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PP-046 ASSOCIATION OF CORONARY ARTERY CALCIFICATION AND SERUM PROLIDASE ACTIVITY
Cardiology Posters / International Journal of Cardiology 140, Supplement 1 (2010) S1–S93
must be considered that cTn elevation may be seen in many conditions other than acute coronary syndrome such as sepsis, pulmonary embolism, heart failure, and renal failure. However, elevations of troponin should not be considered to be due to isolated seizures. We present a patient with ischemic changes on electrocardiography (ECG) and increased troponin levels following a generalized tonic-clonic seizure (GTC) but without any angiographically significant lesion. Methods: A 51-year-old woman with a history of epileptic seizures treated with phenytoin was admitted to the emergency department after three episodes of GTC seizure. History has been taken from her relatives. It was lasting over five minutes with little cyanosis and then general weakness and somnolence was pursuing by their description. She had a history of head trauma and operation to drain subdural hematoma 38 years ago. Her last evaluation in our neurology clinic including electroencephalography was normal and magnetic resonance imaging revealed small former changes due to head trauma. Use of phenytoin 3X100mg for seizures and ramipril for hypertension were recommended. Her physical examination was unremarkable. ECG showed normal sinus rhythm with 2-3mm ST segment depression and negative T waves at inferolateral derivations. The patient’s blood tests were within normal range with the exception of mildly elevated levels of creatine-phosphokinase MB fraction (CK-MB) (40 ng/ml, normal <2.88 ng/ml) and cTnT (0.370 ng/ml, normal <0.1 ng/ml). Echocardiography at admission revealed normal ventricular function with an ejection fraction of 65%. Cranial computerized tomography didn’t demonstrate any acute pathology. The cTnT subsequently increased to 0.422 ng/ml with a CK-MB of 63 ng/ml, which is a significant elevation and led to cardiology consultation. Results: cTnT concentrations did not increase in response to epileptic seizures alone, and hence felt that elevated TnT was likely due to acute coronary syndrome. Subsequently, coronary angiography had been performed and revealed coronary nonsignificant plaques with small muscular bridge at distal segment of left anterior descending artery. cTnT decreased to normal levels and ECG changes disappered at the follow-up period in the coronary-care-unit. Conclusions: Despite the knowledge of cTnT is not elevated following uncomplicated seizure, we want to show it is not absolutely correct. Some causes such as apnea, tachycardia, and the increase in myocardial oxygen consumption seen during epileptic seizures would lead to myocardial injury and an elevation in cTnT levels. This point is important when evaluating patient to identify exact mechanism that causing clinical situation.
PP-046 ASSOCIATION OF CORONARY ARTERY CALCIFICATION AND SERUM PROLIDASE ACTIVITY Yusuf Sezen 1 , Abdulkerim Fidan 1 , Memduh Bas 1 , Ali Yildiz 1 , Recep Demirbag 1 , Nurten Aksoy 2 , Hakim Celik 2 , Abdullah Taskin 2 , Hatice Sezen 3 1 Harran University School of Medicine, Department of Cardiology, Sanliurfa, Turkey 2 University of Harran Faculty of Medicine, Department of Biochemistry and Clinical Biochemistry, Sanliurfa, Turkey 3 Sanliurfa Training and Research Hospital, Department of Biochemistry and Clinical Biochemistry, Sanliurfa, Turkey Objective: Prolidase is a cytosolic exopeptidase that plays major role in collagen turnover. Previous studies revealed the association of serum prolidase activity and coronary artery disease (CAD). Previous reports also indicated that the presence of coronary artery calcification (CAC) was associated with the presence, mortality and morbidity of the cardiovascular diseases. Consequently we aimed to evaluate the relationship between the CAC and serum prolidase activity in patients with CAD. Methods: CAC presence was visually established by examining coronary angiography images before coronary artery was dyed with contrast agent. 128 CAD patients with CAC and 156 CAD patients without CAC were enrolled. Fasting blood samples were used for spectrofotometric assessment of prolidase activity. Independent samples t-test, chi-square test and binary logistic regression analysis were used for statistical analysis. Results: Age (62.7±9.6 vs. 60.1±10.2years, respectively; p=0.030), frequency of diabetes mellitus (42.2% vs. 27.6%, respectively; p=0.012) and serum prolidase activity (701.7±17.3 vs. 685.4±30.0U/l, respectively; p<0.001), were significantly higher; whereas serum triglyceride level was significantly lower (156.4±74.5 vs. 190.4±97.6mg/dl, respectively; p=0.042) in CAD patients with CAC compared to CAD patients without CAC.
S55
Serum prolidase activity (Beta=0.017, chi-square=28.709, p=0.032) was the only independent predictor of CAC. Conclusions: With the findings of the present study we have –for the first time in the pertinent literature- shown that the serum prolidase activity is increased in CAD patients with CAC. These findings suggest that prolidase may take role in the development of visually detected CAC.
PP-047 A CORONARY ARTERY BYPASS CASE IN A CLASS-III MORBID OBESITY PATIENT Ali Vefa Ozcan, Ibrahim Goksin, Murat Aslan Pamukkale University, Medical Faculty, Department of Cardiovascular Surgery, Denizli, Turkey Objective: Morbid obesity increases mortality and morbidity up to 50-100% in the coronary artery bypass surgery (CABG) [1]. Sternal wound infections, sternal dehiscence, atrial fibrillation, various lung problems and deep venous thrombosis are some of the problems that can be encountered in the postoperative period. Methods: The patient was 58 years old, diabetic, male. He did not have a history of MI or hypertension. He was complaining of severe angina pectoris for 2 months. He was on coumadin for atrial fibrillation. Hepatic and renal functions were normal. Total cholesterol: 187 mg/dl, TG: 123 mg/dl, HDL: 37 mg/dl, LDL: 125 mg/dl. His body mass index (BMI) or Quetelet index was 47.8 kg/m2 [2]. Angiographic findings: 1. ECHO revelaed an EF of 60% without significant valvular disease. Forced expiratory volume in 1 second (FEV1) = 76%. Angiographic findings Coronary arteries Lesion (%), LAD-proximal 70, 1. Diagonal 70, Cx- proximal 99, RCA- crux 70. Process: Midline sternotomy was performed under general anesthesia. After 3 mg/kg heparin was given, aortic and two-stage venous cannulation were done. Four vessel (LAD, D1, Cx, PDA) coronary artery bypass grafts were performed using saphenous vein grafts. LIMA was not used because of the morbid obesity.28 0C hypothermia was used. Cardiac flow was 6000 cc/min. Arterial pressure was 50-60 mmHg. X-clamp time was 82 minute. Sternotomy was closed with steel wire of standard technique. No complication was observed in the postoperative period. Patient was extubated on the 5h. Total drainage was 425 cc. Patient discharged on the 10th day. Results: In this morbid obese patient, operation process was successfully completed without any problems including the ones mentioned above. Conclusions: In this patient, obesity did not increased the hospital stay, costs or the complications which is encouraging for the future patients.
PP-048 SERUM HIGH-SENSITIVITY C-REACTIVE PROTEIN, AMILOID ASSOCIATED PROTEIN AND N TERMINAL PROBNP LEVELS DO NOT PREDICT REVERSIBLE MYOCARDIAL ISCHEMIA Murat Baskurt 1 , Faruk Akturk 2 , Kudret Keskin 3 , Polat Canbolat 1 , Kadriye Kilickesmez 1 , Sezer K. Muniboglu 1 1 Istanbul University, Institute of Cardiology, Cardiology Department, Istanbul, Turkey 2 Mehmet Akif Ersoy, Education and Research Hospital, Kucukcekmece, Istanbul, Turkey 3 Cerkezkoy Government Hospital, Cerkezkoy, Tekirdag, Turkey Objective: The aim of this study was to detect if there were any relationship between serum high-sensitivity C-reactive protein (hs-CRP), serum amiloid associated protein (SAA) and N terminal pro B type natriuretic peptide (NT-proBNP) levels and reversible myocardial ischemia during cardiovascular exercise testing and to find out whether these biomarkers could predict transient myocardial ischemia. Methods: 96 patients (36 women, 60 men, mean age 57±8.5 years) were included to the study. Venous blood samples were taken from patients before and 15 minutes after exercise testing. SAA and hs-CRP were studied using immunonephelometric assays (Dade-Behring, BN II, Marburg, Germany). NT-proBNP (pg/mL) was studied by using the immulite 1000 Chemiluminescent Immunoassay System (Siemens medical solution diagnostics, Deerfiled, USA). 48 patients (18 women, 30 men) with positive exercise testing were taken into the exercise testing positive and 48 patients (18 women, 30 men) with negative exercise testing were taken into
must be considered that cTn elevation may be seen in many conditions other than acute coronary syndrome such as sepsis, pulmonary embolism, heart failure, and renal failure. However, elevations of troponin should not be considered to be due to isolated seizures. We present a patient with ischemic changes on electrocardiography (ECG) and increased troponin levels following a generalized tonic-clonic seizure (GTC) but without any angiographically significant lesion. Methods: A 51-year-old woman with a history of epileptic seizures treated with phenytoin was admitted to the emergency department after three episodes of GTC seizure. History has been taken from her relatives. It was lasting over five minutes with little cyanosis and then general weakness and somnolence was pursuing by their description. She had a history of head trauma and operation to drain subdural hematoma 38 years ago. Her last evaluation in our neurology clinic including electroencephalography was normal and magnetic resonance imaging revealed small former changes due to head trauma. Use of phenytoin 3X100mg for seizures and ramipril for hypertension were recommended. Her physical examination was unremarkable. ECG showed normal sinus rhythm with 2-3mm ST segment depression and negative T waves at inferolateral derivations. The patient’s blood tests were within normal range with the exception of mildly elevated levels of creatine-phosphokinase MB fraction (CK-MB) (40 ng/ml, normal <2.88 ng/ml) and cTnT (0.370 ng/ml, normal <0.1 ng/ml). Echocardiography at admission revealed normal ventricular function with an ejection fraction of 65%. Cranial computerized tomography didn’t demonstrate any acute pathology. The cTnT subsequently increased to 0.422 ng/ml with a CK-MB of 63 ng/ml, which is a significant elevation and led to cardiology consultation. Results: cTnT concentrations did not increase in response to epileptic seizures alone, and hence felt that elevated TnT was likely due to acute coronary syndrome. Subsequently, coronary angiography had been performed and revealed coronary nonsignificant plaques with small muscular bridge at distal segment of left anterior descending artery. cTnT decreased to normal levels and ECG changes disappered at the follow-up period in the coronary-care-unit. Conclusions: Despite the knowledge of cTnT is not elevated following uncomplicated seizure, we want to show it is not absolutely correct. Some causes such as apnea, tachycardia, and the increase in myocardial oxygen consumption seen during epileptic seizures would lead to myocardial injury and an elevation in cTnT levels. This point is important when evaluating patient to identify exact mechanism that causing clinical situation.
PP-046 ASSOCIATION OF CORONARY ARTERY CALCIFICATION AND SERUM PROLIDASE ACTIVITY Yusuf Sezen 1 , Abdulkerim Fidan 1 , Memduh Bas 1 , Ali Yildiz 1 , Recep Demirbag 1 , Nurten Aksoy 2 , Hakim Celik 2 , Abdullah Taskin 2 , Hatice Sezen 3 1 Harran University School of Medicine, Department of Cardiology, Sanliurfa, Turkey 2 University of Harran Faculty of Medicine, Department of Biochemistry and Clinical Biochemistry, Sanliurfa, Turkey 3 Sanliurfa Training and Research Hospital, Department of Biochemistry and Clinical Biochemistry, Sanliurfa, Turkey Objective: Prolidase is a cytosolic exopeptidase that plays major role in collagen turnover. Previous studies revealed the association of serum prolidase activity and coronary artery disease (CAD). Previous reports also indicated that the presence of coronary artery calcification (CAC) was associated with the presence, mortality and morbidity of the cardiovascular diseases. Consequently we aimed to evaluate the relationship between the CAC and serum prolidase activity in patients with CAD. Methods: CAC presence was visually established by examining coronary angiography images before coronary artery was dyed with contrast agent. 128 CAD patients with CAC and 156 CAD patients without CAC were enrolled. Fasting blood samples were used for spectrofotometric assessment of prolidase activity. Independent samples t-test, chi-square test and binary logistic regression analysis were used for statistical analysis. Results: Age (62.7±9.6 vs. 60.1±10.2years, respectively; p=0.030), frequency of diabetes mellitus (42.2% vs. 27.6%, respectively; p=0.012) and serum prolidase activity (701.7±17.3 vs. 685.4±30.0U/l, respectively; p<0.001), were significantly higher; whereas serum triglyceride level was significantly lower (156.4±74.5 vs. 190.4±97.6mg/dl, respectively; p=0.042) in CAD patients with CAC compared to CAD patients without CAC.
S55
Serum prolidase activity (Beta=0.017, chi-square=28.709, p=0.032) was the only independent predictor of CAC. Conclusions: With the findings of the present study we have –for the first time in the pertinent literature- shown that the serum prolidase activity is increased in CAD patients with CAC. These findings suggest that prolidase may take role in the development of visually detected CAC.
PP-047 A CORONARY ARTERY BYPASS CASE IN A CLASS-III MORBID OBESITY PATIENT Ali Vefa Ozcan, Ibrahim Goksin, Murat Aslan Pamukkale University, Medical Faculty, Department of Cardiovascular Surgery, Denizli, Turkey Objective: Morbid obesity increases mortality and morbidity up to 50-100% in the coronary artery bypass surgery (CABG) [1]. Sternal wound infections, sternal dehiscence, atrial fibrillation, various lung problems and deep venous thrombosis are some of the problems that can be encountered in the postoperative period. Methods: The patient was 58 years old, diabetic, male. He did not have a history of MI or hypertension. He was complaining of severe angina pectoris for 2 months. He was on coumadin for atrial fibrillation. Hepatic and renal functions were normal. Total cholesterol: 187 mg/dl, TG: 123 mg/dl, HDL: 37 mg/dl, LDL: 125 mg/dl. His body mass index (BMI) or Quetelet index was 47.8 kg/m2 [2]. Angiographic findings: 1. ECHO revelaed an EF of 60% without significant valvular disease. Forced expiratory volume in 1 second (FEV1) = 76%. Angiographic findings Coronary arteries Lesion (%), LAD-proximal 70, 1. Diagonal 70, Cx- proximal 99, RCA- crux 70. Process: Midline sternotomy was performed under general anesthesia. After 3 mg/kg heparin was given, aortic and two-stage venous cannulation were done. Four vessel (LAD, D1, Cx, PDA) coronary artery bypass grafts were performed using saphenous vein grafts. LIMA was not used because of the morbid obesity.28 0C hypothermia was used. Cardiac flow was 6000 cc/min. Arterial pressure was 50-60 mmHg. X-clamp time was 82 minute. Sternotomy was closed with steel wire of standard technique. No complication was observed in the postoperative period. Patient was extubated on the 5h. Total drainage was 425 cc. Patient discharged on the 10th day. Results: In this morbid obese patient, operation process was successfully completed without any problems including the ones mentioned above. Conclusions: In this patient, obesity did not increased the hospital stay, costs or the complications which is encouraging for the future patients.
PP-048 SERUM HIGH-SENSITIVITY C-REACTIVE PROTEIN, AMILOID ASSOCIATED PROTEIN AND N TERMINAL PROBNP LEVELS DO NOT PREDICT REVERSIBLE MYOCARDIAL ISCHEMIA Murat Baskurt 1 , Faruk Akturk 2 , Kudret Keskin 3 , Polat Canbolat 1 , Kadriye Kilickesmez 1 , Sezer K. Muniboglu 1 1 Istanbul University, Institute of Cardiology, Cardiology Department, Istanbul, Turkey 2 Mehmet Akif Ersoy, Education and Research Hospital, Kucukcekmece, Istanbul, Turkey 3 Cerkezkoy Government Hospital, Cerkezkoy, Tekirdag, Turkey Objective: The aim of this study was to detect if there were any relationship between serum high-sensitivity C-reactive protein (hs-CRP), serum amiloid associated protein (SAA) and N terminal pro B type natriuretic peptide (NT-proBNP) levels and reversible myocardial ischemia during cardiovascular exercise testing and to find out whether these biomarkers could predict transient myocardial ischemia. Methods: 96 patients (36 women, 60 men, mean age 57±8.5 years) were included to the study. Venous blood samples were taken from patients before and 15 minutes after exercise testing. SAA and hs-CRP were studied using immunonephelometric assays (Dade-Behring, BN II, Marburg, Germany). NT-proBNP (pg/mL) was studied by using the immulite 1000 Chemiluminescent Immunoassay System (Siemens medical solution diagnostics, Deerfiled, USA). 48 patients (18 women, 30 men) with positive exercise testing were taken into the exercise testing positive and 48 patients (18 women, 30 men) with negative exercise testing were taken into