The relationship between epicardial fat thickness and gestational diabetes mellitus

Aim: Gestational diabetes mellitus (GDM) is associated with cardiovascular diseases; however, the relationship between epicardial fat thickness (EFT) and GDM remains unclear. The present study evaluates and compares EFT using transthoracic echocardiography in pregnant women with GDM. Materials and methods: This cross-sectional study included 129 pregnant women in the third trimester: 65 with GDM (GDM group) and 64 with uncomplicated pregnancies (control group). As defined by the World Health Organization, the diagnosis of GDM was based on an abnormal 2-h oral glucose tolerance test (OGTT) results. We used echocardiography to measure EFT in blood samples for all the participants. Results: The postprandial blood glucose level was significantly higher in the GDM group than in the control group (P < 0.001). There were no significant differences in BMI, heart rate, systolic and diastolic blood pressure or lipid parameters between the groups. In the GDM group, isovolumic relaxation time (IVRT) parameters were significantly higher than in the control group. EFT was significantly higher in the GDM group (P < 0.001) and was correlated with postprandial glucose, BMI, age, and heart rate in both the groups. Only postprandial glucose and BMI remained significantly associated with EFT after multiple stepwise regression analysis. Conclusion: Echocardiographically measured EFT was significantly higher in the patients with GDM. The findings show that EFT was strongly correlated with postprandial glucose. © 2014 Nar et al

Post-discharge heart failure monitoring program in Turkey: Hit-PoinT

Objective: The aim of this study was to assess the efficacy and feasibility of an enhanced heart failure (HF) education with a 6-month telephone follow- up program in post-discharge ambulatory HF patients. Methods: The Hit-Point trial was a multicenter, randomized, controlled trial of enhanced HF education with a 6-month telephone follow-up program (EHFP) vs routine care (RC) in patients with HF and reduced ejection fraction. A total of 248 patients from 10 centers in various geographical areas were randomized: 125 to EHFP and 123 to RC. Education included information on adherence to treatment, symptom recognition, diet and fluid intake, weight monitoring, activity and exercise training. Patients were contacted by telephone after 1, 3, and 6 months. The primary study endpoint was cardiovascular death. Results: Although all-cause mortality didn't differ between the EHFP and RC groups (p=NS), the percentage of cardiovascular deaths in the EHFP group was significantly lower than in the RC group at the 6-month follow up (5.6% vs. 8.9%, p=0.04). The median number of emergency room visits was one and the median number of all cause hospitalizations and heart failure hospitalizations were zero. Twenty-tree percent of the EHFP group and 35% of the RC group had more than a median number of emergency room visits (p=0.05). There was no significant difference regarding the median number of all-cause or heart failure hospitalizations. At baseline, 60% of patients in EHFP and 61% in RC were in NYHA Class III or IV, while at the 6-month follow up only 12% in EHFP and 32% in RC were in NYHA Class III or IV (p=0.001). Conclusion: These results demonstrate the potential clinical benefits of an enhanced HF education and follow up program led by a cardiologist in reducing cardiovascular deaths and number of emergency room visits with an improvement in functional capacity at 6 months in post-discharge ambulatory HF patients.Türk Kardiyoloji Derneği Kalp Yetmezliği Çalışma Grub

Temperature Effects Explain Continental Scale Distribution of Cyanobacterial Toxins

Insight into how environmental change determines the production and distribution of cyanobacterial toxins is necessary for risk assessment. Management guidelines currently focus on hepatotoxins (microcystins). Increasing attention is given to other classes, such as neurotoxins (e.g., anatoxin-a) and cytotoxins (e.g., cylindrospermopsin) due to their potency. Most studies examine the relationship between individual toxin variants and environmental factors, such as nutrients, temperature and light. In summer 2015, we collected samples across Europe to investigate the effect of nutrient and temperature gradients on the variability of toxin production at a continental scale. Direct and indirect effects of temperature were the main drivers of the spatial distribution in the toxins produced by the cyanobacterial community, the toxin concentrations and toxin quota. Generalized linear models showed that a Toxin Diversity Index (TDI) increased with latitude, while it decreased with water stability. Increases in TDI were explained through a significant increase in toxin variants such as MC-YR, anatoxin and cylindrospermopsin, accompanied by a decreasing presence of MC-LR. While global warming continues, the direct and indirect effects of increased lake temperatures will drive changes in the distribution of cyanobacterial toxins in Europe, potentially promoting selection of a few highly toxic species or strains.Peer reviewe

An unusual etiology of ischemic stroke: Woven coronary artery anomaly

Woven coronary artery is extremely rare and is still not a clearly defined coronary anomaly in which epicardial coronary artery is divided into multiple thin channels at any segment of the coronary artery, and subsequently, these multiple channels merge again in a normal conduit. The described cases were usually incidentally detected and were considered a benign pathology. But, malignant cases with developing complications such as ischemia, infarction, and arrhythmia are increasing in the literature. In this report, we present a young man with a woven right coronary artery associated with a silent myocardial infarction, inferobasal segment acinesia, an area of scarring, and cardioembolic stroke thought from the scar area. Although it is reported as a benign coronary anomaly in the literature, we should be careful especially in terms of the complications that it causes. Keywords: Inferobazal-segment acinesia, Ischemic stroke, Woven coronary anomal

Calcification of breast artery as detected by mammography: association with coronary and aortic calcification

WOS: 000458367000027PubMed: 30764597Background/aim: Coronary artery calcification (CAC) and aortic calcification (AC) are significant risk factors for coronary atherosclerosis. This study investigated how breast arterial calcification (BAC) detected from routine mammography correlates with coronary artery calcification and aortic calcification. Materials and methods: A total of 404 female patients above 40 years of age who, within a 6-month period, had undergone thoracic computed tomography and mammography for various reasons were screened retrospectively at our clinic. Mammographies were assessed for BAC and thoracic CT investigations were assessed for CAC and AC. Patients included in the study were scored as 0 (none), 1 (mild), 2 (moderate), or 3 (severe) depending on the number and shape of CAC, AC, and BAC lesions observed. Results: Four hundred and four females were enrolled in the study. While BAC was detected in 123 patients, no BAC was observed in the other 281 patients. In the BAC-positive patients, the rates of CAC (45.5% vs. 19.9%, P < 0.001) and AC (67.5% vs. 32.4%, P < 0.001) were notably higher than in the BAC-negative patients. In addition, multivariate regression analysis detected the presence of BAC as an independent variable for both CAC and AC. Conclusion: The presence of BAC appeared to be a significant risk factor for CAC and AC, and the BAC grade was considered an independent risk factor for CAC

Relation of the aortic stiffness with the GRACE risk score in patients with the non ST-segment elevation myocardial infarction.

İstanbul Bilim Üniversitesi, Tıp Fakültesi.BACKGROUND: Current guidelines recommend clinical risk scoring systems for the patients diagnosed and determinated treatment strategy with in Non-ST-elevation elevation myocardial infarction (NSTEMI). Previous studies demonstrated association between aortic elasticity properties, stiffness and severity CAD. However, the associations between Aortic stiffness, elasticity properties and clinical risk scores have not been investigated. In the present study we have evaluated the relation between the Global Registry of Acute Coronary Events (GRACE) risk score and aortic stiffness in patients with NSTEMI. METHOD: We prospectively analyzed 87 consecutive patients with NSTEMI. Aortic elastic parameter and stiffness parameter were calculated from the echocardiographically derived thoracic aortic diameters (mm/m(2)), and the measurement of pulse pressure obtained by cuff sphygmomanometry. We have categorized the patients in to two groups as low ((n = 45) (GRACE risk score ≤ 140)) and high ((n = 42) (GRACE risk score > 140)) risk group according to GRACE risk score and compare the both groups. RESULTS: Table 1 shows baseline characteristics of patients. Our study showed that Aortic strain was significantly low (3.5 ± 1.4, 7.9 ± 2.3 respectively, p < 0.001) and aortic stiffness index was significantly high (3.9 ± 0.38; 3 ± 0.35, respectively, p < 0.001) in the high risk group values compared to those with low risk group. The aortic stiffness index was the only independent predictor of GRACE risk score (OR: 119.390; 95% CI: 2.925-4872.8; p = 0.011) in multivariate analysis. CONCLUSION: We found a significant correlation between aortic stiffness, impaired elasticity and GRACE risk score. Aortic stiffness index was the only independent variable of the high GRACE risk score. The inclusion of aortic stiffness into the GRACE risk score could allow improved risk classification of patients with ACS at admission and this may be important in the diagnosis, follow up and treatment of the patients

Relation of the aortic stiffness with the GRACE risk score in patients with the non ST-segment elevation myocardial infarction

WOS: 000345121000087PubMed ID: 25356178Background: Current guidelines recommend clinical risk scoring systems for the patients diagnosed and determinated treatment strategy with in Non-ST-elevation elevation myocardial infarction (NSTEMI). Previous studies demonstrated association between aortic elasticity properties, stiffness and severity CAD. However, the associations between Aortic stiffness, elasticity properties and clinical risk scores have not been investigated. In the present study we have evaluated the relation between the Global Registry of Acute Coronary Events (GRACE) risk score and aortic stiffness in patients with NSTEMI. Method: We prospectively analyzed 87 consecutive patients with NSTEMI. Aortic elastic parameter and stiffness parameter were calculated from the echocardiographically derived thoracic aortic diameters (mm/m(2)), and the measurement of pulse pressure obtained by cuff sphygmomanometry. We have categorized the patients in to two groups as low ((n = 45) (GRACE risk score 140)) risk group according to GRACE risk score and compare the both groups. Results: Table 1 shows baseline characteristics of patients. Our study showed that Aortic strain was significantly low (3.5 +/- 1.4, 7.9 +/- 2.3 respectively, p < 0.001) and aortic stiffness index was significantly high (3.9 +/- 0.38; 3 +/- 0.35, respectively, p < 0.001) in the high risk group values compared to those with low risk group. The aortic stiffness index was the only independent predictor of GRACE risk score (OR: 119.390; 95% CI: 2.925-4872.8; p = 0.011) in multivariate analysis. Conclusion: We found a significant correlation between aortic stiffness, impaired elasticity and GRACE risk score. Aortic stiffness index was the only independent variable of the high GRACE risk score. The inclusion of aortic stiffness into the GRACE risk score could allow improved risk classification of patients with ACS at admission and this may be important in the diagnosis, follow up and treatment of the patients