Objectives: We aimed to compare right and left ventricular functions by echocardiography (ECHO) according to chronic obstructive pulmonary disease (COPD) groups, and to determine their associations ...with functional parameters.
Methods: Data of patients with COPD who underwent ECHO between 2015 and 2018 were analyzed retrospectively. The results of pulmonary function tests, 6-minute-walking test (6MWT), Modified Medical Research Council (mMRC), COPD assessment test (CAT), and BODE scores were recorded together with ECHO results showing right and left ventricular functions.
Results: 126 COPD patients were evaluated. Of these, 37.3% was in group A, 28.6% in group B, 12.7% in group C, and 21.4% in group D. Most common comorbidities were cardiovascular diseases (CVD) and pulmonary hypertension (PH); these were most frequently seen in groups D and B. Regarding ECHO parameters, differences were present among groups in systolic pulmonary arterial pressure (sPAP) and left ventricle end-systolic diameter (LVEF) (p < 0.001 and 0.004, respectively). sPAP was highest in groups D and B whereas LVEF was lowest in group D.
Conclusion: Our results suggest that patients' symptoms in symptomatic COPD groups B and D might be related to increased PAP and concomitant cardiovascular comorbidities. Therefore, a detailed cardiovascular investigation should be performed from early stages in COPD.
Acromegaly is a rare condition caused by a pituitary adenoma that secretes growth hormone. The mortality rate is 72 % higher in patients with acromegaly than in the general population according to ...meta-analyses. Mortality analysis has shown as many as 60 % of acromegalic patients die due to cardiovascular disease. Sudden cardiac death may occur in patients with acromegaly and malignant ventricular arrhythmia may play an important role in this fatal complication; however, the precise mechanism is not fully known. QT dispersion (dQT) is an electrophysiological factor known to be associated with a tendency for ventricular arrhythmia and sudden cardiac death. This study aimed to evaluate dQT as an early predictor of ventricular tachyarrhythmia, as sudden cardiac death commonly occurs in acromegalic patients. This cross-sectional case–control study enrolled 20 patients (10 female and 10 male) with acromegaly and 20 healthy controls (11 female and 9 male) after exclusion criteria were applied. Each participant underwent 12-lead electrocardiography, including ≥3 QRS complexes, at a speed of 25 mm/s after a 15-min rest. In each participant, the QT interval (beginning of the Q wave to the end of the T wave) was corrected (QTc) for heart rate using Bazett’s formula
QTc dispersion (dQTc) (QTc max – QTc min) was also calculated. There was no significant difference in median dQTc between the acromegalic patients (0.79 s) and the controls (0.45 s) (
p
> 0.05). Active acromegalic patients (
n
= 14) were estimated to have a median dQTc of 0.82 s, after excluding from the analysis six patients that were under full biochemical control, and that had randomly obtained growth hormone levels <0.4 ng/mL, GH <1 ng/mL based on oral glucose tolerance test, and normal IGF-I for age and gender. A significant difference was noted in median dQTc between the active acromegalic patients and the controls (
p
= 0.015). The dQT in active acromegalic patients was longer than that in the control group, which indicates that patients with active acromegaly might have an elevated risk for ventricular arrhythmia. We think that a non-invasive, simple and inexpensive marker—measurement of dQT—as part of cardiac monitoring could be valuable for screening complications in acromegalic patients.
Abstract Objective This study investigated the prophylactic effect of nebivolol against hyper-homocysteinaemia (hHcy) induced oxidative stress in brain, heart, liver and kidney tissues and ...histomorphometric changes in the thoracic aorta. Methods Twenty-four adult male Wistar rats were divided into a control, nebivolol, hHcy and nebivolol + hHcy group. hHcy was induced by oral administration of l -methionine (1 g/kg/day) for 28 days. 10 mg/kg/day nebivolol was administered orally for 28 days. Malondialdehyde (MDA) and glutathione (GSH) levels and catalase (CAT) and superoxide dismutase (SOD) activities in the tissues were determined. The total cross-sectional area (TCSA), luminal cross-sectional area (LCSA) and intima-media thickness (IMT) were measured in the thoracic aorta. Results Homocysteine (Hcy) levels were lower in the nebivolol + hHcy group than in the hHcy group. Nebivolol treatment significantly decreased high MDA levels in the brain, heart and liver tissues. The level of GSH was higher in the brain, heart and kidney tissues of the nebivolol + hHcy group ( P < 0.001). The activity of CAT increased only in the kidney tissue of the nebivolol + hHcy group ( P < 0.01), and the activity of SOD was significantly increased in all the tissues in this group. Increased TCSA and IMT in the nebivolol + hHcy group were significantly decreased after nebivolol administration. The LCSA was significantly higher in the hHcy group than the control group, probably due to outward vascular remodelling. Conclusion Nebivolol treatment may be useful in different clinical scenarios where hHcy affects physiopathological pathways.
Abstract Aims Pulse wave velocity (PWV) is an accepted evaluation method to assess vascular changes and determine cardiovascular disease risk in type 1 diabetes (T1D) patients. The aim of this study ...was to identify atherosclerosis risk by using oscillometric device in pediatric patients who had T1D but no end organ impairment and no cardiovascular disease findings. Materials and methods Pediatric patients with T1D and no determined end organ impairment and cardiovascular disease were involved in the study. Results A total of 72 patients with T1D containing 32 males and 40 females were included in the study. A total of 77 patients including 39 males and 38 females were evaluated as healthy control group. The average age of patients with T1D was 12.8 ± 3.7 years, their average weight was established as 43.8 ± 16.7 kg. The average age of control group was 12.3 ± 1.6 years and average weight was determined as 46.8 ± 12.8 kg. When the results obtained by pulse wave method were compared; PWV and Alx_75 values in T1D patients (respectively, 4.63 ± 0.40 and 22.9 ± 6.7) were determined significantly higher than those of control group (respectively, 4.42 ± 0.34 and 16.6 ± 6.6). A positive correlation was identified between diabetes duration and HbA1c (instant and mean) levels in patients with T1D with respect to PWV and Alx_75 values. Conclusions Arterial stiffness was impaired in children with T1D with no end organ impairment using oscillometric method. This impairment was related to high HbA1c levels and diabetes duration.
Amaç: Natriüretik peptidlerin dolaşımdaki konsantasyonları miyokard enfarktüsü sonrası sağkalım ile yakın ilişkilidir. Bizler bu çalışmada natriüretik peptid ailesinden N Terminal ( NT ) proBNP’ nin ...ST segment elevasyonlu miyokard enfarktüslü olgularda prognostik değerini araştırmayı amaçladık.Gereç ve Yöntem: Çalışmaya Uludağ Üniversitesi Tıp Fakültesi Kardiyoloji Kliniği yoğun bakımına akut ST segment elevasyonlu miyokard enfarktüsü tanısı ile yatan ve dahil edilme kriterlerini karşılayan 57 hasta alındı. Yoğun bakımda standart tedavi başlanan olgulardan 6 ve 36’ncı saatte plazmada NT – proBNP bakılmak üzere venöz kan örnekleri alındı. Hastaların eş zamanlı EKG’leri çekildi ve kardiyak enzimleri çalışıldı. Üçüncü ayda poliklinik kontrolüne çağrılan hastalar istenmeyen major kardiyak olaylar ( ölüm, revaskülarizasyon, tekrarlayan miyokard enfarktüsü ve angina ) açısından değerlendirildi ve NT – proBNP değerleri ölçüldü. Her üç NT – proBNP değeri ile istenmeyen major kardiyak olaylar arasındaki ilişki araştırıldı.Bulgular: Çalışmaya dahil edilen hastalar ST segment elevasyonuna göre anterior MI geçiren ( Grup A ) ve inferior MI geçiren ( Grup B ) hastalar şeklinde iki gruba ayrıldı. Her ne kadar istatistiksel olarak anlamlı fark oluşturmasa da Grup A’ da sol ventrikül ejeksiyon fraksiyonunun daha düşük, duvar hareket skor indeksinin daha yüksek olduğu saptandı ( p>0,05 ). Üçüncü ay sonunda en az bir istenmeyen major kardiyak olay geçirenlerle hiç geçirmeyenler arasında NT – proBNP seviyeleri açısından anlamlı istatistiksel fark elde edilemedi ( p>0,05 ). 36’ ncı saatte saptanan ortalama NT – proBNP düzeyi 6’ ncı saat ortalama NT – proBNP düzeyi ile kıyaslandığında Grup A olgularında 10,6 ± 26,2 kat artış gösterdiği, Grup B olgularında 3,6 ± 4,7 kat artış gösterdiği saptandı ve bu değer her iki grup arasında istatiksel olarak anlamlı fark oluşturdu ( p=0,016 ). Sol ventrikül ejeksiyon fraksiyonu ile NT – proBNP seviyeleri arasında korelasyon gözlenmedi. İstatiksel olarak anlamlı bir fark oluşturmasa da özellikle 36’ ıncı saat NT – proBNP değerleri 300 pg/ml’ nin üzerinde olduğunda daha fazla sayıda olgunun istenmeyen major kardiyak olaylar geçirdiği tespit edildi.Sonuç: Çalışma sonucunda NT – proBNP seviyelerinin her ne kadar istatistiksel anlamlılığa ulaşmasa da istenmeyen major kardiyak olayları öngörmede önemli veriler sağlayacağı kanısındayız. Özellikle 36’ ıncı saat NT – proBNP değerlerinin 300 pg/ml’ nin üzerinde olması istenmeyen major kardiyak olayların önceden tespitinde ve önlem alınmasında önemli katkı yapabilir.
Anticoagulant therapy of the patients with mechanical heart valve prosthesis (MHV) in the course of pregnancy requires careful monitorization and well estimation of each step regarding benefits and ...handicaps of each treatment strategy in the particular trimester. Unfractioned heparin with close monitoring of activated thromboplastin time (APTT), low molecular weight heparin with close monitoring of anti Xa levels or warfarin with close monitoring of INR are the main options. It may be challenging most of the sometimes because of the procoagulant nature of pregnancy as well as physiological changes like increased glomerular filtration rate. During the follow up, any recent onset symptom should call prompt and careful investigation beginning with transthoracic echocardiography and planning further transesophageal echocardiography and fluoroscopic studies if needed. If MHV thrombosis is detected, management of patients differs due to the presence of obstruction, critical illness, thromboembolic events or thrombus size. Thrombolytic therapy and the surgical thrombectomy are the options for critically ill patients. International guidelines suggest surgical approach as a first line therapy if the risk of surgery is not too high. However, the complication and success rates of studies with fibrinolytic agents are encouraging. Each strategy comes with its own particular risk and regardless of the selected strategy MHV thrombosis during the pregnancy is a high risk situation. In this paper, we report a 26year old patient presented with recent onset dyspnea due to MHV thrombosis in the mitral position. After the failure of unfractioned heparin, and because of hemodynamic deterioration she was referred for urgent surgery. She recovered after the surgery, however baby was found to have congenital diaphragmatic hernia and is still monitored in the intensive care unit. This report includes, treatment strategies of anticoagulant medication for the pregnant patients with MHV prosthesis and management of MHV thrombosis during the pregnancy.
The aim of this study was to evaluate the expression levels of cardiac-related circulating microRNAs (miRNAs) in ST-elevation myo- cardial infarction (STEMI) patients.
This study has a prospective ...experimental cohort design. A total of 12 consecutive patients with acute chest pain within 12 h admit- ted to emergency department (STEMI group) and 13 adult patients with normal coronary angiography during the same period were enrolled (control group) in this study. Changes in the expression of miR-122, miR-208, miR-375, miR-22, miR-133b, miR-92b, miR-21, miR-133a, miR-423-5p, miR-27b, miR-30a-3p, miR-17, miR-30d, miR-642, and miR-95 were analyzed using quantitative reverse transcription-polymerase chain reaction. Blood samples were collected before angiography and 24 h after angiography. Data were analyzed using the Statistical Package for the Social Sciences v19.
The STEMI group included 12 patients (7 males) with an average age of 56.5±8.3 (range, 44-69) years. The control group included 13 patients (9 males) with an average age of 59±11 (range, 42-80) years. When fold differences were calculated for the miRNA expression values, only miR-30d and miR-423-5p expression levels in STEMI patients showed significant differences in expression levels compared with control patients. The miRNA levels were 2.3-fold higher for miR-30d (p=0.034) and 6.9-fold higher for miR-423-5p (p=0.017). There was no significant cor- relation between troponin I and miR-30d or miR-423-5p levels (p>0.05).
In this study, the expression levels of miRNAs related to cardiac disease were evaluated in peripheral blood. The circulating miR- 423-5p and miR-30d levels in peripheral blood were found to be higher in STEMI cases than in the control group. Further studies should be conducted to evaluate their potential use as biomarkers in STEMI cases.
There are still contradictory data in the literature whether patients with acromegaly are under risk in terms of atherosclerotic heart disease. Increased arterial stiffness develops before ...atherosclerosis and is evaluated to be a risk factor for atherosclerosis. Mean platelet volume (MPV) is currently gaining interest as a new independent cardiovascular risk factor. There are contrasting views about arterial stiffness in patients with acromegaly. There is no report in literature studying MPV in acromegaly patients. The aim of this study was to evaluate MPV and arterial stiffness in patients with acromegaly.
This study was designed as an observational cross-sectional, case-controlled study. Twenty-eight patients with acromegaly and 22 healthy volunteers were recruited for the study. The arteriography device Mobil-O-Graph® (IEM GmbH. Stolberg, Germany) which can perform oscillometric measurements was used to measure arterial stiffness. The Mann-Whitney U test, Student's t-test, Spearman's nonparametric correlation analysis and the chi-square test were used to statistical analyze.
Aortic pulse wave velocity (PWV) value was found to be 6.41 ± 2.12 m/s in the patient group with active acromegaly and 5.24 ± 1.04 m/s in the healthy control group. The difference was statistically significant (p=0.03). The mean MPV value was found to be 9.68 ± 1.11 in the patient group with active acromegaly and 8.53 ± 1.18 in the healthy control group. There was a statistically significant difference between the two groups (p=0.004). In patients with acromegaly, a positive correlation was found between MPV and insulin-like growth hormone-I (IGF-1) level (p=0.021, r=0.434).
We determined an increase in aortic PWV and MPV in patients with acromegaly. In conclusion, evaluation of MPV and arterial stiffness in future studies could be beneficial in determining the risks for cardiovascular disease in patients with acromegaly.
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