects of BAV disease on the ascending aorta and pulmonary artery (PA), and an evaluation of the consequences for systolic and diastolic functioning of the left and right ventricles. Methods: Total of 66 patients were eligible for inclusion. Pulmonary artery maximum diameter (PAD) was obtained 1 cm distal to the pulmonary annulus. Using pulsed-wave tissue Doppler imaging, left ventricular (LV) early diastolic velocity (E′) measurement was obtained at the annulus with placement of sample volume. Right ventricle (RV) peak global strain rate during systole (RV-SRS), early diastole (RV-SRE), and late diastole (RV-SRA) were calculated. Results: In this study, 40.9% (n=27) of patients were female and average age was 35±11years. RV-SRS values (β=-.781, t=-2.723; p=0.010) and log-LV tissue Doppler imaging E’ (β=2.996, t=-5.405; p=<0.001) were negatively correlated, and log-PAD (β=4.861, t=3.052; p=0.005) was positively and independently correlated with ascending aortic diameter. Conclusion: Ascending aorta diameter is positively correlated with PA diameter in BAV patients, and RV strain rate and LV diastolic parameters are affected before development of the valve disease.Amaç: Biküspit aort kapağı, valvulogenez sırasında anormal aorti kapakçık oluşumu sonucunda ortaya çıkan gelişimsel bir anomalidir. Bu çalışmada, biküspit aort kapak hastalığının pulmoner arter ve çıkan aortaya etkileri, bu durumun sağ ve sol ventrikül sistolik ve diyastolik fonksiyonları üzerine etkisi değerlendirildi.Yöntemler: Çalışmaya 66 hasta dahil edildi. Pulmoner arter en yüksek çapı (PAD), pulmoner anulusun 1 cm distalinden ölçüldü. Sol ventrikül (LV) erken diyastolik hızı, örnek hacim anulusa yerleştirilerek elde edildi. Sol ventrikül (LV) erken diyastolik hız (E'), doku Doppler görüntüleme tekniği kullanılarak ve örnek hacim anulusa yerleştirilerek elde edildi. Sağ ventrikül (RV) pik global strain hızı sistol (RV-SRS), erken diyastol (RV-SRE) ve geç diyastolde (RV-SRA) ölçüldü.Bulgular: Hastaların %40.9'u (n=27) kadın ve ortalama yaşları 35±11'di. Sağ ventrikül sistolik pik global strain hızı (?=0.781, t=-2.723; p=0.010) ve log-LV E' (?=-2.996, t=-5.405; p=<0.001) değerlerinin çıkan aorta çapı ile negatif, log-PAD (?=4.861, t=3.052; p=0.005) değerlerinin ise pozitif ve bağımsız ilişkili olduğu saptandı. Sonuç: Biküspit aort kapaklı hastalarda çıkan aort çapı ile pulmoner arter çapı arasında pozirtif bir korelason olduğunu ve RV strain hızı ve LV diyastolik parametrelerinin kapak hastalığı gelişmeden önce etkilendiğini saptadık