FIB-4 liver fibrosis index correlates with aortic valve sclerosis in non-alcoholic population.

AIM: Hepatic fibrosis, a progressive scarring of liver tissue, is commonly caused by non-alcoholic fatty liver disease (NAFLD), which increases the risk of cardiovascular disease. The Fibrosis-4 (FIB-4) index is a non-invasive tool used to assess liver fibrosis in patients with NAFLD. Aortic valve sclerosis (AVS), a degenerative disorder characterized by thickening and calcification of valve leaflets, is prevalent in the elderly and associated with increased cardiovascular morbidity and mortality. Recent studies have suggested that AVS may also be linked to other systemic diseases such as liver fibrosis. This study aimed to investigate the relationship between the FIB-4 index and AVS in a non-alcoholic population, with the hypothesis that the FIB-4 index could serve as a potential marker for AVS. METHOD: A total of 92 patients were included in this study. AVS was detected using transthoracic echocardiography, and patients were divided into groups according to the presence of AVS. The FIB-4 index was calculated for all patients and compared between the groups. RESULTS: A total of 17 (18.4%) patients were diagnosed AVS. Patients with AVS had higher rates of diabetes mellitus, older age, hypertension, angiotensin-converting enzyme inhibitor use, higher systolic blood pressure (BP) and diastolic BP in the office, coronary artery disease prevalence, left atrial volume index (LAVI), left ventricular mass index (LVMI), and late diastolic peak flow velocity (A) compared to those without AVS. Moreover, AVS patients had significantly higher creatinine levels and lower estimated glomerular filtration rate. Remarkably, the FIB-4 index was significantly higher in patients with AVS. In univariate and multivariate analyses, higher systolic BP in the office (OR, 1.044; 95% CI 1.002-1.080, p = .024) and higher FIB-4 index (1.46 ± .6 vs. .91 ± .46, p < .001) were independently associated with AVS. CONCLUSION: Our findings suggest that the FIB-4 index is associated with AVS in non-alcoholic individuals. Our results highlight the potential utility of the FIB-4 index as a non-invasive tool for identifying individuals at an increased risk of developing AVS.

Anxiety disorders and depression are associated with resistant hypertension.

BACKGROUND: Anxiety and depression can adversely affect the prognosis following cardiovascular diseases (CVDs) and may be associated with resistance to hypertension (HT) treatment. A better understanding of the complex biological substratum of resistant HT complicated by depression and anxiety is crucial for designing future primary care strategies. OBJECTIVES: To evaluate the relationship between anxiety and depression and resistant HT, which will help to look at resistant HT from a broader perspective and aid the development of new strategies for diagnosis and treatment. MATERIAL AND METHODS: We used a stratified random sampling method to select HT patients aged 18 and older in primary care setting. A total of 300 consecutive patients with persistent HT who were diagnosed with essential HT and uncontrolled blood pressure (BP) despite antihypertensive therapy were prospectively included in the study. Anxiety and depression were investigated, and scoring was evaluated using the Hospital Anxiety and Depression Scale (HADS). RESULTS: The study included 108 controlled and 91 uncontrolled HT patients. The HADS scales were higher in the controlled HT group compared to the uncontrolled HT group (6 (0-18) compared to 9 (0-20), p = 0.001; 5 (0-17) compared to 7 (0-16), p < 0.001, respectively). Body mass index (BMI) and C-reactive protein (CRP) were also significantly higher in the uncontrolled HT patients compared to the normotensive group. Anxiety was associated with a 2.18 times increased risk of HT and a 1.99 times increased risk of depression. Thus, anxiety and depression predicted resistant HT in both univariate and multivariate analyses. CONCLUSIONS: During the treatment of HT, efforts should be made to improve the psychological and social functions of the patients beyond the primary therapy for control of the disease. As such, we hope to draw attention to the importance of psychological factors, especially anxiety and depression, in any field of medicine related to managing resistant HT.

Presystolic wave as a predictor of interatrial block in patients with supraventricular tachycardia.

The identification of interatrial block (IAB) through electrocardiography (ECG) has been correlated with an elevated likelihood of developing atrial fibrillation (AF) and stroke. IAB is diagnosed by evaluating P-wave prolongation on a surface ECG. The presystolic wave (PSW) is an echocardiographic marker determined by pulse-wave examination of the aortic root during late diastole. As IAB and PSW share similar pathophysiological mechanisms, we speculated that PSW, as a component of the P wave, might be useful in predicting IAB. In the present study, we aimed to determine the relationship between PSW and IAB. Patients with pre-diagnosis of supraventricular tachycardia (SVT) on electrocardiography or rhythm Holter monitoring between January 2021 and December 2022 were included in the study. Surface 12-lead ECG and transthoracic echocardiography (TTE) were performed for the diagnosis of IAB and PSW. Patients were divided into two groups based on the presence of IAB, and PSW was compared between the groups. In total, 104 patients were enrolled in this study. IAB was diagnosed in 16 patients (15.3%) and PSW was detected in 33 patients (31.7%). The PSW was higher in the IAB ( +) group than in the IAB ( -) group (10 patients (71.4%) vs. 23 patients (32.4%), p = 0.008). PSW may be a useful tool for predicting IAB in patients with SVT. Further studies are needed to determine the clinical utility of PSW in the diagnosis and management of IAB.

Modified Glasgow Prognostic Score Predicted High-Grade Intracoronary Thrombus in Acute Anterior Myocardial Infarction.

High-grade intracoronary thrombus (ICT) burden leads to greater myocardial injury following anterior myocardial infarction (MI). The modified Glasgow prohgnostic score (mGPS) is a novel immune-inflammatory index, calculated by using C-reactive protein (CRP) and albumin levels, was shown to have prognostic value in heart diseases. The present study investigated the role of mGPS in predicting high grade ICT in patients with acute anterior MI admitted between February 2017 and March 2020. Blood samples were obtained at admission and mGPS was calculated. The ICT burden was evaluated visually from angiographic images. Patients were divided into 2 groups according to the ICT burden as high and low. A total of 1132 patients were enrolled: a mean age 61 ± 12.4 years and 370 males (32.7%). Serum albumin was lower, whereas mGPS and CRP were higher in high grade ICT group. CRP (odds ratio (OR): 1.404 95% CI: 1.312-1.502; P < .001), albumin (OR: .486; 95% CI: .301-.782 P < .001), and mGPS (0 vs ≥ 1) (OR: 7.391; 95% CI: 3.910-13.972; P < .001) were independent predictors of high-grade ICT burden in the left anterior descending coronary artery. The mGPS is a novel predictor of high-grade ICT burden and may be useful for risk stratification in patients with acute anterior MI.

The relationship between ascending aortic diameter with left atrial functions and left ventricular mass index in a population with normal left ventricular systolic function.

AIM: Ascending aortic dilatation is a common clinical issue. In the present study, we aimed to evaluate the relationship between ascending aortic diameter with left ventricular (LV) and left atrial (LA) functions, and LV mass index (LVMI) in a population with normal LV systolic function. METHODS: A total of 127 healthy participants with normal LV systolic function took part in the study. Echocardiographic measurements were obtained from each subject. RESULTS: The mean age of the participants was 43 ± 14.1 years and 76 (59.8%) were female. The mean aortic diameter of the participants was 32.2 ± 4.7 mm. A negative correlation was found between aortic diameter and LV systolic function (LVEF r = -.516, p < .001; Gls r = -.370). In addition, there was a strong positive correlation between aortic diameter with LV wall thicknesses, LVMI (r = .745, p < .001), and systolic and diastolic diameters. The relationship between aortic diameter and diastolic parameters was evaluated, a negative correlation with Mitral E, Em, E/A ratio, and a positive correlation with MPI, Mitral A, Am, E/Em ratio were found. CONCLUSION: A strong correlation between ascending aortic diameter with LV and LA functions, and LVMI in individuals with normal LV systolic function.

Effect of Coronavirus Disease-2019 Infection on Left Atrial Functions.

Objective: Left atrial (LA) dysfunction is a crucial risk factor for cardiovascular events, and various pathologies may affect LA function. Coronavirus disease-2019 (COVID-19) is an ongoing global pandemic causing morbidity and mortality. In the present study, we aimed to evaluate LA functions in patients who recovered from COVID-19. Methods: Sixty consecutive patients recovered from COVID-19 and 60 healthy individuals as a control group were included in the study. Blood samples and echocardiography measurements were obtained from each subject. The two groups were compared in terms of demographic and echocardiographic characteristics. Results: In the COVID-19 group, LA maximum volume (LAVmax) (P = 0.040), LA pre-A volume (LAVpre-A) (P = 0.014), and LA active emptying fraction (P = 0.027) were higher, while LA passive emptying fraction (P = 0.035) was lower. In addition, left ventricular ejection fraction (P = 0.006) and isovolumetric relaxation time (P = 0.008) were decreased in this group. Although LA volume index was higher in the COVID-19 group, it does not reach statistical significance. Conclusion: LA functions may be impaired in patients recovered from COVID-19 infection.

Serum apelin levels and cardiovascular diseases.

Apelin is a G protein-linked receptor endogenous ligand, synthesized as a 77-amino acid pre-propeptide. Increased expression of apelin is present in many cardiovascular (CV) tissues, including cardiomyocytes. It is a peripheral vasodilator and one of the most potent stimulants of ventricular contraction. Apelin may be a valuable therapeutic for both blood pressure regulation and myocardial performance. More information is needed for the CV pathophysiology of apelin. We will discuss the importance of apelin level in CV diseases in this review.

Assessment of treatment patterns and patient awareness in atrial fibrillation patients using non-vitamin K antagonist oral anticoagulants (ASPECT-NOAC).

Background and Aim: Despite the advances in oral anticoagulation with NOACs, careful patient and dose selection is required with NOAC therapy. Our study aimed to assess treatment patterns of NOACs in AF along with patients' continuity to NOAC treatments in first year, and their knowledge level of AF and NOAC treatment. Methods: ASPECT-NOAC was designed as an observational, prospective, and multicenter study. AF patients who were prescribed NOACs within last four months were recruited from 34 outpatient cardiology clinics covering all geographic regions of Turkey. Baseline data were collected initially whereas patient awareness was evaluated at 3 to 4 weeks. Final study visit was performed at 12 months. Results: In total, 991 patients were included to the study. Mean ± standard deviation of age was 69.4 ± 10.2 years and 53.0% of patients were female. Mean duration from AF diagnosis was 24.9 ± 50.9 months. Mean CHA2DS2-VASc and HAS-BLED scores were 3.1 ± 1.5 and 1.6 ± 1.1, respectively. AF disease and NOAC treatment knowledge levels were found to be 48.9 ± 23.1% and 73.0 ± 19.3%, respectively. Among reduced dose users 71.4% of patients were prescribed inappropriate reduced doses. Through the study follow-up, 32 patients (3.2%) deceased and NOAC therapy was discontinued in 74 patients (8.7%). Conclusion: AF patients who recently started NOAC treatment in Turkey were found to have variable knowledge about their disease and anticoagulation treatment. It was observed that most of the patients continued the NOAC treatment throughout the study. Reduced dosing of NOACs was common, which was associated with higher baseline risk for bleeding as well as stroke.

Aortic propagation velocity in the prediction of coronary artery disease severity.

AIMS: To investigate the association of the aortic propagation velocity (APV) with coronary artery disease (CAD) in patients with stable angina pectoris (SAP) through SYNTAX scores (SS). METHODS: The study population comprised 214 SAP subjects who received a coronary angiography. The APV and carotid intima-media thickness (CIMT) were examined and SS was calculated. Subjects were grouped following specific SS criteria: SS less than 22 (low) and SS greater than or equal to 22 (high). RESULTS: High SS subjects had lower APV compared to low SS [39.0 (32.0-51.7) vs. 55.0 (45.0-62.0) cm/s, respectively; P<0.001] and higher CIMT (0.86 ± 0.24 vs. 0.74 ± 0.21 mm, respectively; P<0.001). APV demonstrated a negative correlation with the CIMT (r=-0.239, P<0.001), age (r=-0.188, P=0.006) , and SS (r=-0.561, P<0.001) and showed a positive association with LV ejection fraction (r=0.163, P=0.017). APV, CIMT, diabetes, low-density lipoprotein cholesterol (LDL-C), and age were determined to be markers independently of a high SS. CONCLUSION: APV, CIMT, diabetes, LDL-C and age are independently linked to the CAD severity of SAP subjects. Decreased APV, an indicator of subclinical atherosclerosis, may independently help determine the severity of atherosclerotic CAD in SAP patients.

The role of serum interleukin-37 levels, inflammation and blood pressure in patients with preeclampsia.

AIM: Preeclampsia is one of the major causes of perinatal, fetal, and maternal mortality and morbidity. The aim of this study was to investigate the association of serum interleukin 37 (IL 37) with preeclampsia. METHODS: 39 women with preeclampsia were included as the study group. 38 healthy, and normotensive pregnant women, at similar gestational week with similar gravidity volunteered as the control group. Clinical findings, biochemical parameters, maternal and perinatal outcomes, and the serum concentrations of IL37 were compared between the groups. The relationship of IL 37 concentrations with clinical findings and blood pressure outcomes were also investigated. RESULTS: Maternal serum IL 37 concentrations were significantly higher in patients with preeclampsia compared to the healthy pregnant women in the control group (p = .005). IL 37 positively correlated systolic blood pressure (BP) (r = 0.344, p = .002), and diastolic BP (r = 0.332, p = .003). IL 37 was identified as an independent predictor of preeclampsia. CONCLUSIONS: Serum IL 37 concentrations were higher in preeclamptic patients compared to healthy pregnant women. Furthermore, IL 37 concentrations achieved success in identifying preeclampsia with hypertension. Increased IL 37 activity may have a role in the pathophysiology of preeclampsia.

Association between Omentin-1 and Coronary Artery Disease: Pathogenesis and Clinical Research.

Like other adipokines, omentin-1 is secreted from visceral adipose tissue and plays a vital role in the development of chronic inflammatory diseases, including cardiovascular events. Recent studies have shown that circulating omentin-1 levels are associated with various metabolic risk factors, such as high blood pressure, increased waist circumference, dyslipidemia, and glucose intolerance. The decrease in serum omentin level is an independent predictor of Coronary Artery Disease (CAD) and is associated with the severity of this disease. Since there is no relevant review in the literature, we aimed to summarize the studies on the relationship between omentin-1 and CAD.

An echocardiographic predictor of contrast-induced nephropathy following percutaneous coronary intervention in acute coronary syndrome: aortic valve sclerosis.

Objective. Aortic valve sclerosis (AVS) is closely related to endothelial dysfunction. The association of AVS with contrast-induced nephropathy (CIN) is unknown. We planned to investigate the relationship of AVS besides known parameters with CIN. Design. Baseline characteristics, biochemical values, and AVS of 292 consecutive patients with acute coronary syndrome (ACS) that underwent percutaneous coronary intervention (PCI) were analyzed. Results. Fifty-three patients (18.2%) had CIN. Patients with CIN were older, less likely to be smokers, and had more prevalent prior bypass surgery, higher Mehran score, creatinine, and uric acid concentrations than those without CIN. AVS was more prevalent in patients with CIN. Logistic regression analysis including all related parameters identified Mehran score (OR = 1.036, p = .033), uric acid concentration (OR = 1.244, p = .023), and AVS (OR: 2.223, p = .027) as independent predictors of CIN. Conclusion. AVS is independently associated with CIN in patients with acute coronary syndrome undergoing percutaneous coronary intervention. AVS may help to identify high-risk patients for CIN, who would benefit from preventive measures.

Mitral annular calcification predicted major cardiovascular events in patients presented with acute coronary syndrome and underwent percutaneous coronary intervention.

Background: Despite the presence of several clinical studies evaluating the association of atherosclerosis and MAC, no data is present regarding the value of MAC in predicting CV adverse events in patients with acute coronary syndrome (ACS).Methods: Prospective, observational cohort study including 314 patients presented with ACS and underwent percutaneous coronary intervention (PCI). MAC was defined by increased echodensity located at the junction of the atrioventricular groove and posterior mitral leaflet on the parasternal long-axis, short-axis, or apical four-chamber view. Patients were followed for a median 25.1 (23.1-26.5) months for any occurrence of major adverse cardiovascular events (MACE).Results: Among 316 patients 46 (14%) had MAC. Seventy (22.1%) patients had MACE during the follow-up. Patients with MACE had higher creatinine, white blood cell count (WBC), C-reactive protein (CRP), peak troponin I, glucose level at admission compared to those without MACE. Age (HR = 1.026, 95% CI = 1.004-1.049; p = .023), myocardial blush grade (HR = 0.637, 95% CI = 0.480-0.846; p = .008), MAC (HR = 2.429, 95% CI = 1.126-5.239; p = .026), and WBC at admission (HR = 1.079, 95% CI = 1.007-1.157; p = .031) were independent predictors for MACE.Conclusion: In patients presented with ACS and underwent PCI, MAC detected by TTE was an independent predictor for MACE during the long-term follow-up.

Serum visfatin level is associated with complexity of coronary artery disease in patients with stable angina pectoris.

BACKGROUND: Visfatin is an adipokine that plays a role in the inflammatory process of atherosclerosis. This study aimed to investigate whether adipokine is associated with the extent of stable coronary artery disease (CAD). METHODS: The study population included 110 patients who underwent elective coronary angiography (CAG) due to stable angina pectoris. The severity of CAD was assessed by the 'Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX)' score. We evaluated patients in two groups: group 1 with a SYNTAX score <22 (low) and group 2 with a SYNTAX score ⩾22 (intermediate to high). RESULTS: Serum visfatin (8.6 ± 4.2 ng/ml versus 13.4 ± 5.2 ng/ml, p < 0.001) and serum C-reactive protein (CRP) levels [0.46 (0.25-0.77) mg/dl versus 0.71 (0.32-1.10) mg/dl, p < 0.001] were lower in group 1. A positive significant correlation was found between serum visfatin level and SYNTAX score (r = 0.559, p < 0.001). In a multivariate logistic regression analysis, visfatin [odds ratio (OR) 1.22, 95% confidence interval (CI) 1.10-1.36; p < 0.001], CRP (OR 6.22, 95% CI 1.70-22.7; p = 0.006), and diabetes mellitus (OR 3.83, 95% CI 1.10-13.2; p = 0.034) were found to be independent predictors of SYNTAX score. CONCLUSIONS: Serum visfatin level was positively correlated with CAD severity in patients with high SYNTAX score. Serum visfatin level can be a useful biomarker for predicting high SYNTAX scores in patients with angina pectoris undergoing CAG.

The relationship between total atrial conduction time and left atrial global strain in patients with psoriasis vulgaris.

INTRODUCTION: Psoriasis vulgaris is a chronic, multisystem disease that results in the development of atrial fibrillation (AF) over time. In this study, our goal was to assess predictors of AF in patients with psoriasis, including total atrial conduction time (TACT) and left atrial global longitudinal strain (LAGLS). MATERIAL AND METHODS: A total of 80 individuals, including 40 psoriasis patients and 40 healthy controls, were enrolled in the study. A physical examination was performed, biochemical parameters were studied, and Holter electrocardiography was carried out. Conventional echocardiography, atrial tissue Doppler, and speckle tracking echocardiography were recorded. RESULTS: No significant difference was observed between psoriasis patients and healthy controls with regard to age, and the average duration of psoriasis was 5.7 years. High-sensitivity C reactive protein levels were higher in the patient group compared to the control group (respectively, group 1: 1 ±0.8; group 2: 0.6 ±0.3, p < 0.05). Atrial arrhythmia was not detected in the Holter ECG monitoring. A significant moderate negative correlation between TACT and LAGLS (r = -0.57, p < 0.05) was observed, and there was a significant moderate positive correlation between the duration of disease and TACT (r = 0.52, p < 0.05). CONCLUSIONS: In the current study, we determined that LAGLS decreased, TACT was prolonged, and P-wave dispersion increased in patients with psoriasis. The current results may improve predictions of AF risk in psoriasis patients in clinical practice.

Relation of multicenter automatic defibrillator implantation trial implantable cardioverter-defibrillator score with long-term cardiovascular events in patients with implantable cardioverter-defibrillator.

OBJECTIVE: To test the hypothesis that multicenter automatic defibrillator implantation trial (MADIT) - implantable cardioverter-defibrillator (ICD) scores predict replacement requirement and appropriate shock in a mixed population including both primary and secondary prevention and long-term adverse cardiovascular events. METHODS: The study has a retrospective design. Patients who were implanted with ICD in the cardiology clinic of Atatürk University Faculty of Medicine between 2000 and 2013 were included in the study. For this purpose, 1394 patients who were implanted with a device in our clinic were reviewed. Then, those who were implanted with permanent pacemaker (n=1005), cardiac resynchronization treatment (CRT) (n=45) and CRT-ICD (n=198) were excluded. RESULTS: A total of 146 patients (98 males, 67.1%) with a mean age of 61.1 (±14.8) years were recruited. The median follow-up time was 21.5 months (mean 30.6±25.9 months; minimum 4 months, and maximum 120 months). The median MADIT-ICD scores in the patients were 2. MADIT-ICD scores were categorized as low in 15.1%, intermediate in 57.5%, and high score in 27.4% of patients. Accordingly, MADIT-ICD scores (1.29 [1.00-1.68], p=0.050), hemoglobin (0.86 [0.75-0.99], p=0.047), and left ventricular ejection fraction (EF) (0.97 [0.94-0.99], p=0.023) were determined as independent predictors of major adverse cardiovascular events in the long-term follow-up of ICD-implanted population. CONCLUSION: In this study, we showed that there was an independent association of long-term adverse cardiovascular events with MADIT-ICD score, hemoglobin, and EF in patients implanted with ICD.

The role of serum bilirubin levels in determining venous thromboembolism.

OBJECTIVE: Venous thromboembolism (VTE) is a disease that includes both deep venous thrombosis (DVT) and pulmonary embolism (PE). Bilirubin is an endogenous anti-inflammatory marker associated with atherothrombosis. The purpose of our study was to investigate the association of serum bilirubin levels with the presence of VTE. METHODS: A total of 103 patients with VTE (distal DVT, n = 34; proximal DVT, n = 30; PE, n = 39) and 50 control patients were cross-sectionally enrolled. Peripheral venous duplex ultrasound and computed tomography were used for the diagnosis of VTE. Fasting blood samples were drawn for biochemical analyses. RESULTS: Baseline characteristics were not different between groups. The VTE group had lower bilirubin level (9.0 ± 2.6 µmol/L vs 7.3 ± 3 µmol/L; P = .001) and higher high-sensitivity C-reactive protein (hs-CRP) concentration (0.8 [0.3-2] mg/L vs 1.1 [0.2-3] mg/L; P = .008) and white blood cell count (7.4 ± 1.5 × 109/L vs 8.2 ± 2.7 × 109/L; P = .02) compared with control patients. In the analysis of variance, the levels of total direct bilirubin and hs-CRP were clearly different between the control group and VTE subgroups (distal and proximal DVT and PE). The receiver operating characteristic curve analysis showed a cutoff value of 8.9 µmol/L for total bilirubin (sensitivity, 74%; specificity, 55%) and an area under the curve of 0.659 (P < .001). CONCLUSIONS: Bilirubin level, hs-CRP concentration, and white blood cell count were independently associated with VTE.

Relationship Between C-Reactive Protein to Albumin Ratio and Thrombus Burden in Patients With Acute Coronary Syndrome.

Increased coronary thrombus burden is known to be a strong predictor of adverse cardiovascular (CV) outcomes. C-reactive protein to albumin ratio (CAR) can be used as a surrogate marker of pro-inflammation which is closely related to prothrombotic state. We aimed to evaluate the association between CAR and coronary thrombus burden in patients who presented with acute coronary syndrome (ACS). Patients who presented with ACS and treated with primary percutaneous coronary intervention were included in the study. Patients were divided into 2 groups as high thrombus burden and low thrombus burden. The study population included 347 patients with non-ST-segment elevation myocardial infarction (169 [48.7%]) and ST-segment elevation myocardial infarction (178 [51.3%]). The CAR was significantly higher in patients with higher thrombus burden (24.4 [1.2-30.2] vs 31.9 [2.2-31.3], P < .001). Independent predictors for increased thrombus burden were higher CRP level (odds ratio [OR]: 0.047; 95% confidence interval [CI]: 0.004-0.486; P = .010), lower serum albumin level (OR: 0.057; 95% CI: 0.033-0.990; P = .049), higher CAR (OR: 1.13; 95% CI: 1.03-1.23; P = .008), higher neutrophil-lymphocyte ratio (OR: 1.18; 95% CI: 1.05-1.31; P = .004), and baseline troponin I level (OR: 1.06; 95% CI: 1.01-1.13; P = .017). Novel CAR can be used as a reliable marker for increased coronary thrombus burden that is associated with adverse CV outcomes.

Epicardial Adipose Tissue Predicts Carotid Intima-Media Thickness Independently of Body Mass Index and Waist Circumference.

Background: Visceral obesity is strongly associated with atherosclerosis. Even though waist circumference (WC) is the most common assessment method of total visceral adipose tissue and cardiometabolic risk, this method lacks direct measurement of adipose tissue and has better correlation to subcutaneous fat rather than visceral fat. We intended to investigate whether epicardial adipose tissue (EAT) is clinically superior to body mass index (BMI) and WC in predicting Framingham risk score (FRS) and carotid intima-media thickness (CIMT). Methods: Our study included 331 patients who were admitted to our outpatient clinic for risk factor assessment. We calculated BMI, FRS, and WC, and the patients underwent echocardiographic and carotid examinations to measure EAT and CIMT. The metabolic syndrome (MS) score was calculated by summing the MS risk factor scores. Results: The area under the curve values of EAT were similar to FRS and higher than those of weight, BMI, and WC for both increased CIMT and the presence of carotid plaque. Male gender, age, low-density lipoprotein-cholesterol level, and EAT thickness were independent predictors of CIMT, whereas male gender, age, WC, uric acid concentration, and EAT significantly predicted the presence of carotid plaque. Conclusions: This study demonstrated that epicardial adipose tissue (EAT) has a stronger correlation with CIMT than BMI and WC, and it was a significant predictor of increased CIMT and the presence of carotid plaque. Additional data are required to clarify the diagnostic and therapeutic role of EAT in managing obese patients, and to decrease their cardiometabolic risk.

Left ventricular hypertrophy is associated with increased sirtuin level in newly diagnosed hypertensive patients.

Background: Arterial hypertension is one of the leading causes of mortality and morbidity in general population. Sirtuin 1 (SIRT1) has diverse anti-inflammation, anti-oxidant, and anti-apopytosis effects on endothelium and is associated with endothelial aging and dysfunction. The objective of this study was to evaluate the relation of serum SIRT1 level with left ventricular hypertrophy (LVH) in newly diagnosed hypertensive patients. Methods: One hundered and twenty-five consecutive, newly diagnosed hypertensive patients were divided into two groups with regard to presence of LVH and compared to 40 healthy control subjects. LVH was determined by transthoracic echocardiography using the cube formula. Serum SIRT1 level was analyzed with enzyme-linked immunosorbent assay. Results: Serum SIRT1 level was significantly higher in patients with LVH compared to those without LVH (14.3 ± 3.9 ng/ml vs. 7.9 ± 3.6 ng/ml, ​P < 0.001) and healthy control subjects (14.3 ± 3.9 ng/ml vs 6.6 ± 2.0 ng/ml, P < 0.001). Multivariate logistic regression analysis revealed higher serum SIRT1 level independently predicted LVH in hypertensive patients (OR 1.50; 95% CI, 1.30-1.73; P < 0.001). Receiver-operating characteristic curve analysis demonstrated a cutoff value of 9.4 had a sensitivity of 90% and specificity of 74% for the prediction of LVH (AUC 0.885; 95% CI, 0.815-0.935; ​P < 0.0001). Conclusion: SIRT1 was a powerful biomarker for predicting LVH in hypertensive patients.