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Objective: The atherogenic lipoprotein phenotype is closely associated with the risk assessment of Coronary Artery Disease (CAD) and the monitoring of treatment processes. Particularly, high levels of small dense low-density lipoprotein (sdLDL) and low levels of large buoyant low-density lipoprotein (lbLDL) are critical in determining Pattern B. This study aims to determine the lipid phenotype using the Association Rule Mining (ARM) method, based on concentrations of lipids, lipoproteins, apoproteins, and sdLDL. Materials and Methods: This retrospective case-control study utilized analytical research methods. Numerical variables were expressed as mean, standard deviation, median, and min-max values. Statistically significant differences were observed between the low-density lipoprotein (LDL) size categories in terms of triglycerides (TG), LDL, high-density lipoprotein (HDL), apolipoprotein B (ApoB), apolipoprotein E (ApoE), sdLDL, and lbLDL distributions. ARM was employed to detect the lipoprotein phenotype. Results: Statistically significant differences were found between the LDL size categories in distributions of TG, LDL, HDL, ApoB, ApoE, sdLDL, and lbLDL (pTG<0.001, pLDL=0.03, pHDL<0.001, pApoB=0.016, pApoE=0.004, psdLDL<0.001, and plbLDL<0.001). The ARM method revealed that the probability of phenotype B is 100% for sdLDL values in the range of 15.5-109 and lbLDL values in the range of 0-31.5. Conclusion: This study introduces a contemporary approach for detecting lipoprotein phenotypes using ARM, further substantiating the strong correlation between atherogenic phenotypes and sdLDL. [ABSTRACT FROM AUTHOR]

Background: YKL-40 (human cartilage glycoprotein 39, chitinase-3-like protein 1) is an inflammatory marker secreted mainly by macrophages and has distinctive roles on extracellular matrix remodeling, macrophage maturation, adhesion, and migration. Despite the presence of robust data suggesting the association of YKL-40 with variety of cardiovascular diseases (CV), there is no study up to date evaluating the role of YKL-40 on the long-term prognosis in patients with hypertension (HT). Methods: A single center, prospective, observational cohort study that included 327 consecutive hypertensive patients which were presented to a cardiology outpatient clinic. Patients were followed up for 7.89 ± 0.12 years. Primary outcome of the study was the occurrence of major cardiovascular outcomes (MACE) defined as all-cause mortality, new onset heart failure (HF), and coronary artery disease (CAD) requiring revascularization. Results: A total of 135 patients constituted the final study population [mean age: 52.4 ± 10.2, female: 63 (46%)]. A total of 28 (20.7%) patients had MACE during the follow up. Cox regression analysis revealed that age (HR: 1.046, 1.016–1.093 CI 95%, p =.026), diabetes (HR: 2.278, 1.026–5.057 CI 95%, p =.043), and YKL-40 level (HR: 1.019, 1.013–1.026 CI 95%, p =.005) significantly predicted MACE. We found that sensitivity and specificity of YKL-40 > 93.5 for predicting MACE was 71.4% and 65%, respectively with an area under curve (AUC) 0.723 (0.617–0.828 CI 95%, p <.001) Conclusion: Elevated serum YKL-40 level predicted MACE in hypertensive patients during a long-term follow up. [ABSTRACT FROM AUTHOR]

Aim: Recent studies suggest that apelin can be a novel potential therapeutic mediator to improve the diagnosis, and treatment of preeclampsia. This study aimed to investigate the association of serum apelin‐13 and apelin‐36 with preeclampsia and to detect their relationship with preeclampsia‐associated perinatal morbidity. Methods: Forty‐four women with preeclampsia were included as the study group. Forty‐four healthy pregnant women, at similar gestational week with similar gravidity, formed the control group. The clinical findings, biochemical indicators, maternal and perinatal outcomes, and the serum concentrations of apelin‐36 and apelin‐13 were evaluated. The levels of apelin‐13 and apelin‐36 were determined with commercial kits using a competition‐based enzyme‐linked immunosorbent assay method. Results: The mean gestational age at sampling was 35.77 ± 2.515 weeks in the preeclamptic group, 36.45 ± 2.057 weeks in the control group (P = 0.270). Maternal serum apelin‐36 and apelin‐13 concentrations were significantly lower in patients with preeclampsia compared to the individuals in the control group (P = 0.030 and P = 0.005, respectively). The optimal cut‐off points of apelin‐36 and apelin‐13 measurements for discriminating between preeclampsia and controls were evaluated by the receiver–operator curve analysis. The results showed that apelin‐13 and apelin‐36 are moderately successful markers to differentiate subjects with preeclampsia from healthy pregnant women. The concentrations of apelin‐13 and apelin‐36 in both groups were not statistically different in cases with and without adverse fetal/neonatal outcomes. Conclusion: In conclusion, we investigated serum apelin‐13 and apelin‐36 concentrations in preeclamptic patients and demonstrated markedly lower maternal concentrations compared to healthy pregnant women. [ABSTRACT FROM AUTHOR]

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Epicardial adipose tissue (EAT), localized beneath the visceral pericardium, is a metabolically active endocrine and paracrine organ with possible interactions within the heart. Recent studies identified possible roles of uric acid (UA)-induced oxidative stress and increased inflammatory status in the pathogenesis of ascending aortic dilatation. The aim of this study was to investigate whether EAT is an independent factor for ascending aortic dilatation. The patients were evaluated by a complete transthoracic echocardiographic examination including measurements of EAT and aortic dimensions. Serum levels of UA and C-reactive protein and EAT thicknesses were compared in 38 patients with dilated ascending aorta (DAA) (the diameter ≥ 37 mm) vs. 107 subjects with normal aortic diameter (AD) of < 37 mm. EAT thickness was significantly higher in DAA group compared to normal AD group (8.3 ± 2.7 vs. 5.4 ± 2.2 mm, p < 0.001) as well as age (53 ± 10 vs. 48 ± 9 years, p = 0.004), the presence of hypertension (54% vs. 30%, p = 0.009) and UA levels (6.0 ± 1.4 vs. 5.2 ± 1.1 mg/dL, p < 0.001). There was a strong correlation between EAT thickness and ascending aortic diameter (r = 0.521, p < 0.001). In multiple logistic regression analysis, EAT thickness (OR: 1.429, p = 0.006), body mass index (OR: 1.169, p = 0.014) and UA levels (OR: 1.727, p = 0.023) were independently correlated to ascending aortic dilatation. We therefore propose that increased EAT thickness is an independent predictor of ascending aortic dilation. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Fragmented QRS may Predict Postoperative Atrial Fibrillation in Patients Undergoing Isolated Coronary Artery Bypass Graft Surgery" by M. Çetin and coworkers in the 2012 issue.

The article presents a case study of a 62-year-old male with a history of chest pain. He underwent a complicated non-cardiac operation, where medical results show three types of single coronary artery (SCA) according to the origination from left, right or non-coronary aortic sinuses. The medical results also found and characterized new type of SCA.

Aneurysm of the superior mesenteric artery (SMA) is a rare condition and most of them are symptomatic. Gradually increasing abdominal pain, intestinal ischemic symptoms and rupture are the most common symptoms. We herein report a giant SMA aneurysm detected in a patient with complaint of abdominal discomfort. [ABSTRACT FROM AUTHOR]

Although there are several studies regarding the association between RDW and the vascular events, information is scant about possible role of RDW in cardiovascular system. We aimed to investigate whether RDW is related with the severity and extent of angiographically assessed coronary artery disease (CAD). Two hundred ninety and six stable eligible patients who had undergone coronary angiography with a suspicion of CAD were enrolled consecutively. Two hundred and nine (71%) of 296 patients had CAD (men 70%, mean age±SD: 61±11yrs) and 87 patients (29%) had normal coronary arteries (NCA) without any atherosclerotic lesion (men 48%, 52±11yrs). Red blood cell distribution width values were significantly different among the subgroups determined for the severity and extent of CAD. When 14.8% was accepted as the cut-off value for RDW, the sensitivity and the specificity for the detection of CAD was 68% and 52%. When we performed multiple logistic regression analysis to determine the independent predictors of CAD, we found a positive independent relationship between age, gender, family history of CAD and RDW and CAD. Our results show that RDW has a significant relationship with CAD independent of nonspecific inflammation and circulating inflammatory cells. Although we cannot conclude the underlying pathologic process of RDW, we believe that these findings may pave the way for further studies searching the role of RDW in atherosclerosis. [ABSTRACT FROM AUTHOR]

Although there are several studies regarding the association between RDW and the vascular events, information is scant about possible role of RDW in cardiovascular system. We aimed to investigate whether RDW is related with the severity and extent of angiographically assessed coronary artery disease (CAD). Two hundred ninety and six stable eligible patients who had undergone coronary angiography with a suspicion of CAD were enrolled consecutively. Two hundred and nine (71%) of 296 patients had CAD (men 70%, mean age±SD: 61±11yrs) and 87 patients (29%) had normal coronary arteries (NCA) without any atherosclerotic lesion (men 48%, 52±11yrs). Red blood cell distribution width values were significantly different among the subgroups determined for the severity and extent of CAD. When 14.8% was accepted as the cut-off value for RDW, the sensitivity and the specificity for the detection of CAD was 68% and 52%. When we performed multiple logistic regression analysis to determine the independent predictors of CAD, we found a positive independent relationship between age, gender, family history of CAD and RDW and CAD. Our results show that RDW has a significant relationship with CAD independent of nonspecific inflammation and circulating inflammatory cells. Although we cannot conclude the underlying pathologic process of RDW, we believe that these findings may pave the way for further studies searching the role of RDW in atherosclerosis. [ABSTRACT FROM AUTHOR]

Background: Visceral obesity is strongly associated with atherosclerosis. Even though waist circumference (WC) is the most common assessment method of total visceral adipose tissue and cardiometabolic risk, this method lacks direct measurement of adipose tissue and has better correlation to subcutaneous fat rather than visceral fat. We intended to investigate whether epicardial adipose tissue (EAT) is clinically superior to body mass index (BMI) and WC in predicting Framingham risk score (FRS) and carotid intima-media thickness (CIMT)., Methods: Our study included 331 patients who were admitted to our outpatient clinic for risk factor assessment. We calculated BMI, FRS, and WC, and the patients underwent echocardiographic and carotid examinations to measure EAT and CIMT. The metabolic syndrome (MS) score was calculated by summing the MS risk factor scores., Results: The area under the curve values of EAT were similar to FRS and higher than those of weight, BMI, and WC for both increased CIMT and the presence of carotid plaque. Male gender, age, low-density lipoprotein-cholesterol level, and EAT thickness were independent predictors of CIMT, whereas male gender, age, WC, uric acid concentration, and EAT significantly predicted the presence of carotid plaque., Conclusions: This study demonstrated that epicardial adipose tissue (EAT) has a stronger correlation with CIMT than BMI and WC, and it was a significant predictor of increased CIMT and the presence of carotid plaque. Additional data are required to clarify the diagnostic and therapeutic role of EAT in managing obese patients, and to decrease their cardiometabolic risk.

Background: Apelin, an endogenous peptide, has recently gained attention due to its positive inotropic effects in heart failure physiopathology. We investigated the relationship between serum apelin levels and the severity of calcific aortic stenosis (AS)., Methods: A total of 68 consecutive patients diagnosed with calcific AS and a control group of 32 subjects were included in the study. The subjects were divided into three group as follows: the control group, the mild-moderate AS group and the severe AS group. Blood samples were obtained from all of the subjects, which were used for biochemical comparisons of apelin 36 and high-sensitive C-reactive protein (hsCRP) levels., Results: Plasma apelin 36 levels were significantly lower in the patients with severe AS [490 (247-1074) pg/ml] compared to both the mild-moderate AS [209 (97-453) pg/ml] and control [660 (378-1200) pg/ml] groups (p < 0.001). Correlation analysis between the left ventricular mass index and apelin concentrations revealed a significant negative correlation between the two parameters (p < 0.001, r = -0.478)., Conclusions: Our study demonstrated decreased apelin levels and increased hsCRP concentrations in patients with severe calcific AS. Our findings may help to clarify the exact pathophysiologic role of apelin in cardiovascular diseases.

Objective: Fragmented QRS complexes (fQRS) are defined as various RSR' patterns in 2 contiguous leads corresponding to a major coronary artery territory. Although the reason of association between fQRS and cardiac events was documented as cardiac fibrosis, the predictive role of fQRS was not studied for postoperative atrial fibrillation (POAF) which is a frequent and serious complication in patients undergoing isolated coronary artery bypass graft (CABG) surgery. Therefore, this issue was investigated in the present study., Methods: The current study has a prospective observational design. Two hundred and seventy two eligible patients who underwent isolated CABG surgery were enrolled consecutively. The patients were divided in two groups with post-op atrial fibrillation (AF) and non-AF. The occurrence of new-onset AF following CABG and the relationship with fQRS were searched. The logistic regression analysis was used to determine independent predictors for POAF. The sensitivity and specificity of study variables in predicting POAF were calculated using a receiver-operating characteristic curve (ROC)., Results: POAF occurred in 62 of 272 patients (22.8%). Patients with POAF were generally older (p<0.001) and female (p=0.006), with preexisting hypertension (p=0.008), lower hemoglobin levels (p=0.011), chronic obstructive lung disease (p=0.003), prolonged QRS time (p=0.004), and higher EUROSCORE (p<0.001) compared to non-AF patients. Patients with POAF had lower left ventricular ejection fraction (p<0.001) and high fQRS rate (p<0.001), but similar left atrial size (LA, p=NS). Interestingly, LA size was significantly enlarged in patients with fQRS (3.8±0.6 vs. 4.1±0.5 cm, p=0.002). In addition, the patients with POAF had prolonged stay in the cardiac surgery intensive-care unit (p<0.001) and extended in-hospital care (p=0.001). New-onset POAF was significantly related to the presence and number of fQRS. In the logistic regression analysis, only age (OR: 1.044, 95% CI: 1.008-1.082, p=0.016), female gender (OR: 2.347, 95% CI: 1.079-5.106, p=0.031), the presence and number of fQRS (OR: 6.020, 95% CI: 3.152-11.5 and OR: 1.522, 95% CI: 1.282-1.807, both of, p<0.001) were independent predictors of POAF. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and the diagnostic accuracy (DA) of presence of fQRS on pre-op electrocardiogram to predict POAF were 66%, 76%, 45%, 88% and 74%, respectively. The area under ROC was found as 0.733 (p<0.001, 95% CI: 0.657-0.810)., Conclusion: In our study, we found that new-onset POAF was independently related to the presence and number of fQRS in patients undergoing CABG surgery. In addition, fQRS on pre-op surface ECG had high predictive values for new-onset POAF.

Objectives: The QRS complex fragmentations (fQRS) frequently seen on admission electrocardiograms (ECGs) with narrow or wide QRS complex are associated with increased morbidity and mortality. The causative relationship between fQRS and cardiac fibrosis is known, but the relation of fragmented QRS before and after primary percutaneous coronary intervention (p-PCI) with myocardial infarction and reperfusion parameters has not been studied until now., Study Design: The study included 184 consecutive patients with ST elevation myocardial infarction (STEMI) who underwent p-PCI. Presence or absence of fQRS on pre- and post-PCI ECGs and its change following PCI were investigated. In addition, independent predictors of fQRS were also investigated. Patients with significant organic valve disease and patients having any QRS morphology with QRS duration ?120 ms as well as patients with permanent pacemakers were excluded from the study., Results: Patients with fQRS on admission ECG had higher leukocyte counts (p=0.001), higher CK-MB (p=0.001) and troponin levels (p=0.005), increased pain to balloon time (p=0.004), higher Killip score (p<0.001), prolonged QRS time (p<0.001), higher Gensini score (p<0.001) and more frequent Q waves on ECG (p<0.001) in comparison to patients with non-fragmented QRS. In addition, these patients usually had an infarction of anterior territory related to a lesion in proximal LAD and wider jeopardized myocardium (p<0.001). fQRS was significantly related to infarction and myocardial reperfusion parameters before and after p-PCI. In the setting of STEMI, absence of fQRS on admission ECG predicted increased ST resolution, higher reduction in QRS duration, and better myocardial reperfusion., Conclusion: FQRS may be useful in identifying patients at higher cardiac risk with larger areas of ischemic jeopardized or necrotic myocardium.

Background: Epicardial adipose tissue (EAT), localized beneath the visceral pericardium, is a metabolically active endocrine and paracrine organ with possible interactions within the heart. Coronary artery ectasia (CAE) is a clinical entity characterized with localized or diffuse dilatation, of the coronary arteries, with a diameter of greater than 1.5 times that of adjacent segments. Although the etiopathogenesis is not clearly understood, some studies have revealed that CAE may be a form of atherosclerosis that has greater inflammatory properties than atherosclerosis. The goal of this study was to investigate whether EAT and the level of C-reactive protein (CRP) are increased in patients with isolated CAE compared to normal subjects., Methods: Thirty-three patients with isolated CAE (mean age: 57±9 years) and 32 age- and gender-matched control participants with NCA, but without CAE (mean age: 56±10 years), were included in the study. The relationship between EAT thickness, CRP levels and the presence of CAE was investigated., Results: Epicardial adipose tissue thickness was significantly higher in CAE group compared to NCA group (7.2±3.2 vs. 4.7±2.1 mm, p<0.001). Body mass index (BMI, p=0.013), CRP (p=0.047), and the percentage of isolated CAE (p=0.012) were significantly higher in patients with an increased EAT thickness. While CRP correlated with increased EAT, it was not related to CAE. However, CRP levels were higher in patients with diffuse coronary ectatic involvement than the focal lesions (0.58±0.32 vs. 0.31±0.11 mg/dL, p=0.046). When we performed multiple logistic regression analysis, only increased EAT thickness was related to CAE independent of CRP and BMI (OR: 1.442, 95%CI: 1.066-1.951, p=0.018)., Conclusion: This is the first study, displaying a significantly higher EAT-thickness in patients with isolated CAE. We believe that further studies are needed to clarify the role of adipose tissue in patients with isolated CAE.