Yüksek duyarlıklı C-reaktif protein düzeyleri ve safen ven greft hastalığı arasındaki ilişkinin değerlendirilmesi

Amaç: Bu çalışmada safen ven greft hastalığı (SVGH) ile yüksek duyarlıklı C-reaktif protein (hs-CRP) seviyeleri arasındaki ilişki değerlendirildi. Çalışma planı: Çalışmaya koroner arter baypas greft ameliyatı öyküsü olan, önceden belirlenen objektif kriterlere göre koroner anjiyografi yapılan toplam 78 hasta (54 erkek, 24 kadın; ort. yaş 60.4±9.4 yıl; dağılım 37-78 yıl) dahil edildi. Ateroskleroza neden olan risk faktörleri sorgulandı ve tüm hastaların biyokimyasal testleri çalışıldı. Safen ven greftlerden herhangi birinde %50 ve daha fazla darlık olması SVGH olarak tanımlandı. Hastalar SVGH olan (grup 1) ve SVGH olmayanlar (grup 2) olmak üzere iki gruba ayrıldı. Bulgular: Her iki grubun demografik özellikleri ve laboratuvar değerleri karşılaştırıldığında, grup 1’de vücut kütle indeksi (VKİ), total kolesterol/yüksek yoğunluklu lipoprotein (HDL) kolesterol, ürik asit (ÜA) ve hs-CRP düzeyleri anlamlı oranda yüksek olup, HDL kolesterol düzeyi anlamlı oranda düşüktü. Yapılan çok değişkenli lojistik regresyon analizinde VKİ, ÜA ve hs-CRP düzeylerinin SVGH’yi öngörmede bağımsız belirteçler olduğu tespit edildi (hs-CRP OR: 1.522, p<0.01, ÜA OR: 1.48, p=0.01, VKİ OR: 1.31, p=0.04). Yapılan ROC analizinde hs-CRP düzeyi 0.8 mg/dL ‘‘kesim değeri’’ olarak alındığında %80 duyarlılık ve %85 özgüllük oranı ile SVGH’yi belirlediği bulundu. Sonuç: Çalışmamızda SVGH’yi öngördüren en güçlü belirtecin hs-CRP olduğu saptandı. Yüksek duyarlıklı C-reaktif protein, SVGH varlığını öngörme ve izleminde noninvaziv, güvenilir ve yararlı bir belirteçtir.Background: In this study, we aimed to evaluate the relationship between the levels of high-sensitivity C-reactive protein (hs-CRP) and saphenous venous graft disease (SVGD). Methods: A total of 78 patients (54 males, 24 females; mean age 60.4&plusmn;9.4 years; range 37 to 78 years) with previous history of coronary artery bypass graft (CABG) surgery who underwent coronary angiography based on predetermined objective clinical criteria were included. Risk factors leading to atherosclerosis were questioned and biochemical tests were studied in all patients. A 50% or more stenosis in at least one of the saphenous vein grafts was defined as SVGD. The patients were divided in two groups according to the presence of SVGD (group 1), and the absence of SVGD (group 2). Results: When we compared the demographic characteristics and laboratory findings of both groups, body mass index (BMI), total cholesterol/high-density lipoprotein (HDL) cholesterol ratio, uric acid (UA) and hs-CRP levels were significantly higher, while HDL cholesterol level was significantly lower in group 1. Multivariate logistic regression analysis showed that BMI, UA and hs-CRP levels were independent predictors of SVGD (hs-CRP OR: 1.522, p&lt;0.01, UA OR: 1.48, p=0.01, BMI OR: 1.31, p=0.04). The ROC analysis demonstrated that a 0.8 mg/dL hs-CRP cut-off value indicated SVGH with a 80% sensitivity and 85% specificity rate. Conclusion: In our study, hs-CRP was found to be the most powerful predictor of SVGD. High-sensitivity-C-reactive protein is a noninvasive, reliable and useful parameter in the prediction and monitoring of SVGD

Fibrinogen to albumin ratio’s prognostic value in ischemic stroke patients who underwent mechanical thrombectomy

Background and purpose – Fibrinogen to albumin ratio (FAR) is thought to have a predictive effect in diseases such as cancer and myocardial infarction. We aimed to elucidate the prognostic value of FAR in ischemic stroke patients who underwent mechanical thrombectomy. Methods – A total of 103 patients hospitalized for acute stroke who underwent mechanical thrombectomy within 6 hours of symptoms’ outset have been analyzed retrospectively. Stroke severity was interpreted via the National Institutes of Health Stroke Scale (NIHSS) score during the neurological examination. Recanalization success after mechanical thrombectomy was evaluated with the TICI score (Thrombolysis in Cerebral Infarction scale), and 2b – 3 patients were recorded as those with recanalization. The patients’ modified Rankin scale (mRS) at discharge and at the end of the third month were recorded. Results – Statistically significant differences were observed in age, admission blood glucose, glomerular filtration rate and FAR according to the mRS scores of the patients in the third month (p<0.05). Significant variables in the risk factor analysis were re-evaluated in the multivariate model. The best model was determined using the backward Wald method in the multivariate model,and it was determined that differences in age, admission blood glucose, and FAR were significant. Conclusion – FAR can be used as a novel, effective, economical, and practical biomarker in patient with acute ischemic stroke who underwent mechanical thrombectomy

The frequency of aspirin resistance by a modified thrombelastography method and its relationship with clinical and laboratory parameters in patients with stable coronary artery disease

Amaç: Kardiyovasküler hastalıklarda antitrombosit tedavinin temelini oluşturan aspirinle tedavi edilen hastalarda %0.4 ile %83.3 arasında değişen oranlarda aspirin direncine rastlanmaktadır. Bu çalışmada, kararlı koroner arter hastalığı (KAH) tanısı ile takip edilen ve 100 mgr/gün aspirin kullanan hastalarda modifiye tromboelastogram (mTEG) yöntemi kullanılarak aspirin direnci sıklığı ve aspirin direnci ile ilişkili klinik ve biyokimyasal parametrelerin araştırılması amaçlandı. Çalışma planı: Çalışmaya kararlı KAH tanısı ile izlenen ve 100 mgr/gün aspirin kullanan 168 hasta (115 erkek, 53 kadın; ort. yaş 60±8) alındı. Aspirine verilen yanıt mTEG yöntemi ile belirlendi. Bu yöntemde tam kanda araşidonik asitle oluşturulan trombosit agregasyon inhibisyonunun (TAİ) %50’nin altında olması aspirin direnci olarak kabul edildi. Bulgular: Yirmi yedi hastada (%16.1) aspirin direncine rastlandı. Trombosit agregasyon inhibisyon düzeyi, hiperlipidemi, sigara kullanımı, spironolakton kullanımı, sistolik kan basıncı, nabız basıncı, total kolesterol ve fibrinojen ile negatif ilişki gösterdi. Çoklu regresyon analizinde, bunlar arasında sadece fibrinojen düzeyi (OO=1.063, p=0.010) ve nabız basıncının (OO=1.197, p=0.023) aspirin direnci ve TAİ’yi öngörmede bağımsız gösterge olduğu saptandı. Alıcı işletim karakteristiği analizinde, kesim değeri olarak nabız basıncı 50 mmHg ve fibrinojen değeri 400 mgr/dl alındığında, bunların aspirin direncini öngörmede duyarlığı sırasıyla %88.9 ve %74, özgüllüğü %64.4 ve %68 bulundu. Sonuç: Fibrinojen düzeyi ve nabız basıncı ölçümünün aspirin direncini öngörmede kolay ve kullanışlı yöntemler olduğu düşünüldü.Objectives: Aspirin is the cornerstone of antiplatelet therapy in cardiovascular medicine. However, aspirin resistance has been demonstrated in 0.4% to 83.3% of aspirin-receiving patients. The aim of this study was to investigate the frequency of aspirin resistance using a modified thrombelastography (mTEG) method and re- lated clinical and biochemical parameters in patients with stable coronary artery disease (CAD), who received 100 mg/day aspirin. Study design: The study included 168 patients (115 males, 53 females; mean age 60±8 years) with stable CAD, receiv- ing aspirin at a dose of 100 mg/day. Aspirin responsiveness was determined using mTEG, where aspirin resistance was defined as arachidonic acid-induced whole blood platelet aggregation inhibition (PAI) of less than 50%. Results: Aspirin resistance was detected in 27 patients (16.1%). Platelet aggregation inhibition showed negative correlations with hyperlipidemia, smoking, spironolac- tone use, systolic blood pressure, pulse pressure, and total cholesterol and fibrinogen levels. In multivariate regression analysis, only fibrinogen level (OR=1.063, p=0.010) and pulse pressure (OR=1.197, p=0.023) were found to be independent indicators of aspirin resistance and PAI. In ROC analysis, cut-off values of 50 mmHg for pulse pressure and 400 mg/dl for fibrinogen level predict- ed aspirin resistance with 88.9% and 74% sensitivity and 64.4% and 68% specificity, respectively. Conclusion: Our findings suggest that measurements of fibrinogen level and pulse pressure may be used as easy and reliable methods in predicting aspirin resistance

Wartość prognostyczna nowo zdefiniowanej skali CHA2DS2-VASc-HSF w ocenie stopnia ciężkości choroby wieńcowej u chorych z zawałem serca z uniesieniem odcinka ST

Background: CHADS2 and CHA2DS2-VASc scores are widely used in clinical practice and include similar risk factors for the development of coronary artery disease (CAD). It is known that the factors comprising the newly defined CHA2DS2-VASc-HSF score promote atherosclerosis and are associated with severity of CAD. Aim: To investigate the association of the CHA2DS2-VASc-HSF score with the severity of CAD as assessed by SYNTAX score (SxS) in patients with ST segment elevation myocardial infarction (STEMI). Methods: A total of 454 consecutive patients with STEMI (males 79%, mean age 57.3 ± 12.9 years), who underwent primary percutaneous coronary intervention were included in our study. The patients were divided into three groups according to the SxS tertiles: low SxS group (SxS &lt; 14; 151 patients), intermediate SxS group (SxS 14–20; 152 patients), and high SxS group (SxS ≥ 21; 151 patients). Results: The CHADS2, CHA2DS2-VASc, and CHA2DS2VASc-HSF scores were found to be significantly different among the SxS groups (p &lt; 0.001, p &lt; 0.001, and p &lt; 0.001). After multivariate analysis, the CHA2DS2-VASc-HSF score was associated with high SxS (odds ratio [OR] 1.258, 95% confidence interval [CI] 1.026–1.544; p = 0.028) together with age (OR 1.032, 95% CI 1.013–1.050; p = 0.001) and ejection fraction (OR 0.927, 95% CI 0.901–0.955; p &lt; 0.001). Conclusions: A newly diagnosed CHA2DS2-VASc-HSF score predicts the severity of atherosclerosis in patients with STEMI.Wstęp: Skale CHADS2 i CHA2DS2-VASc są powszechnie stosowane w praktyce klinicznej. Uwzględniają one podobne czynniki ryzyka rozwoju choroby wieńcowej (CAD). Wiadomo, że czynniki zawarte w nowo zdefiniowanej skali CHA2DS2-VASc-HSF sprzyjają rozwojowi miażdżycy i wiążą się ze stopniem ciężkości CAD. Cel: Celem pracy było zbadanie związków między oceną w skali CHA2DS2-VASc-HSF a stopniem ciężkości CAD określonym za pomocą skali SYNTAX (SxS) u chorych z zawałem serca z uniesieniem odcinka ST (STEMI). Metody: Do badania włączono 454 kolejnych chorych z STEMI (mężczyźni 79%, średnia wieku 57,3 ± 12,9 roku) poddanych pierwotnej przezskórnej interwencji wieńcowej. Pacjentów podzielono na trzy grupy w zależności od tercyla punktacji w skali SxS: grupa z niską punktacją w skali SxS (SxS &lt; 14; 151 chorych), grupa z pośrednią punktacją w skali SxS (SxS 14–20; 152 chorych) i grupa z wysoką punktacją w skali SxS (SxS ≥ 21; 151 chorych). Wyniki: Stwierdzono, że między grupami SxS występowały istotne różnice w punktacji w skalach CHADS2, CHA2DS2-VASc i CHA2DS2VASc-HSF (p &lt; 0,001; p &lt; 0,001 i p &lt; 0,001). Po przeprowadzeniu analizy wieloczynnikowej punktacja w skali CHA2DS2-VASc-HSF wiązała się z wysokim wskaźnikiem SxS (iloraz szans [OR] 1,258; 95% przedział ufności [CI] 1,026–1,544; p = 0,028) oraz z wiekiem (OR 1,032, 95% CI 1,013–1,050; p = 0,001) i frakcją wyrzutową (OR 0,927; 95% CI 0,901–0,955; p &lt; 0,001). Wnioski: Nowo zdefiniowana skala CHA2DS2-VASc-HSF umożliwia ocenę stopnia ciężkości zmian miażdżycowych u chorych z STEMI.

Związek między niedoborem witaminy D a krętym przebiegiem tętnic wieńcowych

Background: Increasing evidence suggests a relationship between vitamin D (VD) insufficiency and cardiovascular disease. Aim: We aimed to investigate the association between serum 25-hydroxyvitamin D (25-OH VD) with coronary tortuosity (CT) in patients with normal or near-normal (&lt; 40% stenosis) coronary arteries. Methods: The present study was cross-sectional and observational. We enrolled 356 consecutive patients who had undergone coronary angiography for suspected ischaemic heart disease and were found to have normal or near-normal coronary arteries. Patients were categorised as VD insufficient (&lt; 30 ng/mL) or VD sufficient (≥ 30 ng/dL). CT was defined as the presence of ≥ three bends (defined as ≥ 45° change in vessel direction) along the main trunk of at least one coronary artery, present both in systole and in diastole. Results: The study populations were divided into two groups according to the presence of CT: patients with CT (n = 103, 29%) and patients without CT (NCT; n = 253, 71%). CT is more frequently seen in elderly women and is positively correlated with hypertension. The incidence of VD insufficiency was significantly higher in the CT group (n = 46, 45%) than in the NCT group (n = 90, 36%; p = 0.005). In further multivariate logistic regression analyses, adjustment for major clinical parameters affecting CT showed statistically significant correlations between 25-OH VD and CT (odds ratio = 0.77, 95% confidence interval 0.66–0.98, p = 0.006). Conclusions: Vitamin D insufficiency was independently associated with coronary tortuosity.Wstęp: Coraz więcej danych wskazuje na związek niedoboru witaminy D (VD) z chorobami sercowo-naczyniowymi. Cel: Badanie przeprowadzono w celu oceny zależności między stężeniem 25-hydroksywitaminy D (25-OH VD) w surowicy a krętym przebiegiem tętnic wieńcowych u chorych z prawidłowymi lub nieznacznie zmienionymi (zwężenie &lt; 40%) tętnicami wieńcowymi. Metody: Badanie miało charakter przekrojowy i obserwacyjny. Włączono do niego 356 kolejnych pacjentów poddanych koronarografii z powodu podejrzenia choroby niedokrwiennej serca i u których stwierdzono prawidłowy lub nieznacznie zmieniony obraz tętnic wieńcowych. Chorych podzielono na dwie grupy: osoby z niedoborem VD (&lt; 30 ng/ml) oraz osoby z prawidłowym stężeniem VD (≥ 30 ng/dl). Kręty przebieg tętnic wieńcowych definiowano jako obecność ≥ 3 zagięć (określonych jako zmiana kierunku przebiegu naczynia o ≥ 45°) w głównej części co najmniej jednej tętnicy wieńcowej, widocznych zarówno w czasie skurczu, jak i rozkurczu. Wyniki: Badaną populację podzielono na dwie grupy w zależności od występowania krętego przebiegu naczyń: osoby z krętym przebiegiem tętnic wieńcowych (CT; n = 103, 29%) i osoby bez krętego przebiegu tętnic wieńcowych (NCT; n = 253, 71%). Kręty przebieg tętnic wieńcowych występuje częściej u kobiet w podeszłym wieku i jest dodatnio skorelowany z nadciśnieniem tętniczym. Niedobór VD występował istotnie częściej w grupie CT (n = 46, 45%) niż w grupie NCT (n = 90, 36%; p = 0,005). W wieloczynnikowej analizie regresji logistycznej wykazano, po skorygowaniu względem najważniejszych parametrów klinicznych wpływających na krętość tętnic, statystycznie istotną korelację między stężeniem 25-OH VD a krętym przebiegiem tętnic wieńcowych (iloraz szans = 0,77; 95% przedział ufności 0,66–0,98; p = 0,006). Wnioski: Niedobór VD był niezależnie związany z krętym przebiegiem tętnic wieńcowych