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Contrast-induced nephropathy (CIN) accounts for about 10% of all hospital-acquired acute kidney injury. We aimed to assess the role of the combination of 2 inflammatory biomarkers, the C-reactive protein (CRP)/albumin ratio (CAR), in the development of CIN after percutaneous coronary intervention (PCI) in patients with non-ST-elevation myocardial infarction (NSTEMI). Patients with NSTEMI (n = 205) treated by PCI were classified according to the development of CIN. Both groups were compared according to clinical, laboratory, and demographic characteristics, including inflammatory biomarkers and specifically, CAR. Contrast-induced nephropathy was observed in 10.2% of patients. More advanced age, the presence of diabetes and dyslipidemia, left ventricular ejection fraction, and CAR correlated with the development of CIN. Analysis also showed a significant association between CAR and the development of CIN (CAR in CIN (+): 8.54 ± 8.48, range: 0.7-32, median: 7.13 vs CAR in CIN (−): 2.36 ± 3.01, range: 0.1-24, median: 1.33, P < .001). Multivariate logistic regression analysis showed the impact of CAR on the development of CIN (odds ratio: 1.244, 95% confidence interval: 1.102; 1.392, P < .01). We conclude that CAR, as a combination of 2 inflammatory biomarkers, is a more accurate predictor of CIN development compared with the single-marker assessment of albumin and CRP in the context of NSTEMI.

Background: The presence of intracoronary thrombus is associated with increased ischaemic complications in patients with NSTEMI. High thrombus burden is an independent predictor of major adverse ca...

Summary Background: This study was designed to determine the short- and long-term effects of proximal aortic anastomosis, performed during isolated coronary artery bypass grafting (CABG) in patients with dilatation of the ascending aorta who did not require surgical intervention. Methods: The study was performed on 192 (38 female and 160 male patients; mean age, 62.1 ± 9.2 years; range, 42–80 years) patients with dilatation of the ascending aorta who underwent CABG surgery between 1 June 2006 and 31 May 2014. In group 1 (n = 114), the saphenous vein and left internal mammarian artery grafts were used, and proximal anastomosis was performed on the ascending aorta. In group 2 (n = 78), left and right internal mammarian artery grafts were used, and proximal aortic anastomosis was not performed. Pre-operatively and in the first and third years postoperatively, the ascending aortic diameter was measured and recorded using transthoracic echocardiography at four different regions (annulus, sinus of Valsalva, sinotubular junction and tubular aorta). Results: A statistically significant difference was found between the groups for the number of grafts used and the duration of aortic cross-clamping and cardiopulmonary bypass. No significant intergroup difference was seen for the mean diameter of the ascending aorta (p > 0.05). Annual changes in the aortic diameter were found to be extremely significantly different in both groups (p = 0.0001). Mean values of the aortic diameter at the level of the sinotubular junction and tubular ascending aorta, mean aortic diameters (p = 0.002 and p = 0.0001, respectively), annual increase in diameter (p = 0.0001 and p = 0.0001, respectively), and mean annual difference in diameter (p = 0.0001 and p = 0.0001, respectively) at one and three years postoperatively were statistically significantly different between the groups. Conclusion: In patients with ascending aortic dilatation who did not require surgical intervention and who had proximal anastomosis of the ascending aorta and underwent only CABG, we detected statistically significant increases in the diameter of the sinotubular junction and tubular aorta up to three years postoperatively.

A traditional hematological marker, red cell distribution width (RDW), is accepted as a novel marker of atherosclerotic vascular diseases. Clinical importance of the RDW as a prognostic biomarker in peripheral vascular disease (PVD) has been reported in a few studies. Herein, we aimed to show the correlation between RDW and PVD severity and its complexity in terms of angiographic evaluation. A total of 118 patients who underwent peripheral lower extremity angiography were subsequently evaluated retrospectively. Upon admission, RDW level was measured with automated complete blood count. Severity and complexity of the PVD was evaluated according to Trans-Atlantic Inter-Society Consensus (TASC II) classification. A TASC II A-B lesion was defined as simple PVD, and a TASC II C-D lesion was defined as prevalent and complex PVD. Then, both groups were compared statistically according to clinical, laboratory, and demographic features, including RDW levels. In 49.6% of the patients, TASC II C-D lesions were observed. Advanced age, male gender, and body mass index (BMI) were associated with TASC II groups. Red cell distribution width levels were correlated with presence of PVD, as well as TASC II grades (p:0.02). The fourth quartile (75th percentile) of the RDW levels was 14.1, and patients with RDW levels &ge, 14.1 had a more significant correlation with the presence and severity of PVD (p:0.001). In the multivariate regression analysis, elevated RDW was found to be an independent predictor of the presence of PVD and also TASC II C-D lesions (OR:2.26, with a 95% confidence interval (CI) 0.051&ndash, 0.774, p:0.02). Elevated RDW levels was associated with TASC II C-D lesions, which indicated more prevalent and complex PVD.

Aim: We investigated the association between platelet indices and the severity of coronary artery disease (CAD) in patients with ST-segment–elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PPCI). Methods: A total of 484 consecutive patients who were routinely referred to coronary angiography for STEMI and 81 age- and gender-matched patients with normal coronary arteries were included in the present study. We analyzed the relation between the platelet distribution width (PDW) and the angiographic severity of CAD. The SYNTAX score was used for assessing the severity of coronary atherosclerosis. Results: The mean platelet volume (MPV), the plateletcrit (PCT) and the neutrophil levels were significantly higher in the STEMI group than in the control group. Patients with an elevated SYNTAX score (>32) had higher PDW values. The levels of plateletcrit and the estimated glomerular filtration rate (eGFR) were lower in the high SYNTAX score group compared to the moderate-to-low SYNTAX score group. The PDW was positively correlated with age (r = 0.128, p=0.004) and SYNTAX score (r = 0.209, pConclusion: Platelet distribution width, an inexpensive and easily measurable laboratory variable, is independently associated with high SYNTAX score.

We investigated the utility of the preprocedural red cell distribution width (RDW) for predicting contrast-induced acute kidney injury (CI-AKI) in patients with ST-segment-elevation myocardial infarction (STEMI) who underwent a primary percutaneous coronary intervention.A total of 630 consecutive patients who were routinely referred to coronary angiography for STEMI were included in the present study.CI-AKI was observed in 79 patients (12.5%). The RDW, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and the mean platelet volume were significantly higher in the CI-AKI group than in the non-CI-AKI group (P0.001, P=032, P=0.025, and P=0.039, respectively). Serum total bilirubin and direct bilirubin levels were not different among the study groups. Using multivariate logistic regression analysis, we found that left ventricular ejection fraction [odds ratio (OR)=0.972, 95% confidence interval (CI) 0.945-0.998, P=0.033], estimated glomerular filtration rate (OR=0.970, 95% CI 0.959-0.981, P0.001), contrast volume (OR=1.007, 95% CI 1.002-1.012, P=0.009), and RDW (OR=1.406, 95% CI 1.120-1.792, P=0.005) were independent predictors of CI-AKI.Red blood cell distribution width, an inexpensive and easily measurable laboratory variable, is associated independently with the development of CI-AKI. Our data suggest that RDW may be a useful marker in CI-AKI risk stratification.

WOS: 000354157700016 PubMed: 25772252 Background: Serum fibroblast growth factor 23 (FGF-23) and fetuin-A are established predictors of morbidity and mortality due to cardiovascular disease. The objective of the present study is to evaluate the relationship between coronary artery disease (CAD) and serum concentrations of FGF-23 and fetuin-A. Methods: A total of 383 subjects who underwent coronary computed tomography angiography (CCTA) were included in the study. CCTA detected CAD in 208 patients; the rest of the patients had no detectable CAD. Results: Serum FGF-23 and fetuin-A levels were significantly increased in CAD patients compared to non-CAD patients (26.6 +/- 21.1 pg/mL vs. 17.9 +/- 16.1 pg/mL, p = 0.001 and 826 +/- 350 mg/L vs. 595 +/- 300 mg/L, p < 0.001, respectively). Serum FGF-23, fetuin-A, low-density lipoprotein (LDL)-cholesterol, and uric acid values were elevated in non-diabetic patients with CAD when compared to those without CAD. FGF-23, and fetuin-A were not significantly different in diabetic patients with CAD when compared to those without CAD. Using multivariate logistic regression analysis, we found that age, hypertension, LDL-Cholesterol, highdensity lipoprotein (HDL)-Cholesterol, hs-CRP, uric acid, FGF-23 and fetuin-A levels were independently associated with the presence of CAD. Conclusion: FGF-23 and fetuin-A were positively correlated with coronary atherosclerosis Similar trends were seen among diabetic patients, but this did not reach statistical significance. FGF-23 and fetuin-A could be used as novel risk markers of cardiovascular disease. (C) 2015 Elsevier Inc. All rights reserved. Mugla Saki Kocman UniversityMugla Sitki Kocman University Mugla Saki Kocman University.

Background: Serum alkaline phosphatase (ALP) level has been shown to be a prognostic factor for myocardial infarction and stroke via its promotion of vascular calcification. Aim: To investigate for the first time the correlation between serum ALP level and coronary collateral circulation (CCC) development. Methods: A total of 356 patients with stable angina pectoris were evaluated retrospectively. Patients were classified according to ALP level and CCC grade. Rentrop 0–1 flow was defined as impaired CCC. Serum ALP > 129 mg/dL in men and > 104 mg/dL in women was defined as elevated ALP. All groups were compared statistically according to clinical, laboratory and demographic features. Results: Impaired CCC was observed in 53.7% of the patients. The mean ALP level was 102.8 ± 57.9 mg/dL, and elevated ALP levels were obtained in 19.4% of cases. There was a significant correlation between ALP and CCC grade, and impaired CCC was associated with relatively higher ALP values (65.2% vs. 50.9%, p = 0.03). Multivariate regression analysis also showed a significant correlation between elevated ALP level and impaired CCC (OR 1.85, with a 95% CI 1.056–3.264; p = 0.03). Conclusions: Serum ALP is a widely avaliable unfavourable prognostic parameter in coronary heart disease. Elevated ALP levels were associated with inadequate CCC, which supports the previously reported literature concerning the negative prognostic value of ALP levels in cardiovascular settings.

Background Vitamin D deficiency may be associated with an increased risk of renovascular disease. We assessed the correlation between vitamin D levels and contrast-induced nephropathy (CIN) in patients undergoing coronary angiography (CAG). Methods Vitamin D and parathyroid hormone (PTH) levels were assessed before CAG in 403 patients. Estimated glomerular filtration rate (eGFR) was calculated using the Cockcroft-Gault equation. Patients with eGFR 2 were hydrated with 0.9%-saline at 1 mL/kg/h for 12 hours before and after CAG. CIN was defined as serum creatinine increase of > 0.5 mg/dL or > 25% within 48-72 hours after CAG. Results CIN developed in 74 participants. Baseline eGFR, blood urea and creatinine in CIN (+) and (−) groups were not significantly different ( P = 0.14, P = 0.07, and P = 0.61, respectively). Total volume of contrast medium (CM) was higher in the CIN (+) group (132 ± 64 mL vs 90 ± 41 mL; P = 0.01). Vitamin D levels were lower (median 8.5 [range, 0.5-26.6] ng/mL vs 14.9 [range, 1.9-93.5] ng/mL; P = 0.01) and PTH levels were higher (median 73.9 [range, 22-530] pg/mL vs 44.2 [range, 5-361] pg/mL; P = 0.01) in the CIN (+) group. Multivariate logistic regression analysis revealed that lower vitamin D levels (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.11-1.26; P = 0.01) and increased CM volume (OR, 1.01; 95% CI, 1.008-1.017; P = 0.01) were independently correlated with CIN. In patients who had undergone percutaneous coronary intervention, lower levels of vitamin D were independently associated with CIN development. Conclusions Lower vitamin D levels, implying possible vitamin D deficiency, are associated with a higher incidence of CIN.

Background and aim: The aim of this study was to evaluate the effect of atorvastatin and rosuvastatin on erectile dysfunction in hypercholesterolaemic patients. Methods: Ninety consecutive male hypercholesterolaemic patients (mean age 50.4 ± 7.9 years) who were otherwise healthy were included into the study prospectively. None of the patients had any cardiovascular risk factors except hypercholesterolaemia.The patients were divided into two groups. One group received atorvastatin while the other group was given rosuvastatin. All patients were followed for six months and International Index of Erectile Function-5 (IIEF-5) score and blood samples were re-evaluated. Results: Patients were in similar ages in both groups. There were also no statistical differences in terms of blood glucose levels, total cholesterol, low density lipoprotein, high density lipoprotein, triglyceride and mean IIEF score in both groups at the beginning. After six months, no IIEF score changes were observed in the rosuvastatin group after the medication. However, the IIEF score was significantly lower in the atorvastatin group (p = 0.019). Conclusions: Rosuvastatin showed no effect on erectile dysfunction, while we observed increased erectile dysfunction with atorvastatin. Our study reveals that different statin types may have different effects on erectile dysfunction.

Introduction A rapid restoration of epicardial coronary flow in acute myocardial infarction is crucial for saving jeopardized myocardium. The no-reflow phenomenon is one of the major problems in a primary percutaneous coronary intervention (PCI) and may be defined as an outcome of different pathological pathways. Our aim was to evaluate clopidogrel resistance in patients who underwent primary PCI and the relationship with the no-reflow phenomenon. Materials and methods A total of 127 patients (mean age 54.0 ± 11.4 years, 83.7% men) were assessed for this purpose. No-reflow was defined as less than 50% ST-segment resolution on ECG. Result No-reflow was significantly frequent in patients with clopidogrel resistance (25.3 vs. 57.1%, P=0.006). Univariate analysis and multivariate analysis showed that clopidogrel resistance and anterior myocardial infarction were only independent predictors of no-reflow phenomenon in patients treated with a primary PCI during acute myocardial infarction. Conclusion Our study showed that clopidogrel resistance may be one of the responsible mechanisms for the no-reflow phenomenon. Assessment of simple ECG after a primary PCI may help clinicians to determine patients with a poor prognosis.

Objective: To identify the frequency of atrioventricular (AV) conduction improvement after discontinuation of the culprit drug in patients with AV block. Background: AV blockers are considered as reversible causes of AV block that do not require pacemaker (PM) implantation. However, controversial reports declared that a major part of these drug-induced AV blocks are persistent or recurrent. Methods: Of 668 consecutive patients with symptomatic type II second- or third-degree AV block, 2:1 AV block, atrial fibrillation, and bradyarrhythmia, 108 patients (62 patients enrolled prospectively) using AV blockers without myocardial infarction, electrolyte abnormalities, digitalis toxicity, and vasovagal syncope were enrolled into the present study. The level of AV block (AV-nodal or infranodal) was defined according to electrocardiographic characteristics. Results: The most frequent culprit medications were β-blockers followed by digoxin. Drug discontinuation was followed by resolution of AV block in 72% of cases, whereas spontaneous resolution of AV block occurred in only 6.6% of patients who had AV block in the absence of medications. However, 27% of patients with improved AV conduction experienced a recurrence of AV block despite discontinuation of the culprit drug. Twenty-one of 24 carvedilol-induced AV blocks resolved after discontinuation of the drug and never recurred, whereas 24 of 36 metoprolol-induced AV blocks persisted or recurred. A digoxin-induced AV block usually improved (28 of 39) after withdrawal of the drug. Roughly half of the patients with drug-induced AV block underwent permanent PM implantation. Conclusion: Drug-induced AV block is a serious disease that requires a permanent PM for almost half of the patients. (PACE 2012;XX:1–7)

WOS: 000375094600003 PubMed ID: 27111307 Objective: Therapeutic hypothermia improves neurologic prognosis after cardiac arrest. The aim of this study was to report clinical experience with intravascular method of cooling in patients with cardiac arrest resulting from ST-segment elevation myocardial infarction (STEMI). Methods: Thirteen patients (11 male, 2 famele; mean age was 39.6+/-9.4 years) who had undergone mild therapeutic hypothermia (MTH) by intravascular cooling after cardiac arrest due to STEMI were included. Clinical, demographic, and procedural data were analyzed. Neurologic outcome was assessed by Cerebral Performance Category (CPC) score. Results: Anterior STEMI was observed in 9 patients. One patient died of cardiogenic shock complicating STEMI. Mean cardiopulmonary resuscitation (CPR) duration and door-to-invasive cooling were 32.9+/-20.1 and 286.1+/-182.3 minutes, respectively. Precooling Glasgow Coma Scale score was 3 in 9 subjects. Twelve patients were discharged, 11 with CPC scores of 1 at 1-year follow-up. No major complication related to procedure was observed. Conclusion: In comatose survivors of STEMI, therapeutic hypothermia by intravascular method is a feasible and safe treatment modality. Amaç: Kalp durması sonrası tedavi amaçlı hipotermi uygulamasının nörolojik prognoz üzerine olumlu etkisi gösterilmiştir. Bu yazıda, ST yükselmeli miyokart enfarktüsüne (STYME) bağlı kalp durması geçiren hastalarda damariçi yöntemle yapılan soğutma tedavisine ilişkin çalışmamız sunuldu. Yöntemler: ST yükselmeli miyokart enfarktüsü sonrası kalp durması nedeniyle damariçi yöntemle tedavi amaçlı hipotermi uygulanan 13 hasta (11 erkek, 2 kadın; ortalama yaş 39.6±9.4 yıl) çalışmaya dahil edildi. Klinik, demografik ve soğutma işlemine ait veriler incelendi. Nörolojik takipler Serebral Performans Kategorisi skorlaması kullanılarak yapıldı. Bulgular: Dokuz hastada akut ön duvar miyokart enfarktüsü tespit edildi. Bir hasta kardiyojenik şok nedeniyle kaybedildi. Ortalama kardiyopulmoner canlandırma süresi ve kapı invaziv soğutma süresi sırasıyla 32.9±20.1 ve 286.1±182.3 dakikaydı. Soğutma öncesi dokuz hastada Glaskow Koma Skalası 3 bulundu; 12 hasta taburcu edildi, 11 hastanın bir yıllık takipte Serebral Peformans Kategorisi skoru 1 olarak saptandı. Soğutma işleminden kaynaklanan ciddi komplikasyon gözlenmedi. Sonuç: ST yükselmeli miyokart enfarktüsü sonrası koma halinde bulunan hastalarda damariçi yöntemle yapılan tedavi amaçlı hipotermi faydalı ve güvenli bir tedavi seçeneğidir.

OBJECTIVE Recent studies have shown that epicardial adipose tissue (EAT) thickness is increased in patients with hypertension. In this study, we aimed to investigate the relation of EAT thickness with resistant hypertension (RHT). PARTICIPANTS AND METHODS Study participants (n=150) were classified into three groups according to their office and ambulatory blood pressure measurements: RHT (n=50), controlled hypertension (CHT, n=50), and normotension (NT, n=50). All patients underwent a transthoracic echocardiographic examination to measure EAT thickness. RESULTS Clinical and biochemical characteristics of the groups were similar, except the CRP level, which was significantly increased in hypertensive patients compared with patients with NT (P

Anomalous origin of left and right coronary arteries from a single coronary ostium in the right sinus of Valsalva is rare. Previously, few reports have described percutaneous coronary interventions (PCI) in this anomaly. We report a case of a 78-year-old female who had acute inferior myocardial infarction with a severe lesion in the anomalous left main coronary artery (LMCA) arising from a single ostium in the right sinus of Valsalva.

Levels of galectin-3, a member of a family of soluble β-galactoside-binding lectins, are reported to be higher in patients with type 2 diabetes mellitus (DM) and metabolic syndrome. Conflicting results exist on the effects of galectin-3 in diabetic patients. The aim of this study was to investigate the relationship between galectin-3 levels and coronary artery disease (CAD), coronary plaque burden, and plaque structures in patients with type 2 DM.A total of 158 consecutive patients with type 2 DM undergoing planned coronary computed tomography angiography (CCTA) were included in this study. The study population was divided into CAD and non-CAD groups according to the presence of CCTA-determined coronary atherosclerosis.Galectin-3 concentrations were significantly higher in the CAD group than in the non-CAD group (1412.0 ± 441.7 vs. 830.2 ± 434.9 pg/ml, P0.001). Galectin-3 levels were correlated positively with BMI, high-sensitivity C-reactive protein, the total number of diseased vessels, the number of plaques (all, P0.001), and the calcified plaque type (P = 0.001). In addition, galectin-3 levels were found to be a significant independent predictor of coronary atherosclerosis in type 2 diabetic patients (P = 021; odds ratio, 1.002; 95% confidence interval, 1.000-1.003).Galectin-3 is a novel, promising biomarker that may help identify type 2 diabetic patients who may require early CAD intervention because of the potential risk of coronary atherosclerosis.

OBJECTIVE The total burden of subclinical coronary atherosclerosis is significant in young adults. Serum lipoprotein-associated phospholipase A2 (Lp-PLA2) is an established predictor of morbidity and mortality because of cardiovascular disease. The aim of the present investigation was to evaluate the relationship between subclinical coronary atherosclerosis and serum Lp-PLA2 concentrations in a population of young adults. PATIENTS AND METHODS A total of 261 individuals younger than 45 years of age who had undergone coronary computed tomography angiography were evaluated. The study group included 101 patients in whom coronary computed tomography angiography detected subclinical coronary atherosclerosis; the control group included 160 sex-matched and age-matched healthy control patients. RESULTS Serum Lp-PLA2 levels were increased significantly in the study group patients compared with the control patients (15.42±11.88 vs. 8.06±4.32 ng/ml, P

Evidence suggests that low 25-OH vitamin D 25(OH)D concentrations may increase the risk of several cardiovascular diseases such as hypertension, peripheral vascular disease, diabetes mellitus, obesity, myocardial infarction, heart failure and cardiovascular mortality. Recent studies suggested a possible relationship between vitamin D deficiency and increased carotid intima-media wall thickness and vascular calcification. We hypothesized that low 25(OH)D may be associated with coronary atherosclerosis and coronary plaque burden and composition, and investigated the relationship between serum vitamin D levels and coronary atherosclerosis, plaque burden or structure, in young adult patients by using dual-source 128x2 slice coronary computed tomography angiography (CCTA). We included 98 patients with coronary atherosclerosis and 110, age and gender matched, subjects with normal findings on CCTA examinations. Patients with subclinical atherosclerosis had significantly higher serum total cholesterol, triglycerides, hs-CRP, uric acid, HbA1c and creatinine levels and lower serum 25(OH)D levels in comparison with controls. There was no significant correlation between 25(OH)D and plaque morphology. There was also a positive relationship between 25(OH)D and plaque burden of coronary atherosclerosis. In multivariate analysis, coronary atherosclerosis was associated high hs-CRP (adjusted OR: 2.832), uric acid (adjusted OR: 3.671) and low 25(OH)D (adjusted OR: 0.689). Low levels of 25(OH)D were associated with coronary atherosclerosis and plaque burden, but there was no significant correlation between 25(OH)D and plaque morphology.

Objective: The purpose of this study was to examine the influence of lunar phases on blood pressure in non-hypertensive individuals.

Atherosclerotic plaques tend to involve arterial localizations in which blood flow is not laminar due to arterial bends and bifurcations. A 49-year-old man was admitted to hospital with breathlessness and was subsequently diagnosed with left ventricular failure. Coronary angiography revealed three-vessel coronary artery disease and an anomalous extra left anterior descending artery taking off from the right sinus of Valsalva and spared from atherosclerosis. The absence of side branches and the relative lack of bends in arterial geometry were considered to be the cause of resistance to atherosclerosis. The present case identifies local flow conditions as an important factor determining the genesis of atherosclerosis in arterial segments.

WOS: 000342236900007, PubMed ID: 25197023, Background: Elevated gamma-glutamyl transferase (GGT) levels have been demonstrated to be associated with poor prognoses in patients with coronary artery disease. Coronary computed tomography angiography (CCTA) is a noninvasive imaging modality that may differentiate the structure of coronary plaques. Elevated plaque burdens and noncalcified plaques, detected by CCTA, are important predictors of atherosclerosis in young adults. Hypothesis: The present study investigated the possible relationship between GGT levels and coronary plaque burdens/structures in young adults with coronary atherosclerosis. Methods: CCTA images of 259 subjects were retrospectively examined, and GGT levels were compared between patients with coronary plaques and individuals with normal coronary arteries. Coronary plaques, detected by CCTA, were categorized as noncalcified, calcified, and mixed, according to their structures. The significant independent predictors of coronary atherosclerosis were also analyzed using multivariate logistic regression analysis. Results: GGT levels were significantly higher in patients with coronary plaque formation than in controls (35.7 +/- 14.7 vs 19.6 +/- 10.0 U/L; P < 0.001). GGT levels were also positively correlated with the number of plaques; presence of noncalcified plaques; and levels of high-sensitivity C-reactive protein (hs-CRP), hemoglobin A1c, uric acid, and triglycerides. Moreover, smoking and levels of GGT, hs-CRP, uric acid, and low high-density lipoprotein cholesterol were independent predictors of coronary atherosclerosis. Conclusions: GGT is an inexpensive and readily available marker that provides additional risk stratification beyond that provided by conventional risk factors for predicting coronary plaque burdens and plaque structures in young adults.

To identify the frequency of atrioventricular (AV) conduction improvement after discontinuation of the culprit drug in patients with AV block.AV blockers are considered as reversible causes of AV block that do not require pacemaker (PM) implantation. However, controversial reports declared that a major part of these drug-induced AV blocks are persistent or recurrent.Of 668 consecutive patients with symptomatic type II second- or third-degree AV block, 2:1 AV block, atrial fibrillation, and bradyarrhythmia, 108 patients (62 patients enrolled prospectively) using AV blockers without myocardial infarction, electrolyte abnormalities, digitalis toxicity, and vasovagal syncope were enrolled into the present study. The level of AV block (AV-nodal or infranodal) was defined according to electrocardiographic characteristics.The most frequent culprit medications were β-blockers followed by digoxin. Drug discontinuation was followed by resolution of AV block in 72% of cases, whereas spontaneous resolution of AV block occurred in only 6.6% of patients who had AV block in the absence of medications. However, 27% of patients with improved AV conduction experienced a recurrence of AV block despite discontinuation of the culprit drug. Twenty-one of 24 carvedilol-induced AV blocks resolved after discontinuation of the drug and never recurred, whereas 24 of 36 metoprolol-induced AV blocks persisted or recurred. A digoxin-induced AV block usually improved (28 of 39) after withdrawal of the drug. Roughly half of the patients with drug-induced AV block underwent permanent PM implantation.Drug-induced AV block is a serious disease that requires a permanent PM for almost half of the patients.

Background Hypothyroidism is a reversible cause of atrioventricular (AV) block. Few reports have described reversible AV block caused by hyperthyroidism. However, it is unknown whether patients with AV block are expected to have a benign course after the initiation of appropriate therapy for thyroid dysfunction. Methods The study group consisted of patients with II or III degree AV block and bradyarrhythmia (≤40 bpm) excluding patients with myocardial infarction, electrolyte abnormalities, digitalis toxicity, and vasovagal syncope. Thyroid dysfunction is diagnosed when thyroid stimulating hormone and thyroxine levels are not in defined normal ranges. AV block was determined by surface electrocardiogram (ECG). The cause and effect relation between AV block and thyroid dysfunction was evaluated. Results Of 668 patients, 29 (4.3%) had hypothyroidism (19 overt) and 21 (3.1%) had hyperthyroidism (8 overt). The most frequent ECG finding was complete AV block (27 of 50 patients). Ten patients had bradyarrhythmia and 13 had second-degree AV block. Euthyroid state was achieved in 10 hypothyroidic (34%) and in 7 hyperthyroidic patients (33%) with hormone replacement and antithyroid therapy, respectively, during the follow-up period (≤21 days). Thyroid dysfunction was found to be not related with AV block in 40 patients (80%). However, in 4 of 10 patients with AV block related to thyroid dysfunction the resolution of AV block occurred after the placement of pacemaker (>21 days). Overall, 44 of 50 (88%) patients with AV block in association with thyroid dysfunction were implanted with a permanent pacemaker. Of 6 patients who did not receive a pacemaker, 2 had complete AV block and 4 had bradyarrythmia. Conclusion AV block associated with thyroid dysfunction needs great attention regardless of type of the thyroid disease. Patients with II and/or III degree AV block in the setting of thyroid dysfunction almost always need permanent pacemaker insertion even after normalization of thyroid status.

Atrial fibrillation is a frequent arrhythmia, and atherosclerotic coronary artery disease remains as the most common etiological factor underlying atrial fibrillation, along with systemic hypertension. The relationship between uncomplicated coronary artery disease and atrial fibrillation is not explained satisfactorily. Inflammation is now recognized as an important pathogenetic mechanism for both disorders. We hypothesise that inflammation originated from atherosclerotic coronary arteries may disseminate downstream to atrial tissue and initiate or stabilize atrial fibrillation. Studies conducted with drugs bearing anti-inflammatory properties such as hydroxymethylglutaryl coenzyme A inhibitors decrease frequency of both conditions. Such a relationship may become a novel therapeutic target to prevent this arrhythmia or decrease the frequency of paroxysms.