Objective: To test the potential role of heart-type fatty acid-binding protein (H-FABP) in detecting increased perioperative cardiac risk in comparison with cardiac troponin I (cTnI) in the early ...postoperative period. Subjects and Methods: Sixty-seven patients who had clinical risk factors and underwent elective intermediate - or high-risk noncardiac surgery were included in this study. Serum specimens were analyzed for H-FABP and cTnI levels before and at 8 h after surgery. None of the patients had chest pain; 27 had a history of ischemic heart disease, 3 of heart failure, 5 of cerebrovascular diseases, 40 of diabetes and 46 of hypertension. Results: The mean duration of the operations was 2.33 ± 1.27 h (range 1-6). In the postoperative period, 27 (40.3%) patients had increased H-FABP levels (≥7.5 ng/ml); the median preoperative serum H-FABP level was 0.13 ng/ml (<0.1-5.9) and the median postoperative H-FABP level was 6.86 ng/ml (<0.1-13.7). Only 1 (1.5%) patient had cTnI >0.1 µg/l during the postoperative period. Correlation analysis revealed that the presence of diabetes was associated with an increased H-FABP level (r = 0.30, p = 0.01). Of the 27 patients with H-FABP ≥7.5 ng/ml, 21 (87%) had diabetes. There was no significant correlation with other clinical risk factors, type or duration of surgery. Conclusion: The H-FABP levels significantly increased in the postoperative period. Most patients with increased postoperative H-FABP levels were diabetic. High H-FABP levels could alert clinicians to increased perioperative cardiovascular risk and could prevent underdiagnosis, especially in diabetic patients.
Introduction
Erythropoietin (EPO) is a haematopoietic stimulatory protein that is used to treat anaemia in patients on dialysis. In addition, EPO has been shown to have anti-inflammatory properties, ...which may be important as dialysis patients tend to exist within a chronic, low-grade inflammatory state, and tend to be more susceptible to infections. It has been suggested that EPO has direct immunomodulatory potency on monocytes/macrophages.
Methods
In this study, we aimed to clarify the effects of EPO during the inflammatory processes in human mononuclear phagocytic cells by monitoring the secretion of the following cytokines; midkine, tumour necrosis factor alpha (TNF-α), and interleukin-6 (IL-6). For this purpose, U937 human histiocytic lymphoma cell lines were used. Time-dependent effects of varying doses of EPO (0.1 to 50 IU/ml) treatment during lipopolysaccharide (LPS)-mediated cytotoxicity was measured by 3-4,5-dimethylthiazol-2-yl-2,5 diphenyltetrazolium bromide test. LPS-stimulated midkine secretion was measured immunohistochemically and quantification of TNF-α, IL-6 and midkine secretion was achieved by ELISA.
Results
EPO treatment prevented the direct toxic effects of LPS on the U937 cells. TNF-α, IL-6 and midkine secretions were found to increase in the U937 cells in response to LPS treatment. Interleukin-6 response was varied in a doseand time-dependent manner.
Conclusion
Treatment with EPO significantly inhibits the LPS-induced secretion of midkine and TNF-α regardless of the dosage. The data presented here provide the first evidence to indicate that EPO treatment directly reverses some of the cytotoxic and secretory effects of LPS in mononuclear cells. Inhibition of midkine secretion might be responsible for the anti-inflammatory role of EPO.
Metabolic syndrome (MetS) has been shown to be independently associated with increased risk for incident heart failure and coronary artery disease. We investigated whether there was deterioration in ...right ventricular functions in MetS patients with preserved left ventricular functions and its association with the number of MetS components.
The study included 192 consecutive patients (148 women, 44 men; mean age 54.3 ± 8.5 years) with the diagnosis of MetS based on the NCEP-ATP III criteria and 20 healthy controls (12 women, 8 men; mean age 51.6 ± 8.4 years). All subjects underwent conventional and tissue Doppler (TDI) echocardiography to assess left and right ventricular functions, including right ventricular myocardial performance index (MPI) and tricuspid annular plane systolic excursion (TAPSE).
The number of MetS components were three in 43.8%, four in 31.3%, and five in 25% of the patients. Right ventricular TDI-derived MPI was higher in patients with MetS compared to controls median 0.5 (range 0.2-3.3) vs. 0.3 (0.1-0.7), p=0.000. This was possibly due to significantly shortened right ventricular ejection time in MetS patients (p<0.05). Although TAPSE was within the normal range in MetS patients, it was significantly decreased compared to controls (p=0.000), accompanied by significantly lower TDI-derived S wave, E wave, and E/A ratio (p=0.000). None of the MetS components were significantly correlated with right ventricular TDI-derived MPI. There was no association between the number of MetS components and echocardiographic parameters.
Our findings show that, despite preserved left ventricular systolic functions, both systolic and diastolic functions of the right ventricle deteriorate in MetS patients.
Acute ST elevation myocardial infarction has high mortality and morbidity rates. The majority of patients with this condition face erectile dysfunction in addition to other health problems. In this ...study, we aimed to investigate the effects of two different reperfusion strategies, primary angioplasty and thrombolytic therapy, on the prevalence of erectile dysfunction after acute myocardial infarction. Of the 71 patients matching the selection criteria, 45 were treated with primary coronary angioplasty with stenting, and 26 were treated with thrombolytic agents. Erectile function was evaluated using the International Index of Erectile Function in the hospital to characterize each patient＇s sexual function before the acute myocardial infarction and 6 months after the event. The time required to restore blood flow to the artery affected by the infarct was found to be associated with the occurrence of erectile dysfunction after acute myocardial infarction. The increase in the prevalence of erectile dysfunction after acute myocardial infarction was 44.4% in the angioplasty group and 76.9% in the thrombolytic therapy group （P= 0.008）. In conclusion, this study has shown that reducing the time of reperfusion decreases the erectile dysfunction prevalence, and primary angioplasty is superior to thrombolytic therapy for decreasing the prevalence of erectile dysfunction after acute myocardial infarction.
Metabolic syndrome (MS) was independently associated with increased risk of incident heart failure and coronary artery disease. In this study, we sought to identify whether there is an association ...between metabolic syndrome components and left ventricular diastolic functions and brain natriuretic peptide (BNP) levels.
This study is a cross-sectional, observational study. Two hundred consecutive patients with MS were selected to form the study population. Echocardiographic parameters and BNP were determined. Mann-Whitney U test and Kruskal-Wallis test were used to compare BNP levels in categorical variables. Spearman rank correlation analysis was used to investigate the correlation between BNP level and other numerical variables. Linear regression analysis was used to find the variables affecting the BNP level.
BNP level was higher in females than males 11.14 (0.12-87) vs 7.49 (0.01-99) pg/dl, p=0.04. None of the MS parameters affects the BNP level in MS patients. MS criteria number that the patient had was not related to BNP level. Sixty seven percent of patients had left ventricular (LV) diastolic dysfunction. BNP was independent from LV diastolic function. Multiple linear regression analysis demonstrated that having diabetes mellitus increases BNP level by 7.73 unit (β=7.73, 95% CI - 2.321 - 13.149, p=0.006).
None of the MS parameters affects the BNP level in MS patients. Diastolic dysfunction existence did not affect the BNP level of MS patients. There is an association between diabetes mellitus and BNP, independent of left ventricle diastolic functions.
Abstract
Objectives: Thymosin beta 4 (Tβ4) plays an essential role in cardiac vessel development and is currently being developed as a therapeutic agent for the treatment of coronary artery disease ...(CAD) in some experimental studies. Thus, we aimed to investigate the association of serum Tβ4 levels and collateral formation in patients presenting with severely stenotic CAD. Methods: Thirteen patients with poor collateral development and 16 age- and sex-matched patients with good collateral development who had ≥ 95% stenosis in at least one major coronary artery on coronary angiogram (CAG) were enrolled in the study. The Gensini score was calculated for each patient by using CAG results. Collateral development was classified according to the Cohen-Rentrop method. Serum Tβ4 levels were measured with enzyme-linked immune sorbent assay. Results: There were no statistically significant differences between the two groups in regard to clinical and laboratory characteristics of the patients except for Tβ4 levels. The Tβ4 levels in the well-collateralized study group were found to be significantly higher than those of the poorly collateralized study group and serum Tβ4 levels were positively correlated with the collateral development. Conclusions: Our findings suggest that serum Tβ4 levels are significantly associated with the collateral development in severe CAD.
A 40-year-old male patient was admitted to the hospital with acute chest pain. A sirolimus-eluting stent (SES) had been deployed to the circumflex artery (Cx) 3 years before. Now, inferior ST-segment ...elevations were observed and coronary angiography revealed stent thrombosis with distal TIMI 3 grade flow in the Cx. Tirofiban infusion was administered and the control angiography 2 days later revealed complete resolution of the thrombus. Stent thrombosis is a rare but usually poor prognostic event, frequently associated with large myocardial infarction (MI) or death. Very late drug-eluting stent (DES) thrombosis remains a major problem of interventional cardiology due to its high morbidity and mortality. We conclude that tirofiban may be an interesting candidate drug for treatment of very late stent thrombosis.
It is known that primary angioplasty is more effective than thrombolytic therapy for the treatment of ST-segment elevation acute myocardial infarction. The aim of the present study is to compare the ...effects of the two strategies on the left ventricular functions using the Tei index (a combined myocardial performance index). Of 81 patients (11 female, mean age 52.7 ± 11.9 years, and 70 male, mean age 54.8 ± 11.5 years) matching the selection criteria, 41 patients were treated by primary percutaneous transluminal coronary angioplasty and stenting (group A, 41 patients) and 40 patients were treated by thrombolytic agents (streptokinase) (group B, 40 patients). All patients underwent a complete two-dimensional transthoracic echocardiographic and Doppler study in the left lateral decubitus position from multiple windows. There was no significant difference between the two groups in isovolumetric contraction time and ejection time. Isovolumetric relaxation time was 95.2 ± 18.4 in group A and 116.2 ± 28.1 in group B (
P
= 0.001) and the Tei index was 0.51 ± 0.12 in group A and 0.59 ± 0.16 in group B (
P
= 0.019). Isovolumetric relaxation time and Tei index were significantly higher in group B. Primary angioplasty is superior to thrombolytic therapy as assessed by the Tei index even in the first 3 h, with no apparent change in systolic function.
Abstract Coronary stents have marked an era in the interventional cardiology and have significantly decreased the rates of acute restenosis. Although diminished rates of restenosis have been observed ...with stents with respect to balloon angioplasty, restenosis is still a major problem of the interventional procedures. Stent thrombosis (ST) after percutaneous coronary intervention (PCI) is a rare and usually poor prognostic event that might result in myocardial infarction (MI) and sudden death .We wanted to summarize the main features of the issue.
There are many studies demonstrating deteriorated ventricle and endothelium functions in familial Mediterranean fever (FMF) patients. As FMF is an autoinflammatory disease with an ongoing ...inflammatory activity and inflammation plays an important role in the development and progression of atherosclerosis in some of the rheumatic diseases, we aimed to investigate the early markers of atherosclerosis in patients with FMF by the measurements of serum paraoxonase-1 (PON-1) activity, mean platelet volume (MPV) and malondialdehyde (MDA) level.
This study is a cross-sectional, observational study. Forty consecutive patients with FMF and twenty healthy volunteers were selected to form the study population. The diagnosis of FMF was based on Tel-Hashomer criteria. Serum PON-1 activity, MPV and MDA level were determined to examine their association with FMF. Student's t-test, Mann-Whitney U test, Pearson correlation analysis were used for statistical analysis.
The mean PON-1 activity in FMF patients was significantly lower than in the healthy population (141.46±38.29 vs. 179.62±10.73 U/l, p<0.01). Serum MDA levels were the same between the groups (1.08±0.66 vs. 1.08±0.33 nmol/mL, p=0.99). MPV was higher in FMF patients than in the control l group (8.87±0.99 vs. 8.22±0.45 fl, p=0.04). PON, MPV and MDA levels were the same in FMF patients with acute attack and attack -free period.
Our results show that PON-1 activity is lower in patients with FMF. Reduced PON-1 activity and increased MPV, independent of the oxidative stress status of these patients, may lead to increased atherosclerotic propensity in FMF.
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