Assessment of myocardial performance index in hypertensive patients with or without hyperuricaemia.

BACKGROUND: Myocardial performance index (MPI) is impaired in patients with hypertension. Uric acid is biologically active and can stimulate oxidative stress, endothelial dysfunction, inflammation, and vasoconstriction. Hyperuricaemia may provide a negative contribution to impaired MPI in hypertension. AIM: The study was designed to assess the MPI in hypertensive patients with or without hyperuricaemia. METHODS: A total of 96 consecutive hypertensive patients were divided into two groups according to levels of serum uric acid (SUA); 49 normouricaemic patients (defined as SUA < 7.0 mg/dL in men and < 6.0 mg/dL in women) and 47 hyperuricaemic patients. SUA levels and other biochemistry parameters were determined by a standard analytical technique. All patients were evaluated by two-dimensional and Doppler echocardiography. RESULTS: The two groups were similar according to age, body mass index, and smoking status. Mean MPI value (0.498 ± 0.06 vs. 0.410 ± 0.05, p < 0.001) was significantly higher in the hyperuricaemic group than the normouricaemic individuals and positively correlated with the mean value of SUA levels (r = 0.51, p < 0.001). CONCLUSIONS: Our study demonstrated that high SUA levels were significantly associated with impaired MPI in hypertensive patients. SUA may suggest a valuable laboratory finding in assessing the risk of developing subclinical impaired left ventricular global function.

The relationship between serum lectin-like oxidized LDL receptor-1 levels and systolic heart failure.

OBJECTIVES: Lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) appears to be involved in atherosclerotic plaque vulnerability and rupture. In this study, we aimed to evaluate the utility of serum LOX-1 levels in the diagnosis and assessment of left ventricular systolic HF and LOX-1's relationship with serum pro-brain natriuretic peptide (NT-proBNP). DESIGN AND SETTINGS: This was a cross-sectional study of all eligible patients admitted to the department of cardiology of the University Hospital between July 2011 and April 2012. METHODS: Fifty-five patients with a diagnosis of systolic heart failure and 25 patients without systolic HF were enrolled in this study. Serum C-reactive protein, NT-proBNP, and LOX-1 were studied. RESULTS: Serum LOX-1 and NT-proBNP levels were significantly higher in the heart failure group and showed a positive correlation with NT-proBNP and negative correlations with left ventricular ejection fraction (EF). In addition, LOX-1 levels in patients with ischaemic cardiomyopathy were significantly higher, while they were similar in patients with dilated cardiomyopathy compared to control subjects. CONCLUSION: Our study demonstrates the utility of the serum LOX-1 levels in the diagnosis of left ventricular systolic heart failure. LOX-1 may have a place in the diagnosis of heart failure, in particular in patients with ischaemic cardiomyopathy.

The utility of inferior vena cava diameter and the degree of inspiratory collapse in patients with systolic heart failure.

INTRODUCTION: Both inferior vena cava (IVC) diameter and the degree of inspiratory collapse are used in the estimation of right atrial pressure. AIM: The purpose of this study is to evaluate the utility of IVC diameter, using echocardiography as a marker of volume overload and the relationship between these parameters and N-terminal pro-B natriuretic peptide (NT-proBNP) in patients with systolic heart failure (HF). METHODS: We included 136 consecutive patients with systolic HF (left ventricular ejection fraction, <50%), including 80 patients with acutely decompensated HF and 56 patients with compensated HF as well as 50 subjects without a diagnosis of HF. All patients underwent transthoracic echocardiography to assess both their IVC diameters and the degree of inspiratory collapse (≥50%, <50%, and no change [absence] groups); NT-proBNP levels were measured, and these data were compared between the 2 groups. RESULTS: Inferior vena cava diameter and NT-proBNP were significantly higher among the patients with HF than among the control subjects (21.7 ± 2.6 vs 14.5 ± 1.6 mm, P < .001 and 4789 [330-35000] vs 171 [21-476], P < .001). The mean IVC diameter was higher among the patients with decompensated HF than among the patients with compensated HF (23.2 ± 2.1 vs 19.7 ± 1.9 mm, P < .001). The values of NT-proBNP were associated with different collapsibility of IVC subgroups among HF patients. The NT-proBNP levels were 2760 (330-27336), 5400 (665-27210), and 16806 (1786-35000), regarding the collapsibility of the IVC subgroups: greater than or equal to 50%, less than 50%, and absence groups, P < .001, respectively, among HF patients. There was a significant positive correlation between IVC diameter and NT-proBNP (r = 0.884, P < .001). A cut off value of an IVC diameter greater than or equal to 20.5 mm predicted a diagnosis of compensated HF with a sensitivity of 90% and a specificity of 73%. CONCLUSIONS: Inferior vena cava diameter correlated significantly with NT-proBNP in patients with HF. Inferior vena cava diameter may be a useful variable in determining a patient's volume status in the setting of HF and may also enable clinicians to distinguish patients with decompensated HF from those with compensated HF.

Improvement of the myocardial performance index in atrial fibrilation patients treated with amiodarone after cardioversion.

PURPOSE: This study evaluated the response to electrical cardioversion (EC) and the effect on the myocardial performance index (MPI) in patients with persistent and long-standing persistent atrial fibrillation (AF). METHODS: We enrolled 103 patients (mean age 69.6 ± 8.9 years, 40.7% males) with a diagnosis of persistent and long-standing persistent AF. EC was applied to all patients after one g of amiodarone administration. Echocardiographic findings before EC were compared in patients with successful versus unsuccessful cardioversions and in patients with maintained sinus rhythm (SR) versus those with AF recurrence at the end of the first month. We also compared echocardiographic data before EC versus at the end of the first month in the same patients with maintained SR. RESULTS: SR was achieved in 72.8% of patients and was continued at the end of the first month in 69.3% of the patients. The MPI value of all patients was found to be 0.73 ± 0.21. The size of the left atrium was determined to be an independent predictor of the maintenance of SR at 1 month. In subgroup analyses, when we compared echocardiographic findings before EC and at the end of the first month in patients with maintained SR, the MPI (0.66 ± 0.14 vs 0.56 ± 0.09, p < 0.001) values were significantly decreased. CONCLUSIONS: Our study is the first to show impairment of the MPI, which is an indicator of systolic and diastolic function, in patients with persistent and long-standing persistent AF and improvement of the MPI after successful EC.

Serum fetuin-A levels in patients with systolic heart failure.

OBJECTIVE: Inflammation and dystrophic calcification have been associated with cardiovascular disease (CVD) and chronic heart failure (CHF). The aim of the present study was to investigate the potential usefulness of fetuin-A as a biomarker in CHF. METHODS: Serum fetuin-A was measured in 66 CHF patients with left ventricular function < 50% and in 31 healthy controls at baseline. Fetuin-A was evaluated as a diagnostic marker for systolic heart failure and compared with C-reactive protein (CRP) and pro-brain natriuretic peptide (pro-BNP). RESULTS: The levels of serum fetuin-A were significantly decreased in the CHF patients compared to the control group (P < 0.01). Although there were significant correlations between fetuin-A and certain parameters in patients and controls, none of these were present consistently in either group. It was found that serum fetuin-A levels could identify patients with systolic heart failure with a high degree of sensitivity and specificity. CONCLUSIONS: Serum fetuin-A is decreased in CHF patients, indicating that anti-inflammatory activity is downregulated in CHF and that calcification may be associated with CHF.

[Comparison of pneumatic compression device and sand bag with respect to peripheral vascular complications in elective cardiac catheterization and percutaneous femoral artery interventions]. / Kalp kateterizasyonu ve elektif perkütan girisimlerde periferik damar komplikasyonlari açisindan femoral arter pnömotik kompresyon cihazinin kum torbasi yöntemi ile karsilastirilmasi

OBJECTIVES: After coronary angiography and percutaneous coronary intervention (PCI), the classic sand bag method and compression devices are widely used for control of bleeding and prevention of vascular complications. The purpose of our study was to assess the major peripheral vascular complications and to compare the sand bag and a pneumatic compression device ("Close Pad") in terms of major peripheral vascular complications after coronary interventions. STUDY DESIGN: Between June 2011 and November 2011, a total of 434 patients who admitted to the Department of Cardiology of Uludag University Faculty of Medicine were included in the study. 396 patients underwent coronary angiography and 38 patients underwent PCI. Sand bag was applied in 209 patients. Bleeding requiring transfusion, hematoma larger than 10 cm(2), pseudoaneurysm, and arteriovenous (AV) fistula were defined as the major local complications. Logistic regression analysis were used to evaluate the datas. RESULTS: Major vascular complications occurred in 2% of diagnostic angiography and in 13.2% of PCI patients (p=0.003). The major vascular complications were significantly higher with the Close Pad device compared with sand bag (5.3% vs. 0.5%, p=0.007). Smoking, PCI, Close Pad, clopidogrel, and anticoagulants were observed to have increased risk of major local complications. In the logistic regression analysis, only smoking and Close Pad usage were evaluated as independent variables that increased the risk of major vascular complications (p<0.05). CONCLUSION: Close Pad usage demonstrated increased risk of vascular complications when compared with the sand bag in patients undergoing cardiac catheterizations. After the PCI, patients should be selected carefully for application of the Close Pad.

[Intracranial hemorrhage due to pulmonary thromboembolism in heparin therapy and therapeutic management of patients hospitalized with massive pulmonary embolism after discharge]. / Pulmoner tromboemboli tedavisi için heparin kullanirken intrakraniyal kanama gelisen ve masif pulmoner tromboemboli nedeniyle tekrar hastaneye yatirilan hastada tedavi yönetimi.

A patient with a history of intracranial hemorrhage who was hospitalized due to massive pulmonary thromboembolism (PTE) was presented. A 59-year-old female patient had an intracranial hemorrhage while under anticoagulant therapy due to PTE after a knee operation. Therefore, the anticoagulant therapy was discontinued. Forty-seven days after the cessation of the anticoagulant treatment, the patient was admitted to the emergency department with a complaint of acute dyspnea and presyncope. Transthoracic echocardiography showed signs of right ventricular overload. Contrast-enhanced thorax computed tomography showed saddle-like filling defects in the level of pulmonary trunk bifurcation to the extension of both the main pulmonary arteries. The patient was admitted with a massive PTE. Fibrinolytic treatment could not be given due to the history of hemorrhagic stroke while under heparin infusion therapy. The patient dyspnea did not resolve, so pulmonary angiography and thrombus aspiration was planned. The patient's clinical status had improved after the thrombus aspiration. After the thrombus aspiration, bemiparin treatment was given via effective anti-factor Xa level. Due to lower extremity Doppler ultrasonography showing subacute-chronic thrombosis on the right popliteal vein, inferior vena cava filter was inserted. When thrombolytic therapy cannot be given to patients with a high risk bleeding, the embolectomy and/or aspiration of pulmonary thrombus may be an appropriate treatment option. In such patients, for anticoagulant therapy, unfractioned heparin with close aPTT follow-up or low molecular weight heparin therapy with antifactor Xa follow-up can be used.