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Introduction: Suppression of Tumorigenicity 2 (ST2), a member of the interleukin-1 (IL-1) superfamily, is recognized as an important biomarker in inflammatory responses and cardiovascular diseases. Elevated serum levels of sST2 have prognostic value, particularly in cases of cardiac stress such as heart failure and acute pulmonary embolism (APE). We aimed to assess ST2 levels as a potential biomarker for right heart dysfunction in APE patients, particularly in the context of its limited predictive value for mortality and risk stratification. Methods: Patients diagnosed with APE confirmed via computed tomography pulmonary angiography (CTPA) were enrolled in this study. To ensure the specificity of sST2 elevation to APE, patients with other conditions known to cause elevated sST2 levels were excluded. Results: After pre-clinical evaluation, 66 patients diagnosed with APE who met the study criteria, and 62 healthy subjects in the control group, were included in this study. sST2 levels were positively correlated with APE. Conclusions: In patients diagnosed with APE, sST2 levels had high sensitivity. sST2 levels are elevated in APE and are associated with right ventricular dysfunction, but do not independently predict mortality or risk stratification based on Pulmonary Embolism Severity Index (PESI) scores. [ABSTRACT FROM AUTHOR]

The basic components of energy drinks include caffeine, guarana, taurine, ginseng, and sugar. The excessive consumption of energy drinks has been associated with cardiovascular events such as tachycardia and myocardial infarction in the literature. We herein describe a 24-year-old man admitted to the emergency department. The patient's medical history and family history were unremarkable. It was, however, learned that he had consumed 8 to 10 cans of energy drinks per day (3.5--4 Lit/d) in the 2-week period leading to the hospital admission. Physical examination revealed bilateral diffuse rales and 2+ pretibial edema. Echocardiography showed a left ventricular ejection fraction of 25% with global left ventricular hypokinesia and dilated left ventricular dimensions. Coronary angiography demonstrated normal coronary arteries. On cardiac magnetic resonance imaging, the left ventricle was dilated, and the systolic function was reduced. No pathological enhancement was observed. This case report and many previous studies support a possible link between caffeinated energy drinks and cardiovascular events. [ABSTRACT FROM AUTHOR]

Objective: Our aim was to investigate the possible relationship between myeloperoxidase (MPO) and myocardial damage markers such as heart-type fatty acid-binding protein (H-FABP) and troponin T (TnT) in patients with chronic heart failure (HF). Materials and Methods: Forty-two consecutive patients (age range: 27-80 years) with chronic HF were enrolled in the study. Serum H-FABP, TnT and MPO levels were measured. Routine biochemical and clinical parameters were recorded. Echocardiographic examinations were performed on all patients. A linear regression analysis was performed to determine the correlates of serum H-FABP. Results: The MPO, H-FABP and TnT levels were 255 ± 227, 60.6 ± 48.5 and 0.07 ± 0.15 ng/ml, respectively. In multiple linear regression analysis, age (β = -0.36, p = 0.006), creatinine level (β = 0.3, p = 0.024) and serum MPO level (β = 0.41, p = 0.009) were significant determinants of H-FABP levels. Bivariate predictors were not significantly associated with TnT levels in linear regression analyses. Conclusions: The MPO was significantly associated with serum H-FABP levels but not with TnT. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure classifies blood pressure (BP) as normal, prehypertension, and hypertension. Although it has been shown that there is a relationship between hypertension and arterial stiffness, there is not sufficient data about arterial stiffness in patients with prehypertension. The present study was designed to evaluate arterial stiffness and wave reflections in subjects with prehypertension. We evaluated arterial stiffness and wave reflections of 45 subjects with prehypertension and an age-matched control group of 40 normotensive individuals, using applanation tonometry (Sphygmocor, AtCor Medical, Sydney, Australia). Aortic pulse wave velocity (PWV) was measured as indices of elastic-type aortic stiffness. The heart rate-corrected augmentation index (AIx@75) was estimated as a composite marker of wave reflections and arterial stiffness. Aortic PWV (10 ± 2.5 vs. 8.6 ± 1.7, m/s, p = 0.004) and AIx@75 (21 ± 8.3 vs. 10 ± 9.1, %, p = 0.0001) were significantly higher in subjects with prehypertension than in the control group. In multiple linear regression analysis, we found that the presence of the prehypertension was a significant predictor of aortic PWV (β = 0.26, p = 0.009) and AIx@75 (β = 0.46, p = 0.0001). Our results suggest that arterial functions were impaired even at the prehypertensive stage. [ABSTRACT FROM AUTHOR]

Augmentation index (AIx), a measure of wave reflection, is regulated by a number of factors, including endothelial function and vascular smooth muscle tone. The relationship between local endothelium-derived factors and AIx is well known; however, association between endothelial damage markers and AIx has not been sufficiently studied. This study investigates whether endothelial damage markers—von Willebrand factor (vWF) soluble thrombomodulin (sTM)—are associated with wave reflections. We studied 46 (48.5 ± 10.6, years) never-treated patients with hypertension (HT) and an age-matched control group of 40 (47 ± 8.6, years) normotensive individuals. von Willebrand factor and sTM levels were determined in all subjects. We evaluated the aortic AIx of the study population using applanation tonometry (Sphygmocor, AtCor Medical, Sydney, Australia). The heart rate-corrected augmentation index (AIx@75) was estimated as a marker of wave reflections. Endothelial damage markers and AIx@75 were significantly higher in hypertensive patients than in controls. In the whole population, the vWF level (β = 0.24, p = 0.01) was an independent determinant of AIx@75 in multivariate analysis. However, the sTM level was not associated with AIx@75. We found that the vWF level was an independent determinant of AIx@75. Our results suggest that increased an vWF level contributes significantly to increased wave reflections. [ABSTRACT FROM AUTHOR]

It is well known the relationship between oxidative stress and vascular function. However, association between total antioxidative capacity and arterial stiffness was not studied in patients with hypertension (HT). This study investigated whether total antioxidative capacity is associated with arterial stiffness and wave reflections. We studied 46 (age 48.5 ± 10.6 years) never treated patients with HT and age-matched control group of 40 (age 47 ± 8.6 years) normotensive individuals. Total antioxidative capacity level was determined in all subjects. We evaluated arterial stiffness and wave reflections of the study population, using applanation tonometry (SphygmoCor). Carotid-femoral pulse-wave velocity (PWV) was measured as index of aortic stiffness. The heart rate-corrected augmentation index (AIx@75) was estimated as a composite marker of wave reflections and arterial stiffness. Carotid-femoral PWV (10.5 ± 2.2 vs 8.7 ± 1.6, m/s, P = 0.0001) and AIx@75 (22.7 ± 9.5 vs 15 ± 11, %, P = 0.001) were significantly higher in patients with HT compared with age-matched control subjects. Total antioxidative capacity level (274 ± 70 vs 321 ± 56 µmol/l, P = 0.001) was significantly lower in hypertensive patients than controls. In the whole population, total antioxidative capacity level negatively correlated with AIx@75 ( r = −0.24, P = 0.02) in univariable analysis, but not with carotid-femoral PWV ( r = −0.08, P = 0.43). Also, we found that total antioxidative capacity level (β = −0.21, P = 0.03) was an independent determinant of AIx@75 in multivariable analysis. Our results suggest that the decrease in the ability of antioxidant defenses contributes significantly to increased wave reflections. [ABSTRACT FROM AUTHOR]

Objective: The evidence of structural and functional cardiac abnormalities has been demonstrated by echocardiography in patients with chronic kidney disease (CKD). This study investigated whether left ventricular (LV) asynchrony is present in patients with CKD and normal QRS duration. Methods: Tissue synchronization imaging (TSI) was performed in 25 (56 ± 14 years) patients with CKD and narrow QRS complexes and 25 (51 ± 12 years) control subjects. LV asynchrony was identified on TSI images and the time to regional peak systolic velocity (Ts) in LV was measured by the six-basal–six-midsegmental model. Four TSI parameters of systolic asynchrony were computed when Ts was measured in ejection phase. Results: The standard deviation of Ts of 12 LV segments (33.6 ± 17.8 vs 16.7 ± 10 ms, P = 0.0001), standard deviation of Ts of the six basal LV segments (30 ± 20 vs 17.6 ± 9.6 ms, P = 0.008), maximal difference in Ts between any two of the 12 LV segments (102 ± 45 vs 54 ± 32 ms, P = 0.0001), and maximal difference in Ts between any two of the six basal LV segments (78 ± 50 vs 46 ± 22 ms, P = 0.007) were prolonged in patients with CKD compared with controls. The prevalence of LV systolic asynchrony was significantly higher in patients with CKD compared with controls (44% vs 12%, P = 0.01). The standard deviation of Ts of 12 LV segments were significantly associated with LV diameters, LV volumes, LV mass, blood pressure levels, and renal functions in univariate analysis. Conclusion: The results of this study indicate that LV systolic asynchrony may develop in patients with CKD. [ABSTRACT FROM AUTHOR]

Background. The role of endogenous relaxin on hypertensive cardiovascular damage remains unknown. We investigated the relaxin level and its relation to cardiovascular function in patients with never treated hypertension (HT). Methods. We studied 42 (47.8±10 years) never treated patients with HT and 40 age-matched (47±8.6 years) normotensive individuals. Serum relaxin levels were determined in all subjects using enzyme-linked immunosorbent assay. Left ventricular (LV) diameters were evaluated by transthoracic echocardiography. Ejection fraction and LV mass index were measured. Diastolic functions were evaluated with both conventional and tissue Doppler echocardiography. We evaluated central aortic pressures, heart rate-corrected augmentation index (AIx@75), a marker of wave reflections, and aortic pulse wave velocity (PWV) as indices of elastic-type aortic stiffness of the study population using applanation tonometry (SphygmoCor). Results. Relaxin levels were significantly lower in hypertensive patients as compared with controls (36.5±7.3 vs 49.7±39.8 pg/ml, p=0.03). The relaxin level was negatively correlated with brachial and central aortic pressure. However, serum relaxin was not significantly associated with LV diameters, ejection fraction, LV mass index, LV diastolic function, AIx@75 or aortic PWV in our study. Conclusion. Serum relaxin is decreased in patients with HT. However, low endogenous relaxin is not related to cardiovascular function. [ABSTRACT FROM AUTHOR]

Background: β-thalassemia major (β-TM) is a congenital hemolytic disorder characterized by impaired left ventricular and endothelial function. However, elastic properties of the aorta have not been sufficiently investigated in patients with β-TM. We investigated whether β-TM is related to impaired ascending aortic elastic properties. Methods: We studied 36 patients with β-TM (age: 15.8 ± 2.6 years) and 30 age- and sex-matched control subjects by echocardiography. Aortic elastic indexes, aortic strain (%), distensibility (cm2 dyn−1 10−3), and stiffness index were calculated from the echocardiographically derived thoracic aortic diameters (mm/m2), and the measurement of pulse pressure obtained by cuff sphygmomanometry. Results: Patients versus control subjects had increased aortic diameters (P < 0.001), lower mean aortic strain (9 ± 3.6 vs. 14.9 ± 3.2, P < 0.001) and distensibility (0.6 ± 0.36 vs. 0.8 ± 0.2, P < 0.012), and higher mean stiffness index (5.3 ± 2.4 vs. 2.8 ± 0.6, P < 0.001). Aortic elastic indexes were significantly associated with ferritin level, while stiffness index was significantly related to platelet count. Conclusion: Elastic properties of ascending aorta are impaired in patients with β-TM. Impaired functions of aorta may lead to deterioration of left ventricular function. [ABSTRACT FROM AUTHOR]

Abstract: Background: There is an increasing evidence linking inflammation to some cardiovascular conditions, such as coronary artery disease and hypertension. Similarly, there is emerging data to support the association between inflammation and atrial fibrillation (AF). We also investigated the role of systemic inflammation in different categories of AF. Methods: Eighty five consecutive patients with AF were enrolled in this study. AF was categorized as new onset, chronic (persistent and permanent) and lone. Age- and sex-matched 30 healthy people consisted of control group. Serum level of high sensitive C-reactive protein (hs-CRP) and interleukin-6 (IL-6) was measured. Results: Serum hs-CRP level was higher in overall AF patients than in controls (0.63±0.57 vs 0.23±0.1 mg/dL, p =0.001). Similarly, IL-6 level was also higher in all AF patients compared with controls (29±36 vs 11.6±9.7 pg/mL, p =0.008). In subgroup analysis, hs-CRP and IL-6 levels were significantly higher in both chronic (0.69±0.62 vs 0.23±0.1 mg/dL, p =0.001; 30±39 vs 11.6±9.7 pg/mL, p =0.001, respectively) and new onset AF patients (0.51±0.46 vs 0.23±0.1 mg/dL, p =0.003; 28.4±31 vs 11.6±9.7 pg/mL, p =0.009, respectively) compared with controls. These markers were not different in new onset and chronic AF subgroups. On the other hand, hs-CRP and IL-6 levels tended to be high in lone AF patients (p =0.06). The presence of AF was an independent factor for hs-CRP (OR=0.35, 95%CI=0.1–0.61, p =0.005) and IL-6 (OR=17, 95%CI=1–37, p =0.037). Conclusions: Our results support that inflammation may have an important role in the AF pathogenesis. [Copyright &y& Elsevier]

Discusses the case of a female patient with right coronary artery aneurysm mimicking aortic root dissection. Results of the patient's physical examination and transthoracic echocardiography; Therapy given to the patient; Information on the transesophageal echocardiography and coronary angiography performed on the patient.

Background: Behçet’s disease is a systemic vasculitis in which studies have given conflicting results about ventricular diastolic functions. However, tissue Doppler echocardiography has never been used in any of these studies. Aortic stiffness, a cardiovascular risk factor, may also precede ventricular dysfunction. Objectives: The aim of this study was to assess aortic stiffness and biventricular diastolic functions in patients with Behçet’s disease. Methods: A total of 26 patients with Behçet’s disease (mean age; 33±10 years) and 20 age- and sex-matched controls (mean age; 33±7 years) were included. Aortic stiffness was evaluated by aortic strain and distensibility. Ventricular diastolic functions were evaluated with both conventional and tissue Doppler echocardiography. Mitral E and A wave, E/ A ratio of E wave, deceleration time, and isovolumic relaxation time were calculated. Results: There was no significant difference in diastolic Doppler parameters between patients and controls. Similarly, there was no significant difference in mitral annular E and A velocities between these two groups. Aortic strain in patients with Behçet’s disease was found to be significantly less than in the controls (8.3±4.9% and 15.7±2.7% respectively, p<0.001). Aortic distensibility was also significantly low in patients with Behçet’s disease when compared to controls (0.45±0.28 and 0.78±0.13 respectively, p<0.001). Beta index values were significantly high in Behçet’s patients (7.23±5.93 and 2.69±0.55 respectively, p<0.001). Conclusion: No significant diastolic dysfunction was found in left and right ventricles in patients with Behçet’s disease by using both conventional and tissue Doppler echocardiography. However, an increase in aortic stiffness was found, suggesting an inflammatory involvement of proximal aorta. [ABSTRACT FROM AUTHOR]

Right-sided infective endocarditis (IE) is observed especially in patients using intravenous medications or illicit drugs, and who have right-sided pacemaker, central venous catheter, or congenital heart disease. We present a case of successful medical and surgical treatment for isolated tricuspid valve infective endocarditis with abnormal hematological and pulmonary findings in a young woman without predisposing risk factors. [ABSTRACT FROM AUTHOR]

Hypertension terms 'dipper' and 'non-dipper' are propounded by the change that occurs during ambulatory blood pressure (BP) monitoring. The purpose of this study is to present whether the serum urotensin II levels are different in patients with dipper and non-dipper hypertension and to put forward the effects causing this difference, if there are any. Patients recently diagnosed with hypertension were included in the study. With ambulatory BP monitoring, 81 patients with high BP were divided into two groups, dipper ( n = 40) and non-dipper ( n = 41). Serum urotensin II levels were analyzed by ELISA method. Serum urotensin II levels were higher in patients with non-dipper hypertension than in patients with dipper hypertension (204 [106-533] vs. 140 [96-309], P = .004). There was a positive correlation between total systolic BP and serum urotensin II levels ( r = 0.408 and P = .009), but the relation in the non-dipper hypertension group was not significant ( r = 0.194 and P = .2). In conclusion, serum urotensin II levels were higher in non-dipper HT patients than dipper HT patients. This higher urotensin II level might be responsible for poor prognoses. [ABSTRACT FROM AUTHOR]

Background. We aimed to determine the status of the autonomic nervous system in patients with autosomal-dominant polycystic kidney disease (ADPKD) who were normotensive and had normal renal function. Methods. A total of 28 normotensive ADPKD patients with normal renal function and 30 healthy control subjects consented to participate in the study. Heart rate recovery (HRR) indices were defined as the reduction in heart rate from the rate at peak exercise to the rate at the 1st, 2nd, 3rd and 5th minutes after the cessation of the exercise stress test; these results were indicated HRR1, HRR2, HRR3 and HRR5, respectively. Results. The 1st- and 2nd-minute HRR indices of patients with ADPKD were significantly lower than those of the healthy control group (27.1±7.9 vs 32.0±7.9; p=0.023 and 46.9±11.5 vs 53.0±9.0; p=0.029, respectively). Similarly, HRR indices after the 3rd and 5th minutes of the recovery period were significantly lower in patients with ADPKD when compared with indices in the control group (56.7±12.0 vs 65.1±11.2; p=0.008 and 62.5±13.8 vs 76.6±15.5; p =0.001, respectively). Conclusion. Impaired HRR index is associated with normotensive early-stage ADPKD patients. Increased renal ischemia and activation of the renin-angiotensin-aldosterone system (RAAS) may contribute to impairment in the autonomic nervous system in these patients before the development of hypertension. Even if ADPKD patients are normotensive, there appears to be an association with autonomic dysfunction and polycystic kidney disease. [ABSTRACT FROM AUTHOR]

We designed this study to evaluate the diameters of the aorta and its major branches in patients who had coronary ectasia. We assigned 80 patients (mean age, 57 ± 11 yr) with isolated coronary artery ectasia to the study group and 25 patients (mean age, 54 ± 10 yr) without structural or coronary arterial disease to the control group. All patients underwent coronary angiography and angiography of the aorta and its branches. We used computed quantitative angiography to measure the diameters of the coronary arteries, the aorta, and the major aortic branches. Within the study group, the diameter indices of the proximal portions of the right common iliac artery (P=0.041) and the left common iliac artery (P=0.035) were significantly larger than the diameter indices within the control group. The diameter indices of all other evaluated arteries were similar in both groups (all P >0.05). [ABSTRACT FROM AUTHOR]

The aim of this prospective study was to investigate the diagnostic value of plasma D-dimer levels and antithrombin-III activity in predicting prosthetic valve thrombus. The study group comprised 97 consecutive patients with prosthetic heart valves (59 with mitral, 21 with aortic, and 17 with both mitral and aortic prostheses) and 35 healthy control subjects. Six patients presented with symptoms of obstruction; the remaining 91 were asymptomatic. Patients were evaluated by both transthoracic and transesophageal echocardiography. Asymptomatic nonobstructive thrombus was detected in 13 patients (13%), whereas obstructive thrombus was demonstrated in all symptomatic patients. Plasma antithrombin-III levels of patients with prosthetic valve thrombi were slightly lower than those of patients without thrombus and of the control group, but the difference was not statistically significant. However, significantly higher plasma D-dimer levels were observed in patients with prosthetic valve thrombi, compared with patients without thrombus and the control group (735 ± 633 µg/L, 372 ± 342 µg/L, and 228 ± 219 µg/L, respectively). Valve thrombus, the prosthetic heart valve itself, and INR levels were identified as major determinants of plasma D-dimer levels. A plasma D-dimer level of >445 µg/L predicted the presence of a prosthetic valve thrombus with 57.8% sensitivity and 83.3% specificity (positive predictive value, 47.8%; negative predictive value, 87.8%). Current data suggest that increased plasma D-dimer levels can be clinically helpful in predicting the presence of prosthetic valve thrombus. Plasma antithrombin-III activity does not seem to have a diagnostic value in predicting prosthetic valve thrombi. [ABSTRACT FROM AUTHOR]