Aortic valve sclerosis is a sign of increased arterial stiffness in clinically asymptomatic subjects

Background: Classic risk scores may under estimate the risk of cardiovascular (CV) events in specific risk groups requiring appropriate medical and interventional treatment. Arterialstiffness has been known as a sign of CV risk and has a predictive value for CV events beyond classic CV risk factors. The purpose of this study was to investigate the relation between thecardio-ankle vascular index (CAVI) that has been recently reported as a new surrogate marker of arterial stiffness and aortic valve sclerosis (AVS).Methods: Eighty patients with AVS and 80 control subjects were enrolled to the study. Arterial stiffness was evaluated by VaSera-1000 CAVI instrument and AVS was defined by echocardiography as thickening and calcification of the normal trileaflet aortic valve without obstruction to the left ventricular outflow.Results: CAVI was significantly higher in patients with AVS compared to the control subjects (10.5 ± 2.7 vs. 8.6 ± 1.4, p < 0.001). Higher frequency of AVS was detected in patients with abnormal than borderline and normal CAVI values (69% vs. 27% and 20%, respectively, p < 0.001). In univariate analysis, there was a significant association between AVS and CAVI (95% confidence interval [CI] 1.44–2.48, p < 0.001]. Multivariate analysis demonstrated CAVI (95% CI 1.39–2.44, p < 0.001) as an independent determinant of AVS.Conclusions: Detection of increased arterial stiffness could prevent patients from being mistakenly classified as at low or moderate risk, when they actually are at high risk. Assessment of aortic valve during echocardiography examination may offer the opportunity to identify these subjects

Atherosclerosis burden and coronary artery lesion complexity in acute coronary syndrome patients

Background: Syntax score (SS) is a prognostic marker in patients with acute coronary sydromes (ACS). Carotid intima media thickness (CIMT) and cardio ankle vascular index (CAVI) are well known surrogate marker of atherosclerosis burden. But association between atherosclerosis burden and coronary artery disease (CAD) complexity in ACS patients has not been investigated yet. Methods and Results: Consecutive patients with first time diagnosis of ACS (n = 172) were enrolled. SS, a marker of CAD complexity, was assessed by dedicated computer software. CIMT was examined by B-mode ultrasound. CAVI was assessed by VaSera VS-1000 cavi instrument. SS for low, intermediate and high tertiles of CIMT value were 10.1 ± 8.2 vs 11.4 ± ± 7.9 and 15.2 ± 8.8; p = 0.02). SS for normal, borderline and abnormal CAVI values were 4 ± 3.7 vs 11.1 ± 7.2 and 14.1 ± 9.1, respectively p = 0.009). Also, there was independent association between SS and CIMT (95% coinfidence interval [CI] 2.1–19, p = 0.014) and CAVI (95% CI 15–29, p = 0.021]. Neither traditional cardiovascular risk factor nor thrombolysis in myocardial infarction (TIMI) risk score was independent determinant of SS. Conclusions: We have shown that patients with higher atherosclerosis burden have more complex coronary artery lesions. Also these patients may be identified early by using surrogate markers of atherosclerosis. Its clinical significance requires further research

Changes in Serum Natriuretic Peptide Levels after Percutaneous Closure of Small to Moderate Ventricular Septal Defects

Background. B-type natriuretic peptide has been shown to be a very sensitive and specific marker of heart failure. In this study, we aimed to investigate the effect of percutaneous closure of ventricular septal defects with Amplatzer septal occluders on brain natriuretic peptide levels. Methods. Between 2008 and 2011, 23 patients underwent successfully percutaneous ventricular septal defect closure in 4 cardiology centers. Brain natriuretic peptide levels were measured in nine patients (4 male, mean ages were 25.3 ± 14.3) who underwent percutaneous closure with Amplatzer occluders for membranous or muscular ventricular septal defects were enrolled in the study. Brain natriuretic peptide levels were measured one day before and one month after the closure. Patients were evaluated clinically and by echocardiography one month after the procedure. Results. Percutaneous closures of ventricular septal defects were successfully performed in all patients. There was not any significant adverse event in patients group during followup. Decrease in brain natriuretic peptide levels after closure were statistically significant (97.3 ± 78.6 versus 26.8 ± 15.6, P = 0.013). Conclusion. Brain Natriuretic Peptide levels are elevated in patients with ventricular septal defects as compared to controls. Percutaneous closure of Ventricular Septal Defect with Amplatzer occluders decreases the BNP levels

The Relationship between Proliferative Scars and Endothelial Function in Surgically Revascularized Patients

Background: Proliferative scars are benign fibrotic proliferations which demonstrate abnormal wound healing in response to skin injuries. As postulated in the “response to injury hypothesis”, atherosclerosis is also triggered by an endothelial injury. Keloid and atherosclerotic processes have many pathophysiological and cytological features in common. Aims: In this study, we investigated the relationship between proliferative scars and endothelial function in surgically revascularized patients. We aimed to test the hypothesis that atherosclerosis is a wound healing abnormality. Study Design: Cross-sectional study. Methods: Consecutive patients who were admitted to the cardiology outpatient clinic with a history of coronary artery bypass grafting operation were evaluated. Thirty-three patients with proliferative scars at the median sternotomy site formed the keloid group, and 36 age- and sex-matched patients with no proliferative scar at the median sternotomy site formed the control group. Endothelial function was evaluated by flow-mediated vasodilatation of the brachial artery via ultrasonograhic examination. Results: There is no signicant difference according to the demographic data, biochemical parameters, clinical parameters and number of grafts between keloid and control groups. Endothelial-dependent vasodilatory response was lower in the keloid group than the control group (9.30±3.5 and 18.68±8.2, respectively; p=0.001). Conclusion: This study showed that endothalial dysfunction, which is strongly correlated with atherosclerosis, was more prominent in patients with proliferative scars. As proliferative scars and atherosclerosis have many features in common, we might conclude that atherosclerosis is a wound healing abnormality

Aşikar kardiyovasküler hastalığı olmayanlarda koroner arter kalsifikasyonu ile ortalama trombosit hacmi arasındaki ilişki: Gözlemsel bir çalışma

dolaylı bir parametredir. Koroner arter kalsifikasyonunun (KAK) aterosklerotik proçesin bir parçası olduğu uzun zamandır bilinmektedir. Bu çalışmamızda aşikar kardiyovasküler hastalığı olmayan hastalarda KAK ile OTH arasındaki ilişkiyi inceledik. Yöntemler: Bu gözlemsel çalışmada, bilinen kardiyovasküler hastalığı olmayan ve en az bir kardiyovasküler riski olan 259 hasta çalışmaya alındı. KAK çok kesitli tomografi ile değerlendirildi. OTH ise etilen diamin tetra asetik asit (EDTA)’li tüplere alınan kanda ölçüldü. İstatistiksel analiz Kruskal-Wallis, Ki-kare, korelasyon testleri ve çoklu regresyon analiz ile yapıldı. Bulgular: Kalsiyum skoru 0 ile 735 arasında idi. Tek yönlü analizde KAK ile OTH (r0.24, p0.02), yaş (r0.32, p0.001), hipertansiyon (r0.19, p0.03), diyabet (r0.16, p0.005) ve sigara içimi (r0.17, p0.001) arasında anlamlı bir ilişki vardı. Çok yönlü analizde ise OTH (?0.4, %95GA 19.8- 31.1, p0.001), yaş (?0.13, %95GA 0.23-2.4 p0.01) ve sigara içimi (?0.12, %95GA 3.2-15.1, p0.02) KAK’ın bağımsız belirleyicileri idi. Ayrıca anlamlı KAK’ı olanlarda minimal ya da KAK’ı olmayan hastalara göre OTH anlamlı olarak yüksek idi (10.22.4 karşı 8.10.9 ve 7.61.3; R252.7, p0.001). Sonuç: Çalışmamızda OTH ile KAK arasında anlamlı bir ilişki bulduk. Her ne kadar çalışmamız bir korelasyon çalışması olduğu için neden- sonuç ilişkisi açısından bir sonuç çıkarmak zor olsa da yüksek OTH’nin artmış aterosklerotik yükü ve kardiyovasküler riski gösterebileceği söylenebilir. (Anadolu Kardiyol Derg 2012; 12: 35-9)Objective: Platelets have an important role in the pathogenesis of atherothrombosis. It has been shown that platelet size measured by mean platelet volume (MPV), correlates with their reactivity and is still regarded as an easy, useful tool for indirect monitoring of platelet activity in different situations. Coronary artery calcification (CAC) has long been known to occur as a part of the atherosclerotic process. The aim of this study was to determine whether an association exists between MPV and CAC. Methods: In this observational study, we enrolled 259 participants with at least one cardiac risk factor but with unknown cardiovascular disease. Coronary calcification was assessed by multislice computerized tomography and MPV was measured in a blood sample collected in EDTA tubes. Statistical analysis was performed using Kruskal-Wallis, Chi-square, correlation tests and multiple regression analysis. Results: Calcium scores ranged from 0 to 735. There was a significant relation between CAC and MPV (r0.24, p0.02), age (r0.32, p<0.001), hypertension (r0.19, p0.03), diabetes (r0.16, p0.005), smoking (r0.17, p0.001). In linear regression analysis, MPV (β0.4, 95%CI 19.8- 31.1, p<0.001), age (β0.13, 95%CI 0.23-2.4, p0.01) and smoking (β0.12, 95%CI 3.2-15.1, p0.02) independently associated with CAC. In addition, there were significant differences in MPV between significant CAC group compared to the minimal and none (10.2±2.4 versus 8.1±0.9 and 7.6±1.3; p<0.001). Conclusion: We have found significant association between MPV and CAC. Although this study is purely correlative and no causative conclusions can be drawn, it may suggest that higher MPV may reflect increased atherosclerotic burden and cardiovascular risk. (Anadolu Kardiyol Derg 2012; 12: 35-9

İzole koroner arter ektazili hastalarda karotis-femoral nabız-dalga hızı: Gözlemsel bir çalışma

Amaç: Karotis-femoral nabız dalga hızı (NDH) günümüzde arteriyel katılık ölçümünün altın standart yöntemidir ve kardiyovasküler olayların bağımsız öngördürücüsüdür. Artmış NDH aterosklerozun bir göstergesi olarak kabul edilmektedir. İzole koroner arter ektazisi (KAE) ve karotis-femoral NDH arasındaki ilişki tam olarak ortaya konamamıştır. Bu çalışmanın amacı, bu ilişkiyi araştırmaktır. Yöntemler: Enine-kesitli gözlemsel bu çalışmaya, herhangi bir görünür darlığı olmayan 34 izole KAE’li hasta ve anjiyografik olarak normal koroner arterli 24 kontrol dahil edildi. Karotis-femoral NDH değerlendirmek için aplanasyon tonometrisi kullanıldı. İstatiksel analiz Mann-Whitney U ve Ki-kare testleri ile yapıldı. Parametreler arası ilişkilerin değerlendirilmesi için çoklu lineer regresyon analizi kullanıldı. Bulgular: Her 2 grubun temel klinik ve laboratuvar parametreleri benzerdi. Karotis-femoral NDH, izole KAE hastalarında kontrol grubuna göre anlamlı olarak daha yüksekti (10.5±2.4 ve 9.2 ±1.7 m/sn, p=0.02). Çoklu regresyon analizinde, yaş (beta=0.23, %95 GA= 0.001-0.094, p=0.04), ektatik damar sayısı (beta=0.24, %95 GA= 0.044-1.07, p=0.03) ve sistolik kan basıncı (beta=0.52, %95 GA= 0.028-0.1, p=0.001) karotis-femoral NDH ile bağımsız ilişkili bulundu. Sonuç: Artmış karotis-femoral NDH ve izole KAE arasında bir ilişki vardır. Bu ilişki, yetişkin popülasyonda, herhangi bir stenozun olmadığı izole koroner arter ektazisinin patogenezinde aterosklerozun etkisi olduğunu göstermektedir.Objective: Carotid-femoral pulse wave velocity (PWV), the current "gold-standard" measure of arterial stiffness, has emerged as an important independent predictor of cardiovascular events. The increased PWV is recognized as an indicator of atherosclerosis. The relationship between isolated coronary artery ectasia (CAE) and carotid-femoral PWV has not been well-described. The aim of our study was to assess this relation. Methods: Thirty-four patients with isolated CAE without any visible coronary stenosis and 24 control subjects with angiographically normal coronary arteries were enrolled to this cross-sectional observational study. Applanation tonometry was applied to assess the carotid-femoral PWV. Statistical analyses were performed by Mann-Whitney U and Chi-square tests. Multiple linear regression analysis was used for the evaluation of the relations of parameters. Results: The baseline clinical and laboratory parameters of the both groups were similar. Patients with isolated CAE had significantly higher carotid-femoral PWV compared to control subjects (10.5±2.4 vs 9.2±1.7 m/s, p=0.02). In multiple regression analysis, age (beta=0.23, 95% CI=0.001- 0.094, p=0.04), number of ectatic vessels (beta=0.24, 95% CI=0.044-1.07, p=0.03), and systolic blood pressure (beta=0.52, 95% CI=0.028-0.1, p=0.001) were found independently related to PWV. Conclusion: We have shown an association between increased carotid-femoral PWV and isolated CAE, suggesting that atherosclerosis may be involved in the pathogenesis of isolated CAE without any coronary stenosis in the adult population