[Markers of coagulation and fibrinolysis do not detect or predict the presence of left atrial appendage thrombus in patients with atrial fibrillation]. / Atriyal fibrilasyonu olan hastalarda pihtilasma ve fibrinolizis belirteçleri sol atriyal trombüs varligini belirleyemiyor veya öngöremiyor.

OBJECTIVE: This study was designed to evaluate the role of hemostatic variables in arterial blood serum in left atrial thrombosis and to define any hemostatic variables, such as serum biomarkers, that could potentially reduce the need for transesophageal echocardiography. METHODS: This study included patients with non-valvular asymptomatic atrial fibrillation (AF), either paroxysmal, persistent, or chronic. The presence of an left atrial appendix (LAA) thrombus was used to form 2 groups: thrombus (+) and thrombus (-). The serum levels of the thrombotic/fibrinolytic markers including beta-thromboglobulin, prothrombin fragment 1+2, thrombin/antithrombin complex, human plasminogen activator inhibitor-1/tissue plasminogen activator complex, and D-dimer were compared between 2 groups. RESULTS: The mean age of the study population was 65.6±12.2 years (range: 30-96 years), and 33 (61.1%) patients were male. Fourteen (25.9%) patients had an LAA thrombus and 40 patients did not. Two groups did not differ significantly with regard to any of the coagulation/fibrinolysis markers. The LAA thrombus (+) group had significantly higher rates of heart failure, peripheral artery disease, coronary artery disease, and chronic obstructive pulmonary disease (<0.05). Neither the serum levels of the study markers nor demographic and clinical parameters were predictive of an LAA thrombus in binary logistic regression analysis. CONCLUSION: The arterial blood serum markers did not differ significantly between groups with and without an LAA thrombus and did not predict an LAA thrombus in patients presenting with AF.

Is there a relationship between resistin levels and left ventricular end-diastolic pressure?

OBJECTIVE: Resistin, a cysteine-rich peptide, is associated with atherosclerosis and diabetes. Resistin levels increase corresponding to coronary artery disease (CAD) and heart failure severity. Since resistin level tends to elevate with symptomatic heart failure, it is expected to be associated with left ventricular end-diastolic pressure (LVEDP). However, there is no relevant literature on the relationship between resistin levels and LVEDP. We aimed to evaluate the association between resistin levels and LVEDP, severity of CAD, carotid intima-media thickness (CIMT), and echocardiographic diastolic dysfunction parameters. METHODS: For this study, 128 euvolemic patients with creatinine clearance >50 mg/dL and without acute coronary syndrome, who had typical chest pain or were stress test positive, were enrolled. Resistin level was measured by Enzyme-linked immunosorbent assays (ELISA) method. Severe CAD is defined as ≥50% stenosis in one of the major coronary arteries. LVEDP was measured during left heart catheterization. RESULTS: After coronary angiography, 60 patients (46.9%) had severe CAD. The mean LVEDPs were similar for patients with and without severe CAD (p=0.480). The resistin levels did not differ between the groups (p=0.154). The resistin levels did not correlate with LVEDP (r=-0.045, p=0.627), ejection fraction (EF; r=0.110, p=0.228), the Gensini score (r=-0.091, p=0.328), and CIMT (r=0.082, p=0.457). No significant correlation was found between the echocardiographic diastolic dysfunction parameters and resistin levels. CONCLUSION: There was no significant correlation between resistin level and LVEDP, CAD severity, echocardiographic diastolic dysfunction parameters, and CIMT. Further studies are warranted to determine the efficacy of resistin in clinical use.

Comparison of application of 2013 ACC/AHA guideline and 2011 European Society of Cardiology guideline for the management of dyslipidemias for primary prevention in a Turkish cohort.

OBJECTIVE: Atherosclerotic cardiovascular disease is a major global cause of death. The common approach in primary prevention of cardiovascular disease is to identify patients at high risk for cardiovascular disease. This article analyzes and compares the application of 2013 American College of Cardiology/American Heart Association (ACC/AHA) guideline and the 2011 European Society of Cardiology (ESC) guideline for the management of dyslipidemias for primary prevention in Turkish population. METHODS: The study included 833 patients (482 women and 351 men). Risk scores were calculated according to both guidelines and indications for statin treatment were determined according to sex and age group. Variables are presented as mean±SD or median with interquartile range for continuous data and as proportions for categorical data. Variables were analyzed by unpaired t-test, Mann-Whitney U test, chi-square or Fischer's exact test as appropriate. RESULTS: The ACC/AHA would suggest statin treatment in 415 patients out of 833 (49.5%), while ESC would recommend statin for 193 patients out of 833 (23.1%)(p<0.001). Statins would be recommended for 40.4% of women and 62.6% of men for primary prevention by the ACC/AHA, while this figure was 12% for women and 38.4% for men according to the ESC guideline (p<0.001 for both). CONCLUSION: When compared to the ESC guideline, the ACC/AHA guideline suggests augmented statin treatment for primary prevention in Turkish population.

Coronary artery disease detected by coronary computed tomography angiography is associated with red cell distribution width.

OBJECTIVE: Increased red blood cell distribution width (RDW) is associated with severity of coronary artery disease (CAD). The aim of the present study was to retrospectively evaluate the relationship between CAD detected by coronary computed tomography angiography (CCTA) and RDW. METHODS: Records of 291 patients who underwent 16-slice CCTA due to the presence of angina-like chest pain were retrospectively evaluated. Exclusion criteria were applied. Clinical characteristics, risk factors for CAD, and RDW values on CCTA were noted. RESULTS: RDW levels in patients with CAD were significantly higher than in those with normal coronary arteries (NCAs) (15.50±1.57 compared to 14.80±1.41, p=0.001). Diabetes mellitus, hypertension, and history of smoking were significantly more common in the CAD group (p=0.018, p=0.007, and p=0.013, respectively). On multivariate logistic regression analysis, RDW (p=0.009 [odds ratio (OR): 1.352; 95% confidence interval (CI): 1.081-1.683]), age (p<0.001 [OR: 1.063; 95% CI 1.031-1.090]), and history of smoking (p=0.003 [OR: 2.672; 95% CI: 1.360-5.232]) were shown to be independent predictors for CAD detected by CCTA. CONCLUSION: The present results suggest that higher RDW levels are independently associated with presence of CAD detected by CCTA in patients without known CAD. Further studies are warranted to clarify the exact role of RDW in risk stratification.

Hematological parameters can predict the extent of coronary artery disease in patients with end-stage renal disease.

PURPOSE: Aside from traditional factors (e.g., diabetes, age, and hypertension), some hematological parameters, such as neutrophil-to-lymphocyte ratio (NLR), red blood cell distribution width (RDW), and mean platelet volume (MPV), have increasingly been reported as measures of systemic inflammation and atherosclerosis in patients with end-stage renal disease (ESRD). This study aimed to determine whether there is an association between these hematological parameters and the extent of coronary artery disease (CAD) in patients with ESRD. METHODS: A total of 149 consecutive ESRD patients (66 % males) without established CAD were studied. NLR, RDW, and MPV values in all patients were calculated from the complete blood count before coronary angiography. Angiographic views were assessed by an experienced interventional cardiologist, and the extent of CAD was evaluated by the Gensini score. The patients were divided into quartiles of the Gensini score. RESULTS: Age, time on dialysis, calcium-phosphorus product, C-reactive protein levels, NLR, and MPV were significantly different among the groups (all p < 0.05). The Gensini score was correlated with age, time on dialysis (both p < 0.001), NLR (p = 0.004), and C-reactive protein levels (p = 0.034) and inversely correlated with left ventricular ejection fraction (p = 0.023). Multivariate regression analysis showed that age (p = 0.001), time on dialysis (p < 0.001), NLR (p = 0.001), and MPV (p = 0.005) were independent predictors of the extent of CAD. CONCLUSIONS: Aside from the well-known traditional factors, NLR and MPV are independent predictors of the extent of CAD in patients with ESRD.

The effects of a low international normalized ratio on thromboembolic and bleeding complications in patients with mechanical mitral valve replacement.

BACKGROUND: Mechanical heart valve replacement has an inherent risk of thromboembolic events (TEs). Current guidelines recommend an international normalized ratio (INR) of at least 2.5 after mechanical mitral valve replacement (MVR). This study aimed to evaluate the effects of a low INR (2.0-2.5) on thromboembolic and bleeding complications in patients with mechanical MVR on warfarin therapy. METHODS: One hundred and thirty-five patients who underwent mechanical MVR were enrolled in this study. The end points of this study were defined as TEs (valve thrombosis, transient ischemic attack, stroke) and bleeding (all minor and major bleeding) complications. Patients were followed up for a mean of 39.6 months and the mean INR of the patients was calculated. After data collection, patients were divided into 3 groups according to their mean INR, as follows: group 1 (n = 34), INR <2.0; group 2 (n = 49), INR 2.0-2.5; and group 3 (n = 52), INR >2.5. RESULTS: A total of 22 events (10 [7.4%] thromboembolic and 12 [8.8%] bleeding events) occurred in the follow-up period. The mean INR was an independent risk factor for the development of TEs. Mean INR and neurological dysfunction were independent risk factors for the development of bleeding events. A statistically significant positive correlation was found between the log mean INR and all bleeding events, and a negative correlation was found between the log mean INR and all TEs. The total number of events was significantly lower in group 2 than in groups 1 and 3 (P = 0.036). CONCLUSIONS: This study showed that a target INRs of 2.0-2.5 are acceptable for preventing TEs and safe in terms of bleeding complications in patients with mechanical MVR.