Coronary heart disease is associated with mean platelet volume in type 2 diabetic patients.

BACKGROUND: Mean platelet volume (MPV) is an indicator of platelet activation which is a central process in the pathophysiology of coronary heart disease (CHD). The aim of the study was twofold; first to determine whether MPV values is increased in patients with DM, and secondly to evaluate the relation between diabetic complications and MPV. METHODS: The study population included 258 patients divided into two groups. Group A composed of 158 type 2 diabetic patients with coexistent coronary artery disease (stenotic lesions of 50%) (78 women, 80 men; mean age 53.9_10.8; mean diabetes duration 13.1_6.0). One hundred subjects (48 women, 52 men; mean age 53.9_11) without type 2 diabetes with normal coronary angiographies were taken as the control group (group B). To evaluate the extension of CHD, Gensini scoring system was used. RESULTS: The MPV was significantly different in the patient group compared to the controls (9.79 +/- 1.5 fl vs 8.3 +/- 0.9 fl, P<0.001). The existence of CHD was associated with MPV with odds ratio (95% CI) of 2.31 (1.55-4.42, p50.001). CONCLUSION: We have found that diabetic patients with coronary heart disease have significantly higher MPV values compared to control subjects without diabetes and with angiographically normal coronary arteries.

Relationship between elevated platelet volume and saphenous vein graft disease.

BACKGROUND: Saphenous vein graft (SVG) disease is the major determinant of long term graft viability in patients undergoing coronary artery bypass graft (CABG) surgery. Although, platelets play a major role in this pathogenetic process the nature of this interaction has not been yet been clarified. Mean platelet volume (MPV) reflects platelet production rate and stimulation. This study was designed to investigate MPV in patients with late stage SVG disease. METHODS: The study population composed of 188 patients who underwent elective coronary angiography more than one year after coronary artery bypass surgery. The study population was divided in to two groups according to SVG patency. The first group consisted of 90 patients (75 men, 15 women; mean age, 63.4 +/- 9.2 years) with patent SVG's (no-stenosis group). The second group consisted of 98 patients (80 men, 18 women; mean age, 62.1 +/- 10.1 years) with SVG stenosis based on the results of coronary angiography (stenosis group). Greater than 50% stenosis within the SVG was accepted as hemodynamically significant. RESULTS: MPV were significantly higher in patients with SVG disease in comparison with the patients without graft disease group (9.3 +/- 1.19 vs. 8.3 +/- 1.10 fl, respectively, p < 0.001). In a multiple regression model, SVG disease was independently associated with MPV (beta=0.837, p=0.05) along with LDL-cholesterol (beta=0.159, p=0.008) and time interval after bypass surgery (beta=-0.092, p=0.05). CONCLUSION: Platelet volume, and therefore platelet activation, appears to play a causal role in late SVG disease graft disease; hence, MPV may be useful as a post-operative marker of graft success.

[Left ventricular functions in patients with cardiac syndrome X: a tissue Doppler study]. / Kardiyak sendrom X'li hastalarda sol ventrikül fonksiyonlari: Doku Doppler çalismasi.

OBJECTIVE: The aim of the study was to compare diagnostic accuracy of tissue Doppler imaging (TDI) and conventional Doppler echocardiography in diagnosis of left ventricular diastolic dysfunction in patients with cardiac syndrome X. METHODS: Our study was designed as cross-sectional study. In our study, we compared 35 patients with cardiac syndrome X (19 female, mean age 47.2+/- 7.3 years) with 33 healthy persons as control group (18 female, mean age 49.5+/- 7.1 years) with no coronary artery disease and having no ischemic complaints or findings at exercise test. Left ventricular systolic function was found by considering mean values of modified Simpson method for left ventricular ejection fraction and TDI assessment of systolic wave peak velocity. The diastolic function of left ventricle was assessed with conventional echocardiography and TDI. Unpaired t test for independent samples or Mann-Whitney U test were used for comparison of continuous variables, Chi square test - for comparison of categorical variables. To define the capability of predicting diastolic dysfunction for conventional Doppler echocardiography and tissue Doppler imaging ROC curve analysis was applied. RESULTS: Left ventricular ejection fraction and systolic wave peak velocity were similar for both groups. Conventional Doppler echocardiographic measurements for left ventricular diastolic functions delineated the more frequent presence of diastolic dysfunction in cardiac syndrome X group As compared with controls (48% vs 18%; p<0.01). When both methods used for assessing diastolic dysfunction, it was found more apparent (66% vs 24%; p<0.01). When ROC curve was drawn for conventional Doppler echocardiography the AUC was 0.623, the sensitivity and the specificity were 49% and 76%, respectively. When the same was done for TDI the values were AUC=0.669, the sensitivity - 66% and the specificity - 68%. CONCLUSION: Our study revealed the deterioration of left ventricular diastolic function in patients with cardiac syndrome X. We found TDI echocardiography was more sensitive to delineate left ventricular diastolic dysfunction in this category of patients when compared with conventional Doppler echocardiography.

The impact of multiple vessel disease on fractional flow reserve.

BACKGROUND: Fractional flow reserve (FFR) is a method for the assessment of intermediate lesions. The impact of lesions at other coronary arteries on the FFR is not clear. We aimed to investigate the impact of the lesions in the other coronary arteries on FFR measurement. METHOD: FFR was performed in 113 patients with intermediate lesions at the left anterior descending artery. FFR values at baseline (FFRbase) and after adenosine administration (FFRmin) were detected. We divided the patients into groups according to FFRmin value. The first group consisted of 52 patients with a FFR < 0.80 and the second group consisted of 61 patients with a FFR > or = 0.80. We investigated the relationship between Gensini score and FFR values within the groups. RESULTS: A significant negative correlation was found in the analysis comparing Gensini score with FFRbase and FFRmin among the first group (r = -0.248, P = 0.009 and r = -0.685, P < 0.001, respectively). The relative FFR ratio was also significantly related with the Gensini score in the first group (r = -210, P = 0.047).When we divided the patients into 3 subgroups according to the number of the coronary arteries with significant lesion (> or = 70% stenosis) (group I: 1 vessel, group II: 2 vessels, group III: 3 vessels), we observed a relation with FFRbase (0.89 +/- 0.05 vs. 0.87 +/- 0.06 vs. 0.81 +/- 0.09, respectively, P = 0.007) and FFRmin (0.76 +/- 0.04 vs. 0.75 +/- 0.05 vs. 0.68 +/- 0.1 respectively, P = 0.002). In the second group, there was no relationship between Gensini score, FFR values and number of significantly diseased vessels. CONCLUSION: The overall extent and severity of coronary artery disease in a patient may affect the FFR measurement and may lead to misinterpretation of the lesion severity.

Carotid intima-media thickness in patients with cardiac syndrome X and its association with high circulating levels of asymmetric dimethylarginine.

BACKGROUND: The cause of myocardial ischemia and chest pain in patients with cardiac syndrome X (CSX) has been explained by mechanisms including endothelial dysfunction. CSX patients have higher levels of asymmetric dimethylarginine (ADMA) and increased mean common carotid intima-media thickness (C-IMT). Accordingly, this study was designed to examine C-IMT with its association serum endothelial function parameters in patients with CSX. METHODS: The study population consisted of 30 enrolled consecutive patients with diagnosis of CSX. As a control group, 30 individuals with the complaint of anginal chest pain without any ischemia on myocardial perfusion scintigraphy and with normal coronary angiographies were selected. C-IMT was measured by recording ultrasonographic images of both the left and the right common carotid artery. Plasma levels of L-arginine, ADMA, and nitrate/nitrite (NO(x)) were measured from blood samples. RESULTS: Both C-IMT (mm) and carotid atherosclerotic plaques were significantly higher in patients with CSX than in control group. Also, the plasma level of NO(x), L-arginine, and L-arginine/ADMA ratio were lower in patients with CSX than they were in the control group subjects. Plasma ADMA level increased in the CSX patients group. Correlation analysis showed significant positive correlation with C-IMT and plasma ADMA levels and showed significant negative correlation with plasma NO(x) and L-arginine levels. L-arginine/ADMA ratio and C-IMT was also showed significant negative correlation with the same analysis. CONCLUSIONS: CSX patients had higher plasma ADMA levels and C-IMT values than the controls, reflecting the presence of subclinical atherosclerosis. These findings suggest that, besides endothelial dysfunction, presence of atherosclerosis may also contribute to the etiopathogenesis of the CSX phenomenon.

Relationship between elevated levels of serum uric acid and saphenous vein graft disease.

OBJECTIVES: Several studies have shown an association between elevated serum uric acid (SUA) levels and coronary heart disease and cardiovascular mortality. We investigated the relationship between SUA levels and the patency of saphenous vein grafts (SVG) after coronary artery bypass graft (CABG) surgery. STUDY DESIGN: The study included 192 patients (152 men, 40 women) who underwent elective coronary angiography after a mean of 5.6 years following CABG surgery, which involved the use of at least one SVG. The patients were divided into two groups depending on the extent of SVG patency. Stenosis of 50% or greater within the SVG was accepted as hemodynamically significant. Serum uric acid levels were determined with the enzymatic colorimetric method. RESULTS: Ninety patients (71 men, 19 women; mean age 62+/-8 years) were found to have patent SVG. Stenotic SVGs were detected in 102 patients (81 men, 21 women; mean age 62+/-10 years). The time interval between surgery and angiography was significantly longer in the stenotic group (p<0.001). Compared to patients without SVG disease, the mean SUA level was significantly higher in patients with SVG disease (4.9+/-1.2 mg/dl vs 5.8+/-1.4 mg/dl; p=0.02). Serum uric acid levels were similar in patients having stenosis in a single vein graft or multiple vein grafts (p=0.224). In multiple regression analysis, SVG disease was independently associated with SUA (p<0.001), diabetes mellitus (p=0.028), and smoking (p=0.039). CONCLUSION: Our results show that there is a significant association between increased SUA levels and SVG disease in patients undergoing CABG, which may justify the need for early screening for hyperuricemia and antiuricemic treatment.

The assessment of cardiac functions by tissue Doppler-derived myocardial performance index in patients with Behcet's disease.

Vascular involvement is one of the major characteristics of Behcet's disease (BD). However, there are controversial findings regarding cardiac involvement in BD. Although early reports demonstrated that there is diastolic dysfunction in BD, conflicting results were found in the following trials. Hence, a new method for more objectively estimating the cardiac functions is needed. For this aim, we used high-usefulness tissue Doppler echocardiography for detailed analysis of cardiac changes in BD patients because this method was superior to other conventional echocardiographic techniques. The study population included 42 patients with BD (19 men, 23 women; mean age, 35 +/- 10 years, mean disease duration, 2.7 +/- 1.6 years) and 30 healthy subjects (14 men, 16 women; mean age, 38 +/- 7 years). Cardiac functions were determined using echocardiography, comprising standard two-dimensional and conventional Doppler and tissue Doppler imaging (TDI). Peak systolic myocardial velocity at mitral annulus, early diastolic mitral annular velocity (Em), late diastolic mitral annular velocity (Am), Em/Am, and myocardial performance index (MPI) were calculated by TDI. The conventional echocardiographic parameters and tissue Doppler measurements were similar between the groups. Tissue Doppler derived mitral relaxation time was longer (75 +/- 13 vs 63 +/- 16 msn, p = 0.021) in patients with BD. There was statistically significant difference between the two groups regarding left ventricular MPI (0.458 +/- 0.072 vs 0.416 +/- 0.068%, p = 0.016), which were calculated from tissue Doppler systolic time intervals. There was also significant correlation between the disease duration and MPI (r = 0.38, p = 0.017). We have demonstrated that tissue Doppler-derived myocardial left ventricular relaxation time and MPI were impaired in BD patients, although systolic and diastolic function parameters were comparable in the patients and controls.

Mean platelet volume in patients with coronary artery ectasia.

BACKGROUND: Mean platelet volume (MPV) is an indicator of platelet activation, a central process in the pathophysiology of coronary heart disease. The importance of coronary artery ectasia (CAE) lies in the fact that in 85% of cases it is accompanied by atherosclerotic coronary disease. The present study was designed to investigate MPV values in CAE patients in comparison with individuals with normal coronary angiograms. MATERIAL/METHODS: MPV was measured in 67 consecutive patients (mean age: 55.3+/-9.7 years) with isolated CAE and 55 control subjects (mean age: 53.6+/-10.1 years). Coronary artery ectasia was defined as without any stenotic lesion, on visual assessment, of the coronary arteries with a luminal dilatation 1.5-fold or more of the adjacent normal coronary segments. Four subgroups were composed according to the extension of CAE in coronary arteries. RESULTS: MPV was significantly higher in patients with CAE than in the control group (9.27+/-1.32 vs. 8.40+/-0.95, p<0.001). There were no statistically significant differences in MPV among the subgroups with different CAE severity. CONCLUSIONS: It was shown for the first time that patients with CAE have higher MPVs than control subjects with normal coronary angiograms. Hence MPV might be used as a follow-up marker in patients with CAE with or without coronary artery disease.

Mean platelet volume in patients with metabolic syndrome and its relationship with coronary artery disease.

BACKGROUND: Mean platelet volume (MPV) is an indicator of platelet activation which is a central process in the pathophysiology of coronary heart disease. The metabolic syndrome (MS) is characterized as the clustering of closely associated and interdependent atherosclerotic risk factors. MS has also been shown to be strongly associated with poor outcome in patients with coronary artery disease (CAD). The present study was designed to investigate MPV values in patients MS and to interrogate the association with CAD. METHODS: We measured MPV in 205 consecutive patients with metabolic syndrome (mean age, 53+/-7 years) and 140 control subjects without metabolic syndrome (mean age, 52+/-6 years). All patients were selected from individuals who underwent coronary angiography in our hospital with a suspicion of coronary artery disease. To evaluate the severity of coronary artery disease, the patients with MS were subdivided depending upon the coexistence of coronary artery disease: normal coronary arteries, having coronary stenotic lesions of <50%, and having coronary stenotic lesions of >50%. RESULTS: The MPV was significantly higher in patients with MS than in the control group (10.19+/-1.49 fl vs 8.21+/-1.02 fl, p<0.001). According to the CAD severity, there were no statistically significant differences in MPV among these subgroups. CONCLUSION: We have shown for the first time that patients with MS have higher MPV compared to control subjects with normal coronary angiograms and to be associated with CAD. Hence MPV can be used as a follow up marker in patients with MS in the point of CAD.