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INTRODUCTION: Obstructive sleep apnea (OSA) and endothelial dysfunction are associated with cardiovascular risk factors and the development of atherosclerosis. Endocan is a marker of endothelial dysfunction, while obstructive sleep apnea is one of the causes of endothelial dysfunction. In this study, we investigated the relationship between endocan and obstructive sleep apnea severity. MATERIAL AND METHODS: A total of 179 patients with snoring complaints were included. All patients underwent polysomnography, and based on the results, the participations were allocated to the control group (n = 39) or to the obstructive sleep apnea group (n = 140). The OSA group was classified as having mild (apnea-hypopnea index (AHI) = 5-15; n = 43), moderate (AHI = 15-30; n = 42), or severe OSA (AHI > 30; n = 55). All participations had their endocan levels measured. RESULTS: Endocan levels in OSA patients were significantly higher than in the control group (11.8 (3.13-200) vs 3.13 (3.13-23) ng/ml, p < 0.001). Also, endocan levels were significantly higher in the severe OSA group than moderate and mild obstructive OSA (13.2 (3.13-200), 12.6 (3.13-200) and 8.44 (3.13-50.5) ng/ml, p = 0.015, respectively). Multiple logistic regression analysis showed that smoking, age and endocan levels were independent predictors of OSA severity (p = 0.024, p = 0.037, p = 0.004, respectively). CONCLUSIONS: Endocan seems to be a potential risk stratification marker in this patient population.
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Simultaneous multivessel epicardial coronary artery thrombosis is an uncommon finding in acute ST-segment elevation myocardial infarction (STEMI). It generally leads to cardiogenic shock and sudden cardiac death in the hospital. We report a 42-year-old male patient presenting with acute anterior STEMI with triple coronary artery thrombosis. An emergency coronary angiogram showed total occlusion of the left anterior descending artery (LAD) with thrombus formation. At the same time, thrombus formations were also seen in the circumflex artery (CXA), the second obtuse marginal (OM2) branch, and the distal right coronary artery (RCA). We unsuccessfully attempted thrombus aspiration of the LAD. Subsequently, we decided to stent the LAD, and a successful percutaneous coronary intervention (PCI) was performed for the LAD. In a second procedure, RCA thrombosis regressed with 24-hour tirofiban (glycoprotein IIb/IIIa receptor inhibitor) perfusion, although CXA thrombosis and OM thrombosis did not regress. Therefore, we performed stenting of the CXA and OM with a newer provisional technique called the flower petal technique. Thrombolysis in myocardial infarction (TIMI) flow grade III was seen after stenting. The patient was discharged from the hospital 5 days after PCI without any symptoms.
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PURPOSE: To determine the predictive values of D-dimer assay, Global Registry of Acute Coronary Events (GRACE) and Thrombolysis in Myocardial Infarction (TIMI) risk scores for adverse outcome in patients with non-ST-segment elevation myocardial infarction (NSTEMI). PATIENTS AND METHODS: A total of 234 patients (mean age: 57.2±11.7 years, 75.2% were males) hospitalized with NSTEMI were included. Data on D-dimer assay, GRACE and TIMI risk scores were recorded. Logistic regression analysis was conducted to determine the risk factors predicting increased mortality. RESULTS: Median D-dimer levels were 349.5 (48.0-7,210.0) ng/mL, the average TIMI score was 3.2±1.2 and the GRACE score was 90.4±27.6 with high GRACE scores (>118) in 17.5% of patients. The GRACE score was correlated positively with both the D-dimer assay (r=0.215, P=0.01) and TIMI scores (r=0.504, P=0.000). Multivariate logistic regression analysis revealed that higher creatinine levels (odds ratio =18.465, 95% confidence interval: 1.059-322.084, P=0.046) constituted the only significant predictor of increased mortality risk with no predictive values for age, D-dimer assay, ejection fraction, glucose, hemoglobin A1c, sodium, albumin or total cholesterol levels for mortality. CONCLUSION: Serum creatinine levels constituted the sole independent determinant of mortality risk, with no significant values for D-dimer assay, GRACE or TIMI scores for predicting the risk of mortality in NSTEMI patients.
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BACKGROUND: The risk of thrombus formation in the left atrium is known to be very high in patients with both mitral stenosis (MS) and atrial fibrillation (AF). However, that risk should not be ignored in patients with MS in sinus rhythm (SR). The aim of this study was to determine the clinical, echocardiographic, and biochemical factors that could have a determining role in the formation of a left atrial (LA) thrombus in patients with MS in SR. METHOD: A total of 207 consecutive patients with MS who underwent both transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) for diagnosis or to investigate the presence of a thrombus in the LA and appendage were enrolled in this study. RESULTS: LA thrombus was detected in 21 of 207 patients. CHA2DS2-VASc score was not found to be a predictor of LA thrombosis in patients with MS in SR, despite the higher CHA2DS2-VASc scores observed in those patients. The mitral valve area and mitral valve gradient were not predictive of LA thrombus development; however, LA anteroposterior diameter (LAAPD) was found to be a predictor of LA thrombosis. Levels of high sensitivity-C-reactive protein and uric acid were higher in the patients with LA thrombosis, but only uric acid was found to be a predictor of LA thrombosis in multivariate analysis. CONCLUSIONS: A larger LAAPD and an elevated serum uric acid level were found to be independent predictors of LA thrombosis in patients with MS in SR.
