Effects of glomerular filtration rate on the severity of coronary heart disease

Objective: Chronic kidney disease (CKD) is considered to beone of the most common risk factors for cardiovascular diseases.Glomerular filtration rate (GFR) is the best method oftesting level of kidney function and determining stage of kidneydisease. The aim of this study was to examine the impactof renal function on severity of coronary heart disease (CHD).Methods: The present study included 918 patients undergoingelective coronary angiography. GFR was evaluated bysimplified Modification of Diet in Renal Disease (MDRD) formula(mL/min/1.73 m2). The extent and severity of CHD wereevaluated according to SYNTAX score.Results: According to SYNTAX score, 416 patients had normalcoronary arteries or nonsignificant CHD (control group),267 had mild CHD (SYNTAX score: 1–22), 129 had moderateCHD (SYNTAX score: 23–32), and 106 had severe CHD(SYNTAX score: ?33). Estimated GFR values (median [25th–75th percentiles]) were 99.00 (83.00–116.00) in the controlgroup, 85.00 (73.00–101.00) in the mild CHD group, 87.00(73.25–101.75) in the moderate CHD group, and 81.00(65.00–101.00) in the severe CHD group. According to Spearman’srank correlation analysis, a negative correlation foundbetween MDRD and SYNTAX score was statistically significant(p<0.001, r=-0.268).Conclusion: Renal function is an important predictor of presenceand severity of angiographic CHD in patients without severerenal impairment. Negative correlation between MDRDand SYNTAX score was determined. This simple biochemicaltest can be used in determining risk of cardiovascular diseaseaside from other risk factors during routine clinical practice

Tp-e/QT ratio and QT dispersion with respect to blood pressure dipping pattern in prehypertension

Introduction Tp-e/QT, the ratio of the interval between the peak and the end of T wave to the QT interval, is a novel index of arrhythmogenesis. We investigate Tp-e/QT and QT dispersion (QTd) in prehypertensive and normotensive patients with different patterns of nocturnal blood pressure dipping. Patients and methods Forty-seven prehypertensive and 37 normotensive adult patients were included. Ambulatory blood pressure monitoring recording was performed and patients were considered to be dipper if nocturnal blood pressure fall was at least 10%; nondipper if it was 0-10%; and reverse-dipper if less than 0%. Tp-e, QT intervals were assessed by 12-lead ECG and Tp-e/QT was calculated using these measurements. QTd is defined as the difference between the maximum and the minimum QT interval of the 12 leads. Results Tp-e/QT was 0.22+/- 0.02 and 0.16+/- 0.01 in prehypertensives and normotensives, respectively (P< 0.001), whereas cQTd was 36.1+/- 6.8 and 27.2+/- 5.2 ms (P< 0.001). Tp-e and Tp-e/QT were the lowest in the dippers and the highest in the reverse-dippers in the prehypertensive group (Tp-e/QT dipper: 0.21+/- 0.01; nondipper: 0.24+/- 0.02; reverse-dipper: 0.25+/- 0.01; for dipper-nondipper, and dipper-reverse-dipper P< 0.05). However, in the normotensive group, dipping status had no effect on Tp-e/QT. There were no significant differences between dippers, nondippers, and reverse-dippers in terms of cQTd both in prehypertensives and in normotensives. There were no associations between left ventricular mass index and Tp-e, Tp-e/QT, and cQTd in both groups. Conclusion Tp-e, Tp-e/QT, and cQTd are increased in prehypertensives compared with normotensives. Tp-e and Tp-e/QT are associated with the dipping status in prehypertensives. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved

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

Epicardial adipose tissue thickness can be used to predict major adverse cardiac events

Objective Increase in epicardial adipose tissue (EAT) thickness is associated with subclinical and manifest coronary artery disease. In addition, it is associated with the severity and extent of coronary atherosclerosis. We aimed to investigate whether increased EAT thickness is associated with adverse cardiovascular outcomes. Patients and methods Two hundred consecutive patients who were admitted with stable angina pectoris, unstable angina pectoris or acute myocardial infarction (MI), and had undergone coronary angiography were included and followed for revascularization, nonfatal MI, hospitalization for heart failure and cardiovascular death for 26 (5–30) months. Results There were significantly more revascularizations, nonfatal MI and cardiovascular death in patients with an initial EAT thickness more than 7mm (P<0.001 for all). Significant predictors of cardiovascular death were identified as an EAT thickness more than 7mm [hazard ratio (HR) 1.9, 95% confidence interval (CI) 0.4–8.3, P=0.039] and diabetes (HR 3.42, 95% CI 0.7–17.5, P=0.014) in the multivariate Cox regression analysis. Event-free survival for cardiovascular death in the EAT up to 7mm group was 97.9%, whereas it was 90.7% in the EAT more than 7mm group (P=0.021). In addition, significant predictors of MI were identified as an EAT thickness more than 7mm (HR 2.4, 95% CI 0.6–10.0, P=0.021) and diabetes (HR 3.4, 95% CI 1.0–11.2, P=0.04). Event-free survival for MI in the EAT up to 7mm group was 96.4%, whereas it was 68.2% in the EAT more than 7mm group (P=0.001). Conclusion Increase in EAT thickness independently predicts adverse cardiac events including MI and cardiovascular death. Coron Artery Dis 26:686–691 Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserve

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

Epicardial adipose tissue thickness is associated with myocardial infarction and impaired coronary perfusion

Objective: Epicardial adipose tissue (EAT) is associated with the presence, severity and extent of atherosclerotic coronary artery disease (CAD) in addition to subclinical atherosclerosis. We investigated if EAT thickness is related to acute myocardial infarction in patients with CAD. We also searched for the association between EAT thickness and objective coronary flow and myocardial perfusion parameters such as Thrombolysis in Myocardial Infarction Frame count (TFC) and myocardial blush grade (MBG). Methods: Two-hundred consecutive patients with stable angina pectoris or acute coronary syndrome who were admitted to Ufuk University Faculty of Medicine, Dr Rıdvan Ege Hospital cardiology department were included in this observational, cross-sectional study. EAT thickness was evaluated by conventional transthoracic echocardiography. Coronary angiography was performed to determine the coronary involvement and perfusion. Results: Mean EAT thicknesses were 5.4±1.9 mm, 6.3±1.8 mm, and 8.5±1.4 mm in the stable angina pectoris (SAP), unstable angina pectoris (USAP) and acute myocardial infarction groups, respectively (p<0.001). With increasing EAT thickness, TFC increases whereas mean MBG values decrease (for EAT thickness 7 mm; mean TFC: 21.6±2.2, 25.3±3.3 and 35.2±7.7; and MBG values: 2.98±0.14, 2.83±0.57 and 1.7±1.16, respectively; both p<0.001). Cut-off EAT value to predict AMI was identified as 7.8 mm (ROC analysis AUC:0.876; p<0.001, 95% CI:0.822- 0.927). Sensitivity and specificity of EAT cut-off value 7.8 mm to predict AMI were 81.8% and 82.5% respectively. Conclusion: Increased EAT is associated with AMI and it may prove beneficial for choosing patients who would need more aggressive approach in terms of risk reduction using echocardiography which is a relatively cheap and readily available tool as a follow-up parameter