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We aimed to investigate the metabolic effects of HIIT exercise on PCOS patients and how it affects adiponectin, vaspin and leptin. Twenty women with PCOS were included in the study and were divided into two groups. HIIT program was applied for 10 PCOS and Medium Intensity Continuous Training (MICT) program was applied for other 10 PCOS. At the beginning and at the end of the study, total cholesterol, low-density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), triglyceride(TG), insulin, Adiponectin, Leptin, Vaspin levels of both PCOS groups were evaluated. When PCOS patients by performed HIIT exercise for 12 weeks, we found that the levels of leptin and vaspin did not change while adiponectin levels increased. Moreover serum levels of insulin, TG, total cholesterol, LDL-C decreased but levels of HDL-C increased. HIIT increased in the adiponectin levels in women with PCOS and provided more weight loss. [ABSTRACT FROM AUTHOR]

Background: Growth hormone deficiency (GHD) is known to cause higher rates of cardiovascular mortality. The purpose of the study was to analyze the structural and functional changes in the heart and investigate their relation to autonomic function as assessed with heart rate variability (HRV).Methods: Eleven untreated GHD patients (mean age 50.4 +/- 10.7 years, M/F: 3/8) and 15 age- and sex-matched healthy persons (mean age 45.3 +/- 10.4 years, M/F: 5/10) were compared. Both groups were examined with echocardiography, HRV, and exercise testing and findings were analyzed.Results: The groups were similar in height, weight, body mass index, body surface area, systolic and diastolic blood pressure, heart rate. The GHD patients had lower exercise duration and metabolic equivalent (MET) compared to controls (7.94 +/- 1.26 vs. 9.8 +/- 1.9 min, P < 0.001, for MET 8.85 +/- 0.86 vs. 10.7 +/- 2.23, P = 0.03). On echocardiography, GHD patients had lower interventricular septum diastolic diameter (9 +/- 0.89 vs. 10.7 +/- 0.88 mm, P < 0.001) and posterior wall thickness (8.4 +/- 0.93 vs. 9.8 +/- 0.91 mm, P = 0.002), and lower left ventricle mass index (90.9 +/- 20 vs. 112 +/- 8 g/m2, P = 0.01). Left ventricular ejection fraction was lower in the GHD patients (57.4 +/- 5.12% vs. 65.5 +/- 4.1%, P < 0.001). Time and frequency domain heart rate variability parameters, SDNN, SDANN, VLF, LF ve LF/HF were lower in GHD patients compared to controls. There was a significant correlation between left ventricle diastolic diameter and LF (r = 0.62, P = 0.02).Conclusion: GHD seemed to cause decreased left ventricle mass and decreases in the sympathetic components of HRV that may have a bearing on the increased cardiovascular risk seen in these patients. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the effect of the Valsalva maneuver on P-wave durations and dispersion. After the Valsalva maneuver, we found that maximum P-wave duration increased, minimum P-wave duration decreased, and P-wave dispersion increased in controls, whereas the opposite was true for unselected patients with paroxysmal AF. It was concluded that patients with paroxysmal AF performing the Valsalva maneuver normalized their P-wave dispersion, thereby correcting the inhomogeneous intra-atrial conduction. [ABSTRACT FROM AUTHOR]

Background: The use of high-sensitivity troponin levels increases the sensitivity of the diagnosis of non-ST elevation myocardial infarction (NSTEMI). However, the inclusion of other factors in the differential diagnosis, apart from atherothrombosis causing myocardial injury, decreases the specificity of high-sensitivity troponin. In this study, we compared the efficacy of high-sensitivity troponin with serum oncostatin M in NSTEMI cases with elevated urea and creatinine., Methods: This study was performed with a prospective cross-sectional sample. Ninety participants with coronary angiography performed due to a preliminary diagnosis of NSTEMI were included. High-sensitivity troponin I, creatine kinase-MB, lactate dehydrogenase, serum transaminase and oncostatin M levels were quantitatively measured for the first 4-8 hours from the onset of symptoms. All participants had coronary angiography performed within the first 12 hours after attending the emergency service. Based on coronary angiography data, patients with significant coronary stenosis or occlusion detected during coronary angiography were defined as group A, and patients with no occlusion in the coronary artery and who did not require an additional interventional procedure were defined as group B. The SYNTAX 2 score was used to determine the severity of coronary artery disease., Results: Patients in both groups A and B had similar age, sex distribution and comorbidities. Group A had higher serum urea, creatinine, oncostatin M and high-sensitivity troponin I values than group B. With 585 pg/ml as the cut-off value, serum oncostatin M had a sensitivity of 88.6% and specificity of 85% for the diagnosis of NSTEMI. Logistic regression multivariate analysis showed that serum oncostatin M and high-sensitivity troponin I values had diagnostic efficacy for NSTEMI. Serum oncostatin M was found to be more effective than high-sensitivity troponin I in patients with elevated urea and creatinine., Conclusions: Serum oncostatin M had similar sensitivity and specificity for NSTEMI diagnosis as high-sensitivity troponin I. Serum OSM can especially be considered as a complementary diagnostic biomarker for NSTEMI in patients with renal dysfunction., Competing Interests: All the authors declare no conflict of interest.

Background: There are limited data regarding short- and medium-term IgG antibody levels after the CoronaVac and BNT162b2 vaccines. This study aimed to investigate the antibody responses of health workers who initially received two doses of CoronaVac one month apart followed by a booster dose of either CoronaVac or BNT162b2, as well as determine whether either vaccine provided superior results., Methods: This research represents the second phase of a mixed-methods vaccine cohort study and was conducted between July 2021 and February 2022. The participants (n = 117) were interviewed in person and blood samples were collected before and at 1 and 6 months after the booster vaccination., Results: BNT162b2 was found to have greater immunogenic potential than CoronaVac ( p < 0.001). Health workers without chronic disease exhibited statistically significant increases in antibody levels after both vaccines ( p < 0.001), whereas only BNT162b2 caused a significant increase in antibody levels in participants with chronic disease ( p < 0.001). Samples obtained before and at 1 and 6 months after the booster vaccination revealed no age- or sex-based differences in IgG-inducing potential for either vaccine ( p > 0.05). Antibody levels were comparable in both vaccine groups before the booster regardless of COVID-19 history ( p > 0.05); however, antibody levels were significantly higher after the BNT162b2 booster at 1 month (<0.001) and at 6 months, except among participants who had a positive history of COVID-19 infection ( p < 0.001)., Conclusions: Our results suggest that even a single booster dose of BNT162b2 after initial vaccination with CoronaVac provides a protective advantage against COVID-19, especially for risk groups such as health workers and those with chronic diseases.

Background: Laminin, one of the largest glycoproteins of the basement membrane, is an important component of the extracellular matrix. Functions of the basement membrane include regulation of cell signaling behaviors and structural support. Laminin plays a critical role in the regulation of insulin action in muscle, liver, and adipose tissue. The study mainly investigates an association between the change in serum laminin levels and insulin resistance and non-alcoholic hepatosteatosis., Methods: This prospective study included a total of 90 participants; 60 patients diagnosed with Grade 2-3 non-alcoholic hepatosteatosis and 30 age- and sex-matched healthy controls between December 2019 and December 2020. Routine laboratory tests including glucose, insulin, homeostatic model of assessment-insulin resistance (HOMA-IR), alanine aminotransferase (ALT), aspartate aminotransferase (AST), triglyceride, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and C-reactive protein and laminin levels were measured in the serum of the patient and control groups. Enzyme-linked immunosorbent assay was used for the measurement of laminin levels., Results: The median serum laminin levels were lower in patients with hepatic steatosis, compared to the control group (72 ng/L vs. 82 ng/L, respectively; p = 0.003). In the patients with insulin resistance, median laminin levels were lower, regardless of the presence of non-alcoholic hepatosteatosis (67 ng/L vs. 85 ng/L, respectively; p = 0.007). There was a weak, negative correlation between the laminin levels and HOMA-IR., Conclusions: Our study results suggest that, although there is no exact link between laminin and non-alcoholic hepatosteatosis, serum laminin levels are lower in patients with insulin resistance by regulating the insulin effect through integrins.

Aim: In this study, we aimed to investigate the possible role of endotrophin, a profibrotic byproduct of collagen VI, in the complex process of fibrosis development in the disease group with pulmonary fibrosis among interstitial lung diseases., Material and Method: When the patients' participation in the study were completed, smoking or alcohol drinking conditions, and family history were recorded. Their weights and heights were recorded and body mass index (BMI) was calculated. In every patient, Spirometry with bronchodilator testing, determination of single-breath DLCO, and plethysmographic measurement of thoracic gas volume and airway resistance were performed. Blood samples were obtained for the inflammation markers such as sedimentation rate, C-reactive protein (CRP), complete blood count, liver and renal function tests, and lactate dehydrogenase levels. Serum endotrophin levels were measured in all patients., Results: Thirty-five patients with interstitial lung disease who were having pulmonary fibrosis, 35 patients with interstitial lung disease without pulmonary fibrosis, and 20 control patients without any signs or symptoms of interstitial lung disease were included in the study. Age distribution was similar between groups. The fibrotic ILD group was more commonly smoker or ex-smoker compared with the non-fibrotic ILD patients or control cases. Fibrotic ILD patients were leaner, having significantly decreased total lung capacity, diffusion capacity, and higher LDH levels. In the comparison of the 3 study groups regarding the endotrophin levels, there was a significant difference between groups. The fibrotic and non-fibrotic patient groups were compared for the Endotrophin levels and the difference was also significant. However, there was not any significant difference regarding the endotrophin levels between control cases and non-fibrotic ILD patients. Smoked cigarette pocket x year showed a significant positive correlation and DLCO % and KCO % showed a significant negative correlation with the endotrophin levels., Conclusion: Serum endotrophin levels significantly increase in fibrotic ILD patients compared with the non-fibrotic ILD patients and control cases. Endotrophin may be suggested as a diagnostic marker in fibrotic interstitial lung diseases., (Copyright: © 2021 SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES.)

Objective Activated macrophages (M1-type macrophages) in adipose tissue secrete many proinflammatory cytokines that induce insulin resistance (IR). Oncostatin M (OSM), a member of the interleukin-6 (IL-6) family of Gp130 cytokines, plays an important role in a variety of biological functions, including the regulation of inflammatory responses. Proinflammatory cytokines released in patients with IR trigger a chronic, low-grade inflammatory reaction in blood vessel walls. This inflammator response leads to endothelial damage, which is the main mechanism for atherosclerosis and many cardiovascular diseases. Animal studies have reported a relationship between OSM and IR. To the best of our knowledge, however, few clinical studies have examined this topic. Therefore, we studied the relationship between serum levels of OSM and IR. Subjects and methods This prospective cross-sectional case-control study enrolled 50 people with IR (according to the HOMA-IR and QUICKI indices) and 34 healthy controls. The fasting blood concentrations of insulin, glucose, blood urea nitrogen (BUN), creatinine, aspartate aminotransferase (AST), alanine aminotransferase (ALT), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglyceride, total cholesterol, C-reactive protein (CRP), and OSM were determined. Results There were no significant differences between the two groups in age, sex, and HbA1c levels. Univariate analyses showed that waist circumference (WC) and levels of fasting glucose, insulin, CRP, HDL-C, OSM, HOMA-IR, and QUICKI differed between the two study groups. In multivariate analyses, both IR indices (QUICKI and HOMA) and OSM differed between the two groups. Conclusion OSM was correlated with the IR indices (QUICKI and HOMA). For simplicity, it might replace the other IR indices in the future. Further detailed studies are needed to confirm this.

Background: Endotrophin, a type VI collagen cleavage product, has fibrosis, and insulin resistance effects. Type VI collagen also plays a role in cardiac fibrosis. In this study, we aimed to investigate the role of endotrophin in the pathogenesis of cardiac fibrosis by determining its levels in patients with heart failure with reduced and mid-range ejection fraction (EF). We also aimed to determine the possible association between endotrophin and treatment that prevents ventricular fibrosis., Methods: Sixty patients with heart failure with reduced and mid-range EF and 27 volunteers with no cardiac failure were included in this study. In both groups, biochemical tests, EF, and endotrophin levels were measured. ELISA was performed for the determination of endotrophin levels., Results: When compared with the control group, there was no significant difference for endotrophin levels in the patient group (p = .35). Participants in the study were divided into two groups according to their EFs, 40% and less, and 40-49%. They were classified according to their use of renin-angiotensin-aldosterone system (RAAS) blocking drugs. Endotrophin levels were significantly lower in patients with mid-range EFs between 40 and 49% (p = .03) using RAAS blockers., Conclusion: This study is the first to evaluate the relationship between endotrophin and heart failure. Endotrophin levels were found to be low in patients with heart failure with mid-range EF who were using RAAS blockers. This suggests that RAAS blockers may influence endotrophin levels and thus could have a role in the prevention of remodelling., (Copyright © 2019. Published by Elsevier B.V.)

Objectives: Adropin is a novel marker of metabolic syndrome and insulin resistance. The aim of this study was to explore the association of serum adropin levels with hepatosteatosis among adult patients., Materials and Methods: Serum biochemical parameters including liver and renal function tests, insulin levels, and serum adropin levels were compared between adult patients with nonalcoholic fatty liver disease (NAFLD) and healthy control cases., Results: A total of 51 patients with a mean age of 37.9 ± 9.96 years diagnosed with grade 2-3 hepatosteatosis and 30 healthy control cases with a mean age of 34.8 ± 9.5 years were included in the study. Serum adropin levels in the NAFLD group were statistically significantly lower than in the control cases (588.4 ± 261.0 vs. 894.2 ± 301.2, respectively; p < 0.001). The study participants were further subdivided into 2 groups as patients with (n = 35) or without (n = 46) insulin resistance using the serum homeostatic model of assessment-insulin resistance (HOMA-IR). Serum adropin levels were statistically significantly lower in patients with insulin resistance (p < 0.01). There was a negative correlation between adropin levels and serum insulin, HOMA-IR, urea, gamma-glutamyl transferase, total cholesterol, and triglyceride levels., Conclusion: We observed a decrease in serum adropin levels among adult patients with NAFLD. We also found lower levels of serum adropin in patients with insulin resistance, supporting previous data in the literature. Studies investigating the association of adropin levels with other inflammatory parameters are warranted to define its exact role in the pathogenesis of hepatosteatosis., (© 2019 The Author(s) Published by S. Karger AG, Basel.)

Objectives: Angiopoietin-like peptide 4 (ANGPTL-4) plays an important role in lipid metabolism by inhibiting the enzyme lipoprotein lipase. This effect of ANGPTL-4 results in suppression of the release of plasma triglyceride-derived fatty acids. Increase in fatty acid levels entering to the liver and abnormalities in their secretion is one of the main mechanisms in pathogenesis of hepatic steatosis. In this study, we aimed to investigate the role of ANGPTL-4 in pathogenesis of hepatic steatosis by determining its levels in patients with fatty liver disease., Methods: Totally 51 patients (age: 37.9 ± 9.9 years, M/F) diagnosed with grade 2-3 hepatic steatosis with ultrasound and 30 healthy volunteers (age: 34.8 ± 9.5 years, M/F) were included in the study. In both groups, routine biochemical tests including fasting blood glucose, fasting insulin levels, triglyceride, total cholesterol, LDL- cholesterol, HDL-cholesterol, AST, ALT, ALP, GGT levels were measured together with the ANGPTL-4 levels. In determination of ANGPTL-4 levels, ELISA was performed., Results: When compared with the control group, ANGPTL-4 levels were determined to be decreased in patients with hepatic steatosis (369 ± 243 vs 303 ± 286 ng/mL, p = 0.014). There was a negative weak correlation observed between ANGPTL-4 and triglyceride levels (r = -0.246, p = 0.027). Among all groups, when patients with and without insulin resistance were compared; ANGPTL-4 levels were determined to be similar. While fasting blood glucose levels were similar between 2 groups; fasting insulin and triglyceride levels were determined to be increased in hepatic steatosis group (Insulin 17.7 ± 12 vs 7.4 ± 3.3 µIU/mL, p < 0.001, triglyceride 158 ± 46.4 vs 118 ± 59.8 mg/dL p < 0.001)., Conclusions: We have determined lower serum ANGPTL-4 levels in patients with hepatic steatosis. ANGPTL-4 that is regulating LPL activity plays an important role in fatty liver disease pathogenesis via free fatty acid metabolism and peroxisome proliferator-activated receptor-delta (PPAR-δ). We believe that the results of this study would elucidate the investigations about the mechanism of fatty liver disease development and treatments targeting ANGPTL-4., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objective: The aim of this study was to determine how often the recommendations of the Turkish Hypertension Consensus Report are followed, and to draw attention to the report., Methods: The demographic information of 1000 patients diagnosed with hypertension and the details of the antihypertensive medications prescribed at the outpatient service of a tertiary care hospital were recorded, and the data were compared with the recommendations of the report., Results: The mean age of the patients was 62±11 years. In all, 623 (62.3%) of the 1000 patients were women, and 377 (37.7%) were men. A combination of an angiotensin II receptor blocker (ARB) and a diuretic was the most frequently observed prescription. A diuretic was the most used antihypertensive drug (58.7%), followed by an ARB (48.8%). However, as a monotherapy, a calcium channel blocker (CCB) was the most commonly used antihypertensive drug (19.2%). The most frequently used antihypertensive drug group in older patients was diuretics (63.6%), as proposed in the report. Beta blockers (49.1%) were used more often than expected. For the diabetic group also, a diuretic (60.7%) was the most frequently used antihypertensive drug, followed by an ARB (51.1%) and a CCB (45.2%). Angiotensin-converting enzyme (ACE) inhibitors (34.6%) were the fifth most preferred antihypertensive drug class. However, when ACE inhibitors and ARBs were considered as a single group, known as renin-angiotensin system (RAS) blockers, these RAS blockers were the most prescribed antihypertensive drug class, followed by diuretics. In the group of patients with coronary artery disease, treatment was found to be generally consistent with the report, but the use of diuretics was greater than expected. Lastly, 124 of 160 patients who had chronic kidney disease were given RAS blocker therapy, which was in line with the consensus report recommendations., Conclusion: Antihypertensive therapies were individualized, as suggested by the consensus report. However, there are proposals still to be considered in special patient groups.

Acquired hemophilia is a relatively rare clinical presentation, and most cases present with acquired FVIII inhibitor. The co-occurrence of inhibitors to multiple coagulation factors is uncommon. These autoantibodies may induce spontaneous life-threatening bleeding in patients who have had no previous bleeding disorder. Herein, we present a patient with postpartum acquired FVIII and FIX inhibitors who developed intramuscular hematoma and hemothorax during follow-up. She was then treated with activated prothrombin complex concentrate and methylprednisolone., (© 2016 S. Karger AG, Basel.)

Hypertension is a common and important public health problem in Turkey and worldwide. Recommendations on the diagnosis and treatment of hypertension have been presented in many nationally and internationally agreed European and American guidelines. However, there are differences among these guidelines, and some of the recommendations are not consistent with clinical practice in our country. Consensus report preparation, with the participation of relevant associations, was considered necessary to merge recommendations by evaluating hypertension guidelines from the perspective of Turkey and to create a joint approach in the diagnosis and treatment of hypertension in adults. For this purpose, it was aimed to prepare a practical text in Turkey in which all physicians dealing with hypertensive patients, from family practitioners in primary care to specialists in tertiary care, could come to agreement on common concepts, and which would be used as a basic reference guideline. Considering health care practices and sociocultural structure in Turkey, this report aimed to enhance awareness on hypertension, provide a common basis for different definitions and values as well as therapeutic options in various guidelines, and establish a practical reference guide to improve clinical practices in Turkey. This report is not a document describing hypertension in every aspect, but a reference, including basic recommendations with outlines. Care was taken to ensure that recommendations were evidence-based and valid for a majority of patients in clinical practice. However, it should be kept in mind that an approach assessment should be made on an individual basis for each patient.

Objectives: Exocrine pancreatic dysfunction may contribute to malnutrition and lack of appetite in the advanced stages of heart failure. Nutritional assessment was carried out on patients diagnosed with mild or moderate/severe heart failure. Fecal elastase levels are an indicator of pancreatic exocrine function and ghrelin is an appetite hormone which is also investigated for its contribution to malnutrition., Study Design: This is an observational study. 52 patients (32 males, 20 females) aged over eighteen years and hospitalized for acute decompensated heart failure (ADHF) were included in the study. They were compared with 31 people (16 male, 15 female) of the same age as Control Group (C). Patients in New York Heart Association (NYHA) stages 1 and 2 were grouped as mild (miADHF), while those in NYHA stages 3 and 4 were grouped as moderate/severe ADHF (seADHF). Fecal and blood samples were taken at admission. In ADHF patients, exocrine pancreatic functions and their relationship with malnutrition were evaluated. Statistical analyses were performed using Tukey's test, the independent-sample t-test, the Kruskal-Wallis test, the Mann-Whitney U-test, the chi-square test and Pearson's bivariate correlation analysis., Results: Significantly decreased fecal elastase levels were found when moderate/severe ADHF patients and the control group were compared. (C 278.9±144.8, miADHF 336.6±181.7, seADHF 168.7±153.6, p=0.002). 10 seADHF patients (50%) had severe, 4 (20%) moderate, and 6 (30%) mild pancreatic insufficiency. Ghrelin levels were higher in seADHF patients compared to C and miADHF patients (C 69.7±34.6, miCHF 82.5±48.2, SeADHF 105.0±78.1 p=0.361)., Conclusion: Fecal elastase and ghrelin hormone levels can contribute to the determination of malnutrition in ADHF patients.

Multiple myeloma is a neoplastic plasma cell disorder. It is characterized by collections of abnormal plasma cells accumulating in the bone marrow, where they interfere with the production of normal blood cells. It usually presents as a multisystemic involvement, whose symptoms and signs vary greatly. Some patients have slowly progressive disease while others have aggressive clinical behavior by extramedullary involvement. In addition to renal failure, anemia, hypercalcemia, lytic bone lesions, and immunodeficiency, it also affects multiple organ system, such as pancreas, adrenal glands, kidney, skin, lung, liver, spleen, lymph nodes, and bone. To raise awareness of the variable presentations of this disease, we report a 53-year-old male patient, with multiple myeloma in his first remission who relapsed with extramedullary plasmacytomas (EMPs) involving multiple organs, such as pancreas, adrenal glands, kidney, skin, lung, liver, spleen, and lymph nodes.

Objective: Patients may develop kidney failure because of the contrast agent given during coronary angiography. Renal dysfunction and heart failure were previously shown to be associated with the development of contrast nephropathy. In our study, we aimed to investigate whether there is a relationship between subclinical renal (indicated by microalbuminuria) and/or cardiac (indicated by the height of the BNP) dysfunction between the development of contrast-induced nephropathy on patients undergoing angiography due to acute coronary syndrome., Methods: This is an observational prospective cohort study. A total of 170 patients hospitalized with a diagnosis of acute coronary syndrome in the coronary care unit were included in this study. Blood samples were collected from 145 patients without microalbuminuria and 25 patients with microalbuminuria to determine their BNP levels before coronary angiography. The patients' urea and creatinine levels were examined before and 72 h after coronary angiography. Statistical analysis was performed using Kolmogorov-Smirnov test, Mann-Whitney U test, independent samples t-test and the chi-square test., Results: The study subjects included 82 females and 88 males (average age, 64.4±14.5 years). The BNP levels and height distribution of the 145 patients without microalbuminuria were compared between those with and without contrast agent-induced nephropathy, but no significant difference was found (205.6±280.6, 198.0±310.0, p=0.817). Similarly, no relationship between the microalbumin level and contrast agent-induced nephropathy was found in 25 patients., Conclusion: A relationship between BNP, microalbuminuria, and contrast agent-induced nephropathy was not found in patients hospitalized in a coronary care unit with a diagnosis of acute coronary syndrome who were scheduled for coronary angiography. Additional multicenter studies with larger patient groups should be conducted to obtain more data.

Objective: The objective of this study is to confirm whether there is relation between the human leucocyte antigen (HLA) locus and restenosis after percutaneous coronary intervention (PCI) holds in our patient population and whether it can be useful as a prognostic factor., Methods: We examined the HLA phenotypes in 46 consecutive patients (39 men, 7 women, mean age of 57 ± 9 years) who had successful stent implantation in the coronary artery. Selective coronary arteriography was performed 6 months after coronary stenting to assess the presence of restenosis. The HLA phenotyping was performed for HLA-A,-B,-C antigens by Terasaki microlymphocytotoxicity technique and for HLA-DR alleles with PCR-SSP technique., Results: Restenosis(R+) was present in 12 (26.1%) patients (11 men, 1 woman, mean age of 57 ± 10 years). For HLA Class I antigens frequency of HLA-B62 and HLA-CW2 antigen was slightly higher in restenotic patients but did not reach statistical significance. For HLA-DR alleles restenotic patients had higher frequencies for HLA-DRB1(∗)01(R+ %25, R- %14.7), and HLA-DR11(R+ %41.7, R- %20.6), without reaching statistical significance and lower frequencies for DR7(R+ %0, R- %17.6) and D13(R+%8.3, R- %32.4) and HLA-DR53 (R+ %25, R- %35.3) without reaching statistical significance., Conclusion: In conclusion, results show that there was no relationship between the development of restenosis and HLA-subtypes.

Objective: It has been previously reported that intraventricular flow patterns in some hypertensive patients with left ventricular hypertrophy, change to patterns similar to flow profiles of hypertrophic cardiomyopathy. The purpose of the study was to assess left ventricular outflow and mid-septal intraventricular flow patterns in hypertensive and normotensive patients., Methods: Left ventricular outflow and mid-septal flows of 68 patients (41 men, mean age 53 +/- 14 years) and 45 non-hypertensive healthy controls (26 men, mean age 43 +/- 16 years) were assessed with Doppler echocardiography. Acceleration slope, pre-ejection period (PEP), and velocity-time integrals of the flows were recorded at the level and 1, 2 and 4 cm below the aortic valve. M-mode parameters of left ventricular wall thicknesses, dimensions and ejection fractions were also recorded. The data was analysed with the paired Student's t test with pre-hoc Bonferoni correction of the level of significance (0.05/4 = 0.0125) for multiple comparisons., Results: In normotensive patients the acceleration slope uniformly and statistically significantly decreased beneath the aortic annulus and PEP was unchanged. In hypertensive patients the acceleration slope steepened (1596 +/- 531 vs. 1948 +/- 700 cm/sec, p < 0.05) and PEP decreased (108 +/- 23 vs. 98 +/- 20 msec, p < 0.05) 1 cm below the aortic valve and later reverted to the normal pattern of decrease seen in normotensive patients., Conclusion: The increase in acceleration slope and decrease in PEP in the subvalvular region may represent the changing contraction pattern in the hypertensive patients, causing protrusion of the upper septum into left ventricular outflow track and may have a role in the genesis of systolic murmurs.

We examined the possible effect of diurnal variability of heart rate on the development of arrhythmias in patients with chronic obstructive pulmonary disease (COPD). Forty-one COPD patients (M/F: 39/2, mean age: 59+/-8.5 years) and 32 (M/F: 27/5, mean age: 57+/-11 years) healthy controls were included. Twenty-four hour ECG recordings were analyzed for atrial fibrillation (AF) or ventricular premature beats (VPB), and circadian changes in heart rate variability (HRV) were assessed by dividing the 24-h period into day-time (08:00-24:00 h) and night-time (24:00-08:00 h) periods. Night-time total (TP), low frequency (LF) and high frequency (HF) powers were similarly lower from day-time parameters in AF(-) COPD patients (HF 3.91+/-1 vs. 4.43+/-1.04 ms(2), P=0.001) and controls (HF 3.95+/-0.72 vs. 4.82+/-0.66 ms(2), P<0.001). The LF/HF ratios were also significantly reduced in the same patient groups (AF(-) COPD 1.35+/-0.21 vs. 1.27+/-0.19, P=0.04, controls 1.43+/-0.14 vs. 1.24+/-0.09, P<0.001). Night-time TP and LF were increased, HF unchanged and LF/HF significantly increased (1.11+/-0.25 vs. 1.19+/-0.27, P<0.05) in AF(+) COPD patients. Frequency of VPB was correlated with corrected QT dispersion (QTc(d)) (r=0.52, P=0.001) and the day-time/night-time HF ratio (r=0.43, P=0.02). Patients with QTc(d)>or=60 ms did not have the expected increase in night-time HF and had a statistically insignificant increase in LF/HF ratio. In COPD patients with QTc(d)<60 ms, circadian changes in HRV parameters were parallel with the controls. We concluded that COPD patients with arrhythmia had circadian HRV disturbances such as unchanged night-time parasympathetic tone and disturbed sympatho-vagal balance in favor of the sympathetic system all day long, which may explain the increased frequency of arrhythmia.

Study Objective: QT dispersion (QTd) and late potentials derived from signal-averaged ECG (SAECG) have been proposed as noninvasive predictors of cardiac arrhythmias that occur in patients with COPD. In this study, we aimed to investigate QTd and SAECG in patients with COPD., Design: Cross-sectional study., Setting: Teaching chest disease hospital and cardiology center in a university hospital., Patients: Thirty patients with COPD (28 men and 2 women; mean +/- SD age, 60 +/- 9 years) and 31 age- and sex-matched control subjects (28 men and 3 women; mean age, 57 +/- 7 years) were included., Measurements and Results: Respiratory function tests, arterial blood gas analyses, echocardiographic examinations, rhythm Holter recordings, and heart rate variability (HRV) analyses were performed in addition to the measurements of QT intervals and SAECG. Patients with COPD had higher rate of ventricular premature beats (VPBs) as compared to control subjects (924 +/- 493 beats vs 35 +/- 23 beats, p = 0.009). Eight patients with COPD (27%) had nonsustained runs of ventricular tachycardia (VT). QTd rates were significantly increased in patients with COPD as compared to control subjects (57.7 +/- 9.9 ms vs 37.5 +/- 8.2 ms, p < 0.001). On comparing patients with COPD with and without runs of VT, patients with VT had longer QTd (67 +/- 10 ms vs 55 +/- 8 ms, p = 0.001). However no difference in any HRV and late potential parameters were found between patients with COPD with and without runs of VT. VPB rates were strongly correlated with QTd in patients with COPD (r = 0.61, p < 0.001). On SAECG analysis, patients with COPD had significantly increased total QRS duration as compared to control subjects. Nine of the 30 patients with COPD (30%) had positive late potentials. However, QTd and VPB rates were also similar between patients with COPD with and without late potentials., Conclusions: The development of ventricular arrhythmia in patients with COPD was associated with increased QTd. Increased QTd may be associated with autonomic changes seen in patients with COPD.

Background: Autonomic heart rate control is impaired after CABG. The aim of this study was to establish the temporal pattern of change in the decrease of HRV observed after CABG., Methods and Results: Twelve patients with coronary artery disease were assessed with 24-hour Holter recordings 2 days before CABG and 1 week, 3 months, 6 months, 1 year, and 3 years after CABG. All the time-domain and frequency-domain HRV parameters decreased precipitately after CABG and were mostly recovered 3 months after CABG except mean NN, rMSSD, and pNN50. The ratio of LF to HF showed a slight decrease after surgery, recovered to preoperative values after 3 months, surpassed, and continued to increase 6 months after surgery. At 3 years of follow-up the recovery was complete. The rate of change of time-domain and frequency-domain parameters were calculated and their correlation with aortic cross-clamping time, number of vessels bypassed, the amount of cardioplegic used were sought and no statistically significant correlation was found., Conclusion: The recovery of HRV regardless to the preoperative state of the patients and their postoperative course implies that the early drop of HRV after CABG was related to the acute effects of surgery. Late complete recovery of HRV may be due to resolution of ischemia or use of angiotensin-converting enzyme inhibitor.

Background: Supraventricular tachyarrhythmia is a common problem in chronic obstructive pulmonary disease (COPD) patients. The purpose of this study is to analyze the factors associated with paroxysmal atrial fibrillation (AF) in COPD patients., Methods: Forty COPD patients (38 male, 2 female, mean age 60 +/- 9 years) and 33 healthy controls (29 male, 4 female, mean age: 58 +/- 10 years) were included in this study. Echocardiography, 24-hour ambulatory and 12-lead ECG, pulmonary function tests, arterial blood gases, and serum electrolytes were measured. On ECG, maximum (P(max)) and minimum (P(min)) duration of P wave and its difference, P-wave dispersion (PWd), were measured., Results: On echocardiography, diastolic dysfunction was found in 14 of the 40 (35%) COPD patients. Heart rate variability analysis revealed that COPD patients had decreased SDANN, SDNN, SDNNIDX in time-domain, and decreased LF in frequency domain parameters. Fourteen of the 40 COPD patients (35%) had AF. Patients with AF were older (57 +/- 10 vs 64 +/- 5 years, P = 0.03) and had lower SDANN, SDNN, and LF/HF ratio as compared to patients without AF in univariate analysis. All P-wave intervals (P(max), P(min,) and PWd) were increased in COPD patients compared to controls. P-wave dispersion was significantly increased in COPD patients with AF, as compared to patients without AF (57 +/- 11 vs 44 +/- 7 ms, P = 0.001). In logistic regression analysis PWd was found to be the only factor associated with the development of AF (P = 0.04)., Conclusions: The presence of AF was significantly related to the prolongation of PWd, but not with pulmonary function, arterial blood gasses, and left and right atrial function.

Although diagnostic value of transthoracic echocardiography in cardiac echinococcus is well established, the role of transesophageal echocardiography in both the diagnosis and the management of this entity is not well known. We present 3 unusual cases of cardiac hydatid cyst in which transesophageal echocardiography was used. A review of the literature on the subject is also presented.

Increased QT dispersion (QTd), predicting patients with risk of malignant arrhythmia, have recently been reported in hemodialysis patients (HDp). In this prospective study, we aimed to investigate changes in QTd and signal averaged-ECG (SAECG) in HDp after transplantation. Twenty-seven HDp (M/F:18/9, mean age 30+/-8 years) and 24 controls (M/F:14/10, mean age 33+/-6 years) were included. All QT parameters (QTmax, Qtmin, and QTd) were increased in HDp. QTmax and QTd started to decrease at the first month after transplantation. Percentage change in QTd at the third month was significantly correlated with percentage change in LV mass index (r=0.45, P=0.04), serum calcium (r=-0.47, P=0.02) and intact parathyroid hormone (r=0.68, P=0.01). In multivariate regression analysis, only percent chance in LV mass index was retained as significant. As for analysis of SAECG, 4 of the 23 (17%) HDp has abnormal late potentials which disappeared after transplantation. HDp with LV hypertrophy had higher filtered-QRS duration compared to patients without hypertrophy (110+/-12 vs. 97+/-11 msec, P=0.01). It was concluded that increased QTd and presence of late potentials improved early after renal transplantation. These changes were mainly associated with the regression of the LV mass.

Background: Paroxysmal atrial fibrillation (PAF), a common arrhythmia, is caused by the fractionated and nonhomogeneous propagation of sinus impulse., Hypothesis: This study was undertaken to examine the effect of left atrial (LA) dimension and function on P-wave dispersion (deltaP) in unselected patients with PAF and health controls., Method: In this study, 62 consecutive patients with PAF (32 men, 30 women, mean age 55+/-11 years) and 62 age- and gender-matched healthy controls (33 men, 29 women, mean age 52+/-13 years) were studied to compare the effect of LA size, volume, and function on deltaP (difference between maximum and minimum P-wave duration on 12-lead electrocardiogram)., Results: P-wave dispersion in patients with PAF and normal LA diastolic diameter (LAD) was longer than that in controls with normal LA size (53+/-8 vs. 34+/-8 ms, p < 0.001). P-wave dispersion increased in patients with PAF (62+/-12 vs. 53+/-8 ms, p = 0.003) and controls (40+/-7 vs. 34+/-8 ms, p = 0.005) with increased LAD. Presence or absence of PAF did not interact with LAD for their effect on deltaP (2 x 2 analysis of variance test p = 0.20). In the PAF group, deltaP correlated with LAD (r = 0.43, p = 0.002), LA diastolic volume (r = 0.6, p < 0.001), and LA ejection fraction (AEF) (r = - 0.33, p = 0.05). The AEF was preserved when LAD increased in the patients without PAF (0.52+/-0.07 vs. 0.57+/-0.10, p = NS), however was significantly decreased in the PAF group (0.37+/-0.12 vs. 0.49+/-0.10, p = 0.01). On multivariate logistic regression analysis, only deltaP retained significance on development of PAF., Conclusion: It was concluded that deltaP increased in patients with PAF and normal LA size. In controls with increased LA size, deltaP increased but did not reach the levels attained in patients with PAF. The AEF was decreased in patients with PAF but was preserved in those without PAF. These findings can be explained by the changes in LA microarchitecture which concurrently decreased atrial myocardial contraction, increased deltaP, and predisposed to PAF.

We evaluated left atrial appendage function and its relationship to pulmonary venous flow in 53 patients divided into four groups. Group 1 consisted of 10 normal subjects. Group 2 included 15 patients with significant pure mitral stenosis in sinus rhythm. In group 3, there were 13 patients with pure significant mitral stenosis and atrial fibrillation. Group 4 consisted of 15 patients with normal mitral valve and atrial fibrilltion. We found significant decrease in left atrial appendage ejection fraction and maximum emptying flow velocity, velocity time integral of systolic pulmonary venous flow in Groups 2, 3 and 4 in comparison with normal subjects. Systolic pulmonary venous flow velocity was significantly decreased in Groups 3 and 4. There was significant correlation between left atrial appendage ejection fraction and peak emptying flow velocity (r = 0.62, P < 0,001). Systolic peak pulmonary venous flow velocity was significantly correlated with left atrial appendage ejection fraction and maximum emptying flow velocity (r = 0.67, P = 0,01; r = 0.58, P < 0,001, respectively). There was also significant correlation between systolic pulmonary venous flow velocity time integral and left atrial appendage ejection fraction (r = 0.66, P = 0.001). When normals were excluded from analysis, all the correlations were still significant. We concluded that left atrial appendage is a contractile structure, and that systolic pulmonary venous flow velocity is influenced by left atrial appendage dysfunction. Therefore left atrial appendage function needs to be considered when interpreting Doppler transmitral and systolic pulmonary venous flow patterns.

Objective: The aim of this study was to compare QT dispersion (QTd) and signal-averaged electrocardiogram (SA-ECG) parameters that may predict risk of malignant arrhythmias in patients on hemodialysis (HD), on continuous ambulatory peritoneal dialysis (CAPD), and in controls., Setting: Controlled cross-sectional study in a tertiary-care setting., Patients: 28 HD (M/F 18/10; mean age 32 +/- 9 years), 29 CAPD (M/F 17/12; mean age 34 +/- 10 years), and 29 healthy controls (M/F 17/12; mean age 32 +/- 8 years) were included., Interventions: On ECG, minimum (QTmin) and maximum (QTmax) QT duration and their difference (QTd) were measured. In SA-ECG, duration of filtered QRS, HFLA signals less than 40 microV, and RMS voltage (40 ms) were also measured., Results: Higher serum Ca2+ and lower K+ levels were found in CAPD compared to HD. All QT parameters were increased in HD and CAPD compared to controls. QT dispersion was significantly prolonged in HD compared to CAPD. In HD, QTd was correlated with left ventricular (LV) mass index (r = 0.53, p = 0.004), but not in CAPD (r = -0.09, p = 0.63). QT dispersion was significantly prolonged in patients with LV hypertrophy compared to patients without hypertrophy on HD (68 +/- 18 ms vs 49 +/- 18 ms, p = 0.008). In the analysis of SA-ECG, 3 of the 28 (11%) HD and 2 of the 29 (7%) CAPD patients had abnormal late potentials. Patients on HD and CAPD had significantly higher filtered-QRS duration compared to controls (105 +/- 15 ms and 104 +/- 12 ms vs 95 +/- 5 ms, respectively, p = 0.04). Patients with LV hypertrophy had higher filtered-QRS duration compared to patients without hypertrophy (109 +/- 12 ms vs 95 +/- 8 ms, p < 0.001)., Conclusion: Dialysis patients had prolonged QTd and increased filtered-QRS duration in SA-ECG compared to controls. Patients on HD had longer QTd than patients on CAPD. QTd has been correlated to LV mass index in HD, but not in CAPD. This difference might be due to the effect of different dialysis modalities on electrolytes, especially the higher serum Ca2+ levels.

Posttransplant hyperlipidemia is a common complication which may affect long term cardiovascular mortality. In this prospective, placebo-controlled study, 19 renal transplant recipients (11 male 8 female, mean age 31.2 +/- 8.4 years) with good allograft function (serum creatinine <2 mg/dl) more than 6 months after transplantation were included. All the patients had hyperlipidemia (serum cholesterol >230 mg/dl and/or LDL-cholesterol >130 mg/dl) despite dietary interventions. The patients were treated with a triple immunosuppressive regimen. After a 8-week period of placebo plus diet regimen, the patients were put on fluvastatin plus diet for another 8 weeks. The patients were followed for its effect on lipid parameters and side effects. After convertion to fluvastatin, serum cholesterol (263.0 +/- 31.6 vs 223.2 +/- 31.6 mg/dl, p = 0.001), LDL-cholesterol (174.4 +/- 28.3 vs 136.4 +/- 28.5 mg/dl, p = 0.002), Apolipoprotein (Apo) A1 (131.1 +/- 16.9 vs 114.7 +/- 18.4 mg/dl, p = 0.001) and Apo B (109.0 +/- 29.8 vs 97.3 +/- 31.5 mg/dl, p = 0.02) levels decreased significantly. Serum levels of triglycerides, VLDL-cholesterol and HDL-cholesterol levels did not vary under fluvastatin. Serum lipoprotein (a) levels were also unchanged during the whole study period (24.9 +/- 19.4 vs 23.1 +/- 19.8 mg/dl, p > 0.05). We concluded that fluvastatin effectively decreased atherogenic lipoproteins such as serum cholesterol, LDL-cholesterol, Apo B in posttransplant hyperlipidemia, however fluvastatin had no effect on another independent risk factor of atherogenesis, serum lipoprotein (a) levels.

Background: The purpose of the study was to compare the echocardiographic parameters of soccer players to healthy controls and to assess the effect of the position of the soccer players on the echocardiographic findings., Methods: M Mode 2D and Doppler echocardiographic examination were carried out on 83 professional league soccer players and 52 healthy controls., Results: Soccer players had increased interventricular septum (1.14+/-0.13 cm vs 0.99+/-0.17 cm, p<0.001) left ventricular posterior wall (1.08+/-0.16 cm vs 0.91+/-0.13 cm, p<0.001) thickness, increased left ventricular diastolic diameter (5.24+/-0.40 cm vs 4.88+/-0.43 cm, p<0.001), volume (133+/-23 ml vs 113+/-22 ml, p<0.001) and increased left ventricular mass index (142+/-28 g/m2 vs 103+/-23 g/m2, p<0.001) compared to controls. Soccer players had greater mitral E wave to A wave ratio (2.08+/-0.53 vs 1.65+/-0.43, p<0.001) compared to controls. Soccer players were subgrouped according to their position in the play as goal keepers, defensive, midfielder, and offensive players. Comparison among defensive, midfield and offensive players revealed subtle differences between defensive and midfield players. Right ventricular dimensions were higher in goal keepers compared to midfielders due to the greater body surface area of the goal keepers (2.8+/-0.4 cm vs 2.4+/-0.5 cm, p<0.05). Left ventricle end diastolic dimension were similar between groups but when these dimensions were corrected for the greater height of the defensive players the difference between midfields and defensive players became significant (3.05+/-0.18 vs 2.89+/-0.22, p=0.05). On Doppler flow parameters the ratio of peak E wave to A wave velocity (2.27+/-0.55 vs 1.84+/-0.36, p<0.05) was increased in midfield players compared to defensive players., Conclusions: It was concluded that soccer players had greater left ventricular wall thickness, volume and mass compared to controls. But the effect of the position of the players on the measured cardiac dimensions were minimal. These subtle findings were explained by the leveling effect of the playing system and training, and lack of physical training during the previous month.

Left-ventricular hypertrophy (LVH), a bad prognostic sign, is a common finding in hemodialysis patients. The aim of the study was to analyze factors, including angiotensin-converting enzyme (ACE) genotype that may have an effect on the development of LVH in hemodialysis patients. Seventy-nine hemodialysis patients (42 males, 37 females, mean age 37.7 +/- 13.1 years) and 82 age- and sex-matched normotensive healthy controls (40 males, 42 females, mean age 35.6 +/- 5.7 years) were included. Left-ventricular mass index (LVMI) was higher in the hemodialysis group compared to controls (170.1 +/- 69.3 versus 84.9 +/- 15.7 g/m(2), p < 0.001). Fourty-three hypertensive patients in the hemodialysis group had an increased LVMI compared to 36 normotensive hemodialysis patients (194.2 +/- 75.5 versus 141.2 +/- 48.0 g/m(2), p < 0.001). On univariate analysis, LVMI was found to be correlated with blood pressure (r = 0.38, p < 0.001), time spent on dialysis (r = 0.22, p = 0.02) and hemoglobin levels (r = -0.21, p = 0.03). No correlation was found between LVMI and age (r = 0.09, p = 0.22), predialytic creatinine (r = 0.09, p = 0.21) and albumin (r = -0.10, p = 0.18). On multivariate analysis for the predictors of LVMI, blood pressure, time spent on dialysis and hemoglobin levels were also found to be significant. LVMI in DD, ID and II genotypes were 155.0 +/- 71.2, 181.6 +/- 60.6, and 163.6 +/- 83.4 g/m(2), respectively (p > 0.05). No association between LVMI and DD genotype was found. ACE genotype distribution was similar in hemodialysis patients and healthy controls. It was concluded that LVH in hemodialysis patients was mainly related to hypertension, anemia and time spent on dialysis and the DD genotype had no effect on LVMI in hemodialysis patients., (Copyright 2000 S. Karger AG, Basel)

Increased QT dispersion seems to be related to an increased risk of arrhythmia and sudden death, a common cause of mortality in hemodialysis (HD) patients. Increase in sympathetic tone has been documented in HD patients. In this study, we aimed to investigate the effect of changes in the autonomic tone on QT dispersion (QTd) in HD patients. Twenty HD patients (M/F 13/7; age, mean ±SD, 28 ± 10 years) and 22 age- and sex-matched healthy controls (M/F 12/10; age, 30 ± 10 years) were included. The patients were dialyzed three-times weekly; time on dialysis was 17 ± 8 months. The QT durations were measured from 12 lead surface EKGs and were corrected for RR intervals. Corrected maximum (QT c max) and minimum (QT c min) QT intervals and their difference (QT c d) were recorded. The effect of the Valsalva maneuver in the release phase on QT c intervals and dispersion was assessed. The HD patients had prolonged values compared to controls: QT c d, 59 ± 17 ms versus 35 ± 7 ms, p < 0.001; QT c max, 458 ± 41 ms versus 397 ± 21 ms, p < 0.001; and QT c min, 398 ± 36 ms versus 362 ± 25 ms, p < 0.001. After the Valsalva maneuver no changes were observed in controls: QT c max, 397 ± 21 ms versus 396 ± 22 ms, p = 0.9; QT c min, 362 ± 24 ms versus 358 ± 19 ms, p = 0.5; and QT c d, 35 ± 7 ms versus 38 ± 10 ms, p = 0.15. Whereas, in HD patients all values were significantly shortened: QT c max, 458 ± 41 ms versus 427 ± 35 ms, p = 0.003; QT c min, 398 ± 36 ms versus 379 ± 34 ms, p = 0.04; and QT c d, 59 ± 17 ms versus 48 ± 15 ms, p = 0.01. The decrease in QTmax was more prominent than the decrease in QTmin, hence QT dispersion was significantly decreased after the Valsalva maneuver, but differences from controls were still significant. In conclusion, increased sympathetic activity may have a role in the prolonged QT duration and increased QT dispersion in HD patients.

This study was arranged to examine whether vitamin B12 deficiency may cause autonomic dysfunction. Time-domain and long-term frequency-domain heart rate variability parameters from 12 patients with pernicious anemia were compared to 12 age and sex matched controls. In B12 deficient patient group time-domain parameters; SDNN (100.4 +/- 37.86 vs. 131.91 +/- 26.94, P = 0.05), SDANN (87.00 +/- 37.77 vs. 118.83 +/- 26.22, P = 0.05) SD (39.41 +/- 13.32 vs. 53.41 +/- 15.39, P = 0.0221), rMSSD (21.41 +/- 10.00 vs. 28.5 +/- 8.42, P = 0.046) were significantly lower when compared to controls. Difference in pNN50 between groups were not statistically significant. In B12 deficient patients frequency-domain parameters; total power (23.08 +/- 9.89 vs. 34.75 +/- 9.56, P = 0.0078), low frequency power (13.5 +/- 6.57 vs. 22.75 +/- 7.25, P = 0.0069) and high frequency power (7.58 +/- 4.25 vs. 11.58 +/- 3.80, P = 0.0175) were significantly lower when compared to controls. It was concluded that B12 deficiency may cause autonomic dysfunction.