High-sensitive troponin T increase after hemodialysis is associated with left ventricular global longitudinal strain and ultrafiltration rate

Background: Circulating troponin levels are both stable and higher in patients with end-stage renal disease, even in the absence of acute coronary syndrome. These patients commonly have underlying cardiac problems that frequently cause troponin elevation. The effect of hemodialysis (HD) on troponin levels has not been well elucidated. Thus, investigated herein is the relationship between the changes in troponin levels along with left ventricular deformation and volume depletion in patients with end-stagerenal disease.Methods: Patients included were between 18 and 85 years of age and were receiving hemodialysis for at least 6 months. High sensitive cardiac troponin T (hs-cTnT) levels were studied in blood samples taken at the beginning and end of HD. Two-dimensional speckle tracking strain imaging was used to evaluate myocardial contractility.Results: Seventy patients (50.7 ± 16.9 years of age, 27 women) were included in study. The mean volume of ultrafiltration was 3260 ± 990 mL. A significant increase in circulating hs-cTnT levels was observed, as well as a prominent decrease in left ventricular global longitudinal strain (GLS) after HD (52.4 ± 40.2 ng/L vs. 66.8 ± 48.5 ng/L, p < 0.001 and 20.1 ± 3.6% vs. 16.8 ± 3.8% p < 0.001, respectively). Moreover, ultrafiltration rate and GLS were found as the strongest independent variables in relation to the relative increase in hs-cTnT.Conclusions: Hemodialysis can cause a significant increase in hsTnT. This can jeopardize the accuracy of clinical diagnoses based on hs-TnT measurements. GLS may be used as a determinant of this hs-TnT increase. The influence of HD on the cardiovascular system should be kept in mind to prevent unnecessary interventions

Eisenmenger Sendromlu Hastalarda Kalp Hızı Değişkenliği İle Ekokardiyografik Parametreler Ve Serum Belirteçleri Bnp Troponin I Arasındaki İlişki

Amaç: Günümüzde doğumsal kalp hastalıkları olan erişkin hastalara, gelişen cerrahi yöntemler ve spesifik tedavi ajanları sayesinde günlük pratiğimizde daha fazla rastlamaktayız. DKH ilişkili pulmoner hipertansiyonun en ileri safhası olan Eisenmenger sendromlu hastaların tedavisi ve takibi güncel kılavuzların önerisiyle yapılmaktadır. Tüm gelişmelere rağmen bu hastaların takibinde prognoz tayini açısından kısıtlılıklar olması nedeniyle prognostik değeri yüksek başka parametrelere ihtiyaç vardır. ES hastalarında otonomik disfonksiyon geliştiği ve kalp hızı değişkenliği ile otonomik disfonksiyonun değerlendirilebileceği bilinmektedir. Biz çalışmamızda; sağlıklı hasta grubu ile ES hastaları arasında kalp hızı değişkenliği parametrelerini karşılaştırmayı ve kılavuzlarca önerilen prognostik değeri bilinen ekokardiyografik parametreler ve biyokimyasal parametreler olan BNP, troponin-I düzeyleri arasındaki korelasyonu değerlendirmeyi amaçladık. Yöntem: Gazi Üniversitesi Kardiyoloji Polikliniği nde Eisenmenger Sendromu nedeniyle rutin olarak takip edilen, 18 yaş ve üzerinde olan, antiaritmik ilaç tedavisi almayan, son 6 ay içerisinde major cerrahi ve ciddi travma öyküsü bulunmayan, iskemik veya hemorajik serebrovasküler hadise ve aritmi öyküsü bulunmayan, akut kalp yetmezliği tablosunda olmayan 20 hasta ile herhangi bir 77 nedenle polikliniğe başvuran ve yapılan ekokardiyografisinde patoloji saptanmayan 20 sağlıklı gönüllü dahil edilmiştir. Bulgular: Eisenmenger sendromu olan hastalar ve sağlıklı gönüllüler 24 saatlik Holter EKG kaydı sonrası kalp hızı değişkenliği parametreleri açısından değerlendirildi. Zaman bazlı parametreler olan SDNN, SDANN, SDNNi, RMSSD ve TI açısından bakıldığında ES hastalarında sağlıklı gönüllülere kıyasla belirgin azalma izlendi. SDNN, 125,8±36,96 vs 173,30±34,47 (p<0,0001); SDNNi, 48,30±14,65 vs 71,65±19,74 (p<0,0001); SDANN, 116,15±37,22 vs 157,00±31,18 (p<0,0001); RMSSD 32,25±14,32 vs 39,05±14,98 (p=0,151); TI, 40,31±20,05 vs 48,45±14,16 (p=0,150) şeklinde saptandı. HRV parametreleri ile ekokardiyografik parametreler ve biyokimyasal parametreler iki değişkenli analizler ile değerlendirildiğinde aralarında korelasyon saptanmadı. Sonuç: Eisenmenger Sendromu nedeniyle takip edilen hastalarda bakılan, zaman bazlı kalp hızı değişkenliği parametrelerinde sağlıklı hasta grubuna kıyasla belirgin azalma saptanmıştır. Kılavuzlarca önerilen prognoz açısından önemi bilinen ekokardiyografik parametreler ve biyokimyasal parametreler olan Troponin-I ve BNP değerleri ile kalp hızı değişkenliği arasında korelasyon saptanmamıştır. Altgrup analizlerinde de hastalar arasında HRV parametreleri ile 78 cinsiyet, almakta oldukları tedavi, fonsiyonel kapasiteleri ve yaşları arasında korelasyon saptanmamıştır.Grown up congenital heart diseases (GUCH) are more common in our daily practise lately, as a result of improving surgical techniques and specific treatment agents. The treatment and follow up of patients with Eisenmenger sydrome (ES), which is the latest stage of congenital heart disease related pulmonary hypertension, is performed according to the up-to-date guidelines. Despite all improvements, there are several limitations of determining the prognosis of those patients. Therefore, different parameters with high prognostic values are needed. It is known that, patients with ES develop autonomic disfunction which can be evaluated with heart rate variability (HRV). The aim of this study is to compare parameters of heart rate variability in healthy volunteers and patients with ES and also to evaluate the correlation between based prognostic factors, which are echocardiographic parameters and the biochemical parameters BNP, troponin-I levels. Methods: 20 patiens with ES, who are routinely examined at Gazi University Hospital Cardiology Department outpatient clinic, with an age &#8805;18, not using antiarrhytmic drugs, have not undergone major surgery or trauma in the last 6 months, without an history of ischemic or hemorrhagic cerebrovascular events and arrhytmia, not in the phase of acute heart failure and 20 healthy volunteers 80 who were admitted to the out patient clinic with any complaints and had normal echocardiographic parameters were included in the study. Results: Patients with ES and healthy volunteers were evaluated according to parameters of heart rate variability after 24 hour Holter electrocardiography (ECG) recordings. According to the time based parameters, which are SDNN, SDANN, SDNNi, RMSSD and TI, significant decrease was noticed in patients with ES compared with healthy volunteers. The parameters were noted as SDNN, 125,8±36,96 vs 173,30±34,47 (p<0,0001); SDNNi, 48,30±14,65 vs 71,65±19,74 (p<0,0001); SDANN, 116,15±37,22 vs 157,00±31,18 (p<0,0001); RMSSD 32,25±14,32 vs 39,05±14,98 (p=0,151); TI, 40,31±20,05 vs 48,45±14,16 (p=0,150). No correlation was detected when HRV parameters, echocardiographic parameters and biochemical parameters were evaluated with analysis of two variables. Conclusion: Significant decrease of time based HRV parameters was observed in patients with ES, compared to healthy volunteers. No correlation was detected between echocardiographic parameters or the biochemical parameters, BNP, troponin-I levels and HRV. Also, in the subgroup analyses, no correlation was detected between the HRV parameters and gender, treatment modality, funcitonal capacity and age

Association between parathyroid hormone levels and the extensiveness of coronary artery disease.

Previous studies have suggested that there is a relationship between coronary artery disease (CAD) and parathyroid hormone (PTH) levels. Here, we aimed to evaluate the association between PTH levels and severity of CAD

Predictive value of supraventricular short runs for new-onset atrial fibrillation in patients with ischemic stroke

Background: The clinical importance of supraventricular run (SVR) is uncertain in the management of patients with previous cerebrovascular events. We aim to evaluate the role of SVRs in the development of future atrial fibrillation (AF) in patients diagnosed with ischemic stroke. Methods: We retrospectively evaluated patients who underwent 24-h Holter monitoring for the evaluation of possible AF after ischemic cerebrovascular events. The presence and duration of SVR were noted. Subsequent diagnosis of AF was searched in patients with sinus rhythm. Results: A total of 694 patients were included in the analysis. SVR was detected in 104 (14.9%) patients in the study group. Seventy-one (10.2%) patients were diagnosed with AF in the follow-up. SVRs were more prevalent among patients with AF (P < 0.001). The median atrial run duration was 5.96 (2.02–17.84) s in the AF absent group vs. 8.76 (3.78–17.62) s in the AF present group (P < 0.001). The best predictive cut-off duration of an atrial run was 8 s (sensitivity = 61.5% and specificity = 74.4%, Area Under Curve (AUC) = 0.708). Cox regression analysis showed that age (odds ratio [OR]: 1.03, 95% confidence interval [CI]: 1.00–1.060, P = 0.020), presence of short supraventricular run (OR: 2.53, 95% CI 1.40–4.57, P = 0.002), and left atrial diameter (OR: 1.13 95% CI: 1.07–1.19, P < 0.001) were the independent predictors of AF development in the follow-up. Conclusion: Age, left atrial diameter, and the presence of SVRs are associated with an increased risk of future AF after ischemic stroke. SVR duration may be an important parameter in risk stratification

High-sensitive troponin T increase after hemodialysis is associated with left ventricular global longitudinal strain and ultrafiltration rate.

Circulating troponin levels are both stable and higher in patients with end-stage renal disease, even in the absence of acute coronary syndrome. These patients commonly have underlying cardiac problems that frequently cause troponin elevation. The effect of hemodialysis (HD) on troponin levels has not been well elucidated. Thus, investigated herein is the relationship between the changes in troponin levels along with left ventricular deformation and volume depletion in patients with end-stage renal disease

Association of rs10757274 and rs2383206 Polymorphisms on 9p21 locus with Coronary Artery Disease in Turkish Population

Background and Objectives: Genetic predisposition is an important risk factor for coronary artery disease (CAD). In this study, we aimed to evaluate the impact of rs10757274 and rs2383206 polymorphisms in chromosome 9p21 on presence and severity of CAD in a Turkish population. Subjects and Methods: A total of 646 patients who underwent coronary angiography were included in this study. Coronary vessel score and Gensini score were calculated to assess the angiographic severity of CAD. Alleles of AA, AG, and GG were determined for rs10757274 (polymorphism-1) and rs2383206 (polymorphism-2) polymorphisms located in chromosome 9p21 from the blood samples. Results: There was a significant difference between the alleles in polymorphism-1 in the presence of coronary artery disease (38.9% in AA, 48.0% in GG and 56.4% in AG, p=0.017). However, there was no difference between the alleles in polymorphism-2. According to vessel scores, there was a significant difference between the alleles in polymorphism-1 (AA 0.71 +/- 1.04, GG 0.88 +/- 1.07, AG 1.06 +/- 1.12, p=0.018). In polymorphism-2, vessel scores did not show a difference between the alleles. In polymorphism-1, there was a significant difference in Gensini score (p=0.041). Gensini scores did not differ between the alleles in polymorphism-2 (p>0.05 for all). In multivariate analyses, none of the alleles was an independent factor for presence of CAD. Conclusion: The presence of rs10757274 polymorphism including AG allele in chromosome 9p21 was related to CAD. However, this relationship was not independent of other cardiovascular risk factors