The Relationship Between Endocan and Serum Inflammatory Markers in Patients with Senile Calcific Aortic Stenosis.

BACKGROUND: Endocan is an indicator of many pathologies accompanied by inflammation, endothelial cell activation, and dysfunction. In this study, we examined the relationship between degenerative aortic sclerosis, which progresses in a similar pathophysiologic mechanism as atherosclerosis, and serum inflammatory markers and endocan levels. METHODS: A total of 155 patients without known coronary artery disease, aged between 65 and 80 years, were consecutively included in the prospective cross-sectional study. The study population was analyzed in 4 different groups. The control group consisted of patients with normal aortic valve structure, while patients with aortic stenosis were classified as mild aortic stenosis (2-2.9 m/s), moderate aortic stenosis (3-3.9 m/s), and severe aortic stenosis (≥ 4 m/s) according to their aortic velocity. While there were 39 patients in the control group, there were 58, 24, and 34 patients in the mild, moderate, and severe aortic stenosis groups, respectively. RESULTS: There was no statistically significant difference between the groups in terms of patient distribution and characteristics. History of dyspnea and angina was correlated with the severity of aortic stenosis (P <.001). In this study, no statistically significant correlation was found between serum endocan levels and the severity of aortic stenosis (control group: 17.3 ± 6.3 ng/mL, mild aortic stenosis: 17.6 ± 8.7 ng/mL, moderate aortic stenosis: 16.3 ± 3.8 ng/mL, severe aortic stenosis: 15.2 ± 5.9 ng/mL, P =.396). However, it was figured out that there was a positive correlation between endocan levels and hemoglobin (Hg) (r = 0.308, P =.001), platelet (PLT) (r = 0.320, P <.001), and albumin (Alb) (r = 0.206, P =.026). CONCLUSION: In this study, no significant correlation was found between serum endocan levels and the severity of aortic stenosis. On the other hand, there was a positive correlation between endocan levels and Hg, PLT, and Alb.

Long-term (> 3 years) clinical and angiographic outcomes of coronary multilink stent implantations: a single center experience.

The ACS Multilink (ML) stent is a novel second-generation stent. The largest amount of information available on the long-term outcome of coronary stenting is based on the use of Palmaz-Schatz stents. Fewer data exist on long-term follow-up results of ML coronary stents implantations. The authors present the long-term (> 3 years) clinical and angiographic follow-up results of the ACS Multilink coronary stents implanted in their institution. From May 1996 to December 1997, 125 patients underwent 133 coronary ML stent implantations. Stented vessels were as follows: 49% left anterior descending artery, 31% right coronary artery, and 20% left circumflex coronary artery. Indications for stent implantations were elective in 64%, because of suboptimal result from percutaneous transluminal coronary angioplasty (PTCA) in 26%, and bailout from PTCA in 10% of patients. The mean reference diameter of stented vessels was 3.2 +/- 0.2 mm. The mean percentage stenosis was 80 +/- 11% and 3 +/- 5% before and after stent implantation, respectively. Long-term clinical follow-up was completed in 75% (80 men, mean age 53 +/- 10 years) of the patients (either by interview or phone), and angiographic follow-up (37 +/- 12 months) was completed in 58% of the patients. There were no baseline clinical or angiographic differences between those angiographically followed up and the remaining patients. Angiographic restenosis (> 50% diameter stenosis) was detected in 22% of stents. Target lesion revascularization was 12%, nontarget lesion revascularization was 14% in angiographically followed up patients. During the follow-up period death and new myocardial infarction occurred in 12% and 6% of patients, respectively, and survival rate was 88%. This study provides long-term follow-up results of intracoronary Multilink stent implantations for native coronary artery lesions. These data show that clinical and angiographic benefits of ML stents are comparable to those of the first-generation stents, especially to the Palmaz-Schatz stents, of which results have been reported previously. A considerable rate of nontarget lesion revascularization occurs during the follow-up period.

[Frequency and predictors of atrial fibrillation in severe mitral regurgitation]. / Ileri mitral yetersizliginde atriyal fibrilasyonun sikligi ve ongördürücüleri.

OBJECTIVE: The aim of this study was to assess the frequency and the predictive factors for atrial fibrillation (AF) in patients with severe mitral regurgitation (MR). METHODS: This study is a retrospective evaluation involving of 199 patients (100 females, 99 males, mean age 53.8+/-18.5) with severe MR who had been admitted to our clinic between 1997 and 2001. Etiologies of MR were; rheumatic heart disease (n=132), ischemic heart disease (n=44), mitral valve prolapsus (n=14) and mitral annular calcification (n=9). Patients who had AF (n=95), sinus rhythm (n=98) or recurrent AF (n=6) were determined according to ECG. Age, gender, smoking, hypertension, diabetes mellitus, electrocardiographic left ventricular hypertrophy (LVH), echocardiographic left atrial (LA) diameter, left ventricular end-systolic dimension (LVESD), left ventricular end-diastolic dimension (LVEDD), ejection fraction (EF), right atrial size, pulmonary artery pressure and presence or absence of mitral stenosis were recorded. RESULTS: Atrial fibrillation was observed in 50.8% of the patients. Female gender (60% vs. 40%, p=0.009), LA diameter (5.6+/-1.0 cm vs. 4.8+/-0.6 cm, p<0.001) and right atrium size (30.7% vs. 11.2%, p=0.001) were found as the predictive factors of AF in univariate analysis. Multiple logistic regression analysis showed that advanced age (p<0.014), female gender (p=0.02), LA size (p<0.001) and coexistence of MR with mitral stenosis (p<0.013) were independent risk factors for AF in patients with rheumatic MR. None of variables could be predictive for AF in patients with ischemic MR. Atrial fibrillation was found more frequently in patients with rheumatic MR than that of ischemic MR (p<0.001). In rheumatic MR, left atrium cut-off value for AF was found to be 5.5 cm (sensitivity: 52.1%, specificity: 90.7%). CONCLUSION: Atrial fibrillation is a common arrhythmia in severe MR (50.8%). Left atrial size is a powerful independent predictor for AF.

Long-term (3-5 years) clinical and angiographic follow-up results of coronary stenting in elderly patients.

The early and late results of percutaneous transluminal coronary angioplasty in elderly patients are well known, but although stent implantation has become the most frequent percutaneous coronary intervention in many centers, little information exists about its long-term outcome in elderly patients. The aim of this study was to evaluate the long-term clinical and angiographic follow-up results of intracoronary stenting in a study cohort of 120 patients (92 male) over 65 years of age, who underwent successful coronary stenting between June 1995 and December 1997. The target coronary artery was 48% left anterior descending, 21% circumflex and 31% right coronary artery. Stent implantation was elective in 54%, suboptimal in 32% and bailout in 14% of the patients. Long-term (34+/-14 months) clinical and angiographic follow-up was completed in 78% and 56% of the patients, respectively. The following end-points were considered: death, non-fatal myocardial infarction (MI), target and non-target lesion revascularization. Angiographic restenosis was detected in 31% of the patients. During the long-term follow-up period, 14% of the patients died and 11% developed a new MI. Target lesion revascularization was done in 19.4%, non-target lesion revascularization was done in 21%, and the survival rate was 86%. Although the restenosis rates did not deviate greatly from the expected long-term figures in younger populations, they do indicate that the potential for major cardiac events is still high among elderly subjects, in spite of developments in stent technology and medication.

Distribution of risk factors and prophylactic drug usage in Turkish patients with angiographically established coronary artery disease.

BACKGROUND: Coronary artery disease (CAD) is the leading cause of adult deaths in our country. In clinical practice, an adequate level of secondary prevention towards CAD primarily requires full recognition of the distribution of risk factors. The aim of our study was to determine the prevalence of coronary risk factors and the use of prophylactic drugs among patients who have an angiographically proven CAD in our centre, and to compare it with those of the EUROASPIRE I and II studies. DESIGN: Cross-sectional, observational study. METHODS: Our patients comprise 617 subjects (516 male, mean age 57.2 +/- 10.8 years) who underwent an angiography between January 2000 and May 2000 for the first time and in whom significant coronary lesions were detected. Age, gender, family history of premature CAD (FH), diabetes mellitus (DM), hypertension (HT), lipid profile, smoking, body mass index, waist circumference, hip circumference and physical activity data were recorded prior to angiography. The medical treatments received by these cases at discharge from hospital were investigated. Data thus obtained were compared with the results of the EUROASPIRE I and II trials, which studied the frequency of existing risk factors and prophylactic drug use among CAD patients in European countries. RESULTS: Hyperlipidaemia, FH, DM, HT, smoking, obesity, central obesity were found in 52, 26, 20, 41, 65, 18 and 29% of patients, respectively. The use of antiplatelets, beta-blockers, ACE inhibitors, statins and calcium antagonists were 99, 86, 40, 63 and 16%, respectively. CONCLUSION: Upon comparison of the risk factors, prevalence of obesity and DM was found to be similar to the average of nine European countries among our subjects. Smoking was found to be considerably higher, whereas HT, hyperlipidaemia and family history of premature CAD were lower than the European average within our subjects. In our cases the frequency of prophylactic drug usage at discharge was higher than the European means.

[Risk factor distribution according to the obesity degree in patients with coronary artery disease]. / Koroner arter hastaligi bulunan olgularda obezite derecelerinin diger risk faktörleriyle iliskisi.

OBJECTIVE: World Health Organization and other international guide committees defined different obesity categories according to the body mass index (BMI) and waist circumferences. The purpose of our study was (i) to compare the dispersion of other coronary risk factors in patients with coronary artery disease (CAD) with different obesity categories that were defined according to the body mass index (BMI) and the waist circumference, (ii) to determine to which extent these cut-off values effect the dispersion of other coronary risk factors. METHODS: The study group included 617 consecutive subjects (516 male, mean age - 57.2+/-10.8 years) who underwent their first angiography between January 2000 and May 2000 and in whom significant coronary lesions were detected. The distribution of risk factors such as, age, smoking, hypertension, diabetes mellitus, high LDL-C, low HDL-C, total cholesterol/HDL-C ratio, triglycerides, family history of premature CAD was compared between overweight and obese cases defined according to BMI values. The same risk factors were compared among the cases grouped as action level 1 and action level 2 defined by the waist circumference. RESULTS: In male patients; smoking was found to be higher in overweight individuals than in obese cases (71% vs. 56%) (p<0.05). In female patients; the only difference was the ratio of total-C/HDL-C as being greater in obese group than overweight group (p<0.05). In male and female patients there was no significant difference between obese and overweight cases regarding the number of total risk factors. According to the waist circumference, in male patients, smoking was more prevalent in action level 1 group than in action level 2 group. In female patients risk factors prevalence was similar in both groups. CONCLUSION: In patients with CAD, the amount of total risk factors doesn't differ between overweight and obese cases and between patients with action level 1 and action level 2 of the waist circumference. These findings indicate the necessity of using the same secondary prevention approaches in patients with CAD and different levels of obesity.

[Distribution of therapeutic procedures and choice of drug therapies in patients with angiographically confirmed coronary artery disease]. / Koroner arter hastaligi anjiyografik olarak kanitlanmis olgularda tedavi prosedürlerinin dagilimi ve hastaneden cikista ilaç seçimi.

OBJECTIVE: The aims of our study were to assess the distribution of interventional and other therapeutic procedures performed on subjects who had proven CAD by angiography in our clinic; to determine the groups of therapeutic agents prescribed at the time of discharge; and to compare these with the results of EUROASPIRE II, which examined the prophylactic drug therapy upon discharge of CAD patients in 15 European countries. METHODS: Our patients comprises of 617 subjects (516 male, 101 female; mean age 57.2 +/- 10.8 years) who underwent coronary angiography for the first time in our clinic and who were found to have a 50% lesion in at least one of the coronary arteries. In all patients distribution of risk factors on admission, distribution of therapeutic procedures and the use of drug therapies at the hospital discharge were recorded. RESULTS: We found that, 68% of our cases were considered to be eligible for a percutaneous or surgical intervention, while 27% were assessed not as requiring such an intervention and consequently were discharged being prescribed appropriate medications. For the remaining 5% of the subjects, tests for detection of viable myocardium were advised, before selecting the proper type of management. At discharge, prescription rates for antiplatelets, beta-blockers, nitrates, statins, angiotensin-converting enzyme inhibitors (ACE-I), calcium channel blockers and anticoagulants were detected to be %99, 86%, 86%, 63%, 40%, 16%, and 2% respectively. CONCLUSION: Compared with the results of EUROASPIRE II study, these data show that, antiplatelet, beta-blocker, ACE-I and lipid-lowering treatments our subjects received upon discharge were higher, whereas anticoagulant treatment was lower than the averages of the fifteen European countries consisting the EUROASPIRE II study.

Prevalence and predictors of significant coronary artery disease in Turkish patients who undergo heart valve surgery.

BACKGROUND AND AIMS OF THE STUDY: The presence of significant atherosclerotic coronary artery disease (CAD) in patients with valvular heart disease is an important predictor of perioperative mortality. The prevalence of CAD in patients undergoing valvular heart surgery is 20-40% in industrialized countries. The study aim was to determine CAD prevalence in Turkish patients undergoing valvular heart surgery, and to identify predictors of its presence. METHODS: A total of 760 patients (357 males, 403 females; mean age 54.4+/-18.1 years) who underwent coronary angiography before valvular surgery between 1995 and 2000 was enrolled retrospectively. Single- and multi-valve involvement was present in 46% and 54% of patients, respectively. Patients with ischemic mitral regurgitation were excluded from the study. Significant CAD was defined as the presence of > or =50% diameter stenosis anyone of the coronary arteries. The presence of angina pectoris, and of risk factors (e.g. hypertension, smoking, diabetes mellitus (DM), hyperlipidemia, family history of CAD) were sought in all patients. Predictors of CAD were identified by logistic regression analysis. RESULTS: Significant CAD was present in 15.8% of patients (24% males, 9% females) (p <0.001); the highest prevalence was in those with aortic stenosis (p <0.05). CAD was not seen in young patients (aged <45 years) with none of the above-mentioned risk factors. The highest correlation between CAD and risk factors was family history of CAD, followed by DM, hyperlipidemia, hypertension and smoking, in decreasing order. CONCLUSION: The study results showed that CAD in patients with valvular heart disease was less prevalent in Turkey than in industrialized countries. The incidence of coronary lesions rises notably from the age of 50 years in both males and females. Coronary angiography before valvular heart surgery could be omitted in young patients (age <45 years) with none of the coronary risk factors, or without angina.