Hiponatremi tedavisinde vaptan kullanımı

Hyponatremia is the most prevalent electrolyte imbalance, and may be present in up to 30% of hospitalized patients. It is an important predictor of in-hospital mortality. Irrespective of the reason underlying hyponatremia, water metabolism plays an important role. Arginine-vasopressin, which has cardiovascular effects and plays a role in water metabolism, is released from the posterior hypothalamus in response to an increase in plasma osmolality or a drop in the blood pressure, which are detected by osmoreceptors and baroreceptors respectively. Arginine-vasopressin has receptors located on vascular smooth muscle cells, the heart (V1a), the collecting ducts of the renal medulla (V2), the anterior pituitary gland (V1b) and many other organs. Arginine-vasopressin antagonists, known as “vaptans”, have recently attracted attention for the treatment of chronic hypotonic hyponatremia. In this review, we focus on the diagnosis and classification of hyponatremia, current trends in its treatment in the light of guidelines, and the rationale of using vaptans in treating hyponatremia. We also briefly review cornerstone studies in the literature regarding vaptans, and the correct indications, contraindications and cautions in the use of “tolvaptan” and “conivaptan”, two approved vaptans for this indication

The relationship between serum uric acid levels and angiographic severity of coronary heart disease

Background: Many studies have shown that the serum uric acid (SUA) level is associated with atherosclerosis. Aim: To determine the relationship between the SUA level and the presence and severity of coronary heart disease (CHD). Methods: A total of 705 patients who underwent coronary angiography were included in this study. All patients were assessed for the presence of cardiovascular risk factors and ongoing medications. SUA levels were measured in all patients before the procedure after 12 h of fasting. The severity of CHD was assessed by the SYNTAX score. The independent association between the SUA and the severity of CHD was statistically evaluated using IBM SPSS Statistics 21 for Windows. Results: The mean age of the study population was 60.2 +/- 11.0 years. 252 were female (35.7%) and 453 were male (64.3%). Of the patients, 59.0% had significant CHD, 34.6% had diabetes mellitus, 67.7% had hypertension, 55.3% had hyperlipidaemia, and 45.4% were current smokers. The mean SYNTAX score was 10.6 +/- 12.9. According to the SYNTAX score, 289 of the patients (41%) had normal coronary arteries and non-significant CHD (controls, SYNTAX score: 0), 236 of the patients (33.5%) had mild CHD (SYNTAX score: 1-22), 97 (13.8%) had moderate CHD (SYNTAX score: 23-32), and 83 (11.8%) had severe CHD (SYNTAX score: >= 33). The mean SUA values were 5.3 +/- 1.5 mg/dL in the control group, 5.6 +/- 1.4 mg/dL in the mild CHD group, 6.2 +/- 1.6 mg/dL in the moderate CHD group, and 6.5 +/- 1.7 mg/dL in the severe CHD group. According to Spearman's rho analysis, a positive correlation between the SUA levels and the SYNTAX score was determined to be statistically significant (p < 0.001, r = 0.239; p = 0.002, r = 0.148 in men; p = 0.001, r = 0.204 in women). Conclusions: In this study, we found a positive correlation between the SUA level and the SYNTAX score. Therefore, this routine biochemical test can be used for the evaluation of the severity of CHD besides other risk factors in clinical practice. However, larger scale randomised studies are needed to show the effects of SUA on the severity of CHD

Arterial stiffness and central arterial wave reflection are associated with serum uric acid, total bilirubin, and neutrophil-to-lymphocyte ratio in patients with coronary artery disease

Objective: Total bilirubin (TB) was recently recognized as an endogenous anti-inflammatory and anti-oxidant molecule. Uric acid (UA) takes part in cardiovascular diseases by inducing oxidative stress, inflammation, and endothelial dysfunction. We assessed the relationship between serum TB levels, serum UA levels, and inflammatory status assessed by neutrophil-to-lymphocyte ratio (N/L) and arterial stiffness and arterial wave reflection in patients with a clinical diagnosis of coronary artery disease (CAD). Methods: We included 145 consecutive patients admitted with stable angina pectoris (SAP) or acute coronary syndrome (ACS). Blood samples were drawn at admission for complete blood count and biochemistry. Non-invasive pulse waveform analysis for the determination of augmentation index (AIx) and carotid-femoral pulse wave velocity (PWV) measurements were performed with the commercially available SphygmoCor system. Results: When patients were divided into tertiles of PWV and AIx, median N/L and median serum UA levels were the highest and mean TB levels were the lowest in the third tertile (p<0.001 for all). AIx and PWV were positively associated with serum UA and N/L and negatively associated with serum TB levels (p<0.001 for all). After adjustments for age, gender, heart rate, systolic blood pressure, and presence of diabetes, significant correlations persisted for N/L, UA, and TB in ACS patients (p<0.05). In the SAP group, TB was significantly negatively correlated with AIx and PWV, and UA was significantly positively correlated with PWV (p<0.05). Conclusion: N/L ratio and serum UA and TB levels might be used to risk-stratify patients with respect to arterial stiffness in CAD patients, especially in the presence of ACS

Nötrofil lenfosit oranı daha yaygın, ciddi, kompleks koroner arter hastalığı ve miyokart perfüzyonunda bozulma ile ilişkilidir

We investigated the relation between neutrophil to lymphocyte ratio (N/L) and the extent, severity, and complexity of coronary artery disease (CAD) and myocardial perfusion. Study design: One hundred and fifty-one patients who underwent coronary angiography with stable angina pectoris (SAP) (n=93) or acute coronary syndrome (ACS) (n=58) were included in the study. Blood samples were drawn before coronary angiography. Gensini and SYNTAX scores and myocardial blush grade (MBG) were assessed. Results: Neutrophil counts were 4.4±1.4 and 5.0±1.6 in the SAP and ACS groups (p=0.018), whereas lymphocyte counts were 2.2±0.7 and 2.1±0.7, respectively (p=0.104). N/L was 2.2±1.2 in the SAP and 2.6±1.0 in the ACS (p=0.002) groups. In patients with SAP, N/L was significantly correlated with Gensini and SYNTAX scores (Gensini score r=0.32, p=0.002; SYNTAX score r=0.36, p=0.000), but there was no significant correlation between N/L and MBG. In the ACS group, N/L had a more powerful association with both Gensini and SYNTAX scores (Gensini r=0.42, p=0.001; SYNTAX r=0.51, p=0.000). N/L was negatively correlated with MBG in ACS patients (r= -0.48, p=0.000). Significant correlations persisted both in the SAP and ACS groups after correcting for age, diabetes, hyperlipidemia, and statin use; however, the associations were weaker. Cut-off N/L to predict moderate to severe CAD according to SYNTAX score was 2.26, with 72% sensitivity and 71% specificity (area under the curve [AUC]: 0.772, 95% confidence interval [CI] 0.679-0.865, p<0.001). Conclusion: N/L is associated with severe, extensive and complex CAD and may be used to predict moderate to severe involvement in patients with CAD

Deaf athlete: is there any difference beyond the hearing loss?

Regular physical activity and sport is important for enhanced physical fitness and skill performance of deaf athletes. However there are few data in the literature about their medical considerations. In this study we aimed to determine the morphological findings and cardiac status of the deaf athletes and compare them with the normal ones. Thirty deaf and twenty-two normal male athletes without cardiovascular diseases participated in the study. Transthoracic echocardiography and exercise stress testing were performed. Tissue Doppler imaging (TDI)-derived myocardial performance index (MPI) was also evaluated. VO2 max and heart rate recovery were calculated after exercise stress testing. Total cholesterol, LDL and trigliseride levels were significantly increased in the deaf athletes, but they were still found to be in normal ranges according to age and risk factor profile (p< 0.05). End-diastolic diameter and left ventricular mass index were found to be significantly increased in the controls when compared with the deaf athletes (p< 0.001). Heart rate recovery at 1 minute did not show any difference in the deaf group when compared with the control group (p> 0.05). MPI calculated from TDI-derived variables was found to be 0.41±0.073 in the deaf group and 0.46±0.061 in the controls respectively and significantly decreased in the deaf (p < 0.05). Beyond having a hearing loss, the deaf athletes have many cardiac structural and functional differences from their normal counterparts. The factors that give rise to these differences have to be revealed by further research

Thickening of the epicardial adipose tissue can be alleviated by thyroid hormone replacement therapy in patients with subclinical hypothyroidism

Background: Subclinical hypothyroidism (SCH) is a common disorder which has adverse cardiovascular effects. Epicardial adipose tissue (EAT), a novel marker of cardiovascular risk, is increased in SCH. Aim: We aimed to investigate whether L-thyroxine treatment can reverse the thickening of EAT in SCH. Methods: Forty-four patients with SCH and 42 euthyroid control subjects were included. EAT thickness was measured using transthoracic echocardiography at baseline and after restoration of the euthyroid status with 3 months of L-thyroxine treatment. Results: At baseline, mean EAT thickness was significantly greater in the SCH group when compared to the control group (6.3 ± 1.7 mm vs. 4.1 ± 0.9 mm, respectively, p < 0.001). There was a significant positive correlation between baseline serum thyroid stimulating hormone (TSH) level and EAT thickness in the SCH group. There was a significant reduction in mean EAT thickness in response to L-thyroxine treatment (6.3 ± 1.7 mm vs. 5.1 ± 1.4 mm, p < 0.001). The decrease in EAT thickness after L-thyroxine treatment when compared to baseline (DEAT) significantly correlated to the difference in TSH levels before and after treatment (DTSH; r = 0.323; p = 0.032). Conclusions: Epicardial adipose tissue thickness is increased in patients with SCH. This thickening was alleviated with restoration of the euthyroid status with L-thyroxine treatment in our study population of predominantly male, relatively old subjects with greater baseline EAT thickness

Link between angiographic extent and severity of coronary artery disease and degree of sensorineural hearing loss

Aims. Atherosclerosis is a systemic disease that can affect the whole arterial tree. An important cause of neuronal degeneration is atherosclerosis, which may lead to sensorineural hearing loss. We aimed to investigate the relationship between the angiographic severity and extent of coronary artery disease, which is a surrogate of atherosclerotic burden, and the degree of sensorineural hearing loss.Patients and methods. Out of 381 consecutive patients who underwent coronary angiography for symptoms suggesting ischemic heart disease and who had ischemia detected by a noninvasive stress test, 265 patients [mean age, 61.5±13.0 years; median age (25th–75th percentile), 59 years (50.5–67)], including 146 male (55.1%) subjects met the eligibility criteria and were enrolled. Audiological measurements (hearing levels and discrimination scores) were performed before the coronary angiography. The Gensini score was calculated for each angiogram.Results. There was a statistically significant positive correlation between the degree of hearing loss at all frequencies analyzed (250, 500, 1,000, 2,000, 4,000 Hz) and the Gensini score (p<0.05 for all frequencies), which remained significant after adjustment according to age and other risk factors. A statistically significant negative correlation was observed between the Gensini score and the speech discrimination score (p<0.05).Conclusion. The findings of this study suggest that the angiographic severity and extent of coronary artery disease are significantly and independently correlated with the degree of hearing loss. Sensorineural hearing loss was more prominent in patients with higher Gensini scores. We propose that the findings of this study warrant further research and should be verified in large-scale studies