Background and objectives: Despite being within the normal reference range, changes in thyroid stimulating hormone (TSH) levels have negative effects on the cardiovascular system. The majority of patients admitted to hospital with acute coronary syndrome (ACS) are euthyroid. The aim of this study was to investigate the effect of TSH level on the prognosis of in-hospital and follow-up periods of euthyroid ACS patients. Materials and Methods: A total of 629 patients with acute coronary syndrome without thyroid dysfunction were included in the study. TSH levels of patients were 0.3–5.33 uIU/mL. Patients were divided into three TSH tertiles: TSH level between (1) 0.3 uIU/mL and <0.90 uIU/mL (n = 209), (2) 0.90 uIU/mL and <1.60 uIU/mL (n = 210), and (3) 1.60 uIU/mL and 5.33 uIU/mL (n = 210). Demographic, clinical laboratory, and angiographic characteristics were compared between groups in terms of in-hospital and follow-up prognosis. Results: Mean age was 63.42 ± 12.5, and 73.9% were male. There was significant difference between tertiles in terms of TSH level at admission (p < 0.001), the severity of coronary artery disease (p = 0.024), in-hospital mortality (p < 0.001), in-hospital major hemorrhage (p = 0.005), total adverse clinical event (p = 0.03), follow-up mortality (p = 0.022), and total mortality (p < 0.001). In multivariate logistic regression analysis, the high–normal TSH tertile was found to be cumulative mortality increasing factor (OR = 6.307, 95%; CI: 1.769–22.480; p = 0.005) during the 6-month follow-up period after hospitalization and discharge. Conclusions: High–normal TSH tertile during hospital admission in euthyroid ACS patients is an independent predictor of total mortality during the 6-month follow-up period after hospitalization and discharge.
OBJECTIVE:In the current literature, there are few studies investigating the relationship between premature coronary atherosclerosis and nonalcoholic fatty liver disease. We aimed to evaluate the relationship between nonalcoholic fatty liver disease and premature coronary atherosclerosis. METHODS: In this cross-sectional study, female patients aged <55 years and male patients aged <50 years were enrolled. Both male and female patients underwent coronary angiography and abdomen ultrasonography between 2014 and 2019. A stepwise binary logistic regression analysis was carried out to evaluate the independent variables related to premature coronary atherosclerosis and nonalcoholic fatty liver disease. A p-value<0.05 was considered statistically significant. RESULTS: nonalcoholic fatty liver disease was present in 44% of patients (n=377). Notably, 62% of the patients were female and the mean age was 44.5 (39-49) years. In a multivariate analysis, nonalcoholic fatty liver disease was shown to be an independent risk factor of premature coronary atherosclerosis (OR 1.438; 95%CI, 1.050-1.969; p=0.024). CONCLUSIONS: The presence of nonalcoholic fatty liver disease is an important independent risk factor for the development of premature coronary atherosclerosis.
Background:Rheumatoid arthritis (RA) is an inflammatory disease that includes chronic, progressive joint arthritis and also has multi-systemic involvement. It is known that the acceleration of many cardiovascular diseases causing mortality and morbidity, especially atherosclerosis and heart failure, is increased in RA patients.Objectives:In this study, it was aimed to analyze the layer-specific (endocardial, transmural and epicardial) strain values obtained by speckle tracking echocardiography method in the determination of subclinical cardiac dysfunction in RA patients and to determine the correlation between anti cyclic citrullized peptide (Anti-CCP) titers, disease activity score (DAS-28), disease duration and strain values.Methods:This study was performed with 63 RA patients and 31 healthy participants. The patients were grouped as <5 years, 5-10 years and >10 years according to their disease duration. DAS28-CRP was used to determine disease activation. The standard assessment included complete serum concentration of C-reactive protein, Anti-CCP, Romatoid faktör (RF), N-terminal pro b-type natriuretic peptide (NT-proBNP) and homocysteine. Endocardial, transmural and epicardial strain values were analyzed by M-mode, 2D, tissue doppler and speckle tracking echocardiography.Results:When the groups were compared in terms of laboratory data, NT-proBNP value of RA patients was higher than the control group (p=0.044), homocysteine level was similar (p>0.05). When the groups were compared in terms of conventional echocardiographic parameters, ejection fraction of the control group was similar (p>0.05). E/A and E/E’ ratios were found to be significantly different (p<0.001, p=0.015). When the groups were compared in GLS values obtained by speckle tracking echocardiography, endocardium, transmural and epicardium GLS values were lower in RA patients (p<0.05) (Table 1). As the disease duration increased, GLS values were found to be worse (p<0.05). There was a significant correlation between RA disease activity scores level and LV GLS value, increasing levels of disease activity was associated with worse LV GLS (r=0.583, p<0.01 and r=0.681, p<0.01 ve r=0.689, p<0.01 for endocardium, transmural and epicardium respectively. There was a significant correlation between anti-CCP, RF and LV GLS value, higher Anti-CCP and RF titers were associated with worse LV GLS (r=0.467, p<0.01 and r=0.509, p<0.01 and r=0.551, p<0.01) for endocardium, transmural and epicardium respectively.Table 1.Comparison of layer-specific GLS values of groups<55-10>10ControlpGLS endocardiumMean ± SD-23,98±1,84-23,29±1,59-21,71±1,93-24,95±0,73ˠ: 0,000β: 0,000ᶮ: 0,001GLS transmuralMean ± SD-21,78±1,71-21,20±1,66-19,85±1,50-22,98±1,17ˠ: 0,001ᵟ: 0,020†: 0,017ᶮ: 0,001β: 0,000GLS epicardiumMean ± SD-20,05±2,02-19,23±1,77-17,98±1,38-20,83±0,70ᵟ: 0,023β: 0,000ˠ: 0,000ᶮ: 0,001SS: Standard Deviation, ˣ: 1-2, ᵟ: 2-3, β: 3-4, ˠ: 1-3, †: 1-4, ᶮ: 2-4, GLS: Global longitudinal strainConclusion:The layer-specific global longitudinal strain values obtained by speckle tracking echocardiography were found to be decreased in RA patients. This study, which has been shown to decrease strain values before the reduction of ejection fraction values obtained by conventional methods, may be a guide for the clinician in early detection of cardiac dysfunction in RA patients with high DAS-28 score, long disease duration, high Anti-CCP and high RF titers.References:[1]Corrao S, Argano C, Pistone G, Messina S, Calvo L, Perticone F. Rheumatoid arthritis affects left ventricular mass: Systematic review and meta-analysis. Eur J Intern Med 2015;26(4): 259-67.Disclosure of Interests:None declared
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