Search

Background Takotsubo Cardiomyopathy (TC) is a rare disorder that is mostly caused by stress and is often misdiagnosed. We aimed to analyze Takotsubo Syndrome at the molecular level by using the Oxford Nanopore Minion Device and its protocol. Methods and results Ten patients who were previously diagnosed with Takotsubo Syndrome (increased after decrease in ejection fraction and without critical stenosis in coronary arteries) and 10 healthy individuals in the control group were included in our project. The mean age was 53 ± 12.2 for the patient group and 52.4 ± 9.9 for the control group, and the left ventricular ejection fraction was 50.3 ± 11.5 for the patient group and 64.2 ± 2.8 for the control group (p C, (Gly389Arg) and cardiac β-2 ADRB2 (rs1800888-ENSG00000169252), C > T, (Thr165Ile) adrenoceptors was investigated. As a result; no structural variation was detected leading to Takotsubo Cardiomyopathy. The results obtained from the bioinformatics analysis were also checked from the VarSome Tools and similar results were found. Conclusions Many publications in TC susceptibility have that may lead to adrenergic pathway dysregulation, most studied adrenergic receptor genes in the similar literatures too. We searched for genetic variants in b1AR and b2AR genes in our study and however we could not find any variants in this study, we think larger numbers of cohort studies are needed. Supplementary Information The online version contains supplementary material available at 10.1007/s11033-021-06816-w.

Breastfeeding has many benefits for health, also later in life. However, its effects on the cardiovascular system are still unclear. The aim of the present study was to evaluate the effect of exclusive breastfeeding as infants on arterial stiffness in young adults having no cardiovascular risk factors, using aortic pulse wave velocity, and brachial and aortic augmentation index.Eighty-six subjects were included in the study from similar socioeconomic status. 46 subjects who had received exclusive breastfeeding for the first 4-6 months in infancy (26 women, mean age 26.7±4 years) (group 1) and 40 subjects who had received exclusive breastfeeding for less than 3 months or had never been breast-fed (22 women, mean age: 28±3.8 years) (group 2) were recruited. Parameters of arterial stiffness (aortic pulse wave velocity, brachial and aortic augmentation index) were investigated using an arteriograph (TensioMed, Budapest, Hungary), which works on an ossilometric basis.A significant decrease in pulse wave velocity in the breast-fed group was detected compared to the non-breast-fed group (P0.05) but no significant difference was detected for aortic and brachial augmentation index. In addition there was a significant relationship between breastfeeding duration and aortic pulse wave velocity.Breast milk intake in infancy reduces the risk of cardiovascular disease in young adults, independent of other cardiovascular risk factors. It seems that there is a negative relationship between the duration of breastfeeding and the risk reduction.

Background: Although electrical and structural remodeling has been recognized to be important in the pathophysiology of atrial fibrillation, the mechanisms underlying remodeling process are unknown. There has been increasing interest in the involvement of inflammatory molecules and adipokines released from the epicardial fat tissue in the pathophysiology of atrial fibrillation. Objectives: In our study, we aimed to investigate the relationship of atrial fibrillation with increased epicardial adipose tissue, inflammatory molecules released from this tissue and omentin. Methods: Thirty-six patients who were followed up with a diagnosis of permanent AF at the cardiology outpatient clinic 33 individuals without atrial fibrillation (controls) were included in the study. Epicardial adipose tissue thickness of patients was measured by echocardiography. Serum omentin, IL 6, IL 1 beta, TNF alpha and CRP levels were measured. Man-Whitney U test was performed for comparisons and significance was established at 5% (p

Background:Takotsubo Cardiomyopathy (TC) is a rare disorder that is mostly caused by stress and is often misdiagnosed. We aimed to analyze Takotsubo Syndrome at the molecular level by using the Oxford Nanopore Minion Device and its protocol. Methods and Results: Ten patients who were previously diagnosed with Takotsubo Syndrome (increased after decrease in ejection fraction and without critical stenosis in coronary arteries) and 10 healthy individuals in the control group were included in our project. The mean age was 53±12.2 for the patient group and 52.4±9.9 for the control group, and the left ventricular ejection fraction was 50.3±11.5 for the patient group and 64.2±2.8 for the control group (pC, (Gly389Arg) and cardiac β-2 ADRB2 (rs1800888-ENSG00000169252), C>T, (Thr165Ile) adrenoceptors was investigated. As a result; no structural variation was detected leading to Takotsubo Cardiomyopathy. The results obtained from the bioinformatics analysis were also checked from the VarSome Tools and similar results were found.Conclusions: Many publications in TC susceptibility have that may lead to adrenergic pathway dysregulation, most studied adrenergic receptor genes in the similar literatures too. We searched for genetic variants in b1AR and b2AR genes in our study and however we could not find any variants in this study, we think larger numbers of cohort studies are needed.

Background The European Atherosclerosis Society Familial Hypercholesterolaemia Studies Collaboration (FHSC) global registry provides a platform for the global surveillance of familial hypercholesterolaemia through harmonisation and pooling of multinational data. In this study, we aimed to characterise the adult population with heterozygous familial hypercholesterolaemia and described how it is detected and managed globally. Methods Using FHSC global registry data, we did a cross-sectional assessment of adults (aged 18 years or older) with a clinical or genetic diagnosis of probable or definite heterozygous familial hypercholesterolaemia at the time they were entered into the registries. Data were assessed overall and by WHO regions, sex, and index versus non-index cases. Findings Of the 61 612 individuals in the registry, 42 167 adults (21 999 [53.6%] women) from 56 countries were included in the study. Of these, 31 798 (75.4%) were diagnosed with the Dutch Lipid Clinic Network criteria, and 35 490 (84.2%) were from the WHO region of Europe. Median age of participants at entry in the registry was 46.2 years (IQR 34.3-58.0); median age at diagnosis of familial hypercholesterolaemia was 44.4 years (32.5-56.5), with 40.2% of participants younger than 40 years when diagnosed. Prevalence of cardiovascular risk factors increased progressively with age and varied by WHO region. Prevalence of coronary disease was 17.4% (2.1% for stroke and 5.2% for peripheral artery disease), increasing with concentrations of untreated LDL cholesterol, and was about two times lower in women than in men. Among patients receiving lipid-lowering medications, 16 803 (81.1%) were receiving statins and 3691 (21.2%) were on combination therapy, with greater use of more potent lipid-lowering medication in men than in women. Median LDL cholesterol was 5.43 mmol/L (IQR 4.32-6.72) among patients not taking lipid-lowering medications and 4.23 mmol/L (3.20-5.66) among those taking them. Among patients taking lipid-lowering medications, 2.7% had LDL cholesterol lower than 1.8 mmol/L; the use of combination therapy, particularly with three drugs and with proprotein convertase subtilisin-kexin type 9 inhibitors, was associated with a higher proportion and greater odds of having LDL cholesterol lower than 1.8 mmol/L. Compared with index cases, patients who were non-index cases were younger, with lower LDL cholesterol and lower prevalence of cardiovascular risk factors and cardiovascular diseases (all p, Pfizer Independent Grant for Learning Change [16157823]; Amgen; Merck Sharp Dohme; Sanofi-Aventis; Daiichi Sankyo; Regeneron; National Institute for Health Research (NIHR) Imperial Biomedical Research Centre, UK; NIHR; Czech Ministry of Health [NU20-02-00261]; Canadian Institutes of Health Research; Austrian Heart Foundation; Tyrolean Regional Government; Gulf Heart Association, The EAS FHSC is an academic initiative that has received funding from a Pfizer Independent Grant for Learning & Change 2014 (16157823) and from investigator-initiated research grants to the European Atherosclerosis Society-Imperial College London from Amgen, Merck Sharp & Dohme, Sanofi-Aventis, Daiichi Sankyo, and Regeneron. KKR acknowledges support from the National Institute for Health Research (NIHR) Imperial Biomedical Research Centre, UK. KID acknowledges support from a PhD Studentship from NIHR under the Applied Health Research programme for Northwest London, UK (the views expressed in this publication are those of the authors and not necessarily those of the National Health Service, the NIHR, or the Department of Health). TF was supported by a grant from the Czech Ministry of Health (NU20-02-00261). JG receives support from the Canadian Institutes of Health Research. The Austrian Familial Hypercholesterolaemia registry has been supported by funds from the Austrian Heart Foundation and the Tyrolean Regional Government. The Gulf Familial Hypercholesterolaemia registry was done under the auspices of the Gulf Heart Association.

OBJECTIVE Coronary artery ectasia (CAE) is defined as localized or diffuse dilatation in the coronary artery lumen of at least 1.5 times the diameter of adjacent healthy reference segments. The etiology of CAE is still unknown, but the most likely cause is atherosclerosis. The aim of this study was to evaluate several gene polymorphisms that are thought to have an effect on the development of coronary atherosclerosis and have been shown to cause thrombophilia in CAE patients. METHODS The factor V Leiden (G1691A), factor V H1299R, prothrombin G20210A, factor XIII V34L, beta-fibrinogen-455 G>A, plasminogen activator inhibitor (PAI)-1 4G/5G, and methylenetetrahydrofolate reductase (MTHFR) C677T, and MTHFR A1298C polymorphisms were evaluated in 66 patients with CAE and 32 individuals with normal coronary arteries. RESULTS Comparison of the CAE and control groups revealed that the clinical features and the frequency of polymorphism in the thrombophilic genes were similar in both groups. However, when heterozygous and/or homozygous polymorphism was compared between groups, it was found that there was a significantly higher finding of thrombophilic gene polymorphism in the CAE group (p=0.023). CONCLUSION Thrombophilic gene polymorphism may be associated with the formation and clinical presentation of CAE.

Introduction . Ankylosing spondylitis (AS) is a chronic inflammatory disease with an unknown etiology that belongs to the group of spondyloarthropathies. Patients with AS have an increased cardiovascular mortality but the reason is controversial. Central aortic pressure (CAP) is defined as the blood pressure in the aortic root and can be measured non-invasively via arteriography. Inflammation in the aortic root, which also causes aortic regurgitation in late sta ges of AS, possibly causes increased levels of central aortic pressure and this may explain the increased mortality rates from cardiovascular events in patients with AS. We investigated the CAP levels in patients with AS compared to healthy age- and sex-matched control group in this novel study. Material and methods . This is an observational case-control study composed of 30 patients with ankylosing spondylitis without conventional cardiovascular risk factors (such as known diabetes, hypertension, and smoking) or heart failure, peripheral or coronary artery disease. The peripheral blood pressures and CAP measurements were obtained with ‘arteriograph’ (TensioMed, Budapest, Hungary).Pulse wave velocity (PWV), peripheral and central augmentation index (pAIx and cAIx) and systolic central aortic pressure (sCAP) of both the AS and control group were compared. Results . There was no statistically significant difference between the groups for pAIx, cAIx, PWV or PP. Patient with AS had higher sCAP values but there wasn’t any statistically significant difference for sCAP. Conclusion . Our objective was to investigate the relationship between the AS and sCAP. There was an increase in sCAP in AS group compared to controls. But this was not statistically significant. This result can be due to the small population size and should be verified in larger population.

Purpose Chronic thromboembolic pulmonary hypertension (CTEPH) is the only pulmonary hypertension that can be treated surgically. Multidedector computerized tomography angiography (MDCTA) is considered as an important tool. In this study, the important CT findings of CTEPH and the vascular MDCTA findings of CTEPH were classified as central, peripheral, central and peripheral. The aim of this study was to investigate the relationship between these groups with parenchymal and hemodynamic findings. Materials and methods MDCTA examinations of 26 patients who had been diagnosed with CTEPH were retrospectively reviewed. Vascular, cardiac and parenchymal findings were examined in MDCTA. Patients were divided into three groups as peripheral, central and peripheral and central chronic thromboembolism. The relationship between these groups with demographic, vascular, parenchymal and hemodynamic findings was investigated. Results The most common vascular finding was the wall filling defects attached to the lobar and/or segmental arterial walls, while the parenchymal finding was the fibrotic shrinkage. There were no statistically significant differences between the three groups compared to parenchymal findings which are mosaic pattern, brochiectasis, fibrotic changes and atelectasis, pulmonary artery diameter, right atrial diameter and RV/LV ratio. Age and sex were not different in patients between the three groups. Conclusion The results of the this study confirm the important role of MDCTA in the evaluation of vascular, cardiac and parenchymal findings in the patients with CTEPH and identifying patients that would most benefit from surgical treatment by visualization of the segmental and subsegmental branches of the pulmonary arteries.

OBJECTIVE Heart failure (HF) has a high prevalence and mortality rate in elderly patients; however, there are few studies that have focused on patients older than 80 years. The aim of this study is to describe and compare the age-specific demographics and clinical features of Turkish elderly patients with HF who were admitted to cardiology clinics. METHODS The Epidemiology of Cardiovascular Disease in Elderly Turkish population (ELDER-TURK) study was conducted in 73 centers in Turkey, and it recruited a total of 5694 patients aged 65 years or older. In this study, the clinical profile of the patients who were aged 80 years or older and those between 65 and 79 years with HF were described and compared based on the ejection fraction (EF)-related classification: HFrEF and HFpEF (is considered as EF: ≥50%). RESULTS A total of 1098 patients (male, 47.5%; mean age, 83.5+-3.1 years) aged ≥80 years and 4596 patients (male, 50.2 %; mean age, 71.1+-4.31 years) aged 65-79 years were enrolled in this study. The prevalence of HF was 39.8% for patients who were ≥80 years and 27.1% for patients 65-79 years old. For patients aged ≥80 years with HF, the prevalence rate was 67% for hypertension (HT), 25.6% for diabetes mellitus (DM), 54.3% for coronary artery disease (CAD), and 42.3% for atrial fibrilation. Female proportion was lower in the HFrEF group (p=0.019). The prevalence of HT and DM was higher in the HFpEF group (p

WOS: 000464336000007, PubMed ID: 30982817, Objective: Heart failure (HF) is an important health issue of the 21st century and the prevalence in Turkey has been reported as 2.9%. A national profile, frequency data, characteristics of different phenotypes, and risk factors have not yet been well established. The Snapshot Evaluation of Heart Failure Patients in Turkey (SELFIE-TR) was an analysis of a representative sample of HF patients from Turkey. Methods: A total of 23 centers with at least 2 cardiologists from the 12 NUTS-1 regions of Turkey were invited to participate in the research. The contributing centers shared the data of a consecutive enrollment of HF patients, as confirmed by an investigator, on a pre-selected day of each week for the month of October or November of 2015. Results: The mean age of the entire cohort was 63.3 +/- 13.3 years (male/female ratio: 751/303, 71.3%/28.7%). There were 712 acute HF patients and 342 chronic HF patients. The total number of HF patients with reduced ejection fraction (HFrEF), heart failure with mid-range ejection fraction, and heart failure with preserved ejection fraction was 801 (75%), 176 (16.7%), and 77 (7.3%), respectively. The patients with chronic HF were younger than those with acute HF (61.1 +/- 13.3 years vs 67.9 +/- 12.1 years; p

Pulmonary hypertension (PH) is one of the major complications of obstructive sleep apnea syndrome (OSAS). Pulmonary arterial stiffness (PAS) can be used in determination of PH. The aim of the present study was to evaluate the PAS and cardiac function of patients with OSAS and analyses the relationship between OSAS severity and PAS. Sixty newly diagnosed patients with OSAS (mean age 49.6 ± 11.7 years) and 30 healthy controls (mean age 46.4 ± 14 years) were enrolled. Right ventricle (RV) and left ventricle (LV) echocardiographic parameters and PAS values of study groups were compared. There were no significant differences in terms of LV ejection fraction, LV Tei-index and tricuspid annular plane systolic excursion. PAS, mean pulmonary arterial pressure (PAP) and RV Tei-index were significantly higher but tricuspid annulus early diastolic myocardial velocity was lower in patients with OSAS than control subjects (respectively p

Cardiac autonomic modulation and baroreflex sensitivity are altered in individuals with essential hypertension. Hypertension is considered as a strong and independent risk factor for supraventricular and ventricular arrhythmias. The aim of the present study was to evaluate cardiac autonomic control and the arrhythmogenic risk by using 24-h heart rate variability (HRV) and heart rate turbulence (HRT) analysis in essential hypertension without left ventricular hypertrophy (LVH).Fifty-eight newly diagnosed untreated hypertensive patients without LVH (mean age 51 ± 12 years, 26 women) and 56 adult, healthy volunteers (mean age 49 ± 12 years, 24 women) were included in the study. Subjects with secondary causes of hypertension or autonomic dysfunction were excluded. The diagnosis of hypertension was based on ambulatory blood pressure monitoring results. Time-domain HRV parameters and HRT parameters were calculated from 24-hour Holter recordings.Values of SDNN and SDANN in the hypertension group were significantly lower than in the control group (P0.01 and P0.01, respectively). At least one of the turbulence onset (TO) and turbulence slope (TS) values were found abnormal in 10 of 32 hypertensive patients and in 5 of 24 control individuals (P = 0.38). There was no significant difference between HRT parameters, TO and TS (P = 0.67 and P = 0.12, respectively).Sympathetic tone begins to increase in hypertension before LVH develops. However, the impact of this increase on HRT is not clear. There is a need for further research to investigate the impact of hypertension and LVH on HRT.

Bulgular: Hastalarin %59’unda AF saptandi. AF’li hastalarin yas ortalamasi, kadin cinsiyet orani, hipertansiyon , kalp yetmezligi , hiperlipidemi ve inme orani daha yuksek izlenmistir (p

Aims: Most dilated cardiomyopathies are either an ischemic dilated cardiomyopathy (IsDC) or an idiopathic dilated cardiomyopathy (IdDC). The treatments for both IsDC and IdDC are of a similar nature (upwards of 90%). Coronary revascularization, however, is only feasible for IsDC. The purpose of this study was to determine if microRNAs (miRNAs) could be used as biomarkers to distinguish between IsDC and IdDC. Materials and Methods: Patients were divided into two groups: IsDC and IdDC, with 25 patients in each group, and 10 healthy persons serving as a control group. In our study, the following miRNA expressions were detected using the Rotor Gene Q real-time polymerase chain reaction cycler (Qiagen) for all IsDC and IdDC subjects: let-7b-5p, let-7c-5p, miR-1-3p, miR-15b-5p, miR-17-5p, miR-19a-3p, miR-19b-3p, miR-20a-5p, miR-20b-5p, miR-23a-3p, miR-24-3p, miR-27a-3p, miR-28-5p, miR-30e-5p, miR-99b-5p, miR-100-5p, miR-101-3p, miR-103a-3p, miR-106a-5p, miR-125b-5p, miR-126-3p, miR-126-5p, miR-140-5p, miR-191-5p, miR-195-5p, miR-199a-3p, miR-214-3p, miR-222-3p, miR-342-3p, and miR-378a-3p. Results: We found that miR-24-3p, miR-28-5p, miR-100-5p, miR-103-3p, miR-125b5p, miR-214-3p, let-7b-5p, and let-7c-5p were each overexpressed by more than twofold in both the IsDC and IdDC groups when compared to the controls. We also found that miR-15b-5p and miR-106a-5p may be used to distinguish between patients with IsDC and IdDC. Conclusions: Our study has demonstrated that miR-15b-5p and miR-106a-5p expression levels could potentially serve as useful biomarkers for distinguishing between IsDC and IdDC.

WOS: 000433285000010, PubMed ID: 28968197, Once-daily dosing of non-vitamin K antagonist oral anticoagulants (NOACs) may increase patient adherence to treatment but may also be associated with a higher risk of bleeding. In this study, we investigated the adherence to once-or twice-daily dosing of NOACs and the risk of bleeding in nonvalvular atrial fibrillation (NVAF) patients. This multicenter cross-sectional study, conducted between 1 September 2015 and 28 February 2016, included 2214 patients receiving NOACs for at least 3 months, due to NVAF. Patients receiving once-daily or twice-daily NOAC doses were 1: 1 propensity score matched for baseline demographic characteristics and the presence of other diseases. The medication adherence was assessed by the 8-item Morisky Medication Adherence Scale. Risk factors were investigated in relation to minor and major bleeding. The mean age of patients was 71 +/- 10 years, and 53% of the patients were women. The medication adherence was lower in patients receiving twice-daily NOAC doses compared to once-daily-dose group (47% versus 53%, p = 0.001), and there was no difference between the groups in terms of minor (15% versus 16%, p = 0.292) and major bleeding (3% versus 3%, p = 0.796). Independent risk factors for bleeding were non-adherence to medication (OR: 1.62, 95% CI: 1.23-2.14, p = 0.001), presence of 3 or more other diseases (OR: 10.3, 95% CI: 5.3-20.3, p < 0.001), and HAS-BLED (Hypertension, Abnormal renal and liver function, Stroke, Bleeding, Labile INR, Elderly, Drugs or alcohol) score (OR: 4.84, 95% CI: 4.04-5.8, p < 0.001). In summary, the once-daily dose of NOACs was associated with increased patient adherence to medication, while it was not associated with bleeding complications.

Objectives Pulmonary hypertension with heart failure is related to venous insufficiency. However, there is no clear data whether pulmonary arterial hypertension with preserved right ventricular function cause venous insufficiency. In this study, we aim to investigate the relation between pulmonary arterial pressure with venous insufficiency in pulmonary arterial hypertension patients with preserved right ventricular function. Methods Between January 2012 and October 2014, 38 patients with a diagnosis of pulmonary arterial hypertension and 47 control group patients were included. Venous disability score and venous segmental disease score of both groups were calculated in order to measure venous insufficiency. The relationship between venous disability score and venous segmental disease scores and mean pulmonary arterial pressure and World Heart Organization functional capacity was examined. Results Total venous segmental disease score (5 ± 3.9 vs. 2 ± 1.8 p Conclusions The degree of venous insufficiency increase in accordance with the mean pulmonary arterial pressure even in patients with preserved right ventricular function.

Pulmonary arterial hypertension (PAH) is a disease associated with progressive and comprehensive vascular remodeling of small pulmonary arteries. The prognosis of Chronic myelogenous leukemia (CML) has been improved by tyrosine kinase inhibitors (TKIs), which inhibit BCR/ABL kinase pathway. Most of the TKIs induced PAH is limited almost exclusively to dasatinib until now. There was only one report about, PAH was caused by the novel TKI ponatinib. We present a 73 years old-female patient with chronic myeloid leukemia, who had PAH after approximately 72 months with prior exposure to dasatinib. Dasatinib was replaced by nilotinib in this patient. Nilotinib was used 11 months for CML treatment, but no recovery was seen with also this TKI. Finally, ponatinib therapy was started for CML. Signs and symptoms of PAH improved with institution of ponatinib therapy. Therefore we report that the patient with dasatinib induced PAH did not recover after institution of nilotinib as a TKI instead of dasatinib but improved with ponatinib treatment using for CML.

Thromboembolic complication is directly related to CHAWe retrospectively reviewed medical records of 213 patients with NVAF who experienced stroke and 115 patients with NVAF who experienced non-cerebral thromboembolism between 2010 and 2015. In all patients, CHAThe mean CHAThe patients with stroke had similar CHA

Kounis syndrome is a rarely seen syndrome which is also called allergic angina syndrome. Contacted allergic agents cause allergic reaction, and then it leads to vasospastic angina pectoris or myocardial infarction. When the patient contact allergic agent, histamine releases from mast cells, and vasospasm or plaque rupture occurs at coronary arteries. A lot of allergic agents is defined which causes Koinus syndrome. Most of these allergic agents are antibiotics, analgesics, antineoplastics, contrast agents, anethesics, non-steroid antiinflammatory drugs, proton pump inhibitors and venoms. Our patient is the first case report which is the Kounis syndrome after taking deksketoprofen trometamol.

Background Thromboembolic complication is directly related to CHA2DS2-VASc score in patients with non-valvular atrial fibrillation (NVAF). In this study we compared the CHA2DS2-VASc score and in-hospital mortality between NVAF patients with non-cerebral thromboembolism and those with stroke. Methods We retrospectively reviewed medical records of 213 patients with NVAF who experienced stroke and 115 patients with NVAF who experienced non-cerebral thromboembolism between 2010 and 2015. In all patients, CHA2DS2-VASc score before the event was calculated. Results The mean CHA2DS2-VASc score was similar in patients with stroke (4.52±1.66) and those with non-cerebral thromboembolism (4.29±2.02) (p=0.196). In-hospital mortality rate was similar between the groups (19% vs. 17%, p=0.756). The rates of coronary artery disease (52% vs. 38%, p=0.014), prior transient ischemic attack (16% vs. 5%, p=0.001), and prior non-cerebral thromboembolism (18% vs. 3%, p

Unilateral absence of a pulmonary artery a very rare congenital disorder. We here present a case of a 22-year-old female patient with agenesis of the right pulmonary artery accompanying patent ductus arteriosus and Eisenmenger syndrome, diagnosed by chest X-ray and multidetector computed tomography 5 days after giving birth.

Behcet’s disease (BD) is a chronic inflammatory disorder that can affect many systems in the body. Cardiac involvement increases the risk of cardiovascular mortality and occurs in 1%-5% of patients with BD. Ventricular arrythmias are believed to be the cause of this increased risk of cardiovascular mortality and it is also thought to be related with cardiac autonomic dysfunction. Heart rate turbulence (HRT) is a new predictor of cardiac autonomic activity. HRT is an independent and powerful predictor of mortality. In this study, we investigated the cardiac autonomic activity which can be determined by HRT in patients with BD. Forty patients with BD (20 men, mean age: 40 ± 9 years, range: 27-55 years) were diagnosed according to the International Study Group Criteria (ISGC) and gender and age matched healthy volunteers (20 men, mean age: 39 ± 8 years, range: 26-56 years) were included in this study. All of the participants (patients and controls) underwent 24 hours Holter electrocardiogram. HRT parameters, turbulence onset (TO) and turbulence slope (TS) were calculated with HRT (View Version 0.60-0.1 of Software Program). There were no significant differences in TO and TS values between patients with BD and control subject (TO-BD: 0.014 ± 0.03, TO-Control: 0.011 ± 0.04; TS-BD: 7.88 ± 4.9, TS-Control: 9.42 ± 6.7 respectively). Although increased cardiovascular mortality rates in BD have been shown in many studies, HRT values—detecting the risk of sudden death—do not seem to be altered in this disease.

CONTEXT AND OBJECTIVE: Impaired autonomic cardiac function is an important consequence of obstructive sleep apnea (OSA). This impairment is mainly due to intermittent hypoxia episodes following apneas. However, the impact of apnea severity on autonomic cardiac function remains unclear. The aim of this study was to evaluate the relationship between the severity of sleep apnea and heart rate turbulence (HRT) and heart rate variability (HRV) in OSA. DESIGN AND SETTING: Observational cross-sectional study conducted in the Departments of Cardiology and Pulmonary Diseases, Afyon Kocatepe University, Turkey. METHODS: 106 patients with OSA and 27 healthy volunteers were enrolled. Based on apnea hypopnea index (AHI) values, obstructive sleep apnea severity was classified as follows: mild OSA (AHI ≥ 5 and < 15), moderate OSA (AHI ≥ 15 and ≤ 30) and severe OSA (AHI > 30). HRV and HRT parameters were assessed via 24-hour digital Holter electrocardiogram recordings for all subjects. RESULTS: HRV and HRT results were significantly lower among OSA patients than among control subjects (P < 0.05). However, there were no significant differences in HRT and HRV between the three patient subgroups. Correlations did emerge between AHI and the NN-interval parameter RMSSD and between oxygen desaturation and turbulence slope (respectively: r = -0.22, P = 0.037; and r = -0.28, P = 0.025). CONCLUSION: HRT and HRV results deteriorate in OSA. Correlations between apnea severity and these parameters seem to be present. RESUMO CONTEXTO E OBJETIVO: Função autonômica cardíaca prejudicada é consequência importante da apneia obstrutiva do sono (AOS). Este prejuízo deve-se principalmente a episódios de hipóxia intermitente após apneias. No entanto, o impacto da gravidade da apneia na função cardíaca autonômica permanece obscuro. O objetivo deste estudo foi avaliar a relação entre gravidade da apneia do sono com turbulência da frequência cardíaca (TFC) e variabilidade da frequência cardíaca (VFC) em pacientes com AOS. DESENHO E LOCAL: Estudo observacional transversal conduzido nos Departamentos de Cardiologia e Doenças Pulmonares, Afyon Kocatepe University, Turkey. MÉTODOS: 106 pacientes com AOS e 27 voluntários saudáveis foram recrutados. Com base nos valores do índice de apneia-hypopneia (IAH), a gravidade da apneia obstrutiva do sono foi classificada assim: AOS leve (IAH ≥ 5 e < 15), AOS moderada (IAH ≥ 15 e ≤ 30) e AOS grave (IAH > 30). Parâmetros da VFC e TFC foram avaliados por meio de gravações de eletrocardiograma digital Holter de 24 horas para todos os sujeitos. RESULTADOS: Os resultados da VFC e TFC foram significativamente menores nos pacientes com OSA, em comparação com indivíduos controle (P < 0,05). No entanto, não houve diferenças significativas em VFC e TFC, entre os três subgrupos de pacientes. Correlações surgiram entre IAH e o parâmetro do intervalo-NN, RMSSD, e entre dessaturação de oxigênio e declive da turbulência (respectivamente; r = -0,22, P = 0,037; e r = -0,28, P = 0,025). CONCLUSÃO: Os resultados da VFC e TFC deterioram em AOS. Parece haver relação entre a gravidade da apneia e tais parâmetros.

Objective: Cardiac autonomic dysfunction may develop in patients with polycystic ovary syndrome (PCOS). Heart rate variability (HRV) and heart rate turbulence (HRT) are used in assessing cardiac autonomic functions. The goal of this study was to compare the cardiac autonomic functions in patients with PCOS and healthy controls. To our knowledge, this is the first study evaluating cardiac autonomic functions in patients with PCOS with respect to both HRV and HRT. Methods: Twenty-three patients with PCOS (mean age 22.8±3.9 years) and 25 healthy female volunteers who were matched for age and body mass index (BMI) (mean age 23.5±6.2 years) were enrolled in this as case-control study. Twenty-four hour ambulatory electrocardiogram recordings of all participants were taken using Pathfinder software. The time domain parameters of HRV and HRT, including turbulence onset (TO) and turbulence slope, were calculated. Diagnosis of PCOS was made with physical and laboratory findings of hirsutism or biochemical hyperandrogenism and chronic anovulation. Diabetes mellitus, other hormon disorders or hormon therapy, pregnancy, atrial fibrilation, obesite, chronic diseases, disorders of the autonomic nervous system, a history of drug use affecting the autonomic nervous system were excluded. Results: There were no significant differences in HRV and HRT parameters between the two groups. Cardiovascular risk factors, such as BMI, blood pressure, fasting blood glucose, and lipid parameters, were also similar. Triangular index measure of HRV was negatively correlated with high density lipoprotein cholesterol levels (r=-0.47, p

Nasal septum deviation (NSD) can cause obstruction of the upper airway, which may lead to increased pulmonary artery pressure (PAP) and right ventricle dysfunction. The aim of the present study was to evaluate the effect of septoplasty on right ventricular function and mean PAP of patients with marked NSD. 25 patients with marked NSD (mean age = 31.8 ± 12.3 years) and 27 healthy volunteers (mean age = 34.5 ± 10.8 years) were enrolled. Echocardiography was performed for all subjects and right ventricular function and mean PAP were evaluated before and 3 months after septoplasty. Tricuspid annular plane systolic excursion (TAPSE) and tricuspid annulus early diastolic myocardial velocity (E') were significantly lower in patients with NSD than control subjects, while right ventricle myocardial performance index (RVMPI) and mean PAP were significantly higher (respectively, p = 0.006, 0.037, 0.049, 0.046). When preoperative and postoperative findings were compared, the mean PAP decreased whereas TAPSE increased significantly (respectively, p = 0.007, 0.03). The results of the present study demonstrated that mean PAP increased and right ventricular function worsened in patients with NSD. However, mean PAP decreased and right ventricular function tended to recover after septoplasty.

Background: Cardiac autonomic dysfunction may develop in patients with clinical or subclinical thyroid hormone deficiency. Heart rate variability (HRV) and heart rate turbulence (HRT) are used for evaluating changes in cardiac autonomic functions and also used to provide risk stratification in cardiac and noncardiac diseases. The aim of this study is to evaluate cardiac autonomic functions before and 6 months after thyroid replacement therapy in patients with thyroid hormone deficiency. Methods: Forty hypothyroid patients (mean age 48 ± 13, four male) and 31 healthy controls (mean age 51 ± 12, three male) were included in the study. Twenty-four hour ambulatory electrocardiogram recordings were taken using Pathfinder Software Version V8.255 (Reynolds Medical). The time domain parameters of HRV analysis were performed using the Heart Rate Variability Software (version 4.2.0, Norav Medical Ltd, Israel). HRT parameters, Turbulence Onset (TO), and Turbulence Slope (TS) were calculated with HRT! View Version 0.60-0.1 software. Results: HRV and HRT parameters were decreased in the patient group (SDNN; P < 0.001, SDANN; P < 0.009, RMSSD; P = 0.049, TO; P = 0.035, TS; P < 0.001). After 6 months of thyroid replacement therapy, there were no significant changes observed in either HRV or HRT. Conclusions: Hypothyroidism may cause cardiac autonomic dysfunction. Treating hypothyroidism with L-thyroxine therapy does not effectively restore cardiac autonomic function. HRV and HRT can be used as to help monitor cardiovascular-related risk in this population. Ann Noninvasive Electrocardiol 2011;16(4):344–350

Background: It has long been speculated that mobile phones may interact with the cardiac devices and thereby cardiovascular system may be a potential target for the electromagnetic fields emitted by the mobile phones. Therefore, the present study was designed to test possible effects of radiofrequency waves emitted by digital mobile phones on cardiac autonomic modulation by short-time heart rate variability (HRV) analysis. Methods and Results: A total of 20 healthy young subjects were included to the study. All participants were rested in supine position at least for 15 minutes on a comfortable bed, and then time and frequency domain HRV parameters were recorded at baseline in supine position for 5 minutes. After completion of baseline records, by using a mobile GSM (Global System for Mobile Communication) phone, HRV parameters were recorded at turned off mode, at turned on mode, and at calling mode over 5 minutes periods for each stage. Conclusion: Neither time nor frequency domain HRV parameters altered significantly during off mode compare to their baseline values. Also, neither time nor frequency domain HRV parameters altered significantly during turned on and calling mode compared to their baseline values. Short-time exposure to electromagnetic fields emitted by mobile phone does not affect cardiac autonomic modulation in healthy subjects. (PACE 2011; 34:1511‐1514)

Patients with end-stage renal disease (ESRD) are likely to have cardiac autonomic dysfunction, which is related with an increased risk of sudden death. The aim of this study is to detect cardiac autonomic dysfunction in patients with ESRD and to evaluate the possible acute effects of hemodialysis (HD) on cardiac autonomic functions measured by heart rate variability (HRV) and heart rate turbulence (HRT). Thirty-one (mean age 50 ± 13 years, 15 males) with ESRD on regular HD program and 31 healthy volunteers (mean age 51 ± 12 years, 15 males) were included in the study. Twenty-four-hour ambulatory electrocardiogram recordings were taken from the subjects before and after HD and from the control group. Heart rate variability and HRT parameters were calculated from these recordings. All of the HRV and HRT parameters were found to be significantly blunted in patients in comparison with healthy individuals. There were significant differences in HRV after HD, but similar differences were not observed in HRT parameters. Cardiac autonomic functions were significantly altered in patients with ESRD. Heart rate turbulence parameters seemed to be less affected from HD and may be more useful in the evaluation of cardiac autonomic functions in the ESRD population.

Summary Objective: In our study we aimed to identify normal ECG and its variants; the effect of age, gender, body weight and smoking on ECG parameters; and also to define unrecognized diseases by using routine ECG in people with no cardiac problem. Methods: We noted age, gender, chronic diseases, drug use and smoking status of the people included in the study who applied to the Family Medicine Policlinics of AKU Medical Faculty Hospital. We recorded ECG’s and measured the weight and height of all the study group. We used Student-t, Mann-Whitney U and, Kruskal Wallis H tests, to compare three and more groups Variance Analysis; to control normality of the data Shapiro Wilks test were used. We accepted α value as 0.05 and used SPSS 13.0 version. Results: Only heart rate had negative correlation with height (p

The aim of this study was to investigate the clinical relevance of dipper status in women with preeclampsia by comparing arterial stiffness index (SI) values, and dipper and nondipper status.A total of 60 pregnant women in their third trimester were enrolled in the study. SI values were measured using a digital photoplethysmographic method (Pulse Trace System, Micro Medical Ltd., Gillingham, Kent, UK). Twenty-four-hour ambulatory blood pressure was measured by a SpaceLabs 90217 oscillometric device (SpaceLabs Inc., Redmond, WA, USA). Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and pulse pressure (PP) were recorded. Those preeclamptic women whose mean nighttime blood pressure measurements were at least 10% lower compared with mean daytime measurements were classified as dipper status, and those with a decrease of less than 10% were classified as nondipper status.Seventeen women were preeclamptic with a dipper status, 13 women had nondipper status preeclampsia, and 30 women were normotensive. SI values were significantly higher in preeclamptic women compared with normotensive women (8.8+/-1.2 m/s vs. 5.9+/-0.8 m/s, P0.001), but SI values of preeclamptic women with dipper status and preeclamptic women with nondipper status did not differ significantly from each other (P=0.485).There was no significant difference in SI values between the dipper and nondipper preeclamptic groups. These results indicate that dipper and nondipper measurements may not be suitable for clinical follow-up of preeclamptic women.

Hayatı tehdit eden ventriküler aritmilere sebep olabilen uzun QT sendromu doğumsal veya edinsel nedenlere bağlı olarak ortaya çıkabilmektedir. Günümüzde yaygın olarak kullanılmakta olan histamin 1 (H-1) reseptör antagonistleri ve florokinolon grubu antibiyotikler de edinsel uzun QT sendromuna neden olabilen ilaç gruplarındandır. Florokinolon grubu antibiyotikler doz bağımlı olarak gecikmiş düzenleyici potasyum akımının hızlı bileşenini bloke ederler ve bu etkileri ile QT mesafesinde uzamaya ve torsades de pointes’e (TdP) neden olabilirler. Bu grup antibiyotiklerden olan siprofloksasinin de nadir de olsa QT mesafesini uzatabildiği ve TdP’ye neden olabildiği bilinmektedir ve bu etkisi diğer kinolonlarla kıyaslandığında daha nadir gözlenmektedir. Bizim olgumuzda da hem H-1 reseptör antagonisti olan hidroksizin hem de florokinolon grubu bir antibiyotik olan siprofloksasin kullanmaktayken edinsel uzun QT sendromu oluşmuştur

© 2015 CLINICS.Objective: Fibromyalgia is characterized by diffuse musculoskeletal pain and discomfort. There are several reports regarding autonomic nervous system dysfunction in patients with fibromyalgia. Heart rate turbulence is expressed as ventriculophasic sinus arrhythmia and has been considered to reflect cardiac autonomic activity. Heart rate turbulence has been shown to be an independent and powerful predictor of sudden cardiac death in various cardiac abnormalities. The aim of this study is to determine whether heart rate turbulence is changed in female patients with fibromyalgia compared with healthy controls. Methods: Thirty-seven female patients (mean age, 40±11 years) with fibromyalgia, and 35 age- and sexmatched healthy female control subjects (mean age, 42±9 years) were included. Twenty-four hours of ambulatory electrocardiography recordings were collected for all subjects, and turbulence onset and turbulence slope values were automatically calculated. Results: The baseline clinical characteristics of the two groups were similar. There were no significant differences in turbulence onset and turbulence slope measures between patients and control subjects (turbulence onset: −1.648±1.568% vs. −1.582±1.436%, p = 0.853; turbulence slope: 12.933±5.693 ms/RR vs. 13.639±2.505 ms/RR, p = 0.508). Although body mass index was negatively correlated with turbulence slope (r= −0.258, p = 0.046), no significant correlation was found between body mass index and turbulence onset (r= 0.228, p = 0.054). Conclusion: To the best of our knowledge, this is the first study to evaluate heart rate turbulence in patients with fibromyalgia. It appears that heart rate turbulence parameters reflecting cardiac autonomic activity are not changed in female patients with fibromyalgia.

Objective: Atrial fibrillation (AF), commonly observed in advanced ages, displays striking age dependent increase and increased P wave dispersion (PWD) has been shown to be a predictor of AF. In this study we sought to determine whether P wave duration and PWD increase with aging. Method and Results: Eighty-three elderly subjects (group-I mean age 75±8 years) and 40 healthy young subjects (group-II, mean age 37±6 years) participated in this study. 12-lead ECG recorded at a paper speed of 50mm/s was obtained from each participant. Maximum (Pmax) and minimum P wave duration (Pmin) was measured manually with a caliper and the difference between two values was defined as PWD. Pmax and PWD were significantly higher in group-I compared to group-II. (98±8 vs. 93±8 p=0.01, 41±12 vs. 34±13 p=0.002, respectively). Among the elderly population when those with cardiovascular disorders such as hypertension, coronary artery disease and heart failure were excluded, Pmax and PWD were still significantly higher than the young population. (Pmax: 98±7 vs. 93±7, p=0.02 and PWD: 42±11 vs. 34±13, p=0.002). Moreover, on correlation analysis a positive correlation was detected between Pmax and PWD and aging. (r=0.29, p=0.004; r=0.30, p=0.003 respectively). Conclusion: PWD shows age dependent increase and may be a useful marker for estimation the risk of developing AF seen in advanced ages, Amaç: ‹leri yafllarda yag›n olarak görülen atriyal fibrilasyon; yafl ba¤›ml› olarak çarp›c› bir art›fl göstermektedir ve artm›fl p dalga dispersiyonunun atriyal fibrilasyonun bir ön gördürücüsü oldu¤u gösterilmifltir. Bu çal›flmada, yaflla birlikte p dalga dispersiyonunun art›p artmad›¤›n› araflt›rd›k. Metod ve Bulgular: 83 yafll› hasta (grup-1; yafl ortalamas› 75±8 y›l) ve 40 sa¤l›kl› genç birey (grup-2; yafl ortalamas› 37±6 y›l) bu çal›flmaya dahil edildi. Her bir kat›l›mc›dan 50 mm/s ka¤›t h›z›nda 12-derivasyonlu EKG kayd› al›nd›. Maksimum ve minimum p dalga süreleri cetvel ile manuel olarak ölçüldü ve her iki de¤er aras›ndaki fark P dalga dispersiyonu (PDD) olarak tan›mland›. grup-1 maksimum p dalga süresi ve PDD anlaml› flekilde grup-2'den yüksek idi (98±8 ve 93±8 ms p=0.01; 41±12 ve 34±13 ms p=0.002, s›ras› yla). Yafll› grup aras›nda hipertansiyon, koroner arter hastal›¤› ve kalp yetersizli¤i gibi kardiyovasküler hastal›klar› olanlar d›flland›¤›nda bile maksimum p dalga süresi ve PDD yine de genç popülasyondan yüksek idi (Pmax: 98±7 ve 93±7 ms, p=0.02; PDD: 42±11 ve 34±13ms, p=0.002). Üstelik, korelasyon analizinde maksimum p dalga süresi, PDD ve yafl aras›nda pozitif bir korelasyon saptand› (r=0.29, p=0.004; r=0.30, p=0.003 s›ras›yla). Sonuç: PDD yafl ba¤›ml› art›fl göstermektedir ve ileri yafllarda görülen atriyal fibrilasyon geliflim riskini tahmin etmek için faydal› bir gösterge olabilir.

Background: Triptans, which activate 5-hydroxytryptamine (5-HT)-1B/1D receptors in cerebral arteries, are very effective in aborting attacks of migraine. Although activation of 5-HT-1B/1D receptors diminishes the secretion of noradrenaline from cardiac sympathetic nerves, some studies report that they may cause chest discomfort, myocardial infarction and arrhythmias due to coronary vasospasm. The effect of zolmitriptan on cardiac autonomic modulation has not been evaluated in migraineurs. Subjects and Methods: Ten patients with migraine (nine women, mean age 33 ± 4 years) were crossover randomized to 2.5 mg zolmitriptan or identical placebo at least 5 days apart. Both time domain parameters (the mean R-R interval, the standard deviation of RR interval [SDNN], and the root mean square of successive R-R interval differences) and frequency domain parameters (low frequency [LF], high frequency [HF], and LF/HF ratio) of heart rate variability (HRV) were obtained during supine position, controlled respiration and handgrip exercise before and 2 h after zolmitriptan or placebo administration. Results: Baseline HRV parameters were similar for each occasion. Single dose zolmitriptan administration did not affect both time and frequency domain HRV parameters compared with the placebo. Conclusions: A single dose, 2.5 mg oral zolmitriptan administration did not change sympathetic and parasympathetic reactivity and sympathovagal balance in migraineurs. © 2015 Neurology India | Published by Wolters Kluwer - Medknow.

Because transthoracic echocardiography is an inexpensive, easy, and reproducible method, it is the most commonly used noninvasive diagnostic tool to determine pulmonary artery pressure (PAP). Tissue Doppler imaging (TDI) emerged as a new echocardiographic method that can be applied in various clinical conditions. In our study we aimed to evaluate the relationship between tricuspid lateral annulus TDI parameters and pulmonary artery systolic pressure (PASP) as estimated by continuous wave Doppler in patients with chronic obstructive pulmonary disease (COPD). A total of 51 (42 men, mean age: 62.3 +/- 8.2 years) patients with clinically stable COPD were included in the study. The tricuspid annular systolic myocardial velocity (Sm), velocity time integral of Sm (SmVTI), early (Em) and late (Am) peak diastolic myocardial velocities, and myocardial isovolumic relaxation time (IVRTm) were acquired as well as two-dimensional (2-D) and conventional Doppler data. When compared with values of patients without pulmonary hypertension (PHT), Sm, SmVTI, Em, and Em/Am values were found to be lower and IVRTm values higher in patients with PHT. When all the patients were analyzed, there was a significant negative correlation between PASP and Sm and SmVTI (r = -0.82, p0.001 and r = -0.84, p0.001, respectively). Sm velocityor = 12 cm/s had a sensitivity of 85% and a specificity of 93.3% for predicting PASP40 mmHg. SmVTIor = 2.5 cm had a sensitivity of 85.7% and a specificity of 90% for detecting PHT. In our study, there was significant negative correlation between tricuspid lateral annular Sm and SmVTI values and PASP in patients with stable COPD irrespective of the presence of PHT. Tricuspid annular Sm and SmVTI had very good level sensitivity and specificity for predicting PHT. In conclusion, it might be suggested that in cases where noninvasive PASP measurement is not possible, TDI can be used as an alternative and reliable method to assess PAP.

Essential hyperhidrosis is a well recognized dermatologic and neurologic disorder, characterized by excessive sweating of the eccrine sweat glands. It is also associated with cardiac autonomic dysfunction because sympathetic fibers to eccrine glands of palms of the hand arise from stellate and upper thoracic ganglia, which also innervate the heart. In this study, we investigated cardiac function in patients with essential hyperhidrosis by conventional and tissue Doppler imaging methods. Eighteen subjects with essential hyperhidrosis and eighteen control subjects were included in this study. Pulsed-wave Doppler parameters of the left and right ventricles, which represent diastolic filling abnormalities, were obtained by conventional Doppler and tissue Doppler imaging. Isovolumetric relaxation time, isovolumetric contraction time, ejection time and myocardial performance index were also calculated. Mitral inflow peak early (E(M)) and late (A(M)) velocities and E(M)/A(M) ratio, which represent diastolic filling of left ventricle, were significantly lower in hyperhidrotic subjects than in controls. Also, mitral lateral annulus early and late velocities and early/late velocity ratio, reflecting diastolic filling of left ventricle, were significantly lower in hyperhidrotic subjects than those of controls. However, there were no differences between hyperhidrotic subjects and control subjects with regard to the other echocardiographic indices of left and right ventricle diastolic functions. In conclusion, decreased mitral inflow suggests left ventricle diastolic dysfunction in patients with essential hyperhidrosis. This indicates that hyperactivity of sympathetic nervous system in patient with hyperhidrosis may alter cardiac function in long term.