Search

Background and Objectives : Hypertension is typically classified into two main groups, "dipper" and "non-dipper", based on nocturnal blood pressure decline. The coronary artery calcium score (CACS) is an essential biomarker used to assess the presence and severity of coronary artery disease (CAD). This study aims to demonstrate the relationship between CACS and hypertensive patients with moderate-to-high cardiovascular disease (CVD) risk classified as either dipper or non-dipper. Participants and Methods : A total of 167 patients with moderate-to-high CVD risk were divided into two subgroups: 95 patients with dipper hypertension (HT) and 72 with non-dipper hypertension. CACS was measured using coronary computed tomography angiography. Results : In the dipper HT group, there were 60 females (63.2%) and 35 males (36.8%), whereas the non-dipper HT group included 28 females (38.9%) and 44 males (61.1%) ( p = 0.002). The mean age was 57 in the dipper HT group and 62 in the non-dipper HT group ( p = 0.011). The mean CACS was 93 in the non-dipper HT group and 10 in the dipper HT group ( p < 0.001). A history of coronary artery disease was more common in the non-dipper HT group ( p = 0.003). Smoking prevalence was higher in the non-dipper HT group (31 patients, 43.1%) compared to the dipper HT group (25 patients, 26.3%) ( p = 0.023). Correlation analysis showed that CACS was positively correlated with age, BMI, and HbA1c and negatively correlated with eGFR. Higher CACS values were also observed in males and patients with a history of coronary artery disease, diabetes mellitus, and hyperlipidemia. In univariate analysis, age, male sex, smoking, CAD, CACS, and elevated creatinine were identified as significant risk factors for non-dipper HT ( p < 0.05). However, in multivariate analysis, only CACS emerged as a significant independent risk factor ( p = 0.001), while other variables were not significant ( p > 0.05). The area under the curve (AUC) for CACS was 0.759, indicating statistically significant and excellent discriminative capability ( p < 0.001, 95% CI: 0.680-0.839). Conclusions : It was concluded that non-dipper hypertension is associated with higher CACS and indicates a higher cardiovascular risk for this group.

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.

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., (Copyright © 2021 Tehran University of Medical Sciences. Published by Tehran University of Medical Sciences.)

In December 2019, several cases of pneumonia of unknown origin were reported in the city of Wuhan, province of Hubei, China. The pathogen was named as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the disease was named coronavirus disease 2019 (COVID-19). Acute phase reactans (APRs) are critical in the early diagnosis, treatment, and for monitoring the progression of COVID-19. Seventy two patients were included in the study and infections confirmed by real-time reverse transcription polymerase chain reaction. Clinical parameters, the level of APFs and D-dimer were assessed and results were retrived from the patients' medical records. Chest computed tomography (CT) findings were described for each patient and they were divided into two groups, with or without COVID-19 pneumonia. The correlation between APRs and CT findings and the patients' prognosis were evaluated. Twenty eight (38.8%) of the 72 patients were female and 44 (61.2%) were male. The most common symptom was cough (43%) and the most common associated chronic disease was hypertension (12.5%). Thirty (41.6%) patients had completely normal chest CT, while 42 (58.4%) patients had typical findings in terms of COVID-19 pneumonia. C reactive protein (CRP), lactate dehydrogenase (LDH), erythrocyte sedimentation rate (ESR), ferritin, procalcitonin and D-Dimer levels were statistically significantly higher in patients with pneumonia than in those without pneumonia and these parameters were also statistically significantly higher in patients with severe illness. In conclusion, CRP, LDH, ESR, ferritin, and D-Dimer were associated with severe COVID-19 pneumonia. These biomarkers can be used to evaluate the prognosis to predict the clinical course of disease, allowing a proper management and treatment of the patients.

Introduction: Cardiac resynchronization therapy (CRT) is a device-based method of treatment which decreases morbidity and mortality in heart failure with reduced ejection fraction (HFrEF). This study was aimed to investigate the effects of CRT on hemodynamic and arterial stiffness parameters evaluated by noninvasive method, and determine whether there is a correlation between the changes after CRT in these parameters and the clinical response to CRT or not., Methods: The study included 46 patients with HFrEF who were planned to undergo CRT implantation. Before the CRT implantation, clinical and demographic data were recorded from all patients. Hemodynamic and arterial stiffness parameters were measured oscillometrically by an arteriograph before CRT implantation. The patients were re-evaluated minimum three months after CRT; the above-mentioned parameters were measured again and compared to the pre-CRT period., Results: Compared to the period before CRT, mean systolic blood pressure (SBP) (116.8 ± 19.1 mm Hg vs 127.7 ± 20.9 mm Hg, P  = .005), central SBP (cSBP) (106.2 ± 17.3 mm Hg vs 116.8 ± 18.7 mm Hg, P  = .015), cardiac output (CO) (4.6 ± 0.8 lt/min vs 5.1 ± 0.8 lt/min, P  = .002), stroke volume (65.6 ± 16.3 mL vs 72.0 ± 14.9 mL), and pulse wave velocity (PWV) (10 ± 1.6 m/sec vs 10.4 ± 1.8 m/sec, P  = .004) increased significantly in post-CRT period. In addition, the same parameters were significantly increased post-CRT period in patients with clinical response. However, there was not any similar increase in nonresponder patients., Conclusion: This study demonstrated that SBP, CO, and PWV increased significantly after CRT. The modest increases in these parameters were observed to be associated with positive clinical outcomes., Competing Interests: The authors declare no conflict of interest., (© 2020 The Authors. Journal of Arrhythmia published by John Wiley & Sons Australia, Ltd on behalf of the Japanese Heart Rhythm Society.)

Owing to the rapid development of new electrophysiologic techniques, our understanding of arrhythmias and their underlying mechanisms has reached unprecedented levels. In some cases, baseline ECG alterations can be identified before arrhythmia development; early recognition of these alterations is of utmost importance to start appropriate preventive therapies and stratify the risk according to patients' outcomes. Hereby, we report a systematic revision of main baseline ECG abnormalities and their implications on clinical outcomes., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: This study evaluated the atrial electromechanical delay (AEMD) and the left atrial (LA) mechanical functions in patients with surgical early menopause., Methods: A total of 62 patients were included in the study: 33 patients with surgical early menopause and 29 age- and sex-matched healthy controls. The duration distance from the start of the P wave to the beginning of the A wave for the lateral mitral annulus, septal mitral annulus, and lateral tricuspid annulus was assessed by tissue Doppler echocardiography. The differences in these durations were used to calculate the inter- and intra-atrial mechanical delays. LA volumes were evaluated using the biplane area-length technique, and LA mechanical function values were measured., Results: The baseline laboratory and clinical characteristics were similar between the two groups. Surgical early menopause patients displayed increased static atrial electromechanical connection (PA') times for the septal mitral annulus and lateral tricuspid annulus compared to the controls. However, the lateral mitral annulus, the inter-atrial, the intra-LA, and the right atrial EMD PA' times were not significantly altered in surgical early menopause patients compared to controls. Importantly, the LA volume index (28.1 ± 8.17 vs. 24.89 ± 7.96 mL/m², p = 0.019), the maximal LA volume (49.6 ± 14.1 vs. 42.9 ± 16.1 mL, p = 0.004), the minimal LA volume (18.4 ± 7.0 vs. 15.2 ± 9.0 mL, p = 0.022), and the atrial precontraction LA volume (31.0 ± 10.9 vs. 24.9 ± 10.1 mL, p = 0.006) were higher in the patients with surgical early menopause compared to the controls. The LA reservoir, conduit and pumping functions and the total, passive, and active emptying volumes were all comparable between the two groups (p = 0.09; 0.06; 0.68; 0.06; 0.48; 0.07, respectively)., Conclusions: Patients with surgical early menopause demonstrated impaired atrial electrical delay and electromechanical functions., Competing Interests: The authors have no financial conflicts of interest., (Copyright © 2019 Korean Society of Echocardiography.)

Background and Aims: Familial hypercholesterolemia (FH) is a common genetic disease of high-level cholesterol leading to premature atherosclerosis. One of the key aspects to overcome FH burden is the generation of large-scale reliable data in terms of registries. This manuscript underlines the important results of nation-wide Turkish FH registries (A-HIT1 and A-HIT2)., Methods: A-HIT1 is a survey of homozygous FH patients undergoing low density lipoprotein (LDL) apheresis (LA). A-HIT2 is a registry of adult FH patients (homozygous and heterozygous) admitted to outpatient clinics. Both registries used clinical diagnosis of FH., Results: A-HIT1 evaluated 88 patients (27 ± 11 years, 41 women) in 19 centers. All patients were receiving regular LA. There was a 7.37 ± 7.1-year delay between diagnosis and initiation of LA. LDL-cholesterol levels reached the target only in 5 cases. Mean frequency of apheresis sessions was 19 ± 13 days. None of the centers had a standardized approach for LA. Mean frequency of apheresis sessions was every 19 ± 13 (7-90) days. Only 2 centers were aware of the target LDL levels. A-HIT2 enrolled 1071 FH patients (53 ± 8 years, 606 women) from 31 outpatients clinics specialized in cardiology (27), internal medicine (1), and endocrinology (3); 96.4% were heterozygous. 459 patients were on statin treatment. LDL targets were attained in 23 patients (2.1% of the whole population, 5% receiving statin) on treatment. However, 66% of statin-receiving patients were on intense doses of statins. Awareness of FH was 9.5% in the whole patient population., Conclusions: The first nationwide FH registries revealed that FH is still undertreated even in specialized centers in Turkey. Additional effective treatment regiments are urgently needed., (Copyright © 2018 Elsevier B.V. All rights reserved.)

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.)

Unlabelled: The baseline platelet count (BPC) in patients with acute ST elevation myocardial infarction (STEMI) may reflect the baseline anjiografic finding and may also predic long-term outcomes after primary percutaneous coronary intervention (PPCI). Available data for the value of BPC in patients with STEMI treated with PPCI are still questionable. Therefore, we sought to determine the prognostic value of BPC for baseline angiographic finding and the impact of BPC on clinical outcomes of patients treating with PPCI. Blood sample for BPC was obtained on admission in 140 consecutive patients undergoing PPCI. Patients were divided 2 groups that group-1 (104 patients): TIMI flow-grade 0 and group-2 (36 patients): TIMI flow-grade 1-3. Follow-up was performed at 1-9 months. Baseline demographics were comparable, but, BPC was significantly higher in group-1 comparing 2 (293.7±59.8x10(9)/L vs. 237.7±50.9x10(9)/L, p<0.0001), pre-procedural lesion length longer in group-1 comparing 2 (13.6±3.6 mm vs. 11.4±3.9 mm, p:0.003). Distal embolization (19.0% vs. 0.0%, p:0.001), slow-flow (15.2% vs. 2.9%, p:0.033) were more common in group-1 and mean maximum troponin-I level (9.1±4.2 μg/L vs. 5.1±3.9 μg/L, p<0.0001) and mean maximum creatinin kinase (2077.6±1378.4 U/L vs. 1163.4±869.7 U/L, p:<0.0001) were higher in group-1. In-hospital and 30-days major cardiac adverse events (MACEs) (16.5% vs. 5.7%), p:0.14) were similarly in both groups, but, at 6-months target vessel revascularization (13.9% vs. 0.0%, p:0.017) and MACEs significantly higher in the group-1 (24.1% vs. 2.9%, p:0.013)., Conclusion: A higher BPC without any antithrombotic agent is a strongly predictor of total occlusion of IRA in STEMI treated with PPCI. And a higher BPC associated with poor clinical outcomes at 9-months. Apart from prognostic value, measuring of a BPC on admission may also provide further practical and therapeutic profits.

Background: Cardiac syndrome X (CSX) is defined as normal coronary arteries with angina pectoris and a positive stress test. Epicardial adipose tissue (EAT) plays an important role in inflammatory process in cardiovascular system, therefore EAT may affect the pathogenesis of different cardiovascular disease. The aim of this study was to investigate the EAT thickness in patients with CSX and compare normal subjects., Methods: We prospectively enrolled 30 consecutive patients with CSX. The control group consisted of 30 age and sex-matched individuals with anginal chest pain and a negative treadmill or myocardial perfusion scan test. EAT thickness was measured by transthoracic echocardiography., Results: There were no differences in baseline clinical, biochemical and echocardiographic characteristics between CSX patients and the control group. Patients with CSX had significantly increased EAT thickness than those of the controls (3.43 ± 0.88 vs. 2.34 ± 0.89 mm, p=0.0001)., Conclusion: We found that EAT thickness is increased in patients with CSX. This finding suggests that EAT may contribute to the etiopathogenesis of the CSX.

Background: Emerging experimental and clinical data indicates that erythropoietin (EPO) have significant roles in the cardiovascular system. But the relationship between endogenous EPO levels and arterial stiffness remains unknown. We investigated the EPO levels in relation to arterial stiffness parameters in patients with never treated newly diagnosed hypertension (HT)., Methods: We studied 42 (47.8 ± 10 years) never treated HT patients and age and gender-matched 40 (47 ± 8.6 years) normotensive individuals. Serum EPO levels were determined in all subjects using the chemiluminescence immunoassay kit. We evaluated 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 using applanation tonometry (Sphygmocor)., Results: The levels of EPO were not significantly different in hypertensive patients and the controls (10.6 ± 5 vs. 11.6 ± 9, mIU/mL, p = 0.5). Aortic PWV (10.3 ± 2.3 vs. 8.7 ± 1.6 m/s, p = 0.0001) and AIx@75 (22.7 ± 10 vs. 15 ± 11, %, p = 0.002) were significantly higher in hypertensive patients than the controls. EPO levels were not correlated with brachial and central pressures. Also EPO level was not significantly correlated with AIx@75 (r = -0.15, p = 0.17) and aortic PWV (r = -0.16, p = 0.13)., Conclusion: Results from this study indicate that endogenous EPO levels may not be a factor in development of increased arterial stiffness.

Although transcatheter aortic valve implantation (TAVI) has been performed successfully in patients with aortic stenosis and a mechanical mitral valve, to the present authors' knowledge only one report has been made of this being achieved in a patient with a ball-cage-type mechanical mitral valve. In the present case, as the cage section of the mechanical valve was inclined towards the left ventricular outflow tract (LVOT), there was a risk of interaction between the prosthesis and mechanical valve during the TAVI procedure. The successful implementation is described of a self-expandable aortic prosthesis in a patient with a ball-cage-type mechanical valve inclined towards the LVOT.

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.

The single coronary artery, anomalous origin of the right coronary artery from the left anterior descending artery, is a benign and very rare coronary artery anomaly. We firstly present a case with this type of single coronary artery and congenital pulmonary valvular stenosis with large poststenotic dilatation.

Objectives: We aimed to assess arterial stiffness parameters and to investigate the relationship between these parameters and aortic calcification in patients with aortic arch calcification and without symptomatic atherosclerotic disease., Study Design: The population of this study consisted of 41 patients with aortic arch calcification verified by chest X-ray (group I, 17 males, mean age 70±5 years) and individuals without aortic arch calcification (group II, 17 males, mean age 68±6 years). Subjects with symptomatic or known vascular disease were excluded from the study. The arterial stiffness parameters of all subjects were measured non-invasively with a SphygmoCor device. Aortic pulse wave velocity (PWV), augmentation pressure (AP), augmentation index (AIx) and heart rate normalized augmentation index (AIx@75) were used as parameters of arterial stiffness., Results: The two groups were compared according to demographic characteristics, medications currently being taken, and levels of serum lipids. There was no significant difference between the groups. AP in group I was significantly higher than that of group II (p=0.002). AIx and AIx@75 were similar in both groups. Aortic PWV of group I was significantly higher than that of group II (p<0.0001)., Conclusion: According to the results of this study, the presence of aortic calcification, verified by chest radiography, was associated with increased aortic PWV.

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 HRR(1), HRR(2), HRR(3) and HRR(5), 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.

Objectives: Left ventricular (LV) dyssynchrony is a common finding in patients with hypertension and is associated with LV hypertrophy. Arterial stiffness (AS) and central (aortic) blood pressures play a significant role in end-organ damage such as LV hypertrophy caused by hypertension. The objective of this study was to investigate the relationship between AS, central blood pressures (BP) and LV dyssynchrony., Study Design: Thirty-five newly diagnosed hypertensive patients and 40 controls were enrolled in the study. The entire study population underwent a comprehensive echocardiographic study including tissue synchrony imaging. The 12 segmental model was used to measure the time to regional peak systolic tissue velocity (Ts) in the LV and two dyssynchrony indices were computed. Parameters of AS including pulse wave velocity (PWV), augmentation index (AIx@75), and central systolic and diastolic BP were evaluated by applanation tonometry., Results: The baseline clinical and echocardiographic parameters of both groups were similar except for their BPs. Dyssynchrony indices were prolonged in patients with hypertension as compared to the controls. The standart deviation of Ts of 12 LV segments in patients with hypertension and the controls were 48.7±18.8 vs. 25.8±13.1, respectively (p<0.001), and the maximal difference in Ts between any 2 of 12 LV segments was 143.9±52.2 for hypertension patients vs. 83.8±39.4 for controls (p<0.001). PWV (11.9±2.5 vs. 9.5±1.4, p<0.001), AIx@75 (27.4±8.3 vs. 18.3±9, p=0.009), and central systolic (147.6±20.8 vs. 105.4±11, p<0.001) and diastolic (99.8±14.4 vs. 72.8±9.5, p<0.001) pressures were higher in patients with hypertension than in the controls, respectively. In multivariable analysis, central systolic BP (ß=0.496, p=0.03), LV mass index (ß=0.232, p=0.027), and body mass index (ß=0.308, p=0.002) were found to be independently related to dyssynchrony., Conclusion: Central systolic BP is an independent predictor of LV dyssynchrony, but Aıx@75 did not have an independent effect on LV synchronicity in patients with newly-diagnosed hypertension.

Hyperthyroidism causes a variety of adverse effects on the cardiovascular system. Left ventricular (LV) asynchrony is defined as loss of the simultaneous peak contraction of corresponding cardiac segments. The aim of this study was to assess systolic asynchrony in patients with overt hyperthyroidism. Asynchrony was evaluated in 27 patients with overt hyperthyroidism and 21 controls. All the patients and controls were subjected to a tissue synchronization imaging (TSI). The time to regional peak systolic tissue velocity (Ts) in LV by the six-basal-six-mid-segmental model was measured on ejection phase TSI images and four TSI parameters of systolic asynchrony were computed. All TSI parameters of LV asynchrony increased in hyperthyroid patients compared to controls: the standard deviation (SD) of the 12 LV segments Ts (35.7±14.4 vs 20.1±10.1, P<0.0001); the maximal difference in Ts between any 2 of the 12 LV segments (111.9±40.7 vs 65.9±30.7, P<0.0001); the SD of the 6 basal LV segments (31.2±18.2 vs 16.8±9.7, P=0.01); and the maximal difference in Ts between any 2 of the 6 basal LV segments (76.6±42.0 vs 44.4±25.7, P=0.005). Patients with overt hyperthyroidism present evidence of LV asynchrony by TSI.

Objective: Renin-angiotensin system may be activated during atrial fibrillation (AF). Our aim was to evaluate plasma renin activity (PRA) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in patients with different AF types who had normal left ventricular (LV) systolic function., Methods: This cross-sectional study included 97 patients with recent (or=1.9 ng/ml/hour (OR=1.1, 95% CI 1.01-1.23, p=0.03). With NT-proBNP level >or=52 pg/ml, independent predictors were age (OR=1.1, 95% CI 1.01-1.19, p=0.02), presence of persistent and/or permanent AF (OR=6.8, 95% CI 1.03-45.7, p=0.04) and left atrial dimension (OR=1.2, 95% CI 1.03-1.36, p=0.02)., Conclusion: Plasma NT-proBNP levels can be associated with AF and its subtypes in patients with normal LV systolic function, whereas there was no association between PRA levels and AF.

Background: Hypothyroidism has a large number of adverse effects on the cardiovascular system such as impaired cardiac contractility. Left ventricular (LV) asynchrony is defined as loss of the simultaneous peak contraction of corresponding cardiac segments., Objective: To assess systolic asynchrony in patients with overt hypothyroidism., Methods: Asynchrony was evaluated in 31 patients with overt hypothyroidism and 26 controls. Clinical hypothyroidism was defined as serum thyroid-stimulating hormone (TSH) more than 4.2 microIU/mL with reduced free T4 less than 1.10 ng/dL. All the patients and controls were subjected to an echocardiographic study including tissue synchronization imaging (TSI). The time to regional peak systolic velocity (Ts) in LV via the six-basal-six-mid-segmental model was measured on ejection phase TSI images, and four TSI parameters of systolic asynchrony were computed. LV asynchrony was described by these four TSI parameters., Results: The demographic characteristics and conventional echocardiographic parameters of both groups were similar (except total and LDL cholesterol, TSH, free T3, and free T4). All TSI parameters of LV asynchrony were prolonged in hypothyroid patients compared to controls. The standard deviation (SD) of the 12 LV segments Ts was (53.5 +/- 14.1 vs. 29.3 +/- 15.5, P < 0.0001); the maximal difference in Ts between any 2 of the 12 LV segments was (154.5 +/- 37.3 vs. 91.9 +/- 45.2, P < 0.0001); the SD of Ts of the 6 basal LV segments was (47.9 +/- 15.9 vs. 27.1 +/- 16.4, P < 0.0001); and the maximal difference in Ts between any 2 of the 6 basal LV segments was (118.4 +/- 37.9 vs. 69.3 +/- 39.0, P < 0.0001). The prevalence of LV asynchrony was significantly higher in patients with hypothyroidism compared with controls (83.9% vs. 26.9%, P < 0.0001)., Conclusion: Patients with overt hypothyroidism show evidence of LV asynchrony by TSI.

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 (beta = 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.

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 (beta = 0.26, p = 0.009) and AIx@75 (beta = 0.46, p = 0.0001). Our results suggest that arterial functions were impaired even at the prehypertensive stage.

Background: The aim of this study was to assess left ventricular (LV) function and the Tei index by tissue Doppler imaging (TDI), and also to evaluate the relationship of thrombolysis in myocardial infarction (TIMI) frame count (TFC) with the Tei index and LV function in patients with slow coronary flow (SCF)., Methods: We prospectively evaluated 50 patients with SCF and 27 control subjects. Diagnosis of SCF was made by TFC. LV systolic and diastolic function was assessed by conventional echocardiography and TDI., Results: Early diastolic mitral annular velocity (Em), Em/Am, and peak systolic mitral annular velocity (Sm) were lower in patients with SCF than those in controls (13+/-2.8 cm/sec vs 15.2+/-2.8 cm/sec, P = 0.002; 0.88+/-0.22 vs 1+/-0.23, P = 0.03; and 14.1+/-3.51 vs 16.5+/-3.31, P = 0.005, respectively). In patients with SCF, the Tei index was significantly higher than that in controls (0.34+/-9.6 vs 0.29+/-9.5, P = 0.02, respectively). Mean TFC and RCA TFC were positively correlated with the Tei index (r = 0.3, P = 0.02 and r = 0.329, P = 0.02). Left circumflex (LCX) TFC was negatively correlated with Em/Am (r =-0.310, P = 0.03) only in patients with SCF., Conclusion: LV systolic and diastolic function is impaired in patients with SCF. TDI analysis of mitral annular velocities such as the Tei index, Em, Em/Am, and Sm is useful to assess LV systolic and diastolic dysfunction in patients with SCF. Mean TFC and RCA TFC were positively correlated with the Tei index and LCX TFC was negatively correlated with Em/Am. TDI may be better than conventional echocardiography in assessing LV function in patients with SCF.

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 micromol/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 (beta = -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.

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.

Objective: Atrial and/or appendage stunning (AS) usually occur after successful cardioversion of atrial fibrillation (AF). Several parameters except mitral annular velocity were previously evaluated to determine AS. We investigated whether mitral annular velocity was useful for determining of AS., Methods: This study consisted of 52 consecutive patients with AF <3 months who converted to the sinus rhythm. Mitral inflow and annular velocities were measured before and after cardioversion. Left atrial appendage (LAA) size and flow were assessed. The average velocity of septal and lateral segments of mitral annulus was considered as the final annular velocity. Thrombus and/or spontaneous echo contrast (SEC) were also investigated., Results: Of 52 patients, 29 (56%) had AS but 23 did not. There was no significant difference in age, gender, and cardioversion type between two groups. Hypertension was more prevalent in patients without AS compared to those with AS (P = 0.02). Mitral annular systolic and E-wave velocities were comparable in both groups (P > 0.05). Mitral annular A-wave velocity (3.1 +/- 2.9 vs. 7.1 +/- 2.2 cm/s, P < 0.001), and its velocity-time integral (0.27 +/- 0.22 vs. 0.74 +/- 0.19 cm, P < 0.001) were significantly lower in patients with AS compared with those without AS. The annular A-wave velocity < or =3.3 cm/s predicted AS with a sensitivity of 59% and specificity of 76%. It was correlated with mitral inflow A velocity (r = 0.85, P < 0.001), LAA emptying velocity (r = 0.41, P = 0.003) and presence of SEC (r = -0.52, P < 0.001)., Conclusion: After cardioversion of AF, mitral annular A-wave velocity may be a new marker to determine AS.

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.

Objective: The aim of this study was to assess flow-mediated dilatation (FMD) of the brachial artery in patients with acromegaly., Subjects and Methods: We prospectively evaluated 25 patients with acromegaly (14 females, 11 males; aged 42 +/- 12 years; growth hormone (GH) levels 34 +/- 14 ng/ml) and 27 control subjects (15 females, 12 males; aged 45 +/- 8 years; GH levels 3 +/- 1.5 ng/ml). The patients and controls were matched for age, gender, body mass index, cigarette smoking, blood pressure, lipid levels, diabetes mellitus, hypertension, and its duration. Endothelial function, measured as FMD of the brachial artery using ultrasound, was calculated in the 2 groups. The endothelial function was evaluated by assessing 1-min postischemic FMD of the brachial artery., Results: The FMD was lower in patients with acromegaly (9.97 +/- 3.5%) than in controls (16.1 +/- 3.4%), and the difference was statistically significant (p = 0.0001)., Conclusion: Endothelial dysfunction may develop in the preclinical phase of atherosclerosis in patients with acromegaly. Endothelium-dependent FMD may be impaired in acromegalic patients, and measurement of endothelial function may identify high-risk individuals earlier., (Copyright 2009 S. Karger AG, Basel.)

Background: Aortic stiffness is an independent risk factor for cardiovascular events and mortality. The measurement of pulse-wave velocity (PWV) is the most simple, noninvasive, and robust method to determine aortic stiffness. Whether aortic stiffness contributes to aortic valve sclerosis (AVS) remains unknown. The aim of the present study was to examine the relationship between PWV and AVS in subjects free of clinically evident atherosclerotic disease., Methods: We enrolled 62 patients (48 men; age 65 +/- 8 years) diagnosed with AVS and an additional 62 age-, hypertension-, diabetes mellitus-, and history of smoking-matched subjects without AVS. Applanation tonometry was applied to assess the augmentation index and aortic PWV. The subjects with symptomatic vascular disease were excluded from the study. AVS was defined by echocardiography as thickening and calcification of the normal trileaflet aortic valve without obstruction to the left ventricular outflow., Results: There was no significant difference between the two groups regarding the aortic PWV and augmentation index (11.7+/-3.3 vs 11.8+/-3.7, P=0.85; 28.0+/-9.4 vs 25.0+/-8.6, P=0. 17, respectively). The presence of AVS was significantly correlated with ejection fraction (r=0.211, P=0.011), male gender (r=0.362, P=0.0001), and age (r=0.200, P=0.026)., Conclusions: The lack of an association between the aortic PWV and AVS suggests that AVS is a complex phenomenon consisting of several distinct processes, related to both atherosclerotic and nonatherosclerotic processes.

Background: Elevated inflammatory markers have been found to correlate with higher risk for cardiac events in patients with acute myocardial infarction (AMI). It has been suggested that C-reactive protein (CRP) may be involved in the initiation process of atrial fibrillation (AF). However, the role of CRP levels in the occurence of AF in patients with AMI has not been studied. This study investigated whether CRP is a risk factor for AF in patients with acute anterior MI., Methods: We prospectively evaluated 92 consecutive patients (25 women and 67 men; aged 58 +/- 11 y) with a first acute anterior wall MI. Blood samples were obtained at the time of admission to the hospital, and serum CRP levels were measured by an ultrasensitive immunonephelometry method. All patients were evaluated by echocardiography to measure the left ventricular (LV) diameter and functions. All patients were monitored continuously for the detection of AF in the coronary care unit., Results: Atrial fibrillation occured in 19 (20%) of 92 patients. Univariate analysis showed that patients with AF had an advanced age (63 +/- 9.9 versus 56.7 +/- 11.7 y, p = 0.034), higher serum CRP level (2.95 +/- 2.5 versus 1.71 +/- 2.12 mg/dL, p = 0.034), larger LV end-systolic volume (74 +/- 15 versus 63 +/- 19, mL p = 0.02), higher LV ejection fraction (31.1 +/- 6.2 versus 38.4 +/- 10%, p = 0.001), and larger left atrial (LA) diameter (37.1 +/- 4.2 versus 34.7 +/- 3.3 mm, p = 0.01). In multivariate analysis, only age (odds ratio [OR]: 1.05, 95% confidence interval [CI]: 1-1.11, p = 0.036) and CRP levels (OR: 1.27, 95% CI: 1-1.59, p = 0.039) were independent predictors of AF., Conclusion: These results suggest that CRP may be a risk factor for AF in patients with acute anterior wall MI., (Copyright (c) 2008 Wiley Periodicals, Inc.)

Background: Arterial stiffness increases in hypertensive individuals. Arterial stiffness is associated with impairment of systolic and diastolic myocardial function in hypertension (HT). However, the relationship between arterial stiffness and serum heart-type fatty acid-binding protein (H-FABP) levels, a sensitive marker of myocardial damage, has not been previously examined in patients with HT. We investigate the relationship between serum H-FABP levels and arterial stiffness in patients with newly diagnosed HT., Methods: We studied 46 (48.5 +/- 10.6, years) never-treated patients with HT and age-matched control group of 40 (47 +/- 8.6, years) normotensive individuals. H-FABP levels were determined in all subjects. We evaluated arterial stiffness and wave reflections of study population, using applanation tonometry (Sphygmocor). Carotid-femoral 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 marker of wave reflections., Results: 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 than control group. H-FABP levels were increased in hypertensive patients compared with control group (21.1 +/- 14.8 vs. 12.9 +/- 8.5, ng/ml, P = 0.002). In multiple linear regression analysis, we found that the body mass index (beta = 0.42, P = 0.0001) and carotid-femoral PWV (beta = 0.23, P = 0.03) were significant determinants of H-FABP levels., Conclusion: Arterial stiffness is associated with serum H-FABP levels, a sensitive marker of myocardial damage, in patients with newly diagnosed HT.

Cholesterol lowering with statins has been proven to reduce vascular events in primary and secondary prevention of coronary artery disease (CAD). Epidemiologic studies found no or little association between blood cholesterol levels and stroke. However, randomized trials in patients with CAD have shown that statins decrease stroke incidence. These statin trials indicate 21% relative risk reductions for stroke. In subgroup analysis of the Heart Protection Study, simvastatin had no effect on stroke recurrence, in patients with a previous stroke. Recently, Stroke Prevention by Aggressive Reduction in Cholesterol Levels study showed that treatment with high dose atorvastatin reduced risk of stroke in patients with recent stroke and transient ischemic attack and no known CAD. In this review, we will discuss the effects of statins on stroke and the potential mechanisms of action.

Background: The Tei index reflects both systolic and diastolic ventricular function. The aim of this study was to assess the Tei index by tissue Doppler imaging (TDI) and also to evaluate the correlation with growth hormone (GH) and the Tei index and left ventricular (LV) function assessed by TDI in patients with acromegaly., Methods: We prospectively evaluated 25 patients with acromegaly and 27 control subjects. LV systolic and diastolic function was assessed by conventional echocardiography and TDI., Results: Peak E velocity and E/A ratio were lower in those with acromegaly than in those without (P = 0.01; P = 0.002, respectively). Deceleration time of the mitral E-wave (P = 0.01) and isovolumic relaxation time (IVRT) (P = 0.01) were higher in acromegalic patients than those in controls (P = 0.006, P = 0.002). Em (P = 0.01) and Em/Am (P = 0.001) were lower in patients with acromegaly than in controls. In patients with acromegaly, the Tei index was significantly higher than that in controls (0.49 +/- 13.4 vs 0.39 +/- 5.2, P = 0.005). GH was positively correlated with the Tei index (r = 0.65, P = 0.041), Em/Am (r = 0.63, P = 0.021), and interventricular septum (IVS) thickness (r = 0.65, P = 0.008) only in patients with acromegaly. LV diastolic dysfunction was detected 36% by conventional echocardiography and 48% by the Tei index derived from TDI in acromegalic patients., Conclusion: TDI analysis of mitral annular velocities is useful to assess LV diastolic dysfunction in patients with acromegaly. GH was positively correlated with the Tei index and LV diastolic dysfunction. The Tei index may be superior to conventional mitral Doppler indices for identification of LV diastolic dysfunction in patients with acromegaly.

Background: The aim of this study was to assess left ventricular (LV) function and the Tei index by tissue Doppler imaging (TDI), and also to evaluate the relationship of serum cortisol level with the Tei index and LV function in patients with Cushing's Syndrome (CS)., Methods: We prospectively evaluated 22 patients with CS and 23 control subjects. LV function was assessed by echocardiography. Early diastolic (Em), late diastolic (Am), peak systolic (Sm), mitral annular velocities, Em/Am, the Tei index, and E/Em were calculated by TDI. Mitral inflow velocities, color M-mode flow propagation velocity (Vp), relative wall thickness (RWT), and LV mass index (LVMI) were assessed by two-dimensional echocardiography., Result: Peak (E) velocity and the ratio of E to peak late (A) velocity (E/A) were lower in those with CS than in those without. Patients with CS had significantly higher RWT, IVRT, and LVMI than those controls. Vp was lower in the CS-patients than that in control subjects. Em and Em/Am were lower in patients with CS than those in controls. In patients with CS, the Tei index was significantly higher than control subjects., Conclusion: Serum cortisol level was positively correlated with the Tei index and E/Em ratio but negatively correlated with Em, Sm, and EF only in patients with CS. Serum cortisol level positively correlated with the Tei index and E/Em ratio but negatively correlated with Em, EF, and Sm. The parameters obtained from lateral mitral annulus by TDI can be used for identification of LV diastolic dysfunction in patients with CS.

Background: Beta-thalassemia major (beta-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 beta-TM. We investigated whether beta-TM is related to impaired ascending aortic elastic properties., Methods: We studied 36 patients with beta-TM (age: 15.8 +/- 2.6 years) and 30 age- and sex-matched control subjects by echocardiography. Aortic elastic indexes, aortic strain (%), distensibility (cm(2) dyn(-1) 10(-3)), and stiffness index were calculated from the echocardiographically derived thoracic aortic diameters (mm/m(2)), 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 beta-TM. Impaired functions of aorta may lead to deterioration of left ventricular function.

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.

Background: Hyperparathyroid condition might influence endothelial cells. The aim of this study was to assess flow mediated dilatation (FMD) in patients with primary hyperparathyroidism (PHPT)., Methods: We prospectively evaluated 21 patients with PHPT (9 women, 12 men; aged 50 +/- 11 years, serum calcium 11.6 +/- 0.7 mg/dl, intact parathyroid hormone (iPTH) 489 +/- 495 pg/ml) and 27 healthy control subjects (13 women, 14 men; aged 49 +/- 10 years, serum calcium 9.4 +/- 0.5 mg/dl, iPTH 28 +/- 8.5 pg/ml). Endothelial function, measured as FMD of the brachial artery using ultrasound, was calculated in two groups. To avoid confounding factors, conditions known to affect endothelial function like diabetes mellitus, hypertension, dyslipidemia, smoking, coronary and peripheral artery disease were excluded from both groups., Results: FMD was lower in patients with PHPT than that in those without (10.2 +/- 5.8 vs. 19.8 +/- 5.8, P = 0.0001). FMD negatively correlated with serum calcium (r = -0.55, P = 0.002)., Conclusion: Endothelium-dependent FMD may impair in patients with PHPT compared to controls. Endothelial dysfunction can contribute to the deleterious cardiovascular effects of PTH excess. Therapy to reduce or retard endothelial dysfunction in patients with PHPT may lead to decreased cardiovascular morbidity and mortality.

Background: The diagonal ear-lobe crease (ELC) has been suggested as a simple marker of cardiovascular disease in the general population. There is no knowledge concerning the relation between carotid intima-media thickness (IMT), an index of subclinical atherosclerosis, and diagonal ELC. The aim of our study was to assess this relation., Methods and Results: The study population was prospectively selected from apparently healthy subjects. Sixty-five consecutive subjects with ELC and 65 age- and gender-matched control subjects without ELC were included in this study. These were examined by B-mode ultrasound to measure the IMT at the far wall of the common carotid artery. Subjects with ELC had significantly higher carotid IMT compared to control subjects without ELC (0.88+/-0.14 versus 0.69+/-0.14 mm, respectively, p=0.0001). The presence of ELC was independently associated with IMT in the multivariate logistic regression analysis. In addition, we detected a significant positive correlation between the presence of ELC and carotid IMT (r=0.558, p=0.0001)., Conclusions: We have shown for the first time an association between increased carotid IMT and diagonal ELC in apparently healthy subjects.

Background: Cushing's Syndrome (CS) is associated with excess and premature cardiovascular disease. Endothelial dysfunction is the initiating event in the development of atherosclerosis. Endothelial function is assessed by flow-mediated dilatation (FMD) of brachial artery. The aim of this study was to assess FMD in patients with CS., Methods: We prospectively evaluated 22 patients with CS (12 women, 10 men; aged 42 +/- 11 years, serum cortisol 28.2 +/- 14 microg/dl, 24-h urinary free cortisol (UFC) 269 +/- 92 microg/day), and 23 control subjects (13 women, 10 men; aged 43 +/- 10 years, serum cortisol 14 +/- 4 microg/dl, 24 h cortisol 60 +/- 22 microg/day). Endothelial function, measured as FMD of the brachial artery using ultrasound, was calculated in two groups. Endothelial function was evaluated by assessing 1-min postischemic FMD of the brachial artery., Results: FMD was lower in patients with CS than that in those without (11.7 +/- 4.8% vs. 15.8 +/- 3.2%, P = 0.0001, respectively). There was no significant difference between two groups regarding baseline diameter of brachial artery. But, hyperemia diameter was lower in patients with CS than without CS (3.6 +/- 0.22 mm vs. 3.9 +/- 0.19 mm, P = 0.04, respectively)., Conclusion: Endothelium-dependent FMD may impair in patients with CS compared to controls. Measurement of endothelial function may identify high-risk individuals early and therapy to reduce or retard endothelial dysfunction in patients with CS may lead to decreased cardiovascular morbidity and mortality.

Background: The aim of this study was to assess left ventricular (LV) systolic and diastolic function and myocardial performance (the Tei index) by tissue Doppler imaging (TDI) in patients with primary hyperparathyroidism (PHPT)., Methods: We prospectively evaluated 21 patients with PHPT [nine women, 12 men; aged 50 +/- 11 years, serum calcium 2.9 +/- 0.17 mmol/l, intact PTH (iPTH) 51.5 +/- 52.1 pmol/l] and 27 healthy control subjects (13 women, 14 men; aged 49 +/- 10 years, serum calcium 2.35 +/- 0.12 mol/l, iPTH 2.9 +/- 0.9 pmol/l). LV systolic and diastolic function was assessed by conventional echocardiography and by TDI. Early diastolic (Em), late diastolic (Am) and peak systolic (Sm) mitral annular velocities, the ratio Em/Am and the Tei index were calculated from TDI measurements. Mitral inflow velocities, colour M-mode flow propagation velocity (Vp), relative wall thickness (RWT) and LV mass index (LVMI) were assessed by two-dimensional echocardiography., Results: Em and Em/Am were lower in patients with PHPT than in healthy controls (11.2 +/- 1.5 cm/s vs. 13.5 +/- 2.5 cm/s, P = 0.005; 0.94 +/- 0.27 vs. 1.36 +/- 0.44, P = 0.02, respectively). In patients with PHPT, the Tei index was significantly higher than that in controls (0.45 +/- 13.6 vs. 0.33 +/- 8.1, P = 0.02). Peak (E) velocity and the ratio of E to peak late (A) velocity (E/A) were lower in those with PHPT than in those without (59 +/- 15 cm/s vs. 72 +/- 19 cm/s, P = 0.02; 0.8 +/- 0.15 vs. 1.1 +/- 0.33, P = 0.001, respectively). Patients with PHPT had significantly higher RWT (0.50 +/- 0.02 cm vs. 0.41 +/- 0.02 cm, P = 0.0001), isovolumetric relaxation time (IVRT) (115 +/- 13 ms vs. 103 +/- 11 ms P = 0.04) and A velocity (79 +/- 16 cm/s vs. 68 +/- 13 cm/s P = 0.05) than controls. Vp was lower in PHPT patients than in healthy subjects (42 +/- 9.98 cm/s vs. 54 +/- 19.01 cm/s P = 0.04). There were no significant differences between the two groups regarding LV end-diastolic and end-systolic dimensions, LVMI, deceleration time of the mitral E wave, Am and Sm., Conclusion: TDI analysis of mitral annular velocities, Em/Am and the Tei index is useful for assessing LV diastolic dysfunction in patients with PHPT. The parameters obtained from the lateral mitral annulus by TDI can be used for the identification of LV diastolic dysfunction in PHPT patients.

Objective: The aim of this study was to assess the relationship between flow-mediated dilatation (FMD) and left ventricular (LV) systolic and diastolic function in type 2 diabetic patients with or without microalbuminuria., Research Design and Methods: We prospectively evaluated 68 consecutive patients (36 women, 32 men; mean age 57 +/- 11 yr) with type 2 diabetes mellitus (DM). Patients were divided into two groups according to whether or not they had microalbuminuria: group 1 (n = 29, mean age 58 +/- 10 yr) with microalbuminuria and group 2 (n = 39, mean age 56 +/- 10 yr) without microalbuminuria. LV function was assessed by classical methods and Doppler tissue imaging (DTI). Left ventricular ejection fraction (EF), interventricular (IVS) and posterior wall (PW) thickness, peak early (E) and late (A) transmitral filling velocities, their ratio (E/A) and deceleration time of the mitral E wave (DT), LV isovolumetric relaxation time (IVRT), flow propagation of velocity (Vp), and E/Vp were evaluated by conventional echocardiography. Early diastolic (Em), late diastolic (Am), and peak systolic (Sm) mitral annular velocities were measured. Em/Am and the ratio of early diastolic mitral inflow velocity to Em (E/Em), which is a reasonably good index for predicting elevated LV filling pressure, were calculated by DTI. Endothelial function, measured as flow-mediated dilatation of the brachial artery using ultrasound, was calculated in two groups., Results: FMD was lower in those with microalbuminuria than those without (8.8 +/- 6.44% vs 12.6 +/- 7.24%, p = 0.03). Group 1 had longer DT (223 +/- 39 ms vs 199 +/- 37 ms, p = 0.01) and longer IVRT (109 +/- 13 ms vs 100 +/- 13 ms, p = 0.03) than that of group 2 with conventional echocardiography. Group 1 had significantly lower Em/ Am (0.79 +/- 0.27 cm/s vs 1.02 +/- 0.44 cm/s, p = 0.01), lower Vp (40.4 +/- 9.98 vs 50.4 +/- 19.01 cm/s, p = 0.01) than that of group 2. Group 1 had significantly higher serum creatinine (1 +/- 0.33 mg/dL vs 0.7 +/- 0.19, p = 0.001). In logistic regression analysis, FMD was the only variable independently related to microalbuminuria. FMD was positively correlated with EF (r = 0.43, p = 0.02) and E/A (r = 0.40, p = 0.03), and negatively correlated with E/Em (r = 0.41, p = 0.04) and E/Vp (r = 0.41, p = 0.04) only in patients with microalbuminuria., Conclusion: It was found that left ventricular diastolic function and FMD are impaired in type 2 diabetic patients with microalbuminuria. FMD may be related to LV diastolic dysfunction only in patients with microalbuminuria.

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).

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.

Background: Current reperfusion strategies may fail to achieve optimal tissue perfusion in ST-elevation myocardial infarction (STEMI). We investigated the effect of clopidogrel plus aspirin on tissue perfusion and coronary flow in infarct patients treated with fibrinolytic agents., Methods: Consecutive 78 patients with STEMI were randomized to receive clopidogrel plus aspirin (clopidogrel group, n = 42) or placebo plus aspirin (placebo group, n = 36) before streptokinase. Maximum and total ST-segment resolutions (sumSTR) were calculated at 90 minutes after fibrinolysis. TIMI flow grade and corrected TIMI frame count in infarct-related artery were evaluated at predischarge. Inhospital ischemic and hemorrhagic events were also analyzed., Results: Baseline characteristics were comparable in both groups. Both mean maximum ST-segment resolution (54.5 +/- 21.3% vs 44.6 +/- 22.0%, P = .047 ) and sumSTR (52.7 +/- 21.1% vs 42.8 +/- 20.7%, P = .041) were slightly higher in the clopidogrel group than placebo group. The rate of complete sumSTR 70% was significantly higher in the clopidogrel group compared with placebo group (31% vs 11%, P = .021). TIMI flows were similar in both groups, but corrected TIMI frame count was significantly lower in the clopidogrel group compared with placebo group (25.5 +/- 10.5 vs 33.5 +/- 11.8 frames, P = .027). Clinical events were comparable in 2 groups; however, there were 1 death caused by heart failure and moderate bleeding in the clopidogrel group., Conclusion: Our results suggest that clopidogrel plus aspirin compared with aspirin alone may improve myocardial tissue perfusion and coronary flow in STEMI patients receiving streptokinase.

Unsatisfactory results obtained with medical therapy and dual-chamber pacing for prevention of recurrent neurocardiogenic syncope necessitated the development of new treatment modalities. Tilt-training, a novel treatment for recurrent neurocardiogenic syncope based on exercise sessions with prolonged upright posture (either on a tilt-table or standing on foot against a wall), was shown to be effective in preventing the recurrence of neurocardiogenic syncope. The purpose of this study was to demonstrate the long-term beneficial effects of a transient tilt training program lasting 2 months. Thirty-two patients with recurrent neurocardiogenic syncope (mean number of syncope episodes in the last 6 months was 3.4 +/- 2.3) constituted the study group. All of the patients were tilt test positive. The patients were taught a tilt training program with 2 phases (in-hospital training with repeated tilt procedures until 3 consecutive negative results were obtained and home exercises with standing against a wall) and home exercises lasted a maximum of 2 months. After this training program, the patients received no treatment and were followed for the recurrence of syncope. At the end of the follow-up period (376 +/- 45 days), 81% of the patients were free of recurrent syncope. This study revealed that similar successful results can also be obtained with a transient tilt training program as a first line treatment strategy. Less interference with the daily activities of the patients is the major advantage of this strategy. The ease of performance and high effectiveness rate will most likely result in more frequent utilization of this treatment modality.

Objective: The aim of this study was to investigate the efficacy and safety of propafenone in the prevention of atrial fibrillation (AF) relapse after restoration of sinus rhythm., Methods: This study consisted of 110 consecutive patients with recent onset and persistent AF. After restoration of sinus rhythm, patients were randomized to propafenone (n: 58, age: 60 +/- 12 years) or placebo (n: 52, age: 62 +/- 10 years).There were 11 withdrawals (7 in the propafenone and 4 in the placebo group) during follow-up. Follow-up evalutations were conducted at the first, 3rd and then at an interval of three months during 15 months. The clinical characteristics in both groups were comparable. The AF relapse was analysed by the Kaplan-Meier method., Results: At 15-month follow-up, AF relapsed in 20 (39%) and 31 (65%) patients in the propafenone and placebo groups, respectively (p = 0.015). In subgroup analysis, AF recurrence was significantly lower in the propafenone group than in the placebo group only in the recent onset AF patients with spontaneous conversion (21% vs. 61%, p = 0.01). However, the AF relapse rates were similar in patients with persistent AF and with recent AF who converted to sinus rhythm pharmacologically or electrically in the propafenone and placebo groups. Four patients on propafenone and one on placebo had adverse effects necessitating discontinuation of the drug (p = 0.36)., Conclusion: At 15 months, propafenone seems to be superior to placebo for maintaining sinus rhythm in patients with recent onset or peristent AF. This superiority originates mainly from patients with recent onset AF in whom sinus rhythm occurred spontaneously. Its adverse effects are similar to placebo.