Effect of serum gamma-glutamyl transferase levels on myocardial perfusion and long-term prognosis after primary angioplasty in patients with acute ST-elevation myocardial infarction.

BACKGROUND: Gamma-glutamyl transferase (GGT) level was found to be elevated in plasma of patients with cardiovascular risk factors. The aim of our study was to assess the relationship between serum GGT levels and the occurrence of no-reflow as well as to evaluate the prognostic value of GGT in ST-segment elevation myocardial infarction (STEMI) population. METHODS AND RESULTS: One hundred sixty-eight consecutive patients with STEMI who underwent percutaneous coronary intervention (PCI) were enrolled in the study. Patients with STEMI were grouped into tertiles according to their admission serum GGT levels. No-reflow after PCI was assessed both angiographically (thrombolysis in myocardial infarction [TIMI] flow and myocardial blush grade) and electrocardiographically (ST resolution). Gamma-glutamyl transferase levels were higher in patients with STEMI compared to the elective PCI group subjects. Patients with angiographically (TIMI flow ≤2 or TIMI flow 3 with final myocardial bush grade ≤2 after PCI) and electrocardiographically (ST resolution <30%) detected no-reflow were increased in number across the GGT tertiles. In addition, 1-year mortality rates showed a significant increase across the tertile groups (4% vs 11% vs 23%, P < 0.01). Multivariable logistic regression analysis revealed that GGT levels on admission were a significant predictor of long-term mortality of myocardial blush grade-detected no-reflow phenomenon. High GGT level on admission was a significant predictor for long-term mortality and major adverse cardiac events. CONCLUSIONS: In patients with STEMI undergoing primary PCI, high GGT levels at admission were found to be associated with no-reflow phenomenon and increased long-term mortality.

Lower fetuin-A predicts angiographic impaired reperfusion and mortality in ST-elevation myocardial infarction.

AIMS: Fetuin-A is an anti-inflammatory negative acute-phase glycoprotein, synthesized by the liver. In this study, we aimed to investigate the effects of admission fetuin-A levels on coronary and myocardial blood flow and short- and long-term prognosis in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention. METHODS AND RESULTS: One hundred eighty consecutive patients admitted with diagnosis of STEMI and 55 healthy age- and sex-matched volunteer controls were enrolled in the study. Patients with STEMI were divided into 2 groups in respect to thrombolysis in myocardial infarction myocardial perfusion grade after primary PCI: with thrombolysis in myocardial infarction myocardial perfusion grade 0-1-2 and thrombolysis in myocardial infarction myocardial perfusion grade 3. Serum levels of fetuin-A were lower in patients with STEMI than in the healthy group subjects. In-hospital and 1-year deaths were significantly higher in patients from the abnormal perfusion group. In-hospital major adverse cardiac event (MACE) and 1-year follow-up MACE also were significantly higher in patients from the abnormal perfusion group. The receiver-operating characteristic analysis indicated an optimal cut point of less than 200 µg/mL, which detects 1-year mortality with a negative predictive value of 95%. The 1-year mortality rate and 1-year MACE were significantly higher in patients with low fetuin-A level as compared with those with high fetuin-A level. CONCLUSIONS: Because low-admission fetuin-A levels are associated with impaired coronary flow in STEMI patients undergoing primary percutaneous coronary intervention, admission fetuin-A level detection may be helpful in identifying the patients at a greater risk of poor coronary blood flow and worse short- and long-term prognosis.

Elevated serum uric acid predicts angiographic impaired reperfusion and 1-year mortality in ST-segment elevation myocardial infarction patients undergoing percutaneous coronary intervention.

BACKGROUND: Serum uric acid (SUA) is associated with microvascular disease that could alter coronary blood flow and prognosis. We evaluated the effects of admission SUA levels on coronary blood flow and prognosis in 185 consecutive patients with ST-segment elevation myocardial infarction (STEMI) who underwent acute primary percutaneous coronary intervention (PCI). METHODS: Patients undergoing PCI for an acute STEMI were stratified into elevated SUA (>6.5 mg/dL) and normal SUA group (≤6.5 mg/dL). Primary end points were post-PCI myocardial blood flow and in-hospital and 1-year mortality. RESULTS: Serum uric acid level was high in 45 patients (24%) on admission. Subjects with elevated SUA had a higher prevalence of hypertension, previous myocardial infarction, multivessel disease, and Killip functional class III or higher. Corrected thrombolysis in myocardial infarction (TIMI) frame count was longer, and mean TIMI myocardial perfusion grade was higher in patients with elevated uric acid compared with controls. Patients with elevated SUA levels had higher in-hospital (6.6% vs 2.8%, P < 0.01) and 1-year mortality (11.1% vs 5.7%, P < 0.01). Major adverse cardiac events were higher in patients with elevated SUA levels both in-hospital (11.1% vs 5.7%, P < 0.01) and at 1 year (17.7% vs 10%, P < 0.05). An elevated admission SUA level also independently predicted both 1-year mortality (odds ratio, 1.41; 95% confidence interval, 1.24-2.69) and abnormal myocardial perfusion detected by TIMI myocardial perfusion grade in STEMI patients undergoing primary PCI (odds ratio, 2.14; 95% confidence interval, 1.17-4.19, respectively). CONCLUSIONS: Elevated SUA level on admission independently predicts impaired myocardial flow and poor prognosis in STEMI patients undergoing primary PCI.

[The relation between exercise-induced myocardial ischemia and high-sensitive C-reactive protein and neopterin levels]. / Egzersizin neden oldugu miyokardiyal iskemi ile yüksek duyarlilikli C-reaktif protein ve neopterin iliskisi.

OBJECTIVE: High sensitivity C-reactive protein (hsCRP) and neopterin are associated with atherosclerosis. We aimed to evaluate the association between hsCRP and neopterin, and myocardial ischemia during exercise stress test (EST) in patients with stable angina pectoris (SAP) and to assess the predictive value of these mediators in obstructive coronary artery disease. METHODS: Forty-five patients with SAP were included in this prospective observational study. EST- positive group included 23 patients (15 males, mean age 54 ± 10 years) and EST-negative group-22 patients (14 males, mean age 52 ± 9 years). In each patient, blood samples were obtained 1 hour before and 30 minutes after EST. In EST-positive group, coronary angiography was performed to determine the presence and severity of coronary artery lesions as assessed by Gensini score. Statistical analysis was performed using Chi-square, unpaired t, Mann-Whitney U and Wilcoxon rank tests. Logistic regression analysis was used to establish the predictive value of tests. RESULTS: Before EST, hsCRP and neopterin levels were similar between the two groups, however, hsCRP levels were higher in EST-positive group after EST (p=0.03). There was no significant difference between the two groups with respect to neopterin levels after EST (p=0.4). In EST-positive group, EST resulted in significant increases in both hsCRP and neopterin levels (from 3.8 ± 2.8 mg/L to 4.3 ± 3.1 mg/L, p=0.001; from 8.7 ± 4.0 nmol/L to 13.1 ± 10.0 nmol/L, p=0.001, respectively). In EST-negative group only neopterin levels significantly increased after EST (from 6.9 ± 1.8 nmol/L to 9.0 ± 3.9 nmol/L, p=0.001). No relation was observed between the obstructive coronary lesions and the levels of hsCRP or neopterin at any point. CONCLUSION: In SAP patients, independent with the existence of obstructive coronary lesion, elevated levels of hsCRP after EST might be an indicator of immune activation caused by myocardial ischemia.

Frequency of mutated allele CYP2D6*4 in the Turkish ankylosing spondylitis patients and healthy controls.

The aim of this study was to determine the frequency of mutated allele CYP2D6*4 in the Turkish ankylosing spondylitis (AS) patients and healthy controls. Hundred unrelated AS patients who were diagnosed and treated in the Physical Medicine and Rehabilitation Clinic of Ankara Numune Research and Training Hospital and 52 healthy control subjects were included in the study. The wild-type allele of CYP2D6 and the mutated allele CYP2D6*4 were detected by polymerase chain reaction and a subsequent hybridization reaction. CYP2D6*4 allele was not detected in 72 subjects (72%) of the AS patients. Among the remaining 28 patients, 7 (7%) were carriers of two *4 alleles, being homozygous for CYP2D6. Twenty-one patients (21%) were carriers of one *4 allele, being heterozygous for CYP2D6*4. Among the healthy control subjects (n = 52), 23% were heterozygous and 2% were homozygous for CYP2D6*4 polymorphism. The frequency of the CYP2D6*4 allele was 0.175 in the AS patients (100 patients; 200 alleles). The frequency of the CYP2D6*4 allele was 0.134 in control group (52 control subjects; 104 alleles). The odds ratios for development of the AS for the presence of one or two CYP2D6*4 alleles with no CYP2D6*4 alleles as baseline were calculated. No significant risk of AS development was observed for individuals with one or two CYP2D6*4 alleles. Findings of this study showed no significant association between CYP2D6*4 allele and AS in our population. Further studies with larger scaled groups should be performed.

Trace and toxic element patterns in nonsmoker patients with noninsulin-dependent diabetes mellitus, impaired glucose tolerance, and fasting glucose.

PROJECT: Noninsulin dependent diabetes mellitus is supposed to be associated with fluctuations in the plasma levels of several trace elements. There is accumulating evidence that the metabolism of several trace elements is altered in patients with noninsulin dependent diabetes mellitus and that these nutrients might have specific roles in the pathogenesis and progression of this disorder. PROCEDURE: The aim of the present study is to compare the levels of essential trace and toxic elements including lead (Pb), arsenic (As), cadmium (Cd), chromium (Cr), aluminium (Al), nickel (Ni), cobalt (Co), iron (Fe), copper (Cu), selenium (Se), zinc (Zn), vanadium (V), manganese (Mn), barium (Ba), silver (Ag), and mercury (Hg) in patients with noninsulin dependent diabetes mellitus (n = 31), impaired glucose tolerance (n = 20), impaired fasting glucose (n = 14), and healthy controls (n = 22). Plasma concentrations of the elements were measured by using inductively coupled plasma mass spectrometry. RESULTS: The results indicated that values of lead, nickel, aluminium, copper, and chromium were significantly higher, but not above toxic levels, in the plasma of nonsmoker patients with noninsulin dependent diabetes mellitus (P < 0.05). The values for these elements were found to be significantly higher (P < 0.05) in patients with impaired fasting glucose than in controls. Moreover, a statistically significant correlation was found between plasma levels of glycated hemoglobin and of some trace elements like lead, nickel, aluminium, copper, chromium, cadmium, and mercury. CONCLUSIONS: Thus, it was concluded that chronic complications of glucose metabolism disorders might be associated with alterations in the levels of some trace elements. Nevertheless, some more timely and extensive studies are required to clarify the exact mechanisms of each of these changes.

Plasma total homocysteine levels in a healthy Turkish population sample.

OBJECTIVE: The objective of this study is to determine the reference values of homocysteine levels from a sample of healthy native Turks, and the relationship of these levels with gender, age and other risk factors. METHODS AND RESULTS: Plasma homocysteine level was measured in 159 healthy Turkish individuals. Homocysteine levels were determined by the HPLC method and differences between sex and age groupings (20-40 years, 41-60 years, and 61 and older) were compared. Mean homocysteine levels were 8.91 +/- 1.41 micromol/l. The median homocysteine level was 8.35 micromol/l (men 8.80, women 7.0). Homocysteine levels significantly increased with age (r = 0.49) and higher in men than in women in each age group (p < 0.05) (men: 9.51 +/- 1.40; women 7.38 +/- 1.36; p < 0.001). The cut-off point for high homocysteine level is selected to be the value that marks the upper 20% of the control population distribution (12.26 micromol/l). Postmenopausal > 60-year-old women manifested significantly higher increases in total homocysteine concentrations than 20 to 40-year-old premenopausal women. There were no significant correlations between homocysteine and body mass index, glucose, total and lipoprotein lipids, C-reactive protein, creatinine, smoking and alcohol consumption except blood pressure and uric acid. CONCLUSIONS: These data indicate the significance of sex- and age-associated differences of homocysteine levels in native Turkish subjects. Upper reference limits for the plasma total homocysteine concentration increased with age and were higher for men than for women at all ages. Focusing public health initiatives on this issue may reduce the high prevalence of cardiovascular disease in the Turkish population.

Hyperhomocysteinaemia and coronary artery disease in the Turkish population.

OBJECTIVE: Many studies have demonstrated a strong association between elevated plasma total homocysteine (Hcy) levels and vascular disease. The objective of this study was to examine the relation between homocysteine levels and coronary artery disease in Turkish patients. METHODS AND RESULTS: In this study plasma homocysteine levels were measured in control and patient groups. A significant coronary artery lesion was defined as a stenosis of > or = 70% as shown by coronary angiography and determined by on-line quantitative measurements; treatment was by coronary angioplasty. Total plasma Hcy level was measured before the coronary intervention. Plasma homocysteine levels were measured by an HPLC method in patients with a definite diagnosis of coronary artery disease and compared with age- and sex-matched controls. Patients with coronary artery disease had significantly higher mean homocysteine concentrations than control subjects (geometric mean +/- 95% CI: 12.5 +/- 1.1 micromol/l vs. 8.60 +/- 1.07 micromol/l, p<0.001). Eighty-three (59%) members of the patient group and 14 (21%) members of the control group had plasma homocysteine concentrations above the 11.3 micromol/l, which represents the concentration which includes the uppermost quintile of the control group distribution (odds ratio 4.35, 95% CI; 2.1-8.94). CONCLUSION: Results of this study indicate that high plasma levels of homocysteine in Turkish subjects are associated with coronary artery disease. Our data suggest that focusing public health initiatives on this issue may reduce the high prevalence of cardiovascular disease in the Turkish population.