Validation of a new risk score to predict contrast-induced nephropathy after percutaneous coronary intervention.

Contrast-induced nephropathy (CIN) is a frequent, potentially lethal complication of percutaneous coronary interventions (PCIs). We prospectively validated the diagnostic performance of a simple CIN risk score in a large multicenter international cohort of patients who underwent PCI. About 2,882 consecutive patients treated with elective or urgent PCI were enrolled. A simple CIN risk score was calculated for all patients by allocating points according to a prespecified scale (pre-existing renal disease = 2; metformin use = 2; previous PCI = 1; peripheral arterial disease = 2; and injected volume of contrast medium ≥300 ml = 1). CIN was defined as an increase, compared with baseline, of serum creatinine by ≥25%, or by ≥0.5 mg/dl, 48 hours after PCI. CIN occurred in 15.7% of the study population. The predictive accuracy of the CIN risk score was good (c-statistic 0.741, 95% confidence interval 0.713 to 0.769). Receiver-operating characteristic analysis identified a score of ≥3 as having the best diagnostic accuracy. Examination of the performance of the proposed risk score using different definitions of CIN yielded a robust predictive ability. The score exhibited good discrimination (area under the curve ≥0.700) across all predefined subgroups of the study population. Compared with 2 previously published risk scores for CIN, our score demonstrated higher discriminative ability and resulted in a net reclassification improvement and an integrated discrimination improvement (p <0.001). In conclusion, the new risk score can easily be applied in the setting of urgent or elective PCI, allows for robust risk assessment and offers the potential to improve the peri-interventional management of patients at risk for CIN.

Carotid intima-media thickness: a new marker of patients with uterine leiomyoma.

OBJECTIVE: To determine whether or not there are any significant differences in carotid intima-media thickness between patients with uterine leiomyoma and controls. STUDY DESIGN: Patients whose ages were between 40 and 50 years, with body mass index <30kg/m(2), and with a pathological diagnosis of uterine leiomyoma constituted the study group. Control subjects had no uterine leiomyoma proven by sonography. Demographic, clinical, and drug history data were collected. Right, left and mean carotid intima-media thickness measurements were obtained by ultrasonography. RESULTS: Carotid intima-media thickness and serum high-density lipoprotein (HDL) levels were significantly different between the groups (p=0.0001 and p=0.001 respectively), being respectively higher and lower in the leiomyoma group than in controls. Stepwise binary logistic regression analysis revealed that uterine leiomyoma development ratio was 159.32 times higher when carotid intima-media thickness was over 0.61mm (p=0.0001). In patients with uterine leiomyoma, carotid intima-media thickness was significantly less in patients taking statins compared to those not on these drugs (p=0.0001). CONCLUSION: The present study demonstrated a positive association between carotid intima-media thickness and the presence of uterine leiomyoma. Conversely, an inverse association was suggested between HDL and uterine leiomyoma. These findings suggest that women with uterine leiomyoma might have an increased risk of subclinical atherosclerosis.

Anticoagulation in patients with left ventricular systolic dysfunction and sinus rhythm: when?

Left ventricular (LV) systolic dysfunction and chronic systolic heart failure (HF) predispose to intraventricular thrombus formation and embolization resulting in stroke. Current guideline recommends the use of oral anticoagulants in patients with atrial fibrillation and history of previous thromboembolism. However, anticoagulant treatment in patients with LV systolic dysfunction with sinus rhythm and without history of previous thromboembolism is still on debate. Recent epidemiologic date has reported increased stroke rate in patients with systolic HF shortly after diagnosis. This review focuses on the possible causes of increased stroke rate shortly after the diagnosis of HF and subsequently suggests a rationale for the use of oral anticoagulant in these patient groups.

Statins decrease mean platelet volume irrespective of cholesterol lowering effect.

BACKGROUND: Recent clinical observations have demonstrated that the beneficial effects of statins are not limited to LDL lowering effect. They have also favourable effects on platelet activation, endothelial function, inflammation, and coagulation cascade. AIM: To investigate the effects of statins on mean platelet volume (MPV) which is a simple measure of platelet activation volume in patients who have been prescribed statins. Atorvastatin and rosuvastatin were also compared in respect to effects on MPV. METHODS: One hundred and forty five patients were retrospectively included in the study from the outpatient cardiology clinic. Patients who had been given statin treatment were recruited based on the records. Baseline and 4-8 weeks biochemical analysis and haematological measurements and cardiovascular risk factors were recorded. RESULTS: Both statins significantly decreased the MPV. MPV of patients did not show any significant correlation with lipid parameters. Linear regression analysis revealed that there were no statistically significant associations of ∆ MPV with the ∆LDL-cholesterol (beta coefficient = 0.13; p = 0.24), ∆DL-cholesterol (beta coefficient = 0.17; p = 0.18) or ∆triglyceride (beta coefficient = -0.11; p = 0.21) after statin treatment. Both statins had comparable effects on lipid parameters at the end of the one month follow up period. CONCLUSION: Statins significantly reduce MPV irrespective of cholesterol levels, and atorvastatin and rosuvastatin have comparable effects in this regard.

Copeptin and cardiovascular disease: a review of a novel neurohormone.

Neurohormones (NHs) in the cascade of the arginine vasopressin (AVP) system have drawn particular attention in the recent years. Copeptin, the C-terminal portion of provasopressin, is a novel NH of the AVP system, and is known to be co-released with AVP from hypothalamus (neurohypophysis). As a surrogate marker of the AVP system, copeptin has gradually replaced AVP in several clinical studies largely due to its structural and methodological advantages. Copeptin has been regarded as a marker of non-specific stress response, and has also been suggested to have clinical implications in a variety of non-cardiovascular (pneumonia, sepsis, etc.) and cardiovascular conditions (heart failure and acute coronary syndromes (ACSs, etc.)). However, current data on relation of copeptin with other cardiovascular conditions ( arrhythmias, etc.) are still insufficient. The present review primarily focuses on general features of copeptin, its general clinical implications, and specifically aims to cover its potential clinical value in a variety of cardiovascular conditions.

Incremental effects of restless legs syndrome on nocturnal blood pressure in hypertensive patients and normotensive individuals.

BACKGROUND: Few studies have evaluated the role of restless legs syndrome (RLS) in the development of nondipping 24 h blood pressure (BP) patterning/sleep-time hypertension, which has been shown to be an independent predictor of cardiovascular risk. These were indirect studies that had reported the relation between BP and RLS attacks during polysomnographic investigations in the lab. The aim of the present study was to assess the relationship between RLS, which was diagnosed clinically, and night-time BP patterns in a relatively large young cohort who had not been treated before. PATIENTS AND METHODS: After applying the exclusion criteria, this cross-sectional study included 230 consecutive patients with never-treated hypertension who presented to our institution for initial evaluation of hypertension. RLS was assessed using a self-administered questionnaire based on the International Restless Legs Study Group criteria. The questions on RLS were completed by 214 patients and ambulatory BP monitoring was carried out for all patients. RESULTS: In the study group, 133 patients were diagnosed as hypertensive (53.4% nondippings) and 81 patients as normotensives (54.3% nondippings). RLS was present in 61 patients (28.5%) in the total sample. The prevalence of RLS, overall, was significantly higher in nondippings compared with dippings (34.7 vs. 21.2%, respectively; P=0.028). Logistic regression analysis showed that the RLS is an independent determinant for both hypertension (odds ratio=0.43, 95% confidence interval=0.21-0.83; P=0.013) and the nondipping BP patterns (odds ratio=1.96, 95% confidence interval=1.05-3.67; P=0.035). CONCLUSION: We have shown that clinically diagnosed RLS was associated with the nondipping pattern, which has been shown to be an independent predictor of cardiovascular risk.

Mean platelet volume in patients with dilated cardiomyopathy: does it have a role in left ventricular thrombus formation?

We assessed the clinical echocardiograhic, hematological, and biochemical parameters in patients with dilated cardiomyopathy (DCMP) and control individuals mainly focusing on the mean platelet volume (MPV) in terms of DCMP and left ventricle (LV) thrombus formation. Consecutive patients (n = 251) with DCMP and 266 patients without DCMP were studied. Mean platelet volume was significantly greater in patients with DCMP than in control patients (P < .05 for all comparisons). Comparing DCMP patients with LV thrombus (19 patients, 8%) and without LV thrombus (232 patients, 92%) showed that the prevalence of smokers was significantly higher and ejection fraction was significantly lower in patients with LV thrombus. We have shown that patients with DCMP have significantly higher MPV suggesting more platelet activation and the MPV of patients with DCMP and LV thrombus is comparable to those of patients without LV thrombus.

Evaluation of cardiovascular risk factors in women with uterine leimyoma: is there a link with atherosclerosis?

OBJECTIVE: Both uterine leimyoma (UL) and cardiovascular disease are public health problems affecting women at different age ranges. Smoking, obesity, and hypertension have been shown to be associated with UL in different random studies. However cardiovascular risk factors have not been evaluated systematically in patients with UL. Accordingly, we aimed to evaluate the cardiovascular risk factors and their relation with the presence of UL. MATERIAL AND METHODS: One hundred and eighty nine patients with the pathological diagnosis of UL and one hundred and eighty nine age matched control subjects without UL were retrospectively included in the study from our data base of the pathology and gynecology departments. Controls were patients with intact uteri who had visited the same physicians for a routine checkup that included a pelvic examination and uterine sonogram and without mention of physical findings consistent with UL. The following clinical and demographic parameters were recorded; age, sex, hypertension, diabetes mellitus, and hypercholesterolemia. Current cigarette smoking was defined as active smoking within the past 12 months. RESULTS: Comparison of cardiovascular risk factors between with and without UL revealed that the presence of hypertension (80 (42.3%) vs 53 (28%) p=0.004) diabetes mellitus (33 (17.4%) vs. 16 (8.4%) p=0.009), smoking (31 (16.4%) vs. 11 (5.8%) p=0.001), were significantly higher in patients with UL than in control subjects. The mean-age and presence of hyperlipidemia were comparable between the two groups. Logistic regression analysis revealed an independent and positive association of UL with the presence of hypertension (odds ratio 2.02 CI: 1.25-3.27 p=0.004), diabetes mellitus (odds ratio 2.43 CI: 1.23-4.79 p=0.010), and smoking status (odds ratio 3.46 CI: 1.65-7.22 p=0.001). CONCLUSION: We have shown that major cardiovascular risk factors namely, hypertension, diabetes mellitus and smoking are significantly and independently associated with UL. Our findings highlight the possible association of UL with atherosclerosis.