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Öğe A controlled study of the effects of carvedilol on clinical events, left ventricular function and proinflammatory cytokines levels in patients with dilated cardiomyopathy(Elsevier Science Inc, 2005) Tatli, E; Kurum, TBACKGROUND: Carvedilol is known to decrease the severity of ventricular dysfunction, to increase the left ventricular ejection fraction (LVEF), and, consequently, to reduce morbidity and mortality in patients with dilated cardiomyopathy. There is accumulating evidence that inflammatory cytokines have an important role in the pathogenesis of heart failure. OBJECTIVE: To establish whether the addition of carvedilol has an additive beneficial effect on cytokines in patients with dilated cardiomyopathy who are already receiving treatment with angiotensin-converting enzyme (ACE) inhibitors, digoxin and diuretics. METHODS AND RESULTS: In this single-centre, prospective, randomized study, 60 patients with dilated cardiomyopathy with an LVEF less than 40% and already receiving digoxin, ACE inhibitors and diuretics for six months as the standard therapy were randomly assigned to receive either carvedilol (n = 30) or placebo (n = 30). Patients received an initial dosage of 3.125 mg carvedilol or placebo twice daily for two weeks, which was then increased at two-week intervals (if tolerated), first to 6.25 mg, then to 12.5 mg, and, finally, to a target dosage of 25 mg twice daily. Clinical examinations, radionuclide studies, and determinations of plasma levels of tumour necrosis factor-alpha (TNF-alpha), interleukin (IL)-2 and IL-6 were performed at baseline and repeated four months after random assignment. Primary end points were New York Heart Association functional class, LV function and plasma cytokines levels. Eight patients died (seven in the placebo group, P = 0.05). Patients treated with carvedilol had a significant improvement in functional class compared with the baseline values (P = 0.001), with a decrease in the levels of cytokines (IL-6 [P = 0.001] and TNF-alpha [P = 0.001]). LVEF increased from 22.14 7.85% to 27.85 11.80% (P = 0.002), but diastolic function did not change in the carvedilol group. CONCLUSIONS: In patients with dilated cardiomyopathy, the addition of carvedilol to treatment with digoxin, ACE inhibitors and diuretics is associated with a significant improvement in symptoms and in IV function, and suppression of inflammatory cytokines.Öğe Increased pulse wave velocity and shortened pulse wave propagation time in young patients with rheumatoid arthritis(Elsevier Science Inc, 2004) Yildiz, M; Soy, M; Kurum, T; Ozbay, GBACKGROUND: Rheumatoid arthritis (RA) is a systemic immune and inflammatory disease associated with excess cardiovascular morbidity and mortality. Pulse wave velocity (PWV) is an index of arterial stiffness and a marker of cardiovascular events. OBJECTIVE: To investigate arterial stiffness using carotid-femoral (aortic) PWV measurements in young patients with RA. PATIENTS AND METHODS: Eight patients (aged 21 to 34 years, seven women, mean RA duration 13.8+/-12.6 months) with RA according to the criteria of the American College of Rheumatology, and eight age- and sex-matched control subjects (aged 22 to 34 years, seven women) were recruited. Aortic PWV was determined using an automatic device, the Complior (Complior Colson, France), which allowed on-tine pulse wave recording and automatic calculation of PWV RESULTS: The carotid-femoral PWV, systolic blood pressure and heart rate were higher in young patients with RA than in sex- and age-matched control subjects (P=0.03, P=0.02 and P=0.002, respectively). In the young patients with RA, pulse wave propagation time between measurement sites was significantly shorter than in the control group (P=0.02). There were no significant differences in the sex, age, body mass index, waist to hip ratio, diastolic blood pressure, mean blood pressure or pulse pressure between the two groups (P=1.00, P=0.71, P=0.20, P=0.66, P=0.55, P=0.07 and P=0.11, respectively). CONCLUSION: The carotid-femoral PWV is increased and Pulse wave propagation time is decreased in young patients with RA. Measurements of carotid-femoral PWV may provide a simple and noninvasive technique for identifying patients at increased risk of vascular disease.Öğe The potential cardioprotective effects of amifostine in irradiated rats(Elsevier Science Inc, 2004) Tokatli, F; Uzal, C; Doganay, L; Kocak, Z; Kaya, M; Ture, M; Kurum, TPurpose: The aim of this study is to determine the cardioprotective efficacy of amifostine. The study consists of researching the relationship between plasma brain natriuretic peptide levels and the electrical and morphologic changes in irradiated rats with or without amifostine. Methods and Materials: Sixty Wistar albino rats were divided into 4 groups, and their hearts were given 15 Gy/fraction with Co-60. In Groups I and II, the rats were killed after 24 hours to detect early effects; in Groups III and IV, the rats were killed 100 days after irradiation to detect late effects. Before irradiation, Groups I and III received 0.9% saline solution, whereas Groups II and IV received amifostine (200 mg/kg). Twenty rats were used as a control group. Results: On the 100th day, mild myocardial degeneration was detected in 5 rats (33%) from Group III (no amifostine). This percentage was statistically different from that of Group IV (treated with amifostine) and the controls (p = 0.042). There was no statistically significant difference between the mean plasma brain natriuretic peptide values of the groups (p > 0.05). There was no significant difference in electrocardiographies between the groups. There was no correlation between continuous variables. Conclusion: In the amifostine group (IV) on the 100th day, there was no myocardial degeneration, suggesting that amifostine has a cardioprotective effect. (C) 2004 Elsevier Inc.
