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Aim: Non-dipper hypertension (NDHT) is associated with increased cardiovascular mortality. Lots of different electrocardiographic parameters can be used for this purpose. Some electrocardiographic repolarization parameters and some particular parameters obtained from 24 hours holter recordings frequently were used. The aim of this study was to evaluate ventricular arrhythmia risk by using most of this electrocardiographic parameters in patients with dipper hypertension (DHT) and NDHT.Material and methods: 220 patients with hypertension were included this study. Patients were divided into two groups as DHT and NDHT according to the 24 hours ambulatory blood pressure monitoring. Two groups were compared with electrocardiography and echocardiography parameters and also were compared with heart rate variability (HRV) and heart rate turbulence (HRT) parameters.Results: There were no significant differences between DHT and NDHT groups with regard to demographic and laboratory datas. Also echocardiography parameters normally distributed and have no significant differences between two groups. There were no significant differences between DHT and NDHT groups with regard to left ventricular mass index (p=0.280). Although QT, QT dispersion, HRV and HRT parameters differences were not statistically significant , results were in favour of DHT in terms of ventricular arrhythmia risk. Conclusion: When hypertensive patients having no statistically significant differences in terms of left ventricular diamaters and left ventricular mass between them were divided as DHT and NDHT; there were no statistically significant differences between two groups with regard to electrocardiographic ventricular arrhythmia parameters although results were in favour of DHT.

BACKGROUND Increased left ventricular mass index (LVMI) and left ventricular hypertrophy (LVH) are independent predictors of adverse cardiovascular events. However, little is known regarding the association between coronary circulation and LVMI. We aimed to investigate the association between coronary dominance and LVMI, and to demonstrate the impact of coronary dominance pattern on the emergence of LVH. METHODS In total, 367 consecutive patients without known cardiovascular disease and significant obstructive coronary artery disease who underwent diagnostic coronary angiography were prospectively included in the study. Patients were divided into three groups according to coronary dominance pattern. Patients with right dominance (RD), co-dominance (CD) and left dominance (LD) patterns were compared regarding echocardiographically detected LVMI. Additionally, the association between coronary dominance pattern and LVH was investigated. RESULTS The frequency of RD, CD and LD patterns was 70.3%, 19.1% and 10.6%, respectively. LVMI was significantly higher in patients with CD pattern compared with those with RD and LD patterns (P

Amaç: Erken repolarizasyon paterni (ERP) iyi huylu birvaryant olarak kabul edilmesine rağmen, son zamanlarda yapılan çalışmalardahayatı tehdit eden aritmilerle ilişkili olduğu gösterilmiştir. Hayatı tehditeden aritmi ve koroner arter hastalığının (KAH) şiddeti arasında güçlü birilişki olduğunu gösteren farklı çalışmalar vardır. Bu çalışmada ERP'lihastalarda Gensini skoru (GS) değerlerinin ERP'siz hastalara göre daha yüksekolup olmadığını belirlemeyi amaçladık.Gereçve Yöntemler: Çalışmaya ERP'li toplam 110 hastave 90 kontrol grubu alındı. Her hasta için GS hesaplandı. p< 0.05 anlamlıkabul edildi.Bulgular: GS, ERP’li hastalarda kontrol grubuna göreanlamlı derecede yüksekti (19.5±20.2 ve 2.15±4.1; p, Objective:Although early repolarization pattern (ERP) has been recognized as a benignvariant, in recent studies have shown that it is associated withlife-threatening arrhythmias. There are different studies demonstrated thatthere is a strong relationship between life-threatening arrhythmias and theseverity of coronary artery disease (CAD). In this study, we aimed to determinewhether Gensini score (GS) values were higher in patients with ERP compared topatients without ERP.Materialsand Methods: Totally 110 patients with ERP and 90 control subjects wereenrolled to the study. GS was calculated for each patient. p values < 0.05were considered significant.Results:GS was significantly higher in the ERP patients compared with the control group(19.5±20.2 vs 2.15±4.1; p

Aim: Coronary slow flow phenomenon (CSFP) is a microvascular circulation disorder. It is known that serum magnesium has positive effects on anti-inflammation, vasodilatation and endothelial functions. This observational study investigated the association of serum magnesium levels with CSFP.Materials and Methods: Patients who had undergone coronary angiography (CAG) after noninvasive testing were included in the study. CAG records were reassessed for CSFP and 100 patients were diagnosed as having CSFP. Control subjects (n = 80) had normal coronary flow. Serum Mg levels and other biochemical parameters such as glucose, creatinine, cholesterol levels and hemoglobin samples were collected before CAG. Serum Mg values were categorized into two groups: Mg levels equal/under and above 1.9 mg/dL.Results: The mean patient age was 56.1±9.7 years; 68.9% of patients were men. Patient’s hypertension, diabetes mellitus history and smoking habits rate were similar between groups. Biochemical tests revealed lower serum magnesium levels (1.87 vs 1.95mg/dL, p=0.02) for CSFP patients and controls, respectively. In multivariate regression analysis, a serum magnesium level under 1.9 mg/dL (OR:3.33, 95% CI:1.75-6.37, p

WOS:000603443700005 Background: Coronary artery disease (CAD) is the leading cause of mortality in hypertensive patients. Systematic Coronary Risk Evaluation (SCORE) is the preferred scoring system to predict future fatal cardiovascular events in hypertensive patients. However, the relationship between SCORE and coronary atherosclerosis is not well described. We aimed to investigate whether SCORE has a relationship with CAD severity in hypertensive patients, even in the absence of high risk features. Material and methods: Four hundred and fifty-two hypertensive patients who underwent elective coronary angiography and defined as low or moderate risk according to SCORE were included into the study. Patients were divided into two groups. Patients with a SCORE < 1% were defined as low risk group, and patients with a SCORE < 1% and < 5% were defined as moderate risk group. The groups were compared regarding CAD severity. Results: The frequency of stenotic CAD and multivessel disease, and mean SYNTAX score, were significantly higher in SCORE >= 1%, and < 5% group compared to patients with SCORE < 1%. Correlation analysis revealed a significant positive moderate correlation between SCORE and SYNTAX score (Pearson's r: 0.679, p < 0.001). ROC curve analysis demonstrated that a SCORE >= 3% predicted SYNTAX score > 22 with a sensitivity of 75% and a specificity of 86.5% (AUC: 0.879, p < 0.001). Furthermore, multivariate analysis demonstrated that SCORE was an independent predictor of stenotic CAD (OR: 1.616, p < 0.001), multivessel disease (OR: 1.913, p < 0.001), and SYNTAX score > 22. (OR: 1.817, p < 0.001). Conclusion: Our results suggest that SCORE is associated with CAD severity in hypertensive patients even in the absence of high risk features. The SCORE system may be useful in further risk stratification of hypertensive patients with moderate risk features and suspected CAD.

Amac: Ayak bilegi-kol basinc indeksi (AKI), noninvaziv ve ucuz bir metod olup yasli populasyonda periferik arter hastaliginin (PAH) tanimlanmasi icin kullanilir. PAH’nin bir gostergesi olarak AKI, koroner arter hastaligini (KAH) tahmin etmek icin yaygin bir sekilde kullanilmaktadir. Eritrosit dagilim genisligi (EDG) dolasimdaki eritrositlerin boyutlarindaki degiskenligin bir olcusudur. EDG’deki artislar hem kararli hem de kararsiz haldeki KAH ile iliskilidir. Bu calismada, kararli anjina pektoris (KAP) hastalarinda EDG ve AKI belirteclerinin SYNTAX skoru (SS) kullanilarak koroner lezyon siddeti uzerine prediktif bilgi saglayip saglayamayacagini arastirmayi amacladik. Gerec ve Yontemler: Calismaya 109 KAP hastasi dahil edildi. Hastalar once 40 hasta normal koroner arterler ve 69 hasta KAH grubuna ayrilarak degerlendirildi. Sonrasinda KAH hasta grubu, KAH siddetini anjiyografik olarak derecelendiren SS’na gore iki ayri alt gruba (SS 1-22 (n=32) ve SS >22 (n=37) ayrilarak incelendi. p

Miyokardit, miyokard dokusunda iskemik olmayan nekroz ile iliskili miyokard odemi olarak tanimlanir. Akut viral miyokardit, cesitli elektrokardiyografik degisikliklere neden olabilir. Bunlar, iletim bozukluklari, repolarizasyon duzensizlikleri, ventrikuler ektopik atimlar ve ventrikuler tasikardidir. “Torsade de pointes”, QT araliginin uzamasiyla iliskili malign ventrikuler bir aritmidir. Bu yazida Torsade de pointes ve ani kalp durmasi gelisen miyokardit olgusu sunulmaktadir.

research Amaç: Bu çalışmada, ciddi kapak işlev bozukluğu olmayan tek başına biküspit aort kapağı (BAK) bulunan hastalarda sol atriyum (SA) mekanik işlevlerini ve atriyal ileti zamanlarını (AİZ) değerlendirdik, ayrıca SA işlevleri ve aort esneklik parametreleri arasındaki ilişkiyi araştırdık.Yöntemler: Çalışma popülasyonumuz tek başına BAK bulunan 34 hasta (ortalama yaş 34±13 yıl) ile yaş ve cinsiyet açısından uyumlu 29 sağlıklı gönüllüden (ortalama yaş 30±10 yıl) oluşmaktaydı. Sol atriyum hacimleri iki düzlemli alan uzunluk yöntemi kullanılarak ölçüldü. Ayrıca SA aktif, pasif boşalma hacimleri ve fraksiyonları hesaplandı. Atriyum içi ve atriyumlar arası AİZ'ler doku Doppler görüntüleme kullanılarak ölçüldü. Aort gerilimi, aort sertlik indeksi, aort gerilebilirliği ve aort esneklik katsayısı gibi aort esneklik parametreleri hesaplandı.Bulgular: Sol atriyum çapı, en yüksek hacmi, atriyum sistolü öncesi hacmi ve SA aktif boşalma fraksiyonu BAK hasta grubunda anlamlı olarak yüksekti (sırasıyla, 33.2±3.2 mm ve 34.9±2.8 mm, p=0.030; 16.2±4.6 mL/m2 ve 19.8±4.8 mL/m2, p=0.004; 10.2±3.7 mL/m ve 12.1±4.9 mL/m2, p=0.029; %30.4±12.0 ve %39.9±11.8, p=0.003). Atriyal ileti zamanları her iki grup arasında benzerdi. Biküspit aort kapağı hasta grubunda; aort gerilebilirliği anlamlı olarak düşükken, aort sertlik indeksi ve aort esneklik katsayısı anlamlı olarak yüksekti (sırasıyla, 8.1±4.6 [10-6cm2dyn-1] ve 5.1±3.6 [10-6cm2dyn-1], p=0.006; 4.1±2.8 ve 7.3±4.9, p=0.003; 3.6±2.8 [dyn.cm-2106] vs 5.9±3.9 [dyn.cm-2106], p=0.010). Korelasyon analizinde SA aktif boşalma fraksiyonu, aort sertlik indeksi ve mitral A dalga hızı ile anlamlı derecede ilişkiliydi (sırasıyla, r=0.431; p

WOS:000412901900014 PubMed: 27534422 Intracoronary thrombus burden is associated with some adverse events and poor prognosis in patients with ST-segment elevation myocardial infarction (STEMI). Identifying predictors of the intracoronary thrombus burden may contribute to the management of STEMI. In this study, we evaluated whether monocyte count to high-density lipoprotein cholesterol ratio (MHR) is a predictor of intracoronary thrombus burden in patients with STEMI. The study population consisted of 414 patients with STEMI who underwent primary percutaneous coronary intervention (PCI). Angiographic thrombus burden was classified based on thrombolysis in myocardial infarction (TIMI) thrombus grades. The patients were grouped into 2 categories of low thrombus burden and high thrombus burden. The MHR was significantly higher in the high thrombus burden group compared with the low thrombus group (16.0 [9.2-22.1] vs 25.4 [13.5-44.6]; P < .001). In multivariate logistic regression analysis, MHR was an independent predictor of high thrombus burden (odds ratio: 1.067, 95% CI: 1.031-1.105; P < .001). The area under the receiver-operating characteristic curve of the MHR was 0.688 (0.641-0.733; P < .001) to predict high thrombus burden. In conclusion, MHR was independent predictor of high thrombus burden in patients with STEMI who underwent primary PCI.

Myocardial fibrosis causes the fragmentation of QRS complexes on electrocardiogram. We hypothesized that the frequency of fragmented QRS (fQRS) could be more common in patients with psoriasis vulgaris than in healthy control subjects. In this prospective study, 100 patients with psoriasis vulgaris who did not have any cardiovascular disease were compared with 50 healthy volunteers in control group. The Psoriasis Area Severity Index (PASI) was used for expressing the severity of psoriasis. Patients with psoriasis were categorized according to presence of fQRS in ECG [fQRS (+) group and fQRS (−) group]. Patients with psoriasis had higher frequency of fQRS, higher levels of C reactive protein (CRP) and sedimentation rate (ESR) than the control group (n = 49, 49 % vs. n = 3, 6 %, p

Introduction:Bipolar disorder (BD) is asignificant mental health concern in the world. Most of the drugs used in thetreatment of bipolar disease may cause life-threatening arrhythmias byaffecting the distribution of ventricular repolarization (VR). VR is commonlyassessed using QT interval and Twave measurements. The aim of this study was toevaluate VR using the T peak to T end (Tp-e) interval and the Tp-e/QT ratio andto investigate the relationship between lithium therapy and VR parameters inpatients with BD.Patientsand Methods: Forty-six BDpatients under lithium therapy and 45 participants in a control group wereincluded in our study. The Tp-e interval and Tp-e/QT ratio were measured using12derivation electrocardiography (ECG). These parameters were compared betweengroups.Results:The QTinterval (p= 0.01), QTc interval (p= 0.003), Tp-e interval (p< 0.001), andTpe/QT ratio (p= 0.009) were significantly higher in patients with BD than inthe control group. There was a positive correlation between the Tp-e intervaland serum lithium levels (r= 0.317, p< 0.032). In addition, the increasedserum lithium level (β= 0.398, p= 0.007) was found to be an independentpredictor of the prolonged Tp-e interval.Conclusion:ProlongedTp-e interval may be a useful indicator of increased risk of ventriculararrhythmia in patients using lithium therapy., Giriş: Bipolar bozukluk (BD) dünyada önemli birmental sağlık sorununudur. Bipolar bozukluk tedavisinde kullanılan ilaçlarınçoğu, ventriküler repolarizasyonun (VR) dağılımını etkileyerek hayatı tehditeden aritmilere neden olabilir. VR genellikle QT aralığı ve T dalgası ölçümlerikullanılarak değerlendirilir. Bu çalışmanın amacı, Tp-e intervali ve Tp-e/QToranını kullanarak VR’yi değerlendirmek ve bipolar bozukluğu olan hastalardalityum tedavisi ve VR parametreleri arasındaki ilişkiyi araştırmaktır.Hastalar veYöntem: Çalışmamıza lityum tedavisi alan 46 hasta ve 45 katılımcıdanoluşan kontrol grubu dahil edildi. Tp-e aralığı ve Tp-e/QT oranı 12-derivasyonelektrokardiyografi (EKG) kullanılarak ölçüldü. Bu parametreler gruplar arasındakarşılaştırıldı.Bulgular: Bipolar bozukluk olan hastalarda QT interval (p= 0.01),QTc interval (p = 0.003), Tp-e interval (p< 0.001) ve Tp-e / QT oranı (p=0.009) kontrol grubuna göre anlamlı olarak yüksek bulundu. Tp-e intervali ileserum lityum düzeyleri arasında pozitif korelasyon vardı (r= 0.317, p

Background: Ventricular premature contractions (VPCs) may trigger lethal ventricular arrhythmias in patients with structural heart disease. However, this role of VPCs in healthy people remains controversial once that not enough clinical trials are available. Recently, some myocardial repolarization markers, such as Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios, have been reported to be useful for predicting lethal ventricular arrhythmias in various clinical disorders without structural heart disease. Objective: In this study, we aimed to investigate the relation between VPC frequent and myocardial repolarization markers in individuals without structural heart disease. Methods: This study included 100 patients who had complaints of dizziness and palpitations. Twelve-lead electrocardiography and 24-hour ambulatory Holter recordings were obtained from all patients. VPC burden was calculated as the total number of VPCs divided by the number of all QRS complexes in the total recording time. P-values < 0.05 were considered significant. Results: Tp-e interval and Tp-e/QTc ratio were significantly higher in patients with higher VPC burden than in patients with lower VPC burden, and a positive correlation was found between these markers and VPC burden. Tp-e (β = 1.318, p = 0.043) and Tp-e/QTc (β = -405.136, p = 0.024) in the lead V5 were identified as independent predictors of increased VPC burden. Conclusions: Tp-e interval and Tp-e/QTc ratio increased in patients with high VPC number. Our study showed that VPCs may have a negative effect on myocardial repolarization. This interaction may lead to an increased risk of malignant arrhythmias. Resumo Fundamento: As contrações ventriculares prematuras (CVPs) podem provocar arritmias ventriculares letais em pacientes com doença cardíaca estrutural, no entanto o papel das CVPs em indivíduos saudáveis permanece controverso, já que não há muitos estudos clínicos disponíveis. Recentemente, alguns marcadores de repolarização do miocárdio, tais como o intervalo Tp-e e as relações Tp-e/QT e Tp-e/QTc, foram relatados como úteis para prognosticar arritmias ventriculares letais em diversos transtornos clínicos sem doença cardíaca estrutural. Objetivo: Neste estudo, o objetivo foi investigar a relação entre os marcadores de repolarização do miocárdio e as CVPs frequentes em indivíduos sem doença cardíaca estrutural. Métodos: Este estudo incluiu 100 pacientes com queixas de tonturas e palpitações. Eletrocardiografia de 12 derivações e registros de Holter ambulatorial de 24 horas foram obtidos de todos os pacientes. A carga de CVP foi calculada como o número total de CVPs dividido pelo número de todos os complexos de QRS no tempo de registro total. Foram considerados significativos valores p < 0,05. Resultados: O intervalo Tp-e e a relação Tp-e/QTc foram significativamente mais altos em pacientes com carga de CVP mais alta do que nos pacientes com carga de CVP inferior, e encontrou-se correlação positiva entre esses marcadores e a carga de CVP. Tp-e (β = 1,318, p = 0,043) e Tp-e/QTc (β = -405,136, p = 0,024) na derivação V5 foram identificados como preditores independentes da carga de CVP aumentada. Conclusões: O intervalo Tp-e e a razão Tp-e/QTc foram mais altos em pacientes com um valor mais alto de CVP. Nosso estudo mostrou que CVPs podem ter um efeito negativo na repolarização do miocárdio. Essa interação pode resultar em risco aumentado de arritmias malignas.

WOS:000405948700006 PubMed: 28759086 Background: Familial Mediterranean fever (FMF) is a chronic, recurrent auto-inflammatory disease characterised by self-terminating attacks of fever and sterile polyserositis. The main cause of death in auto-inflammatory diseases is cardiovascular events. Additionally, auto-inflammatory diseases have potential effects on the myocardial repolarisation parameters, including the T-wave peak-to-end (Tp-Te) interval, cTp-Te interval (corrected Tp-Te) and the cTp-Te/QT ratio. The aim of this study was to analyse the efficacy of myocardial repolarisation alterations in anticipation of cardiovascular risks in patients with FMF. Methods: This study included 66 patients with FMF and 58 healthy control subjects. Tp-Te and cTp-Te intervals and the cTp-Te/QT ratio were measured from the 12-lead electrocardiogram. Results: In electrocardiographic parameters, analysis of QT, QT dispersion, corrected QT (QTc) and QTc dispersion were similar between the groups. The Tp-Te and cTp-Te intervals and Tp-Te/QT and cTp-Te/QT ratios were significantly prolonged in FMF patients. Multivariate linear regression analyses indicated that erythrocyte sedimentation rate was an independent predictor of a prolonged cTp-Te interval. Conclusions: Our study revealed that when compared with control subjects, Tp-Te and cTp-Te intervals and cTp-Te/QT ratio were increased in FMF patients.

WOS:000423284900007 PubMed: 29256874 Objective: Psoriasis is a chronic inflammatory disorder, which affects around 1%-3% of the human population worldwide. Cardiovascular events are the leading cause of morbidity and mortality in patients with psoriasis. Some studies have reported that psoriasis is related to increased arrhythmias. The Tp-e interval and Tp-e/QT ratio have been accepted as new markers for the assessment of myocardial repolarization and ventricular arrhythmogenesis. The aim of this study was to assess ventricular repolarization in patients with psoriasis using Tp-e interval and Tp-e/QT ratio. Methods: The study population consisted of 74 patients with psoriasis and 74 healthy volunteers. The diagnosis of psoriasis was based on a clinical or histopathological examination of all patients. QT interval, corrected QT (QTc), QT dispersion (QTd), Tp-e interval, corrected Tp-e, and Tp-e/QT ratio were measured from the 12-lead electrocardiogram. These parameters were compared between groups. Results: According to the electrocardiographic parameters, QT and QTc intervals and QTd were significantly higher in patients with psoriasis than in control subjects (p

Aim: Our aim was to evaluate whether there was a relationship between mean platelet volume and myocardial perfusion defect in diabetic patients using myocardial perfusion imaging. Method: Forty-four diabetic patients with myocardial perfusion defect (group 1) and 44 diabetic patients without myocardial perfusion defect (group 2), matched for age and gender, were retrospectively examined. Levels of mean platelet volume (MPV) in the two groups were assessed. Results: MPV was higher in group 1 than group 2 patients (8.76 ± 0.76 and 8.25 ± 0.78 fl), respectively, p = 0.003). Levels of glucose, triglycerides (TG), total cholesterol (TC), low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, haemoglobin (Hb) and glycosylated haemoglobin (HbA1c), and body mass index (BMI) in the two groups were not statistically significantly different. Multivariate logistic regression analyses showed that MPV was the only variable independently associated with myocardial perfusion defects (OR: 2.401, 95% CI: 1.298-4.440, p = 0.013). Conclusion: This study showed that higher MPV was associated with myocardial perfusion defects. Higher MPV in diabetic patients was independently related to myocardial perfusion defects and may be an indicator of myocardial ischaemia.

Objectives: Percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) is associated with lower rates of procedural success and higher complication rates compared with PCIs in non-CTO lesions. The purpose of this study was to analyze the relationship between lesion characteristics and procedural success rates and in-hospital outcomes after PCI for CTO with novel equipment. Study design: We evaluated the prospectively entered data of 63 consecutive patients undergoing PCI for CTO at our institute between August 2009 and June 2012. Results: A total of 63 patients (mean age: 64+-11, 71% male) with one CTO lesion each underwent PCI. There were 46 patients (mean age: 63+-10, 70% male) in the CTO success group and 17 patients (mean age: 65+-13, 76.5% male) in the CTO failure group. Successful revascularization was achieved in 73% of patients. We used antegrade approach in 61 cases and retrograde approach in 2 cases. Our predominant strategy was single-wire technique, which was used in 54 cases (85.7%), followed by parallel-wire technique in 7 cases (11.1%). Moderate-to-severe tortuosity (odds ratio [OR]: 9.732, 95% confidence interval [CI]: 1.783- 53.115, p=0.009) and occlusion duration (OR: 1.536, 95% CI: 1.178-2.001, p=0.002) were independent predictors of procedural failure in the multivariate analysis. No in-hospital major cardiac events occurred. Conclusion: We have reported a study with a relatively high success rate of PCI with very low procedural and in-hospital complications. Moderate-to-severe tortuosity was observed as the most challenging problem despite the utilisation of novel equipment and techniques for CTO recanalization.

Background Due to sensorial autonomic neuropathy, the type and severity of angina pectoris in patients with diabetes mellitus (DM) may be rather different from the type and severity of angina pectoris in patients without DM. Hypothesis The aim of the study was to understand if angina pectoris is related to extensive coronary artery disease (CAD) in patients with DM. Methods The study included 530 patients with DM who underwent coronary angiography at our center in 2009 and 2010. Patients were divided into 4 groups according to type of chest pain: group 1, noncardiac chest pain or no pain; group 2, angina equivalent; group 3, atypical angina; and group 4, typical angina. All angiograms were re-evaluated and Gensini scores were calculated. Three-vessel disease was diagnosed in the presence of stenosis >50% in all 3 coronary artery systems. Results There were no statistically significant differences between the groups with regard to age, sex, systolic or diastolic blood pressures, body mass index, creatinine clearance, or lipid profile. Fasting blood glucose was significantly higher in group 4 than in group 2. Gensini scores were not statistically different between groups 1 and 2 or between groups 3 and 4; however, the scores for groups 3 and 4 were higher than the score for either group 1 or group 2. Prevalence of 3-vessel disease was significantly higher in groups 3 and 4 compared with the other groups. Conclusions The presence of angina pectoris was related to extensive CAD in patients with DM. The extent of CAD was not correlated with the type of angina (typical or atypical).

Longed QT syndromes are cardiac repolarization disorders characterized by longed QT intervals on ECG. This electrophysiological abnormality may lead to syncope or sudden cardiac death due to rapid, polymorphic ventricular tachycardia (VT). Licorice root (Glycyrrhizin glabra root) contains Glycyrrhizin, sterols and many flavones. Glycyrrhizin may have effects on cardiac repolarization and depolarization through the autonomic nervous system. We present a case of polymorphic VT (torsades de pointes) secondary to drinking 5-6 glasses of licorice root tea for constipation for 2 days prior to admission to emergency department. Licorice root consumption should be taken into account in all patients admitted to the hospital for cardiac arrhythmia. It may cause cardiac arrhythmia when consumed regularly and in excessive amounts.

Objectives: Left ventricular (LV) systolic synchrony, defined as simultaneous peak contractions of corresponding cardiac segments, is well documented to be impaired in hypertension but its effect on LV function is not clear. The aim of this study was to assess the impacts of LV systolic dyssynchrony on LV function in newly diagnosed hypertensives. Methods: Forty-eight newly diagnosed hypertensive patients and 33 controls were enrolled. All study population underwent a comprehensive echocardiographic evaluation including tissue synchrony imaging. The time to regional peak systolic tissue velocity (Ts) in LV by 12 segmental models was measured and two parameters of systolic dyssynchrony were computed. Results: Baseline demographic characteristics were similar in both study groups. Dyssynchrony parameters prolonged in newly diagnosed hypertensive patients compared to controls: the standard deviation (SD) of 12 LV segments Ts (40.2 ± 21 vs. 26.2 ± 13.4, P = 0.003); the maximal difference in Ts between any 2 of 12 LV segments (123.3 ± 61.5 vs. 79.8 ± 37.9, P = 0.001). In multivariable analysis, Ts-SD-12 was found to be an independent predictor for systolic function (β=–0.29, P = 0.008). But, both diastolic and global functions were not independently related to Ts-SD-12. Conclusion: LV synchronization is impaired in newly diagnosed hypertensive patients. LV dyssynchrony is one of the independent predictors of systolic function in hypertensive patients.

Objectives: Ankylosing spondylitis (AS) is a chronic inflammatory disease that often leads to cardiovascular complications including aortic regurgitation and conduction disturbances. Left ventricular (LV) systolic asynchrony is defined as loss of the simultaneous peak contraction of corresponding cardiac segments. The aim of this study was to evaluate LV systolic asynchrony noninvasively in patients with AS by using tissue synchrony imaging (TSI). Methods: Asynchrony was evaluated in 77 AS patients (61 male, mean age 36.4 ± 10 years) and 40 controls (35 male, mean age 39.1 ± 8.2 years). All study population underwent a comprehensive echocardiographic evaluation including TSI. The time to regional peak systolic velocity (Ts) during the ejection phase in LV was measured from TSI images by the six-basal and six-midsegmental model, and four TSI parameters of systolic asynchrony were computed. Results: The baseline demographic and echocardiographic characteristics were similar between the patients enrolled and controls. All TSI parameters of LV asynchrony were prolonged in patients with AS compared to controls: the standard deviation (SD) of the 12 LV segments Ts (39.6 ± 19.6 vs. 24.7 ± 11.6, P < 0.001); the maximal difference in Ts between any 2 of the 12 LV segments (122.1 ± 52.9 vs. 82.2 ± 38.6, P < 0.001); the SD of the six basal LV segments (33.5 ± 20.2 vs. 23 ± 13.3, P = 0.008); and the maximal difference in Ts between any two of the six basal LV segments (84.6 ± 48.1 vs. 60.4 ± 34.6, P = 0.008). The asynchrony parameters were significantly correlated with index of myocardial performance (Tei index) and peak systolic mitral annular velocity. Conclusion: TSI showed presence of LV systolic asynchrony in patients with AS which may account for the cardiovascular complications of AS. (Echocardiography 2012;29:661-667)

Objectives: Primary hyperparathyroidism (PHP) is associated with a variety of cardiovascular disturbances such as left ventricular (LV) hypertrophy, diastolic cardiac dysfunction, and hypertension. LV asynchrony is defined as the loss of the simultaneous peak contraction of corresponding cardiac segments. The objective of this study was to assess systolic asynchrony in patients with overt hyperparthyroidism. Methods: Asynchrony was evaluated in 22 patients with PHP and 24 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-midsegmental model was measured on ejection phase TSI images and four TSI parameters of systolic asynchrony were computed. Results: All TSI parameters of LV asynchrony increased in patients with PHP patients compared to the controls: the standard deviation (SD) of the 12 LV segments Ts (37.3 ± 20.6 vs. 21.5 ± 11.1, P = 0.01); the maximal difference in Ts between any 2 of the 12 LV segments (111.2 ± 59.8 vs. 70.2 ± 32.1, P = 0.01); the SD of the 6 basal LV segments (42.9 ± 36.4 vs. 18.5 ± 13, P = 0.003); and the maximal difference in Ts between any 2 of the 6 basal LV segments (89.6 ± 50.5 vs. 48 ± 31.1, P = 0.003). Conclusion: Patients with PHP show an evidence of LV asynchrony by TSI. Asynchrony may contribute to the harmful cardiovascular effects of PHP. (Echocardiography 2011;28:955-960)

Objective: Cardiac syndrome X (CSX) is characterised by typical exertional chest pain, a positive response to exercise testing, and a normal coronary angiography. The relationship of CSX with myocardial fibrosis and ischemia has been clearly demonstrated in previous studies. In addition, fragmented QRS (fQRS) has been reported in the literature as an indicator of myocardial fibrosis. The aim of this study was to investigate the frequency of fQRS in patients with CSX. Methods: This prospective case-control study included 37 patients (CSX group) with typical complaints of angina, ischemia on an exercise test, and normal coronary arteries as detected by angiography and 47 patients (control group) with normal coronary arteries. Echocardiographic examinations were performed according to the recommendations of the American Society of Echocardiography. Continuous variables were expressed as mean±standard deviation (SD), and the qualitative variables were expressed as a percentage or ratio. Data were compared statistically with Shapiro–Wilk test, Student’s t-test, Mann-Whitney U, chi-square and Fisher exact test. Results: There was no significant difference between the CRX and control groups with respect to basic characteristics such as age and sex. fQRS and the frequency of its presentation with stable angina pectoris at the clinic were significantly higher in the CSX group than in the control group (p values: 0.001 and

Background: Family history of premature atherosclerosis imposes a high risk to people. The relationship between atherosclerosis and gene polymorphisms of various biomarkers such as Endothelial Nitric Oxide Synthase (eNOS), C-Reactive Protein (CRP), and Interleukin-6 (IL-6) has shown in previous studies. Aims: The major aim of the study was to evaluate the CRP, eNOS, and IL-6 gene polymorphisms in a group of adolescents who have a parental history of early coronary artery disease (CAD). Study Design: Case-control study. Methods: Thirty-six volunteers with a father with obstructive CAD during the first four decades and 46 subjects with a father with normal coronary arteries documented with coronary angiography were included in the study. Polymerase chain reaction-restriction fragment length polymorphism techniques were used to analyze CRP, eNOS, and IL-6 polymorphisms. Results: We did not find any differences between the two groups with regard to age, sex, body mass index, renal functions, systolic and diastolic blood pressures, lipid profile, and fasting glucose, hemoglobin, and high sensitivity CRP. A significant difference was only observed in IL-6-572 G/C genotype distribution and allele frequency between two groups (Pc=0.036 OR=3.48 CI (95%) 1.17-10.32). Conclusion: The present study showed a significant association between the IL-6-572 G/C gene polymorphism (presence of C allele) and adolescents with a parental history of premature CAD.

Kadı, Hasan (Balikesir Author), Objective: The aim of the study was to investigate the effect of intragastric balloon therapy on left ventricular function and left ventricular mass in a cohort of morbidly obese patients. Subjects and Methods: A prospective trial was performed in a cohort of 17 class II and class III morbidly obese individuals. The intragastric balloon was retained in the stomach for an average of 6 months. Conventional and tissue Doppler echocardiography were performed in all patients before and after the procedure. Results: The mean age of the study participants was 36 +/- 10 years (range: 18-55). The mean body mass index was significantly decreased following the intragastric balloon insertion procedure (44 +/- 8 vs. 38 +/- 5, p < 0.001). The left ventricular mass index and left atrial volume index were significantly decreased following the procedure (112 +/- 21 vs. 93 +/- 17, p = 0.001 and 20 +/- 6 vs. 14 +/- 5, p = 0.02, respectfully). In addition, the ratio of mitral peak early diastolic velocity to tissue Doppler-derived peak diastolic velocity and tissue Doppler echocardiography-derived left ventricular myocardial performance index were decreased significantly following the procedure (9.5 +/- 1.9 vs. 7.7 +/- 1.5, p = 0.002 and 0.57 +/- 0.11 vs. 0.46 +/- 0.06, p = 0.001, respectively). Conclusions: Intragastric balloon therapy resulted in significant weight reduction in morbidly obese patients. This weight reduction was associated with improved left ventricular function.

WOS:000408211500011 PubMed: 28765740 Background and Objectives: Systemic inflammation has an important role in the initiation of atherosclerosis, which is associated with arterial stiffness (AS). Aortic flow propagation velocity (APV) is a new echocardiographic parameter of aortic stiffness. The relationship between systemic inflammation and AS has not yet been described in patients with familial Mediterranean fever (FMF). We aimed to investigate the early markers of AS in patients with FMF by measuring APV and carotid intima-media thickness (CIMT). Subjects and Methods: Sixty-one FMF patients (43 women; mean age 27.3 +/- 6.7 years) in an attack-free period and 57 healthy individuals (36 women; mean age 28.8 +/- 7.1 years) were included in this study. The individuals with atherosclerotic risk factors were excluded from the study. The flow propagation velocity of the descending aorta and CIMT were measured to assess AS. Results: APV was significantly lower (60.2 +/- 16.5 vs. 89.5 +/- 11.6 cm/sec, p

Deli balı zehirlenmesi nadir ve yerel görülen hafif düzeyden ciddi hayatı tehdit eden kardiyak aritmilere neden olabilmektedir. Olgumuz 52 yaşında bayan bir hasta deli balı alımı sonrası, yorgunluk, sersemlik ve baş dönmesi şikayeti ile acil servisimize başvurdu. Yapılan fizik muayenesinde tansiyonu 70/40 mmHg, nabzı 45/dk idi. Öncesinde kardiyak hastalığı ve ilaç kullanımı olmayan hastanın elektrokardiografi (EKG) kaydında atriyal fibrilasyon ve atriyoventriküler (AV) tam blok gözlendi. Hasta acil müdahale sonrası takibe alındı. Takiplerinde şikayetleri gerileyen ve genel durumu stabil olan hasta öneriler ile taburcu edildi. Sonuç olarak, deli balı alımı sonrası hayati tehdit eden aritmiler oluşabilmektedir. Bu sağlık problemi sadece Türkiye’de bazı bölgelerle sınırlı değildir, besin taşıyıcılığı ile bütün dünyada artış göstermektedir. Klin Deney Ar Derg 2011;2(2):216-8 Mad honey intoxication is rarely and locally seen, and it can cause cardiac arrhythmias from mild to life threatening health problems. A 52 year-old female patient admitted to our emergency room with dizziness and fatigue after ingestion of bitter honey. On examination in emergency room, her blood pressure was 70/40 mmHg and pulse value was 45/min. Atrial fibrillation and AV complete block rhythm was detected on her Electrocardiography (ECG) recording. She had no history of known-cardiac disease and use of medicine. On follow-up, her general health status got back to normal. The patient was discharged after her medical status was improved. In conclusion bitter honey intoxication can be life-threatening arrhythmias in people after ingestion of it. It is not restricted health problem to only that region of Turkey, but also to worldwide due to increase in people movement and international nutrition transport. J Clin Exp Invest 2011;2(2):216-8

WOS:000335444500041 PubMed: 26060490 Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia and increases the risk of stroke and death. Patients with hypertensive have an increased risk of developing atrial fibrillation. RDW (Red blood cell distribution width) levels are elevated in cardiovascular disorders including heart failure, stable coronary disease, acute coronary syndrome, slow coronary flow and stroke. Objective: We aimed to investigate the relation between RDW and AF in patients with hypertensive Method: We retrospectively examined 126 consecutive hypertensive patients (63 hypertensive patients with AF and 63 hypertensive patients without AF matched with age and sex Results: The mean age of the study population was 71,09 +/- 8,50 (af group) and 70,97 +/- 8,24 (non-af group) years. RDW level was different among patients with atrial fibrillation and without atrial fibrillation.(15,13 +/- 1,58 and 14,05 +/- 1,15 p

OBJECTIVES In this study, systolic and diastolic function parameters were measured with conventional and tissue Doppler echocardiography in coronary slow flow phenomenon (CSFP) patients and compared to those of a control group. STUDY DESIGN Sixty patients (49 male; mean age 52.4±12.1) in whom CSFP was detected during coronary angiography study and 30 volunteers with normal coronary arteries (21 males; mean age 50.2±12.1) were included in this study. CSFP was determined using the TIMI frame count (TFC) method. TIMI frame count was calculated in each coronary artery using the TFC method. Left ventricular systolic and diastolic function was assessed by conventional echocardiography and tissue Doppler imaging. TFC correlation between diastolic function parameters was measured. RESULTS Baseline demographic and laboratory results did not differ significantly between the groups. TIMI frame counts were greater in the CSFP group compared to controls (p

A relationship between atrial conduction time and hypertension was shown in previous studies. Increased atrial electromechanical intervals used to predict atrial fibrillation by measured tissue Doppler imaging (TDI). So we aimed to search if there was any association between the non-dipping status and atrial electromechanical intervals in pre-hypertensive patients.Forty-one non-dipper and 33 dipper pre-hypertensive subjects enrolled in the study. Systolic and diastolic blood pressures were measured with a mercury sphygmomanometer. Twenty-four hours blood pressure was measured with cuff-oscillometric method. All patients were evaluated by transthoracic echocardiography. Using tissue Doppler imaging (TDI), atrial electromechanical coupling (PA) was measured from the lateral mitral annulus (PA lateral), septal mitral annulus (PA septum) and right ventricular tricuspid annulus (PA tricuspid).Systolic and diastolic blood pressures were significantly higher in subjects with non-dipper phenomenon than dipper ones at night. Twenty-four hours average systolic and diastolic blood pressures were higher in non-dipper pre-hypertensive subjects, but this elevation was not significant. Left and right intraatrial (PA lateral-PA septum and PA septum-PA tricuspid) and interatrial (PA lateral-PA tricuspid) electromechanical coupling intervals were measured significantly higher in non-dipper pre-hypertensive patients (31.3 ± 3.9 versus 24.1 ± 2.3, p = 0.001; 19.5 ± 4.3 versus 13.8 ± 2.1, p = 0.001; and 11.4 ± 2.8 versus 8.8 ± 1.5, p = 0.001). Also, interatrial electromechanical delay was negatively correlated with dipping levels.This study showed that prolonged atrial electromechanical intervals were related non-dipper pattern in pre-hypertensive patients. Prolonged electromechanical intervals may be an early sign of subclinical atrial dysfunction and arrhythmias' in non-dipper pre-hypertensive patients.

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

Objective: To investigate the possible relationship between mitral annular calcification (MAC) and arterial stiffness. Subjects and Methods: Forty-two patients (mean age 68 ± 6 years) with MAC and an age-matched control group of 41 individuals (mean age 66 ± 6 years) were studied. Arterial stiffness and wave reflections of the study population were evaluated by using applanation tonometry (SphygmoCor). Aortic pulse wave velocity (PWV) was measured as an index of aortic stiffness. The heart rate-corrected augmentation index (AIx@75) was estimated as a composite marker of wave reflections and arterial stiffness. Results: Aortic PWV was significantly higher in patients with MAC (12.2 ± 2.3 m/s) than in controls (10.1 ± 1.3 m/s, p = 0.0001). However, AIx@75 was similar between the groups (28 ± 10 vs. 29 ± 10%, p = 0.59). Multivariate analysis involving the whole population revealed that brachial diastolic blood pressure (β = 1.87, p = 0.04) and MAC (β = 0.41, p = 0.0001) were independent determinants of aortic PWV. Conclusion: The data showed that MAC was significantly associated with increased arterial stiffness and that it was an independent determinant of aortic PWV.

OBJECTIVE The role of increased troponin level in risk stratification of acute pulmonary embolism (PE) is well documented. However, relation between right ventricular (RV) myocardial performance (Tei) index and cardiac troponin-T (cTn-T) has not been well investigated. The purpose of this observational prospective study was to assess the relationship between the RV Tei index and cTn-T in patients with acute normotensive PE. METHODS Thirty-eight patients with acute PE diagnosed by computed spiral tomography pulmonary angiography were enrolled to this prospective observational study. All study population underwent a comprehensive echocardiographic study including tissue Doppler imaging within first 12 hours of admission. cTn-T levels were measured on admission. Follow-up echocardiography was performed routinely at the 7th day of hospitalization. Echocardiographic evaluation was repeated at 90 days in patients with insufficient improvement of RV Tei index. The difference between the baseline and follow-up data was analyzed using the paired sample t-test or Wilcoxon test according to normality of distribution. RESULTS The mean of the RV Tei index was 0.46 ± 0.14 and the mean systolic pulmonary artery pressure (sPAP) was 40 ± 20 mmHg. Increased cTn-T level was detected in 37% of the patients (normal value 0.01< ng/mL). Significant correlations were observed between RV Tei index and sPAP with cTn-T levels (r=0.467 and r=0.468, p

Left ventricular (LV) systolic synchrony, defined as simultaneous peak contractions of corresponding cardiac segments, is well documented to be impaired in hypertension but its effect on LV function is not clear. The aim of this study was to assess the impacts of LV systolic dyssynchrony on LV function in newly diagnosed hypertensives.Forty-eight newly diagnosed hypertensive patients and 33 controls were enrolled. All study population underwent a comprehensive echocardiographic evaluation including tissue synchrony imaging. The time to regional peak systolic tissue velocity (Ts) in LV by 12 segmental models was measured and two parameters of systolic dyssynchrony were computed.Baseline demographic characteristics were similar in both study groups. Dyssynchrony parameters prolonged in newly diagnosed hypertensive patients compared to controls: the standard deviation (SD) of 12 LV segments Ts (40.2 ± 21 vs. 26.2 ± 13.4, P = 0.003); the maximal difference in Ts between any 2 of 12 LV segments (123.3 ± 61.5 vs. 79.8 ± 37.9, P = 0.001). In multivariable analysis, Ts-SD-12 was found to be an independent predictor for systolic function (β=-0.29, P = 0.008). But, both diastolic and global functions were not independently related to Ts-SD-12.LV synchronization is impaired in newly diagnosed hypertensive patients. LV dyssynchrony is one of the independent predictors of systolic function in hypertensive patients.