Search

Background: Patients with intermediate-high risk pulmonary embolism (PE) who have acute right ventricular dysfunction and myocardial injury without overt hemodynamic compromise may be candidates for thrombolytic therapy (TT). In this study, we aimed to compare the clinical outcomes of low-dose prolonged TT and unfractionated heparin (UFH) in intermediate-high risk PE patients., Methods: This study enrolled 83 (female: 45 [54.2%], mean age: 70.07±10.7 years) retrospectively evaluated patients with the diagnosis of acute PE who were treated with low-dose and slow-infusion of TT or UFH. The primary outcomes of the study were de-fined as a combination of death from any cause and hemodynamic decompensation, and severe or life-threatening bleeding. Secondary endpoints were recurrent PE, pulmonary hypertension, and moderate bleeding., Results: The initial management strategy of intermediate-high risk PE was TT in 41 (49.4%) patients and UFH in 42 (50.6%) cases. Low-dose prolonged TT was successful in all patients. While the frequency of hypotension decreased significantly after TT (22 vs. 0%, P<0.001), it did not decrease after UFH (2.4 vs. 7.1%, p=0.625). The proportion of hemodynamic decompensation was significantly lower in the TT group (0 vs. 11.9%, p=0.029). The rate of secondary endpoints was significantly higher in the UFH group (2.4 vs. 19%, P=0.016). Moreover, the prevalence of pulmonary hypertension was significantly higher in UFH group (0 vs. 19%, p=0.003)., Conclusion: Prolonged TT regimen with low dose, slow infusion of tissue plasminogen activator was found to be associated with a lower risk of hemodynamic decompensation and pulmonary hypertension in patients with acute intermediate-high-risk PE compared to UFH.

Background: Pulmonary arterial hypertension (PAH) is a severe, life-threatening disorder despite the availability of specific drug therapy. A lack of endogenous prostacyclin secondary to downregulation of prostacyclin synthase in PAH may contribute to vascular pathologies. Therefore, prostacyclin and its analogs including inhaled iloprost may decrease pulmonary arterial pressure and ventricular pressure., Methods: Here, we studied that acute effects of iloprost used in pulmonary vasoreactivity testing on the intracardiac conduction system in patients with PAH. A total of 35 (15 idiopathic PAH, 20 congenital heart disease) patients with PAH were included in this prospective study. Patients were divided into two groups: 22 patients with negative pulmonary vasoreactivity in group 1 and 13 with positive pulmonary vasoreactivity in group 2. Electrophysiological parameters including basic cycle length, atrium-His (AH) interval, His-ventricle (HV) interval, PR interval, QT interval, QRS duration, Wenckebach period, and sinus node recovery time (SNRT) were evaluated before and after pulmonary vasoreactivity testing in both groups., Results: The AH interval (81 [74-93]; 80 [65.5-88], p = 0.019) and SNRT (907.7 ± 263.4; 854.0 ± 288.04, p = 0.027) was significantly decreased after pulmonary vasoreactivity testing. Mean right atrium pressure was found to be correlated with baseline AH (r = 0.371, p = 0.031) and SNRT (r = 0.353, p = 0.037)., Conclusion: Inhaled iloprost can improve cardiovascular performance in the presence of PAH, primarily through a reduction in right ventricular afterload and interventricular pressure. Decreased pressure on the interventricular septum and ventricles leads to conduction system normalization including of the AH interval and SNRT due to resolution of inflammation and edema., (© 2021. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Radiofrequency catheter ablation (RFCA) procedure is performed for many tachyarrhythmias. We performed successful RFCA in a 5-year-old child for supraventricular tachyarrhythmia and Wolff-Parkinson-White syndrome. Acute circumflex artery (CxA) occlusion occurred due to RFCA. After percutaneous balloon angioplasty was performed into the CxA, the patient was treated with systemic steroid to resolve myocardial edema. To the best of our knowledge, systemic steroid was used first time for acute coronary artery injury related myocardial ischemia., (© 2020 Wiley Periodicals LLC.)

Introduction: Obstructive sleep apnea (OSA) and endothelial dysfunction are associated with cardiovascular risk factors and the development of atherosclerosis. Endocan is a marker of endothelial dysfunction, while obstructive sleep apnea is one of the causes of endothelial dysfunction. In this study, we investigated the relationship between endocan and obstructive sleep apnea severity., Material and Methods: A total of 179 patients with snoring complaints were included. All patients underwent polysomnography, and based on the results, the participations were allocated to the control group ( n = 39) or to the obstructive sleep apnea group ( n = 140). The OSA group was classified as having mild (apnea-hypopnea index (AHI) = 5-15; n = 43), moderate (AHI = 15-30; n = 42), or severe OSA (AHI > 30; n = 55). All participations had their endocan levels measured., Results: Endocan levels in OSA patients were significantly higher than in the control group (11.8 (3.13-200) vs 3.13 (3.13-23) ng/ml, p < 0.001). Also, endocan levels were significantly higher in the severe OSA group than moderate and mild obstructive OSA (13.2 (3.13-200), 12.6 (3.13-200) and 8.44 (3.13-50.5) ng/ml, p = 0.015, respectively). Multiple logistic regression analysis showed that smoking, age and endocan levels were independent predictors of OSA severity ( p = 0.024, p = 0.037, p = 0.004, respectively)., Conclusions: Endocan seems to be a potential risk stratification marker in this patient population., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2020 Termedia & Banach.)

Introduction: Increased matrix metalloproteinase-9 (MMP-9) levels in ST-elevation myocardial infarction (STEMI) are well established; however, existing data on MMP-9 values as a prognostic marker after STEMI are limited and have been conflicting., Objective: This study aimed to assess the clinical significance of MMP-9 in predicting two-year adverse cardiovascular events in patients who underwent primary percutaneous coronary intervention (PCI) after STEMI., Methods: In this prospective study, 204 patients with STEMI undergoing PCI were included. Participants were classified as high MMP-9 (n=102) or low MMP-9 (n=102) based on a cutoff of 12.92 ng/ml. Both groups were assessed at one and two years after STEMI., Results: Higher cardiovascular mortality at one year was observed in the high MMP-9 group (13.7% vs. 4.9% in the low MMP-9 group, p=0.03). When the follow-up period was extended to two years, the difference in cardiovascular mortality between the groups was more significant (17.6% vs. 4.9%, p=0.004). There was no significant difference at one-year follow-up in rates of advanced heart failure, however at the end of the second year, advanced heart failure was more prevalent in the high MMP-9 group (16.7% vs. 5.9%, p=0.015). After adjustment for potential confounders, a high MMP-9 value had 3.5-fold higher odds for cardiovascular mortality at two-year follow-up than low MMP-9., Conclusion: These results suggest that high MMP-9 levels are a strong predictor of cardiovascular mortality and advanced heart failure at two-year follow-up in STEMI patients., (Copyright © 2020 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.)

Aim: Stress urinary incontinence (SUI) has some negative emotional and physical effects on sexual functions. In this study, we aimed to question the effects of surgical treatment of stress incontinence on sexual function using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) form., Materials and Methods: A total of 77 sexually active women who were surgically treated for SUI between 2014 and 2015 at a university hospital. Tension-free transvaginal tape (TVT-O) operation and the laparoscopic Burch procedure were performed on 42 and 35 patients, respectively. Patients with isolated stress incontinence were included in this study. All patients enrolled were invited to fill out the PISQ-12 questionnaire before surgery and 6 months after surgery., Results: The mean total postoperative PISQ-12 score in both TVT-O and Burch groups was significantly increased compared to the preoperative period ( P < 0.001 and P < 0.001, respectively). When the PISQ-12 scores were evaluated according to the subgroups, physical and partner-dependent scores significantly increased in the postoperative period compared to the preoperative period in the TVT-O group ( P < 0.001 and P = 0.004, respectively)., Conclusions: Rate of the surgery success for SUI is positively correlated with the improvement of sexual functions. Minimally invasive methods in SUI surgery has been progressively increasing day-by-day. The lesser invasive approaches seem to replace the more invasive approaches in the near future., Competing Interests: There are no conflicts of interest.

Background: Combined surgery for cesarean delivery and preperitoneal mesh repair for inguinal hernia has not been previously reported., Objectives: Our aim was to describe the method and to present the results of this simultaneous surgery through a single incision., Methods: From 2012 to 2014, 15 patients underwent cesarean delivery combined with preperitoneal mesh repair for inguinal hernia. All patient characteristics and perioperative findings were recorded., Results: Among 15 patients, 13 had unilateral inguinal hernias and two had bilateral hernias. The mean times spent for unilateral and bilateral hernias were 35.8 minutes (range, 30-45 minutes) and 67.5 minutes (range, 65-70 minutes), respectively. Direct and indirect hernias were present in one and 15 patients, respectively. One patient had mixed hernia. No significant complication was observed perioperatively. Hospital stay ranged from 1 day to 3 days (mean, 1.87 days), and all patients were discharged without any problem. No recurrence was found during the follow-up periods., Conclusion: Single anesthesia, single incisional scar, and single hospitalization are the major advantages of this simultaneous approach of cesarean delivery and preperitoneal mesh repair for inguinal hernia. Our analysis suggests that this combined procedure can be performed safely in selected cases., (Copyright © 2016. Published by Elsevier Taiwan.)

Background: The aim of the study was to explore the differences in oxidative stress during anesthesia with desflurane/N 2 O or propofol/remifentanil in patients undergoing laparoscopic cholecystectomy and additionally to evaluate the differential effects of desflurane and propofol on ischemic preconditioning (IP)., Materials and Methods: One hundred patients were randomly allocated to four groups. For anesthesia maintenance, the inhalation group (Group I) and the inhalation plus IP group (Group IIP) received desflurane at an end-tidal concentration of 4-6 vol% in oxygen/N 2 O, and the TIVA group (Group T) and TIVA plus IP group (Group TIP) received infusions of propofol and remifentanil. In Groups IIP and TIP, IP was carried out by 10 min of pneumoperitoneum followed by 10 min of deflation. Preoperative and postoperative plasma total antioxidant status (TAS), total oxidant status (TOS), paraoxonase, stimulated paraoxonase, arylesterase, ceruloplasmin, and myeloperoxidase levels were analyzed; oxidative stress index (OSI) was calculated., Results: When oxidative stress parameters were compared between groups, myeloperoxidase values in Group I were statistically significantly lower compared to Group TIP (p = .004 with Bonferroni's correction). There were no differences between preoperative and postoperative TAS, paraoxonase, stimulated paraoxonase, arylesterase, or ceruloplasmin levels (p > .05). In intragroup evaluations, postoperative paraoxonase and stimulated paraoxonase levels were found to be lower than preoperative values in Group TIP (p = .021 and .012, respectively)., Conclusion: In laparoscopic cholecystectomy lasting less than 60 min, there were no differences in the measured oxidative stress parameters between maintenance of anesthesia by desflurane/N 2 O and propofol/remifentanil/N 2 O. The addition of 10 min IP administration during both anesthesia techniques did not result in additional changes in the analyzed oxidative stress.

Background: The purpose of this study is to assess the electrocardiographic and electrophysiological parameters of conduction abnormalities in patients undergoing transcatheter aortic valve implantation (TAVI) due to severe aortic valve stenosis., Methods: The study included 55 patients who underwent TAVI using either the Boston Scientific Lotus (n:25) (Boston Scientific, Natick, MA, USA) or Edwards Sapien XT (n:30) (Edwards Lifesciences, Irvine, CA, USA) prostheses. An electrophysiological study (EPS) was performed in the catheterization room immediately before the initial balloon valvuloplasty and immediately after prosthesis implantation., Results: QRS duration and His-bundle to His-ventricle (HV) intervals, which were similar between the two groups before the procedure, were found to be significantly higher in the Lotus valve group postprocedure. Permanent pacemakers (PPMs) were required more frequently in the Lotus group than in the Sapien XT group at discharge (24.0% vs 6.7%, P = 0.07). With the exception of a higher prevalence of paravalvular leakage (P < 0.001) in patients undergoing Sapien XT implantation, other clinical outcomes were similar between the two groups. Multiple regression analysis revealed that baseline atrioventricular (AV) conduction disorders and HV intervals after the procedure were independently associated with PPM implantation after TAVI., Conclusion: In this first study comparing the findings of EPS and electrocardiography, the impact of the Lotus valve on AV conduction systems was greater than that of the Sapien XT. However, the need for PPM was higher in the Lotus valve than in the Sapien XT. PPM requirement is related to valve design; it may decrease with reduced frame height and metal burden in novel valve systems., (© 2016 Wiley Periodicals, Inc.)

The plateletcrit has been investigated as a new predictor of cardiovascular risk. The objective of our study was to investigate the role of admission plateletcrit in predicting long-term cardiovascular mortality in patients presenting with non-ST-segment elevation myocardial infarction (NSTEMI). We enrolled 296 patients with NSTEMI (mean age 59.2 ± 11.8 years; 228 men, 68 women) in this study. The study population was divided into tertiles on the basis of admission plateletcrit values. A high plateletcrit (n = 98) was defined as a value in the upper third tertile (plateletcrit >0.23), and a low plateletcrit (n = 198) was defined as any value in the lower two tertiles (plateletcrit ≤0.23). The median follow-up time was 38 months. In multivariate analyses, a significant association was noted between high plateletcrit values and the adjusted risk of long-term mortality (odds ratio = 12.15, 95% confidence interval = 1.78-82.77; P < 0.001). In the Kaplan-Meier survival analysis, the long-term mortality rate was 20.4% in the high plateletcrit group versus 4.5% in the low plateletcrit group (P < 0.001). Long-term major advanced cardiac events (MACE), hospitalization for heart failure and reinfarction were significantly higher in patients with high plateletcrit. Admission plateletcrit is a strong and independent predictor of long-term cardiovascular mortality in patients with NSTEMI.

Introduction: Both end-organ damage and high red cell distribution width (RDW) values are associated with adverse cardiovascular events, inflammatory status, and neurohumoral activation in hypertensive disease and in the general population. In this study, we investigated the relationship between RDW and end-organ damage in hypertensive patients., Material and Methods: The 446 systo-diastolic hypertensive patients included in the study received 24-hour ambulatory blood pressure monitoring. Left ventricular mass index, glomerular filtration rate, and microalbuminuria were measured to identify end-organ damage. High-sensitivity C-reactive protein (hs-CRP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels of all patients were also examined., Results: The mean age of the participants was 49.96 ±11.04 years. The mean RDW was 13.06 ±1.05%. Red cell distribution width was positively correlated with left ventricular myocardial index (LVMI), urinary albumin, hs-CRP, and NT-proBNP (r = 0.298, p < 0.001; r = 0.228, p < 0.001; r = 0.337, p < 0.001; r = 0.277, p < 0.001, respectively), while RDW was negatively correlated with eGFR (r = -0.153, p < 0.001). Additionally, while there was a positive correlation between RDW and 24-h systolic blood pressure, no correlation was found between RDW and 24-h diastolic blood pressure (r = 0.132, p = 0.006 and r = 0.017, p = 0.725, respectively). Multiple linear regression analysis revealed that RDW levels were independently associated with eGFR, LVMI, and severity of albuminuria (β = 0.126, p = 0.010; β = -0.149, p = 0.002; β = 0.114, p = 0.035)., Conclusions: High RDW levels in systo-diastolic hypertensive patients were found to be an independent predictor of end-organ damage.

The present study aimed to evaluate the late-term changes in radial artery luminal diameter (RAD) and vasodilatation response following transradial catheterization (TRC). TRC-inducing trauma to radial artery intima may trigger chronic phase vascular changes and lead to anatomical and functional impairment. There is controversial data whether the impairment persists or repairs later. Fifty-six consecutive patients undergoing TRC were enrolled prospectively. Baseline RAD, flow-mediated dilatation (FMD) and nitroglycerin-mediated dilatation (NMD) of the radial artery at the access site were measured before TRC by high-resolution ultrasound. Six months later; RAD, FMD and NMD were measured again at the same access site. RAD at the sixth month was reduced compared with pre-procedural measurements (2.85 ± 0.44 versus 2.74 ± 0.42 mm, p = 0.0001).The average FMD decreased to 5.66 ± 5.87 %, which was significantly lower than the observed pre-procedural FMD (9.45 ± 5.01 %) 6 months after TRC (p = 0.0001). Likewise, the average NMD at the sixth month was reduced compared with pre-procedural NMD (9.52 ± 6.77 versus 6.64 ± 6.51 %, p = 0.018). Logistic regression analysis indicated that pre-procedural radial artery diameter to sheath size ratio was the independent predictor of NMD reduction (95 % confidence interval, β = -9.74, p = 0.024). TRC may lead to a significant luminal diameter reduction and impairment of vasodilatation response in the radial artery at late term.

Introduction: The new definition of periprocedural myocardial infarction (type 4a MI) excludes patients without angina and electrocardiographic or echocardiographic changes suggestive of myocardial ischemia even though significant serum troponin elevations occur following percutaneous coronary intervention (PCI)., Aim: To evaluate the incidence and predictors of serum troponin rise following elective PCI in patients without clinical and procedural signs suggestive of myocardial necrosis by using a high-sensitivite troponin assay (hsTnT)., Material and Methods: Three hundred and four patients (mean age: 60.8 ±8.8 years, 204 male) undergoing elective PCI were enrolled. Patients with periprocedural angina, electrocardiographic or echocardiographic signs indicating myocardial ischemia or a visible procedural complication such as dissection or side branch occlusion were excluded. Mild-moderate periprocedural myocardial injury (PMI) and severe PMI were defined as post-PCI (12 h later) elevation of serum hsTnT concentrations to the range of 14-70 ng/l and > 70 ng/l, respectively., Results: The median pre-procedural hsTnT level was 9.7 ng/l (interquartile range: 7.1-12.2 ng/l). Serum hsTnT concentration elevated (p < 0.001) to 19.4 ng/l (IQR: 12.0-38.8 ng/l) 12 h after PCI. Mild-moderate PMI and severe PMI were detected in 49.3% and 12.2% of patients, respectively. Post-procedural hsTnT levels were significantly higher in multivessel PCI, overlapping stenting, predilatation and postdilatation subgroups. In addition, post-procedural hsTnT levels were correlated (r = 0.340; p < 0.001) with the stent lengths., Conclusions: High-sensitivite troponin measurements indicate a high incidence of PMI even though no clinical or procedural signs suggestive of myocardial ischemia exist. Multivessel PCI, overlapping stenting, predilatation, postdilatation and longer stent length are associated with PMI following elective PCI.

Objective: Red cell distribution width (RDW) is a measure of variation in the size of circulating red blood cells. Recent studies have reported a strong independent relation between elevated RDW and short- and long-term prognosis in various disorders. The aim of the present study was to investigate the relationship between admission RDW-to-platelet ratio (RPR) and in-hospital and long-term prognosis in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI)., Methods: A total of 470 consecutive patients with a diagnosis of STEMI who underwent primary PCI were included in this prospective study. The patients were divided into two groups based on their admission RPR: high (>0.061) RPR group and low (≤0.061) RPR group. The patients were followed for adverse clinical outcomes in-hospital and for up to one year after discharge., Results: In-hospital cardiovascular mortality, major adverse cardiovascular events (MACE), advanced heart failure and cardiogenic shock were significantly higher in the high RPR group (p<0.05). All-cause and cardiovascular mortality, MACE, fatal reinfarction, advanced heart failure, and rehospitalization for cardiac cause were more frequent in the high RPR group in one-year follow-up (p<0.05). High RPR was found to be a significant independent predictor of one-year cardiovascular mortality in multivariate analysis (p=0.003, OR: 3.106, 95% CI: 1.456-6.623)., Conclusion: RPR is an inexpensive and readily available biomarker that provides an additional level of risk stratification beyond that provided by conventional risk parameters in predicting long-term MACE and cardiovascular mortality in STEMI., (Copyright © 2015 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.)

Background: The aim of this study was to assess the periprocedural and one-year outcomes of two different cerebral protection systems used during carotid artery stenting (CAS)., Patients and Methods: We enrolled 90 consecutive patients with carotid artery stenosis who underwent CAS with a proximal flow blockage protection system (mean age 69.7 ± 8) or distal protection with a filter (mean age 70.8 ± 7)., Results: CAS was performed successively on 89 patients (99 %). Adverse events were defined as major stroke, minor stroke, transient ischemic attack (TIA), myocardial infarction, and death. Two strokes, one TIA, one death, and one myocardial infarction were observed in-hospital. There were no significant differences in safety or benefits between the proximal flow blockage embolic protection system (n = 45) and the distal filter protection system (n = 45) in terms of clinically apparent cerebral embolism, TIA, death, or myocardial infarction during the periprocedural stage or during the one-year follow-up period., Conclusions: Although it has been shown that the proximal flow blockage cerebral protection system decreases the risk of silent cerebral embolism, it has no advantage over the distal filter protection system in terms of adverse cerebrovascular or cardiac events during the periprocedural stage or during the long-term follow-up period.

Objective: Patients with resistant hypertension are at increased risk for cardiovascular events. Mean platelet volume (MPV) is an accepted biomarker of platelet activation and considered as a risk factor for cardiovascular disease. The aim of this study was to determine whether MPV levels are higher in resistant hypertensive (RHTN) patients than in controlled hypertensive (CHTN) patients and healthy normotensive controls., Materials and Methods: 279 consecutive patients were included in this study. Patients were divided into three groups: Resistant hypertension patient group [n=78; mean age 56.8±9.8; 42 males (53.8%)]; controlled hypertension patient group [n=121; mean age 54.1±9.6; 49 males (40.5%)]; and normotensive control group [n=80; mean age 49.8±8.5; 34 males (42.5%)]. Physical examination, laboratory work-up, and 24-hour ambulatory blood pressure measurement (ABPM) were performed in all participants., Results: The mean platelet volume levels were significantly higher in RHTN group than in the CHTN and normotensive groups (p<0.001). In correlation analysis office systolic and diastolic blood pressure was positively correlated with MPV., Conclusion: Our study demonstrated that MPV, as an important indicator of platelet activation, was statistically higher in RHTN patients than in CHTN and in normotensive subjects. Elevated MPV levels may help to determine a high risk group for atherosclerosis in RHTN patients.

Objective: Periprocedural myocardial injury (PMI) is known to be a predictor of in-hospital cardiac events and long-term adverse outcomes following a percutaneous coronary intervention (PCI). We aimed to evaluate the correlation between preprocedural serum lipid levels and PMI in patients undergoing elective PCI., Patients and Methods: The final study group included 195 patients (60.1±0.7 years old, 68 women and 127 men). Serum high-sensitive troponin T (hscTnT) concentrations were measured immediately before PCI and 12 h after PCI. Serum total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), and triglyceride (TG) levels were determined immediately before PCI. Serum hscTnT concentrations were adjusted for the clinical and procedural characteristics of the patients using the weighted least-square regression analysis., Results: The average preprocedural hscTnT concentration was 8.1±0.2 ng/l. The average serum hscTnT concentration increased to 34.1±2.8 ng/l (P<0.001) 12 h after PCI. Postprocedural hscTnT concentrations were correlated positively to serum concentrations of TC (r=0.435; P<0.001), LDL-C (r=0.349; P<0.001), and TG (r=0.517; P<0.001). There was also a positive correlation (r=0.205; P<0.01) between postprocedural hscTnT and lesion length. Mild-moderate PMI (postprocedural hscTnT≥14 to <70 ng/l) and severe PMI (postprocedural hscTnT≥70 ng/l) were observed in 122 (48.7%) and 27 (13.9%) patients, respectively. The patients with severe PMI had higher serum TC (P<0.001), LDL-C (P<0.001), and TG (P<0.001) concentrations., Conclusion: The present study indicates that increased preprocedural TC, LDL-C, and TG serum levels are associated with PMI and its severity following elective PCI.

Objectives: The aim of this study was to evaluate the prognostic value of fragmented QRS (fQRS) on electrocardiography (ECG) patients with acute ST-segment elevation in myocardial infarction (STEMI), who are undergoing primary percutaneous coronary intervention (PCI)., Methods: We prospectively enrolled 414 consecutive STEMI patients (mean age of 55.2 ± 12.2 years old, range of 26-91-years old) undergoing primary PCI. The study patients were divided into two groups according to the presence or absence of fQRS as shown by ECG in the first 48 hours. The presence of fQRS group was defined as fQRS(+) (n = 91), and the absence of fQRS group was defined as the fQRS(-) (n = 323) group. Clinical characteristics and the one-year outcome of the primary PCI were analyzed., Results: The patients in the fQRS(+) group were older (mean age 60.7 ± 12.5 vs. 53.6 ± 11.6 years old, P < 0.001). Higher one-year all-cause mortality rates were observed in the fQRS group upon ECG (23.1% vs. 2.5%, P < 0.001, respectively). When using the Cox multivariate analysis, the presence of fQRS on the ECG was found to be a powerful independent predictor of one-year all-cause mortality (hazard ratio: 5.24, 95% confidence interval: 1.43-19.2, P = 0.01)., Conclusions: These results suggest that the presence of fQRS on ECG was associated with an increased in-hospital cardiovascular mortality, and one-year all-cause mortality in patients with STEMI who are under primary PCI., (© 2014 Wiley Periodicals, Inc.)

Objectives: Fragmented QRS (fQRS) has been found to be associated with high mortality and arrhythmic events in acute coronary syndromes. Regional systolic function using wall motion score index (WMSI) is an alternative to left ventricular ejection fraction (LVEF) for the assessment of left ventricular systolic function. The aim of this study was to investigate the relation between the presence of fQRS on admission electrocardiogram (ECG) and WMSI in ST elevation myocardial infarction (STEMI) underwent primary coronary intervention (PCI). The in-hospital and long-term prognostic significance of persistent fQRS was also evaluated., Methods: In this retrospective study, 542 patients with a diagnose of STEMI underwent primary PCI were included. Study patients were divided into two groups according to the presence (n = 153) or absence (n = 389) of a fQRS on admission ECG., Results: WMSI was found to be significantly higher in fQRS(+) group compared to the fQRS(-) group (P < 0.001). In multivariete analysis, WMSI was found to be an independent predictor of fQRS, and fQRS was inversely associated with LVEF. The in-hospital reinfarction (P = 0.003), MACE (P = 0.024), intraaortic balloon pump use (P = 0.014), and advanced heart failure (P < 0.001) were found to be significantly more frequent in the fQRS(+) group. The presence of fQRS on admission was found to be associated with an increase in long-term cardiovascular mortality (P = 0.028), and long-term all-cause mortality (P = 0.022)., Conclusion: WMSI was significantly related with the presence of the fQRS, which reflects the linking between impairment of regional left ventricular systolic function and the presence of severe myocardial injury in STEMI., (© 2014 Wiley Periodicals, Inc.)

Objective: The aim of this cross-sectional study was to evaluate microvolt T-wave alternans (MTWA) as a marker of myocardial electrical instability in normotensive and hypertensive individuals with either nondipper or dipper-type circadian rhythm of blood pressure., Materials and Methods: The study group included a total of 181 patients: 118 hypertensive patients and 63 normotensive healthy volunteers [mean age 46 ± 8; 34 men (54%)]. The patients with hypertension were divided into two groups on the basis of their results of 24-h ambulatory blood pressure monitoring: 61 patients with dipper hypertension [mean age 46 ± 6; 32 men (52.5%)] and 57 patients with nondipper hypertension [mean age 48 ± 10; 36 men (63.2%)]. The MTWAs of all patients were analyzed using the time-domain modified moving average method by means of a treadmill exercise stress test., Results: MTWA positivity was statistically significantly different between all groups. Left ventricular mass index, E/E', interventricular septum, posterior wall, 24-h systolic blood pressure and diastolic blood pressure, and night-time systolic blood pressure and diastolic blood pressure were correlated positively with MTWA. Left ventricular mass index and the presence of nondipper hypertension were determined to be independent predictors of MTWA positivity., Conclusion: The blunting of the nocturnal decrease in blood pressure was associated with MTWA positivity in hypertensive patients.

Unlabelled: Abstract Objective: Patients with a lack of nocturnal decline in blood pressure (BP) are at an increased risk for cardiovascular events. Mean platelet volume (MPV) and soluble CD40 ligand (sCD40L) are accepted biomarkers of platelet activation and considered as a risk factor for cardiovascular disease. The aim of this study was to determine whether MPV and sCD40L levels are higher in non-dipper hypertensive (NDHT) patients than in dipper hypertensive (DHT) patients and healthy controls., Methods: 124 consecutive patients were included to this study. Patients were divided into three groups: NDHT patient group [n = 43; mean age 51.8 ± 6.6; 31 males (72.1%)]; DHT patient group [n = 41; mean age 50.2 ± 7.3; 22 males (53.7%)]; and normotensive group [n = 40; mean age 49.9 ± 6.7; 22 males (55%)]. Physical examination, laboratory work-up and 24-h ABPM were performed for all participants., Results: The sCD40L and MPV levels were significantly higher in the NDHT group than in the DHT and normotensive groups (p < 0.05). In correlation analysis, MPV, 24-h systolic blood pressure (SBP), 24-h diastolic blood pressure (DBP), night-time SBP and night-time DBP were positively correlated with sCD40L., Conclusion: Our study demonstrated that MPV and sCD40L levels were significantly higher in NDHT patients compared to DHT and normotensive patients. sCD40L levels were positively correlated with MPV, 24-h SBP, 24-h DBP, night-time SBP and night-time DBP.

Introduction: Nowadays, clopidogrel and acetylsalicylic acid (ASA) have become routinely applied therapies in percutaneous coronary interventions (PCI) with stenting., Aim: Numerous variables can interfere with antiplatelet responsiveness, so we aimed to investigate the role of different variables associated with ASA or clopidogrel resistance in stable coronary artery disease., Material and Methods: A total of 207 patients undergoing elective PCI were included in the analysis. All patients received a loading dose of clopidogrel and ASA during PCI procedure and followed by dual antiplatelet therapy. Clopidogrel and ASA resistance were measured by impedance aggregometry method., Results: Of the patients, 19.8% had clopidogrel resistance, 18.8% had ASA resistance, 9.2% had both clopidogrel and ASA resistance, and 71.5% were responsive to both drugs. In multivariate analysis, platelet count, angiotensin receptor blocker (ARB) use, and ASA resistance were independent variables associated with clopidogrel resistance, and clopidogrel resistance was the only variable associated with ASA resistance. In differentiating whether clopidogrel resistance exists or not, optimum ASA aggregometry response cut-off values were specified, and in differentiating whether ASA resistance exists or not, optimum clopidogrel aggregometry response cut-off values were specified., Conclusions: In this study, there was a higher incidence of low responsiveness to ASA when there was a low response to clopidogrel, and vice versa. Angiotensin receptor blocker use, platelet count, and ASA resistance were independent variables associated with clopidogrel resistance. Clopidogrel resistance was the only independent variable associated with ASA resistance. Angiotensin receptor blocker use seems to an independent risk factor for clopidogrel resistance in this study, but this result needs to be verified in other studies.

Objective: Left ventricular (LV) hypertrophy (LVH) predicts increased mortality in part due to an elevated incidence of sudden cardiac death in hypertension. The aim of the present study was to investigate the relation of microvolt T-wave alternans (MTWA) with different LV geometric patterns in patient with sustained hypertension., Methods: This study consisted of 311 consecutive patients with sustained hypertension who were divided into four groups according to LV geometrical patterns. 90 patients were in the normal geometry group (NGG) [mean age 49.6 ± 7.8 years; 60 males (66.7%)], 99 patients were in the concentric remodeling group (CRG) [mean age 50.9 ± 6.6 years; 50 males (50.6%)], 63 patients were in the concentric hypertrophy group (CHG) [mean age 51.6 ± 7.3 years; 32 males (50.7%)] and 58 patients were in the eccentric hypertrophy group (EHG) [mean age 51.6 ± 9.0 years; 30 males (51.7%)]. Physical examination, laboratory work-up, office blood pressure measurement, transthoracic echocardiography and MTWA measurements were performed on all participants., Results: MTWA positivity was significantly higher in EHG and CHG as compared to CRG and NGG (p < 0.001). Left ventricle mass index (LVMI), LV end-diastolic diameter (LVEDD), LV end-systolic diameter (LVESD), interventricular septum diameter (IVSd), posterior wall diameter (PWd) and office systolic blood pressure (SBP) were found to be significantly positively correlated with MTWA (all p-values < 0.05)., Conclusion: We demonstrated that increased LVMI is associated with an elevated MTWA positivity in sustained hypertensives. Moreover, clinically significant LV geometric patterns including both concentric and eccentric hypertrophy are related with a raised MTWA positivity, which may lead to particular predilection to life-threatening ventricular arrhythmias and sudden cardiac death in sustained hypertension.

The platelet to lymphocyte ratio (PLR) has been investigated as a new predictor for cardiovascular risk. The aim of the present study was to investigate the prognostic role admission PLRat admission in predicting in-hospital and early mortality in patients presenting with ST segment elevation myocardial infarction (STEMI). A total of 639 consecutive patients with STEMI who underwent primary percutaneous coronary intervention (PCI) were included. The study population was divided into tertiles on the basis of PLR values at the admission. A high PLR (N = 213) was defined as a value in the upper third tertile (PLR >174.9) and a low PLR (N = 426) was defined as any value in the lower two tertiles (PLR ≤ 174.9). The patients were followed for clinical outcomes for up to 6 months after discharge. In Kaplan-Meier survival analysis, the rate of 6-month all-cause deaths was 7% in the high PLR group versus 3% in the low PLR group (P = 0.03). In multivariate analyses, a significant association was noted between high PLR levels and the adjusted risk of 6-month all-cause deaths (odds ratio = 2.51, 95% confidence interval = 1.058-5.95; P = 0.03). PLR is a readily available clinical laboratory value associated with 6-month all-cause death in patients with STEMI who undergo primary PCI.

Objectives: The aim of this study was to evaluate the prognostic value of soluble CD40 ligand (sCD40L) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing a primary percutaneous coronary intervention (PCI)., Background: The prognostic value of sCD40L has been documented in patients with acute coronary syndrome; however, its value in acute STEMI remains unclear., Materials and Methods: We prospectively enrolled 499 consecutive STEMI patients (397 men, 102 women) undergoing primary PCI. The study population was divided into tertiles on the basis of admission sCD40L values. The high sCD40L group (n=168) included patients with a value in the third tertile (≥0.947 mg/l) and the low sCD40L group (n=331) included patients with a value in the lower two tertiles (<0.947 mg/l). Clinical characteristics and in-hospital and 1-year primary PCI outcomes were analyzed., Results: The patients in the high sCD40L group were older (mean age 57.3±12.7 vs. 54.8±11.9, P=0.029). Higher in-hospital and 1-year all-cause mortality rates were observed in the high sCD40L group (7.7 vs. 3.3%, P=0.029; 16.1 vs. 4.8%, P<0.001, respectively). The results of Cox multivariate analysis indicated that a high sCD40L value at admission (>0.947 mg/l) is a powerful independent predictor of 1-year all-cause mortality (odds ratio: 3.68; 95% confidence interval: 1.54-8.77; P=0.003)., Conclusion: The results of this study suggest that a high sCD40L level at admission is associated with increased in-hospital and 1-year all-cause mortality rates in patients with STEMI undergoing primary PCI.

Background: Peripheral arterial occlusive disease (PAOD), which is common in male gender and elderly population, is related with increased cardiovascular mortality and morbidity. Neutrophil to lymphocyte ratio (NLR) has been found to be an independent predictor of cardiovascular mortality in atherosclerosis. The aim of the present study was to investigate the association between NLR and cardiovascular mortality both in patients with intermittent claudication and critical limb ischemia., Methods: In a retrospective study, 593 consecutive patients who had been admitted to the inpatient ward of the vascular department of a large tertiary training and research hospital with diagnosis of symptomatic PAOD between May 2009 and September 2012 were included. Patients were divided into two groups according to their NLR as follows: high NLR (NLR>3.0) and low NLR (NLR ≤ 3.0) groups., Results: During the course of the present study [median follow-up period of 20 months (interquartile range, 12-27)], 75 deaths occurred out of 508 patients (14.8%). Cardiovascular mortality was found to be significantly higher in elevated NLR group (n = 43) as compared to low NLR group (n = 32) (23.6% vs 9.8%, respectively; p < 0.001). Even after adjustment of various risk factors, NLR > 3 and age were found as independent predictors of long-term cardiovascular mortality in Cox regression analysis [hazard ratios (95% confidence interval), 2.04 (1.26-3.30) and 1.04 (1.01-1.07), p = 0.004 and p = 0.004, respectively]., Conclusion: We demonstrated that an increased NLR was related with higher cardiovascular mortality in patients with PAOD, who were admitted with critical limb ischemia or intermittent claudication. NLR, which reflects the patient's inflammatory status, is an inexpensive and readily available biomarker that provides an additional level of risk stratification beyond that provided by conventional risk scores in predicting long-term cardiovascular mortality in PAOD., (Copyright © 2014 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.)

Aims: Atrial septal defect (ASD) is one of the most common congenital heart diseases in adults. We prospectively evaluated early and mid-term effects of the percutaneous closure of secundum ASD on atrial electromechanical delay (AEMD) and left atrial (LA) mechanical functions at the first day and sixth month in patients undergoing percutaneous closure., Methods and Results: Forty-one patients were included in this study. Twenty-six (63.4%) of the 41 patients were female and the mean age was 41 ± 13 years. All the patients had echocardiographic examination before the procedure and at the first day and sixth month after the procedure. LA volumes (maximal, minimal, and presystolic) and EMD (lateral, septal, and tricuspid) were measured. Left and right intra- and inter-AEMD were not changed at the first day but both were significantly shorter at the sixth month. There was no change in the total emptying volume and fraction before and after the procedure. LA maximal, minimal, and pre-systolic volumes, active emptying volume, and fractions were decreased at the first day and at the sixth month compared with pre-procedural volumes. LA passive emptying volume, passive emptying fraction, and conduit volume were increased at the first day and at the sixth month compared with pre-procedural volumes., Conclusion: Our results revealed that there was no change in the LA mechanical reservoir functions, but improved conduit function and impaired contractility functions early and in the mid-term after percutaneous closure of ASD and decreased AEMD only in the mid-term., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.)

Background: Platelets play an important role in the pathogenesis of coronary artery disease (CAD). The importance of dual antiplatelet therapy to prevent recurrent ischemic events in patients who have acute coronary syndrome and who will undergo percutaneous coronary intervention (PCI) is well known and widely accepted as a gold standard. However, despite this apparently effective therapy, incidence of adverse ischemic events could not be decreased enough. Resistance to aspirin/clopidogrel is an important risk factor for adverse ischemic clinical events. Up-to-date studies revealed many risk factors for antiplatelet resistance, one of which is hypertension (HT). Currently, there is no sufficient number of studies evaluating the association between HT and antiplatelet resistance, which is the aim of this study., Methods: We enrolled 145 consecutive patients (19 female [13.1%], 126 male [86.9%], mean age 55 ± 10) with stable CAD receiving regular antiplatelet therapy composed of 100 mg/d aspirin and 75 mg/d clopidogrel. All patients had been implanted nondrug-eluting coronary stent and/or stents at least 1 month ago. The HT was diagnosed by 24-hour blood pressure (BP) monitoring. Clopidogrel and aspirin resistance was measured by impedance aggregometry method., Results: We included 49 patients with HT and 96 nonhypertensive patients with stable CAD. Aspirin resistance was detected in 22 (16.4%) of 134 patients who received aspirin. Clopidogrel resistance was detected in 55 (37.9%) of 145 patients who received clopidogrel. Prevalance of aspirin and clopidogrel resistance was significantly higher in the hypertensive group than in the nonhypertensive group (P = .030 and P = .007, respectively). Correlation analysis revealed weak but significantly positive correlation between clopidogrel resistance and serum uric acid levels, mean platelet volume, platelet count, and 24-hour mean systolic BP (r = -.180, P = .030; r = .189, P = .016; r = .226, P = .006; and r = .200, P = .016, respectively)., Conclusion: We demonstrated higher incidence of antiplatelet resistance in patients with HT. Upon this finding, which is emerged from an actual group of patients with HT, cardioprotective effect of antiplatelet therapy in patients with HT should be argued., (© The Author(s) 2013.)

Objectives: Proximal cerebral protection devices have been developed as an alternative to filter protection devices for reducing neurological complications during carotid artery stenting (CAS). The aim of the present study was to evaluate the frequency of silent cerebral embolism after CAS using different cerebral embolic protection devices and the impact of silent cerebral embolism on neurocognitive function., Methods: One hundred consecutive patients who underwent CAS were enrolled. The patients were randomized to either proximal balloon occlusion or filter protection. Neurocognitive tests were performed before and six months after CAS. Cerebral embolisms were evaluated with diffusion-weighted magnetic resonance imaging (DW-MRI)., Results: The number and volume of new ischemic lesions found with DW-MRI were higher in the filter protection group than in the proximal balloon occlusion group. According to our definition, nine (21%) patients in the balloon occlusion group and 16 (36%) patients in the filter protection group showed neurocognitive decline, and ten (23%) patients in the balloon occlusion group and four (9%) patients in the filter protection group showed neurocognitive improvement (NS). Regarding the group of patients with new cerebral ischemic lesions on DW-MRI, neurocognitive decline occurred in 14 (31%) of 45 patients with DW-MRI lesions and 11 (26%) of 43 patients without DW-MRI lesions (NS)., Conclusion: Neurocognitive outcome after CAS is unpredictable; both neurocognitive decline and improvement can occur. In this study, the proximal balloon occlusion system significantly decreased cerebral microemboli during CAS compared to filter protection. Cerebral microembolism was not found to be associated with neurocognitive decline., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Background: Slow coronary artery flow (SCF) is characterized by angiographically confirmed delayed vessel opacification in the absence of any evidence of obstructive epicardial coronary artery disease. Microvolt T-wave alternans (MTWA) is defined as beat-to-beat changes in shape, amplitude, or timing of ST segments and T waves, and is utilized in predicting sudden cardiac death and life-threatening malign ventricular arrhythmias in high-risk patients. In our study, we aimed to evaluate the effects of slow coronary artery flow on MTWA., Methods: Thirty-nine consecutive patients (SCF group: 6 women and 33 men; mean age, 49 ± 10 years) with angiographally documented SCF in at least 1 major epicardial artery and 39 patients (control group: 13 women and 26 men; mean age, 50 ± 10 years) with normal coronary arteries were included in the study. Coronary flow rates of all patients were calculated by thrombolysis in myocardial infarction frame count (TFC). The MTWAs of all patients were analyzed using the time-domain modified moving average method by means of a treadmill exercise stress test., Results: The age distribution , body mass index, and diastolic and systolic blood pressure (BP) were similar in the SCF and control group. In the SCF group, the three epicardial coronary artery corrected TFCs and mean TFCs were significantly higher than in the control group (for all, p < 0.001). MTWA positivity in the SCF group was statistically significant compared to the control group (p = 0.006). Spearman's correlation analysis, showed a positive correlation between MTWA and right coronary artery (RCA) TFC and mean TFC (r = 0.368, p = 0.001 and r = 0.271, p = 0.016, respectively). In linear regression analysis, only the right coronary artery TFC was correlated with positive MTWA (p = 0.001)., Conclusions: The results of our study suggest that diagnosed SCF is associated with MTWA positivity. Furthermore, we determined that only RCA TFC was predictive of positive MTWA., Key Words: Microvolt T-wave alternans; Slow coronary flow.

Aims: The objective of this study is to determine the effect of intravenous (i.v.) or oral N-acetylcysteine (NAC) in preventing contrast-induced nephropathy (CIN) in patients with moderate-to-severe renal insufficiency undergoing intra-arterial interventions., Materials and Methods: We studied 307 patients with estimated glomerular filtration rate of less than 60 ml/min/1.73 m undergoing an elective intra-arterial procedure. Patients were assigned randomly to three groups according to the prophylactic regimen used. In group 1, patients were administered an i.v. infusion of 0.9% saline (n=103); in group 2, patients were administered oral NAC in addition to an i.v. saline infusion (n=102); and in group 3, patients were administered i.v. NAC in addition to an i.v. saline infusion (n=102). Serum creatinine (SCr) and cystatin C levels were measured at baseline and 4, 24, and 48 h after the application of contrast media. The primary endpoint was defined as an increase in the SCr or cystatin C concentration of at least 0.5 mg/dl and/or of at least 25% from the baseline value at 48 h after administration of the contrast dye., Results: The overall incidence of SCr-based CIN was 11.1%: 6.8% in the saline group, 13.7% in the oral NAC group, and 12.7% in the i.v. NAC group (P=0.231). That of cystatin C-based CIN was 8.1%: 6.8% in the saline group, 6.9% in the oral NAC group, and 10.8% in the i.v. NAC group (P=0.491)., Conclusion: In this study, there was no detectable benefit of either high-dose oral or i.v. NAC over an aggressive hydration protocol in patients with moderate-to-severe renal insufficiency.

Background: Uric acid (UA) is an independent risk factor for the development of coronary heart disease. Serum UA levels have been correlated with all major forms of death from cardiovascular disease, including acute, subacute, and chronic forms of coronary artery disease (CAD), heart failure, and stroke. However, its value in acute ST-segment elevation myocardial infarction (STEMI) remains unclear. The aim of this study was to evaluate the prognostic value of UA in patients with STEMI undergoing primary percutaneous coronary intervention (PCI)., Methods: We prospectively enrolled 434 consecutive Turkish STEMI patients (mean age 55.4 ± 12.4 years, 341 male, 93 female) undergoing primary PCI. The study population was divided into tertiles based on admission UA values. The high UA group (n = 143) was defined as a value in the third tertile (> 5.7 mg/dl), and the low UA group (n = 291) included those patients with a value in the lower two tertiles (≤ 5.7 mg/dl). Clinical characteristics, in-hospital and six-month outcomes of primary PCI were analyzed., Results: Compared to the low UA group, only Killip class > 1 at admission was more prevalent in the high UA group (3.4% vs. 17.5%, p < 0.001, respectively). Higher in-hospital cardiovascular mortality and six-month all-cause mortality rates were observed in the high UA group than in the lower group (12.6% vs. 1.7%, respectively, p < 0.001) and (19.6% vs. 4.1%, respectively, p < 0.001). In Cox multivariate analysis; a high admission UA value (> 5.7 mg/dl) was found to be a powerful independent predictor of six-month all-cause mortality (hazard ratio: 5.57, 95% confidence interval: 1.903-16.3, p = 0.002)., Conclusions: These results suggest that a high level of UA on admission was associated with increased in-hospital cardiovascular mortality, and six-month all-cause mortality in Turkish patients with STEMI undergoing primary PCI., Key Words: Primary angioplasty; ST elevation myocardial infarction; Uric acid.

Introduction: Many studies have reported the diagnostic and prognostic value of haemoglobin A1c (HbA1c) levels in patients with acute coronary syndrome. However, the short- and long-term prognostic value of HbA1c level in patients with ST elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) is controversial., Aim: To investigate whether admission HbA1c level has a prognostic value for in-hospital, short-, and long-term cardiovascular (CV) mortality and major adverse cardiovascular events in patients with STEMI undergoing primary PCI., Material and Methods: This prospective study included 443 consecutive patients with STEMI who underwent primary PCI between September 2010 and July 2012. The patients were divided into three groups based on admission HbA1c levels: group I (HbA1c ≤ 5.6%), group II (HbA1c 5.7-6.4%), and group III (HbA1c ≥ 6.5%). The in-hospital, 1-month, and 1-year CV events of all 3 patient groups were followed up., Results: A significant association was found between HbA1c level and 1-year primary clinical outcomes, including CV mortality, non-fatal reinfarction, and stroke (p = 0.037). In addition, age, Killip class > 1, and left ventricular ejection fraction were found to be independent predictors of long-term CV mortality in multivariate analysis (hazard ratios (95% confidence interval) 1.081 (1.020-1.146), 4.182 (1.171-14.935), and 0.832 (0.752-0.920); p = 0.009, p = 0.028, and p < 0.001, respectively)., Conclusions: In this study, we demonstrated that increased admission HbA1c levels were associated with higher rates of major adverse CV events, including mortality, non-fatal reinfarction, and stroke, in patients with STEMI who underwent primary PCI.

Background: Isolated systolic hypertension (ISHT) is a subtype of hypertension (HT) that often exhibits wide pulse pressure, and pulse pressure has a strong predictive value for future adverse cardiovascular events. Previous studies have shown the effects of leukocyte count on the prognosis of ischaemic heart disease and HT., Aim: Thus, in this cross-sectional study, we analysed the relationship between leukocyte counts and subtypes in HT and non-HT groups., Methods: The study population consisted of 960 consecutive patients who were admitted to the outpatient clinic of our hospital. After ambulatory blood pressure values were assessed, the participants were divided into three groups: ISHT (n = 98), systo-diastolic hypertensives (SDHT, n = 405), and non-hypertensives (non-HT, n = 457)., Results: The subjects in the ISHT group were older than those in the SDHT and non-HT groups (64 ± 10, 53 ± 12, and 52 ± 13, respectively; p < 0.001). The leukocyte and neutrophil counts and neutrophil/lymphocyte (NL) ratios were significantly different in all groups. In subgroup analysis, the leukocyte count, neutrophil count, and N/L ratio were higher in the ISHT and SDHT groups than in the non-HT group (p < 0.001 for all). The leukocyte count, neutrophil count, and N/L ratio were significantly higher in the ISHT group than in the SDHT group (p = 0.023, p = 0.007, p = 0.010, respectively). Neutrophil count (p = 0.012; OR = 1.229, 95% CI 1.046-1.444) was an independent risk factor for ISHT in multivariate logistic regression analysis., Conclusions: The leukocyte and neutrophil counts and N/L ratios were higher in the ISHT group than in the SDHT and non-HT groups. High neutrophil count was an independent predictor of ISHT.