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Purpose: The aim of our study was to determine the prevalence of obesity and abdominal obesity in the West Black Sea region of Turkey and to display the associated chronic diseases, especially Diabetes Mellitus (DM) in this population.Material and Method: We evaluated 2222 (1418 female, 804 male, mean age: 50) participants in Yigilca. The medical histories were recorded and physical examinations were done in all participants. Body weight categories were defined according to the body mass index (BMI) as follows: BMI 94 cm in males and >90 cm in females were accepted as the cut-off points for abdominal obesity. Results: The mean BMI of the participants was 30.6 in females and 27.5 in males. According to BMI, obesity prevalence was 53.1% in females and 26.9% in males. The mean obesity prevalence was 43.5% in general. Abdominal obesity prevalence was 63% in females, 46% in males and 57% in all participants. Obesity prevalence increased with age in both sexes. Especially 3/4 (75%) of females and 1/3 (33%) of males aged 50-59 years were obese. Postmenopausal females had very high (64%) obesity prevalence but the rate was %43 in premenopausal women. While DM prevalence was 12.6% according to patient history, DM prevalence increased to 18.8% by adding patients with fasting glucose >126 mg/dl.Discussion: Obesity, especially abdominal obesity and DM prevalence was found to be at exaggerated rates in both sexes being highest in postmenopausal females. Turk Jem 2012; 16: 52-7

Background: The prevalence of obesity is increasing in the developed and developing world. It is an independent risk factor for heart failure. Left ventricular (LV) diastolic dysfunction has been demonstrated to be a strong predictor of heart failure. In the present study we aimed to assess the impact of body weight on LV diastolic function. Methods: The study was conducted on 2,228 participants (1,424 women, 804 men with a mean age of 49). Traditional and tissue Doppler echocardiographic examination were performed in all of the participants. The demographic and echocardiographic data were compared. Multivariate logistic regression analysis was used to assess the independent predictors of association of LV diastolic function. The study sample was divided into four groups: group 1 (body mass index [BMI] < 25.0 kg/m2), group 2 (BMI 25.0–29.9 kg/m2), group 3 (BMI ≥ 30–39.9 kg/m2), and group 4 (BMI ≥ 40 kg/m2). Results: Septal E was significantly lower in groups 2 and 3 compared to group 1 (P = 0.003). Septal A and septal A’ were significantly higher whereas septal E’ and lateral E’ were significantly lower in the groups 2, 3, and 4 compared to the normal weight group (P < 0.001). Lateral A’, deceleration time, and ejection time were significantly higher in obese when compared to the normal weight (P = 0.025, P < 0.001, and P = 0.009, respectively). The E/E’ ratio was significantly higher in groups 2, 3, and 4 compared to the group 1 (P < 0.001). Logistic regression analysis revealed that age, BMI (OR = 1.060 [95% CI = 1.040 and 1.080]; P < 0.001), hypertension, and diabetes mellitus were independent predictors of LV diastolic dysfunction. Conclusion: BMI is an independent predictor of LV diastolic dysfunction along with age, hypertension, and diabetes mellitus. (Echocardiography 2012;29:647-651)

Objective Subjects with nondipper hypertension carry a higher risk of cardiovascular events than their normotensive counterparts. The present study was designed to investigate cystatin C levels in patients with dipper and nondipper hypertension. Methods Eighty-eight consecutive patients who had been treated with antihypertensive drugs for at least 6 months were included in the study. Dipping and nondipping patterns were detected with ambulatory blood pressure monitoring. Clinical, laboratory, and ambulatory blood pressure monitoring data of patient groups with nondipper and dipper hypertension were compared. Results Patients in the nondipper group were older than those in the dipper group. Serum cystatin C level was higher in the patients in the nondipper group. Cystatin C was negatively correlated with the rate of systolic blood pressure fall at night ( r = −0.41; P < 0.001). Linear regression analyses revealed that only cystatin C level was a significant correlate of nocturnal systolic blood pressure decrease. Logistic regression analyses also showed that cystatin C was an independent predictor of nondipping pattern (odds ratio, 3.586; 95% confidence interval, 1.432–8.98; P = 0.006]). Conclusion The present study showed that cystatin C is higher in patients with nondipper hypertension patients.

WOS: 000298836300011 PubMed: 22299387 Objective Carotid intima media thickness (CIMT) is a strong predictor of future vascular events. However, data for Turkish individuals are limited and the association between cardiometabolic risk factors and CIMT has not been studied before. Therefore, we sought to investigate the CIMT and cardiometabolic risk associates in a large cohort of Turkish adults. Methods and results The study was conducted on 2230 participants (1427 women, 803 men with a mean age of 49). The participants underwent a Doppler Ultrasound examination of CIMT. Mean CIMT was 0.61 +/- 0.19 mm. Age- and sex-adjusted partial correlation analysis revealed that only systolic blood pressure and smoking amount was significantly correlated with CIMT. Receiver operator characteristics (ROC) calculations showed that age had the best area under the curve (AUC =0.84), smoking had the best sensitivity (86%) and diastolic blood pressure (>88 mmHg) had the best specificity (74%) in predicting a person with thickened carotid intima media (>0.8 mm). Independent predictors of thickened carotid intima media were hypertension [(odds ratio (OR) = 2.74; 95% confidence interval (Cl) = 1.663-4.53; P value

Aim: The aim of the Melen Study was to investigate the cardiovascular risk profile of Turkish adults by utilizing newest techniques. Besides prevalence and types of endemic goiter will be established which was an important health problem in the Black sea region Method: The study was conducted on 2230 participants (1427 women, 803 men with a mean age of 49). The participants underwent a Doppler Ultrasound examination of carotid intima media thickness, echocardiographic examination, ECG recording, bioempedance meter analysis of body composition, pulmonary function test and various biochemical analysis. Result: Twenty nine percent of the population had hypertension, 12% had diabetes mellitus and 17% were smokers. Thyroid ultrasonography revealed that 29% of the cohort had goiter. Echocardiographic measurements showed that 39% of the participants had diastolic dysfunction. Comparison of males with females showed that men had significantly higher visceral fat, triglyceride, hemoglobin and CIMT whereas women had higher mean diastolic blood pressure, HDL and total cholesterol. Conclusion: According to the histories of patients, hypertension, diabetes mellitus and smoking were very frequent among Turkish adults. Among the objectively measured variables, diastolic dysfunction, visceral adiposity and goiter were strikingly high.

WOS: 000285544300006 PubMed: 20975532 The efficacy of olmesartan on fibrinolytic capacity has not been studied yet. Therefore, the aim of the present study was to investigate the efficacy of olmesartan on hemostatic/fibrinolytic status by measuring plasma level of plasminogen activator inhibitor-1 (PAI-1) and soluble thrombomodulin levels in patients with hypertension. Forty-two consecutive, newly diagnosed (25 women and 17 men with a mean age of 48 +/- 8 years) patients with untreated essential hypertension were included in the study. Olmesartan medoxomil (20 mg/day) was started and the patients were followed up for 6 months. Baseline biochemical variables, thrombomodulin, and PAI-1 levels were compared with the levels of these variables measured at the end of the 6-month follow-up period. After 6 months of treatment with olmesartan medoxomil, there was a significant reduction in systolic and diastolic blood pressure (from 159.5 +/- 10.9 to 134.6 +/- 12.7 mmHg and from 98.0 +/- 6.3 to 83.9 +/- 7.0 mmHg, respectively). Mean plasma PAI-1 and thrombomodulin levels were also significantly decreased (59.73 +/- 41.91 vs. 48.60 +/- 33.65 ng/ml, P=0.001 and 8.09 +/- 2.29 vs. 6.92 +/- 1.42 mu g/l, P

WOS: 000279875000003 PubMed: 20639701 Objective We aimed to investigate whether there was any association between the nondipping status and sleep quality in relatively young patients with an initial diagnosis of hypertension. Methods One hundred and thirty-three consecutive patients, diagnosed to have stage 1 hypertension by their primary physicians, were referred to our study. Patients with a history of use of any antihypertensive medication were excluded. Eligible patients underwent the Pittsburgh Sleep Quality Index (PSQI) survey, which has an established role in evaluating sleep disturbances. All patients underwent ambulatory blood pressure monitoring. Results There were 71 nondipper patients (mean age 44.3 +/- 5.3 years, 33 male/38 female) and 62 dipper hypertensive patients (mean age 43.3 +/- 6.3 years, 27 male/35 female). The PSQI scores, globally, were significantly higher in the nondippers compared with the dippers. It was noticed that all the components of the PSQI (sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbance, use of sleep medication, and daytime dysfunction) were significantly higher in the nondippers. Correlation analysis showed that systolic blood pressure fall at night was inversely and significantly related with the PSQI (r = -0.46, P < 0.001). Logistic regression analysis showed that the PSQI score is an independent determinant for nondipping hypertension (HT) {odds ratio = 0.842 [95% confidence interval (CI) = 0.748-0.947; P = 0.004]}. Conclusion We showed that poor sleep quality was related with a nondipping pattern, and furthermore, it was an independent predictor of nondipping in newly diagnosed stage 1 hypertensive patients Blood Press Monit 15:184-187 (C) 2010 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.

WOS: 000281677000014 PubMed: 20395226 Contrast-induced nephropathy (CIN) is associated with increased morbidity, extended hospital stay, and higher costs. We compared an atorvastatin plus N-acetylcysteine (NAC) regimen with NAC alone in patients undergoing coronary angiography. A total of 130 patients (mean age 54 +/- 10; 77 men) undergoing coronary angiography were studied. Seven CIN cases occurred in the NAC group and 2 in the atorvastatin + NAC group; this difference was not significant. Baseline mean creatinine and estimated glomerular filtration rate (eGFR) were similar between the 2 groups, whereas after the procedure there was a significant creatinine decrease and eGFR increase in the atorvastatin + NAC group. Change in creatinine (baseline creatinine-creatinine after the procedure) was also significantly higher in patients taking statin plus NAC. Atorvastatin may be effective in protecting patients undergoing coronary angiography from CIN.

WOS: 000269389400004 PubMed: 19521888 Serum cystatin C concentration is an alternative measure of kidney function that is less affected by age, sex or muscle mass, and is a more sensitive indicator of early renal dysfunction than creatinine-based estimations of glomerular filtration rate. Cardiovascular sequela increases progressively with the increase in left ventricular mass. Our goal was to evaluate the effect of olmesartan medoxomil on cystatin C levels and left ventricular hypertrophy (LVH) in patients with hypertension. Forty-four newly diagnosed hypertensive patients (27 women and 17 men) were recruited in the study. Olmesartan medoxomil (20 mg/day) was started and the patients were followed up for 6 months. Baseline echocardiographic findings (i.e. left ventricular mass index), serum creatinine, urine albumin/creatinine ratio (ACR) and serum cystatin C levels were compared with the levels of these variables measured at the end of 6-month follow-up period. After 6 months of treatment with olmesartan medoxomil, there was a significant reduction in systolic and diastolic blood pressure (p < 0.001) and in urine ACR (p = 0.04). Mean serum cystatin C levels decreased from 1.61 +/- 0.24 mg/l to 1.31 +/- 0.29 mg/l (p < 0.001). Olmesartan medoxomil treatment also reduced left ventricular mass index (p < 0.001) and LVH (p < 0.001). Our findings indicate that olmesartan medoxomil decreases serum cystatin C levels, urine ACR and reduces LVH in patients with hypertension. To our knowledge, this study is the first to show that olmesartan medoxomil decreases serum cystatin C levels, indicating that in patients with essential hypertension it may counteract end organ damage.

Aims The provisional strategy (PS) is an accepted modality of treatment in coronary bifurcation interventions, though, after main vessel (MV) stenting, the assessment of the side branch (SB) becomes more difficult. In bifurcation interventions, the major advantage of fractional flow reserve (FFR) is the avoidance of the need for SB intervention. However, SB access with a pressure wire after MV stenting may be difficult, sometimes impossible. The objective of this paper was to evaluate the feasibility and safety of physiologic assessment of SB lesions using FFR with the jailed pressure wire (JPW) in patients undergoing the PS. Although the JPW technique is theoretically possible in the PS, there is no information available on the use of this technique. Methods and results We retrospectively evaluated 11 patients who were treated with the JPW technique at a single centre. Procedures were successfully accomplished in all cases without complications, such as damage of the pressure sensor, failure to measure FFR value, removing the polymer coating, and entrapment or fracture of the JPW. Conclusions In conclusion, our limited experience suggests that the JPW technique in the PS may be a safe and technically feasible approach. This technical report details the JPW technique in patients undergoing the PS.

OBJECTIVE Mean platelet volume (MPV), one of the indices of platelet reactivity has been shown to be related to impaired angiographic reperfusion in ST-segment elevation myocardial infarction (STEMI) patients treated with primary angioplasty or thrombolytics. However data regarding MPV and its association with ST-segment resolution; an indicator of epicardial and tissue level reperfusion in the setting of STEMI are limited. In this study, we aimed to investigate whether MPV on admission is associated with ST-segment resolution in STEMI patients treated with thrombolytics. METHODS We retrospectively evaluated 232 consecutive patients with a diagnosis of first STEMI who were administered thrombolytic therapy within 12 hours of onset of chest pain. ST segment resolution based on baseline and 90 minute electrocardiographies were measured. Patients were grouped into two as with

Transcatheter aortic valve implantation (TAVI) is a promising new technology which is typically used to treat elderly patients with severe aortic stenosis who cannot undergo surgical aortic valve replacement due to high risk factors. This procedure may also be a therapeutic option in particular relatively young cases with severe symptomatic aortic stenosis who are unsuitable candidates for surgery. Clinical experience with TAVI in these patients is very limited due to concerns regarding long-term valve durability. Herein, the case is reported of a 57-year-old man with severe aortic stenosis who presented with decompensated heart failure and successfully underwent transfemoral CoreValve implantation. To the best of the present authors' knowledge, this is the youngest reported patient to have received a CoreValve bioprosthesis to date.

Percutaneous mitral valve repair with the MitraClip is a new promising therapeutic option for symptomatic severe mitral regurgitation (MR). Acute myocardial infarction (MI) is a well recognized cause of papillary muscle rupture (PMR). If PMR is untreated, the prognosis is poor and the mortality could be as high as 80% during the first week of post MI. For patients with PMR, the standard therapy for MR is open surgical repair or replacement. However, in our case, percutaneous mitral valve repair with the MitraClip was chosen technique because of the metastatic colon cancer. We report the case of a 60-year-old woman who underwent successful percutaneous mitral valve repair with the MitraClip system for the treatment of acute MI complicated by PMR.

The prevalence of obesity is increasing in the developed and developing world. It is an independent risk factor for heart failure. Left ventricular (LV) diastolic dysfunction has been demonstrated to be a strong predictor of heart failure. In the present study we aimed to assess the impact of body weight on LV diastolic function.The study was conducted on 2,228 participants (1,424 women, 804 men with a mean age of 49). Traditional and tissue Doppler echocardiographic examination were performed in all of the participants. The demographic and echocardiographic data were compared. Multivariate logistic regression analysis was used to assess the independent predictors of association of LV diastolic function. The study sample was divided into four groups: group 1 (body mass index [BMI]25.0 kg/m(2) ), group 2 (BMI 25.0-29.9 kg/m(2)), group 3 (BMI ≥ 30-39.9 kg/m(2)), and group 4 (BMI ≥ 40 kg/m(2)).Septal E was significantly lower in groups 2 and 3 compared to group 1 (P = 0.003). Septal A and septal A' were significantly higher whereas septal E' and lateral E' were significantly lower in the groups 2, 3, and 4 compared to the normal weight group (P0.001). Lateral A', deceleration time, and ejection time were significantly higher in obese when compared to the normal weight (P = 0.025, P0.001, and P = 0.009, respectively). The E/E' ratio was significantly higher in groups 2, 3, and 4 compared to the group 1 (P0.001). Logistic regression analysis revealed that age, BMI (OR = 1.060 [95% CI = 1.040 and 1.080]; P0.001), hypertension, and diabetes mellitus were independent predictors of LV diastolic dysfunction.BMI is an independent predictor of LV diastolic dysfunction along with age, hypertension, and diabetes mellitus.

Objective Central obesity is a prerequisite for the diagnosis of metabolic syndrome (MetS). Precise measurement of visceral fat by bioelectrical impedance analysis (BIA) has been validated. The aim of this study was to investigate the diagnostic performance of BIA in MetS and validate the best cutoff in a large adult cohort. Materials and Methods The study was performed on the MELEN Study cohort—a prospectively designed survey on the prevalence of cardiometabolic risk factors in Turkish adults. The final cohort consisted of 2219 participants. Weight and visceral body composition were measured without shoes in light indoor clothes using a bioimpedance analyzer (Omron BF 510; Omron Corp, Kyoto, Japan). Plasma concentrations of cholesterol, insulin, fasting triglycerides, high-density lipoprotein cholesterol, glucose, and other biochemical variables were measured. The diagnostic performance of visceral fat measurement by BIA in patients with MetS was assessed. Results Metabolic syndrome was detected in 751 participants (520 women and 231 men with a mean age of 55 [12] years; 34% of the whole study population). Total body fat and visceral fat levels were higher in subjects with MetS. Correlation analyses showed that there were significant correlations between anthropometric and BIA measurements. Receiver operating curve characteristics of visceral adiposity revealed the best cutoff values as greater than 12% for men and greater than 9% for women. The diagnostic performance was good in both sexes (the sensitivity/specificity and area-under-the-curve values were 76%/75% and 0.83 for men and 83%/67% and 0.81 for women, respectively). Conclusions Visceral fat measured with BIA is an easily applicable and useful method for identifying people with MetS. The best cutoff values were higher than 12% for men and higher than 9% for women.

Pioglitazone treatment in type 2 diabetes mellitus produced significant improvements in glycaemic control, plasma lipids, blood pressure and inflammation. The aim of this study was to investigate the effect of pioglitazone on systolic and diastolic function in diabetic patients.Forty-nine diabetic patients were included in the study. The patients had never received thiazolidinedione therapy before. Clinical and echocardiographic variables were measured. 30 mg pioglitazone were administered. The patients were followed up for six months and all the measurements were re-evaluated for comparison. Body mass index (BMI) significantly increased after treatment. Fasting glucose, HbA1c and systolic blood pressure decreased. Insulin resistance improved and the HOMA-IR index decreased after pioglitazone treatment. Mean aortic diameter, left atrial systolic and diastolic volumes significantly decreased after therapy. Among diastolic function variables mitral E wave, E/A, ejection time and pulmonary vein peak reverse flow velocity (PVA) significantly increased whereas isovolumetric relaxation time (IVRT), isovolumetric contraction time (IVCT), deceleration time, E/E' and pulmonary vein late systolic flow (PVS2) decreased after pioglitazone therapy. Among tissue Doppler variables early (E) ventricular inflow velocities measured from the tricuspid lateral annulus, the mitral septal and lateral annulus, the anterior, inferior and posterior free wall significantly increased. Late (A) ventricular inflow velocities measured from the anterior, inferior free wall and the mitral septal annulus also increased.Pioglitazone treatment in type 2 diabetes mellitus produced significant improvements in measures of glycaemic control and diastolic ventricular function.

Kandis, Hayati/0000-0001-9151-6050 WOS: 000291979600011 PubMed: 20660896 Background Congestive heart failure (CHF) is a major public health problem that is related to substantial morbidity, impaired quality of life and diminished survival. Mean platelet volume (MPV) is an indicator of platelet activation. Aim To investigate whether there is a difference of MPV in patients with decompensated and stable heart failure (SHF), and test the prognostic value of MPV in decompensated heart failure (DHF). Methods 136 consecutive patients with DHF were enrolled. 71 with SHF were also enrolled for comparison. Patients were followed up for a mean of 18612 months. The primary endpoint was death from any cause. Clinical characteristics of patients with DHF who died during follow-up were compared with the those of the survivors. Results MPV was significantly higher in DHF group than in the SHF group. 71 patients died during the follow-up period (18612 months). Comparison with survivors revealed that mortality was associated with age, systolic blood pressure, pulmonary artery pressure, serum creatinine, urea and MPV. MPV was determined as an independent risk factor for mortality (OR 1.553, 95% CI 1.024 to 2.354, p = 0.038). Receiver operating characteristic analysis showed that MPV level on admission was a predictor of mortality (area under the curve (AUC) for in-hospital mortality was 0.716 (95% CI 0.632 to 0.789, p = 0.003) and AUC for 6-month mortality was 0.815 (95% CI 0.74 to 0.877, p < 0.001), respectively). Conclusion MPV is increased in patients with DHF. Also, MPV on admission is an independent predictor of in-hospital mortality and 6-month mortality.

WOS: 000276866600006 PubMed: 19929284 Patients with non-dipper hypertension are known to carry a high risk of cardiovascular complications. In this study, we hypothesized that non-dippers may be associated with platelet dysfunction and it can be determined by mean platelet volume (MPV). A total of 216 outpatients treated with antihypertensive drugs for at least 6 months were enrolled. Dipper and non-dipper patterns were detected and clinical, laboratory and ambulatory blood pressure recording data were matched between non-dipping and dipping groups. MPV was significantly higher in patients in non-dipping than dipping groups (p < 0.001). In correlation analyses, MPV was negatively correlated with the rate of systolic and diastolic fall at night (p < 0.001, r=-0.46) and (p < 0.001, r=-0.43), respectively. Also MPV was correlated with nocturnal pulse pressure (p=0.001, r=0.22). Other variables were similar between non-dipping and dipping groups. The present study showed that MPV is higher in non-dipping than dipping hypertensive patients. Platelet activation or dysfunction probably is an alternative mechanism for increasing cardiovascular events in non-dippers.

OP-094 Percutaneous mitral valve repair using Mitraclip has recently emerged as an alternative to surgery for the treatment of severe mitral regurgitation (MR). The purpose of this study is to describe the initial experiences in Turkey with the MitraClip system. Twenty patients with severe MR

OP-053 Mean platelet volume (MPV) is one of the indices of platelet reactivity and has been shown to be related to impaired angiographic reperfusion in ST-segment elevation myocardial infarction (STEMI) patients who treated with primary angioplasty or thrombolytics. However data regarding MPV and

PP-375 Atrial septostomy (AS) is a complex technique used during interventions such as; mitral balloon valvotomy, electrophysiological procedures, left atrial appendage closure and MitraClip. Cardiac perforation occurs in 1-5% of cases even in experienced hands. In daily practice, although AS is

OP-068 Renal denervation is a new promising treatment option which is performed in patients with resistant hypertension defined as blood pressure that remains above goal despite lifestyle measures and concurrent use of 3 antihypertensive agents of different classes, prescribed at optimal doses