Letter to the Editor / Reply Published online: March 28, 2016
Med Princ Pract 2016;25:498 DOI: 10.1159/000445773
Saphenous Vein Graft Disease and Serum Erythropoietin Level Beuy Jooba, Viroj Wiwanitkitb a Sanitation b Hainan
1 Medical Academic Center, Bangkok, Thailand; Medical University, Haikou, China
Dear Editor, We read with interest the recent report entitled ‘Saphenous vein graft disease is associated with a low serum erythropoietin level’ by Kocaoğlu et al. [1]. They mentioned that ‘SVG disease was associated with a low serum EPO level, suggesting that a low EPO level could be predictive of and contributes to the pathophysiology of SVG disease’. There are many concerns regarding this report. First, the diagnostic property of the laboratory test kit for the measurement of EPO was not discussed. Second, they forgot to deal
with possible confounding factors, such as hematologic disease exemplified by thalassemia, an inherited hemoglobin disorder. A previous study has shown that cases with underlying thalassemia usually present with high EPO level [2]. Because bypass graft surgery can be seen in patients with thalassemia in clinical practice [3] SVG should be expected. Hence, the relationship between SVG and serum EPO levels should be different from the observation by Kocaoğlu et al. [1].
References 1 Kocaoğlu İ, Arslan U, Koza Y, et al: Saphenous vein graft disease is associated with a low serum erythropoietin level. Med Princ Pract 2015;24: 544–547. 2 Paritpokee N, Wiwanitkit V, Bhokaisawan N, et al: Serum erythropoietin levels in pediatric patients with beta-thalassemia/hemoglobin E. Clin Lab 2002;48:631–634. 3 Horai T, Tanaka K, Takeda M: Coronary artery bypass grafting under cardiopulmonary bypass in a patient with beta-thalassemia: report of a case. Surg Today 2006;36:538–540.
Reply İbrahim Kocaoğlua, Uğur Arslanb a Department of Cardiology, Aydın State Hospital, Aydın, and bSamsun Education and Research Hospital, Samsun, Turkey
Dear Editor, We would like to thank Joob and Wiwanitkit [1] for their interest in our article. First of all, we used a standardized method to determine EPO levels. Venous blood samples were drawn into a tube without anticoagulant following fasting for ≥8 h from patients undergoing coronary angiography on the same day; all the patients rested in the supine position for ≤1 h at the same time of day (13: 00–14: 00) to avoid diurnal variation. The EPO level was measured using ELISA. Secondly, thalassemia, an inherited hemoglobin disorder, is a childhood disease and patients usually do not survive into late adulthood [2]. Joob and Wiwanitkit cited the study of Paritpokee et al. [3], which was conducted in pediatric patients. However, we do not come across patients with thalassemia and coronary artery disease in practice since they do not reach older age, and atherosclerosis is rarely encountered in pediatric cases [4]. In our study, no patient had thalassemia. We also looked for other confounding factors and performed multivariate analysis including hemoglobin levels and found that low serum EPO levels were independently associated with saphenous vein graft disease [1].
© 2016 S. Karger AG, Basel 1011–7571/16/0255–0498$39.50/0 E-Mail [email protected] www.karger.com/mpp
This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) (www.karger.com/OA-license), applicable to the online version of the article only. Distribution permitted for non-commercial purposes only.
Editor’s Note This response represents solely the opinion of the first and the second author of this article (İ.K. and U.A.). References 1 Kocaoğlu İ, Arslan U, Koza Y, et al: Saphenous vein graft disease is associated with a low serum erythropoietin level. Med Princ Pract 2015; 24: 544–547. 2 Morris CR, Singer ST, Walters MC: Clinical hemoglobinopathies: iron, lungs and new blood. Curr Opin Hematol 2006;13:407–418. 3 Paritpokee N, Wiwanitkit V, Bhokaisawan N, et al: Serum erythropoietin levels in pediatric patients with beta-thalassemia/hemoglobin E. Clin Lab 2002;48:631–634. 4 Wilson PW, D’Agostino RB, Levy D, et al: Prediction of coronary heart disease using risk factor categories. Circulation 1998;97:1837–1847.
Uğur Arslan, MD Department of Cardiology Samsun Education and Research Hospital Baris Avenue 199, TR–55090 Ilkadım, Samsun (Turkey) E-Mail ugurarslan5 @ yahoo.com
Beuy Joob Sanitation 1 Medical Academic Center Bangkhae Road Bangkok 10160 (Thailand) E-Mail beuyjoob @ hotmail.com
Med Princ Pract 2016;25:498 DOI: 10.1159/000445773
Saphenous Vein Graft Disease and Serum Erythropoietin Level Beuy Jooba, Viroj Wiwanitkitb a Sanitation b Hainan
1 Medical Academic Center, Bangkok, Thailand; Medical University, Haikou, China
Dear Editor, We read with interest the recent report entitled ‘Saphenous vein graft disease is associated with a low serum erythropoietin level’ by Kocaoğlu et al. [1]. They mentioned that ‘SVG disease was associated with a low serum EPO level, suggesting that a low EPO level could be predictive of and contributes to the pathophysiology of SVG disease’. There are many concerns regarding this report. First, the diagnostic property of the laboratory test kit for the measurement of EPO was not discussed. Second, they forgot to deal
with possible confounding factors, such as hematologic disease exemplified by thalassemia, an inherited hemoglobin disorder. A previous study has shown that cases with underlying thalassemia usually present with high EPO level [2]. Because bypass graft surgery can be seen in patients with thalassemia in clinical practice [3] SVG should be expected. Hence, the relationship between SVG and serum EPO levels should be different from the observation by Kocaoğlu et al. [1].
References 1 Kocaoğlu İ, Arslan U, Koza Y, et al: Saphenous vein graft disease is associated with a low serum erythropoietin level. Med Princ Pract 2015;24: 544–547. 2 Paritpokee N, Wiwanitkit V, Bhokaisawan N, et al: Serum erythropoietin levels in pediatric patients with beta-thalassemia/hemoglobin E. Clin Lab 2002;48:631–634. 3 Horai T, Tanaka K, Takeda M: Coronary artery bypass grafting under cardiopulmonary bypass in a patient with beta-thalassemia: report of a case. Surg Today 2006;36:538–540.
Reply İbrahim Kocaoğlua, Uğur Arslanb a Department of Cardiology, Aydın State Hospital, Aydın, and bSamsun Education and Research Hospital, Samsun, Turkey
Dear Editor, We would like to thank Joob and Wiwanitkit [1] for their interest in our article. First of all, we used a standardized method to determine EPO levels. Venous blood samples were drawn into a tube without anticoagulant following fasting for ≥8 h from patients undergoing coronary angiography on the same day; all the patients rested in the supine position for ≤1 h at the same time of day (13: 00–14: 00) to avoid diurnal variation. The EPO level was measured using ELISA. Secondly, thalassemia, an inherited hemoglobin disorder, is a childhood disease and patients usually do not survive into late adulthood [2]. Joob and Wiwanitkit cited the study of Paritpokee et al. [3], which was conducted in pediatric patients. However, we do not come across patients with thalassemia and coronary artery disease in practice since they do not reach older age, and atherosclerosis is rarely encountered in pediatric cases [4]. In our study, no patient had thalassemia. We also looked for other confounding factors and performed multivariate analysis including hemoglobin levels and found that low serum EPO levels were independently associated with saphenous vein graft disease [1].
© 2016 S. Karger AG, Basel 1011–7571/16/0255–0498$39.50/0 E-Mail [email protected] www.karger.com/mpp
This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) (www.karger.com/OA-license), applicable to the online version of the article only. Distribution permitted for non-commercial purposes only.
Editor’s Note This response represents solely the opinion of the first and the second author of this article (İ.K. and U.A.). References 1 Kocaoğlu İ, Arslan U, Koza Y, et al: Saphenous vein graft disease is associated with a low serum erythropoietin level. Med Princ Pract 2015; 24: 544–547. 2 Morris CR, Singer ST, Walters MC: Clinical hemoglobinopathies: iron, lungs and new blood. Curr Opin Hematol 2006;13:407–418. 3 Paritpokee N, Wiwanitkit V, Bhokaisawan N, et al: Serum erythropoietin levels in pediatric patients with beta-thalassemia/hemoglobin E. Clin Lab 2002;48:631–634. 4 Wilson PW, D’Agostino RB, Levy D, et al: Prediction of coronary heart disease using risk factor categories. Circulation 1998;97:1837–1847.
Uğur Arslan, MD Department of Cardiology Samsun Education and Research Hospital Baris Avenue 199, TR–55090 Ilkadım, Samsun (Turkey) E-Mail ugurarslan5 @ yahoo.com
Beuy Joob Sanitation 1 Medical Academic Center Bangkhae Road Bangkok 10160 (Thailand) E-Mail beuyjoob @ hotmail.com
