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Summary Background: Obesity and overweight are risk factors for atherosclerosis. Red blood cell distribution width (RDW) is associated with subclinical cardiac diseases. The aim of this study was to investigate the association between RDW and aortic stiffness in overweight or obese subjects. Methods: A total of 101 overweight or obese subjects without overt cardiovascular disorders, and 48 healthy controls were enrolled. RDW, aortic pulse-wave velocity (PWV) and augmentation index 75 (Aix75) were evaluated. The case subjects were divided into two sub-groups according to PWV values; ≥ 10 m/s in group I, and < 10 m/s in group II. Bivariate correlation and multiple regression analyses (stepwise) were performed. Results RDW and PWV were considerably increased in the case groups compared with the controls. RDW was significantly increased in group I compared with group II and the controls [median 12.0 m/s, interquartile range (IQR): 10.5–17.5; median 11.7 m/s, IQR: 10.2–14.2, and median 11.4 m/s, IQR: 9.6–15.5, p < 0.05, respectively]. Resting heart rate and age were higher in group I than group II (81 ± 11 vs 74 ± 12 beats/min and 41 ± 120 vs 36 ± 9 years, respectively, p < 0.05). Regression analyses revealed that while log-RDW, age and resting heart rate were independent predictors for aortic PWV, log-RDW was the most important predictor in the final model. Conclusions: RDW, resting heart rate and age independently predicted arterial stiffness, and RDW may be useful to provide an early recognition of subclinical atherosclerosis in overweight and obese individuals.

Objective: Oxidative stress status in subgroup of heart failure (HF) syndrome still remains unknown. We aimed to study Total Antioxidant Status (TAS), Total Oxidant Status (TOS) and Oxidative Stress Index (OSI) in both systolic and diastolic HF, and also in both ischemic and non-ischemic HF. Materials and Methods: Consecutive 123 chronic HF patients were included in this cross-sectional study. Group 1 consisted of 73 systolic HF patients (50 ischemic patients and 23 non-ischemic patients) and group 2 consisted of 50 diastolic HF patients. As a control group (group 3), 37 healthy subjects were included. Echocardiographic evaluation was performed and TAS, TOS and OSI were studied in all patients. Results: The highest TAS value (1.10±0.24) was found in Group 1, but the lowest in Group 2 (0.90±0.14). Diastolic HF group had the highest TOS value (37.2±10.41) while systolic HF group (32.9±7.26) and control group (26.19±8.00) followed it. OSI was found the highest in diastolic HF group (4.37±1.24) and the lowest in systolic HF group (2.24±0.80). TOS and OSI were similar between ischemic and non-ischemic subgroups of systolic HF but TAS was statistically higher in non-ischemic (p:0.0005). Conclusions: We found higher oxidative stress in HF patients, predominantly in diastolic HF patients. The difference between diastolic and systolic HF with regard to oxidative and antioxidative status seems to come from distinct drugs usage between the groups, which have potential effects on oxidative and antioxidative parameters. To reduce, at least, oxidative stress in diastolic HF patients, medical therapy is needed.

Background: Cardiac output (CO) is an important hemodynamic parameter in the management of heart failure. The aim of this study was to compare CO measurements obtained from the bedside monitor specialized for CO measurement, which is known as estimated continuous CO (esCCO), and transthorasic echocardiography (echoCO) in patients with ejection fraction (EF)

Objective To investigate mean platelet volume (MPV) levels in patients with coronary slow flow (CSF). Methods 465 stable angina pectoris cases with angiographically normal coronary arteries were recruited [coronary slow flow group (n=76), control group (n=389)] in the observational retrospective cohort study. Clinical, biochemical and demographic variables including MPV were noted and coronary blood flow was assessed with TIMI frame count (TFC). Results Gender, smoking, height, serum creatinine, uric acid levels, hemoglobin, waist/hip ratio, systolic blood pressure but not MPV were significantly different among groups. Independent predictors of CSF were height (p=.029) and serum uric acid level (p=.045). Gender, height, weight, hip circumference, systolic blood pressure, fasting blood glucose, serum urea, creatinine, uric acid levels, hemoglobin and platelet count were associated with mean TFC whereas independent predictors of mean TIMI frame count were height (p=.010) and serum uric acid level (p=.041). Conclusion Height and serum uric acid level but not MPV were independent predictors of both CSF and mean TFC.

We aimed to assess the impact of meteorological variables on coronary blood flow (CBF). Coronary blood flow was evaluated using the thrombolysis in myocardial infarction frame count (TFC). The association of CBF with meteorological parameters such as temperature, relative humidity, total solar radiation, atmospheric pressure, wind velocity, and total sunshine duration were investigated as well as demographic, clinical, and laboratory characteristics. Assessment of 1206 patients (median age = 53 years, 723 females) revealed the presence of slow coronary flow (SCF) in 196 patients. Daily maximum temperature [odds ratio = 0.951, 95% confidence interval = 0.916-0.986, P = .007] was the only independent predictor of the presence of SCF, whereas systolic blood pressure (β = −0.139, P = .026), hematocrit level (β = 0.128, P = .044), and daily maximum temperature (β = −1.479, P = .049) were independent predictors of log10 (mean TFC). Findings of the present study suggest a role of meteorological parameters in CBF regulation.

Background: The aim of this study was to perform a multicenter, prospective investigation regarding the epidemiology, the current effectiveness of therapeutic anticoagulation, and the risk of thromboembolism in patients with valvular atrial fibrillation (AF) based on the records of the Atrial Fibrillation in Turkey: Epidemiologic Registry (AFTER) study. Methods: Patients were selected from a total of 2,242 consecutive admissions that presented with AF diagnosed via electrocardiogram. Those diagnosed with non-valvular AF were excluded from the AFTER study population, which left 497 patients with valvular AF for analysis. Results: The etiology of valvular AF in patients was either attributed to rheumatic mitral valve stenosis (n = 217) or possessing a prosthetic heart valve (n = 280). Out of all the patients with valvular AF, 83.1% were taking warfarin for anticoagulation. Only 36.1% demonstrated a therapeutic international normalized ratio (INR), and among those patients it was found that 19.1% exhibited a labile INR. Multivariate analysis revealed that age was the only independent predictor of thromboembolic events in patients with valvular AF. Conclusions: Many valvular AF patients are not maintained at therapeutic INR levels, which poses a threat to patient health as they age and are at greater risk for thromboembolism.

Contrary effects of vitamin B12 deficiency have been shown on the cardiovascular system. Aim of our study was to analyze left ventricular (LV) myocardial deformation, by using the two dimensional (2D) speckle tracking echocardiography (STE) in patients with vitamin B12 deficiency and normal LV ejection fraction.Twenty-five patients with vitamin B12 deficiency (B12 levels200 pg/mL; mean age: 29.6 ± 8.2 years, 15 female), and 27 healthy controls (B12 levels200 pg/mL; mean age: 30.1 ± 6.9 years, 13 female) were included in the study. 2D echocardiography images were transferred to a workstation for further offline analysis. Longitudinal peak systolic (LPSS) and global strain (LGS) was obtained from 4 chamber and apical long axis (APLAX) views.Standard echocardiographic parameters and tissue Doppler imaging (TDI) velocities were compared between the groups. All LPSS values in the patient group except for apical 4C septal wall longitudinal strain were significantly decreased than those in the control group. There was a positive correlation between B12 levels and strain values except apical 4C septal wall strain values.We found that in patients with vitamin B12 deficiency, global and segmental myocardial deformation was impaired and this impairment was correlated with the levels of vitamin B12.

Objectives: We investigated the effects of percutaneous mitral balloon valvuloplasty (PMBV) on right ventricular function in the long term using tissue Doppler imaging. Study design: Twenty-seven patients who underwent successful PMBV were enrolled in the study. Echocardiographic examination, including color tissue Doppler imaging, was done from the lateral tricuspid annulus 24 hours before the intervention, and the examination was repeated 24 hours and 6 months after the intervention. Results: At 24 hours after the intervention, S wave velocity and A' wave velocity were seen to have increased significantly (9.52+-1.85 cm/s vs. 10.92+-1.20 cm/s, p=0.012; -10.44+-2.64 cm/s vs. -11.73+-2.05 cm/s, p=0.029, respectively). E' wave velocity and E'/A' ratio did not change significantly (p>0.05 for both). In the late period, S wave velocity was similar to the value in the early period and significantly higher than the basal level (9.52+-1.85 cm/s vs. 10.69+-1.72 cm/s, p=0.023). However, A' wave velocity in the late period was decreased compared to the early period and was not different from the basal level (-10.44+-2.64 cm/s vs. -10.74+-2.63 cm/s, p>0.05). The increase in E' wave velocity in the late period when compared to the basal level was found to be statistically significant (-7.85+-1.54 cm/s vs. -9.21+-1.81 cm/s, p=0.046). Conclusion: Right ventricular systolic function improved in the early period, and this improvement was seen to continue in the late period of PMBV. Diastolic function did not improve in the early period, but did improve in the late period. Right atrium systolic function improved in the early period; however, in the late period, levels were similar to the basal levels.

[Purpose] The purpose of this study was to investigate the possible relationship between joint destruction and carotid intima-media thickness in patients with rheumatoid arthritis. [Subjects and Methods] Thirty-four RA patients and 31 healthy controls were enrolled in this study. The disease activity for 28 joints was recorded for each patient using the erythrocyte sedimentation rate (DAS28ESR), a visual analog scale (VAS0-10 cm), and a disability index, the health assessment questionnaire (HAQ). X-ray imagesof the patients were scored according to the modified Sharp/van der Heijde method, and the common carotid intimal medial thickness (CIMT) was automatically measured with software using high-resolution Doppler ultrasound. [Results] Contrary to our hypothesis, the modified total Sharp score (mTSS) and CIMT were not significantly associated. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels of the RA patients and the right CIMT, left CIMT, and mean CIMT scores were significantly elevated. Positive correlation was detected between the mean CIMT score and age, CRP levels, LDL concentration and triglycerides (TG) level. In the regression model, where the mean CIMT was the independent variable and age, CRP, LDL, and TG were dependent variables, age was found to be an independent predictor of CIMT. [Conclusions] Patients suffering from RA require close monitoring for cardiovascular risks, and the comorbidity of age-related cardiovascular disease should not be overlooked.

To examine the effects of Ramadan fasting on body composition, arterial stiffness and resting heart rate.This prospective study was conducted at the Department of Cardiology, Harran University, Sanliurfa, Turkey, during Ramadan 2015, and comprised overweight and obese males. Body composition, arterial stiffness and echocardiography were assessed before and after Ramadan. Body composition was assessed by bioelectrical impedance analysis using segmental body composition analyser. Arterial stiffness and haemodynamic parameters were also measured. SPSS 20 was used for data analysis.Of the 100 subjects enrolled, 70(70%) were included. The overall mean age was 37±7 years. No significant changes were observed in blood pressures, resting heart rate, aortic pulse wave velocity, aortic augmentation index-75, aortic pulse pressure, brachial pulse pressure, basal metabolic rate, total body water, fat-free mass, and echocardiographic parameters (p0.05 each). Although aortic pulse wave velocity (m/s) and augmentation index-75 (%) decreased after fasting period compared to that of before Ramadan, these reductions did not reach statistically significant levels (8.6±1.8 vs. 8.9±1.9, and 13.6±6.6 vs. 14.7±9.3, respectively; p0.05 each). Body mass index, waist-hip ratio, body water rate, percentage of body fat mass, body fat mass, and visceral fat mass percentage were significantly reduced (p0.05 each) after Ramadan.Ramadan fasting had beneficial effects on body composition, but did not have any significant effect on arterial stiffness and resting heart rate.

Coronaryartery vasospasm is rare and may appear as focal or diffuse vasospasmthroughout the coronary artery tree. We present a case of unstable angina withcomplete occlusion of the proximal left anterior descending artery andcircumflex coronary artery due to severe diffuse coronary vasospasm, asdemonstrated on coronary angiography. The patient was successfully treated withintracoronary bolus of nitroglycerin with restoration of flow in left coronarysystem.&nbsp

Cardiac syndrome X (CSX) is characterized by the presence of myocardial ischemia in the absence of coronary artery stenosis on angiograms. Its relation to oxidative stress and inflammation is well known. There are no data on thiols and their relation with inflammation in CSX. The aim of this study was to investigate thiol levels and thiol/disulfide homeostasis in CSX patients.Fifty consecutive patients who had documented myocardial ischemia and normal coronary angiogram (CSX group), and 45 age-matched and sex-matched consecutive patients who had normal coronary angiogram without myocardial ischemia (control group) were enrolled in this study. C-reactive protein (CRP), neutrophil/lymphocyte ratio (NLR), native thiol, total thiol, and disulfide levels were measured and disulfide/thiol ratios were calculated in all patients.Demographic, clinical, basic laboratory, and echocardiographic characteristics were similar in the two groups (P0.05). Serum total thiol, native thiol, and disulfide levels decreased significantly in the CSX group compared with the control group (P0.001). CRP and NLR increased significantly in the CSX group compared with the control group (P0.001). Although disulfide/native thiol levels increased in the CSX group, this reduction did not reach statistical significance (5.8 vs. 5.5, P0.05). The reduction of thiols was correlated negatively with CRP and NLR (P0.001). Although univariate logistic regression analyses showed that serum total and native thiol levels, CRP and NLR were independent predictors for CSX estimation, stepwise multivariate logistic regression analysis showed only total thiol levels as an independent predictor for CSX (odds ratio=0.966, 95% confidence interval: 0.950-0.982, P0.001). Also, receiver operating characteristic curve analysis showed that serum total thiol values of 338.4 or below could predict the CSX with 86% sensitivity and 84% specificity (area under curve=0.903; 95% confidence interval: 0.842-0.965).Serum total thiol levels decreased significantly in CSX and this reduction independently predicted CSX with strong sensitivity and specificity. This suggests that the reduction in thiols along with increased inflammation may play a pathophysiological role in the development of CSX.

The aim of this study is to investigate the association between neutrophil to lymphocyte ratio (NLR) and severity of coronary atherosclerosis. A total of 172 patients undergoing coronary angiography were included in the study. Control group consisted of patients with normal coronary arteries. Patients with coronary stenosis were divided into 2 groups by use of Gensini scores. The NLR was higher in severe atherosclerosis group compared with mild atherosclerosis and control groups ( P < .001). In correlation analysis, NLR showed significant correlation with Gensini score. A cutoff value of 2.5 for NLR predicted severe atherosclerosis with a sensitivity and specificity of 62% and 69%, respectively. After multivariate analysis, high levels of NLR were independent predictors of severe atherosclerosis together with glucose and high-density lipoprotein. Our study suggests that the NLR is a predictor of severe atherosclerosis that may be useful for cardiac risk stratification in patients with coronary artery disease.

WOS: 000311649900004, Background: There are limited data that examine the assessment of subsegmental branches of the pulmonary artery by intravascular ultrasound (IVUS). Aim: To assess the structural characteristics of pulmonary arteries by IVUS in the setting of severe mitral stenosis. Material and methods: Twenty-one consecutive patients (3 men and 18 women; mean age: 38 11 years) who were selected for percutaneous mitral balloon valvuloplasty entered the study. Subsegmental branches of the right lower lobe pulmonary artery were imaged by 40 MHz IVUS when the patients underwent right heart catheterization. Minimal lumen diameter (MLD), external elastic membrane diameter (EEMD), lumen area (LA), and area circumscribed by the external elastic membrane (the total vessel area - TVA) were measured. From these measurements, wall area (WA = TVA - LA), intima-media wall thickness [IMT = (EEMD - MLD)/2], relative wall thickness (RWT = IMT/EEMD), and relative wall area (RWA = WA/TVA) were derived. Results: We were able to perform the IVUS examination in all patients without complications. Several IVUS anatomic indexes correlated with hemodynamic data. Pulmonary artery IMT, RWT, and RWA correlated significantly with pulmonary artery systolic pressure (r = 0.763, p = 0.002; r = 0.698, p = 0.001; r = 0.717, p = 0.006, respectively). However, there was no significant correlation between ultrasound measurements and echocardiographic parameters of the mitral valve. Conclusions: The subsegmental branches of the pulmonary artery can be assessed by IVUS. Patients with pulmonary hypertension in the setting of mitral stenosis have greater pulmonary arterial WT. The severity of WT is correlated with pulmonary artery pressure, but it is not associated with mitral valve area. Intravascular ultrasound may provide useful additional information in the management of patients with mitral stenosis.

Objectives: This study was designed to examine haematological changes in infective endocarditis (IE) and the association between laboratory findings and mortality or complications including events in IE.Materials and methods: Forty-four patients who were hospitalized with a diagnosis of IE at the Department of Cardiology, Dicle University, Ataturk University and Harran University, from June 2007 to June 2011, were retrospectively evaluated. The diagnosis of IE was made clinically and was confi rmed with Duke’s criteria. The haematological and biochemical parameters were recorded.Results: Age, white blood cell count, neutrophil count, neutrophil lymphocyte ratio, mean platelet volume and complication rate (p

Aims: This study aimed to investigate heart rate variability (HRV) of patients with severe COPD who are treated by noninvasive mechanic ventilation (NIMV).Patients and Method: Twenty-seven patient (58±8 years, 9 F) with severe COPD treated by nocturnal NIMV at home and 23 sex and age matched volunteers (56±8 years, 11 F) who has not dyspnea as a control group recruited in the study. Subjects underwent spirometry, blood gas analysis, transthoracic echocardiography, 24 hours ambulatory ECG analysis. Time domain HRV analysis performed from ambulatory ECG records. Results: 52% of patients at NYHA functional class II, 36% at class III, and 12% at class IV when they have been treated by NIMV. Groups were similar for age and sex (p>0.05 for both). Heart rates of patients were higher significantly than controls’ (p0.05). But, systolic pulmonary pressures were higher of COPD group (p

WOS: 000295570200003, Background: Conventional echocardiographic methods have already shown that successful mitral balloon valvuloplasty (MBV) can effectively increase left atrial (LA) functions. Aim: To evaluate LA functions after MBV using colour tissue Doppler imaging. Material and methods: Sixty-eight patients (58 females, mean age: 38 +/- 12 years) were included in the study. Within 24 h before MBV, all the patients underwent colour tissue Doppler study in addition to routine conventional echocardiographic examinations. Late diastolic velocities (A') measured at the LA wall adjacent to the septal and lateral annuli were recorded. All the measurements were repeated 24 h after MBV. The MBV was done using the Inoue technique. Successful MBV patients were included in group A and those who developed severe mitral regurgitation (MR) were included in group B. Results: Sixty-one patients underwent successful MBV while 7 developed MR. Mitral valve areas (MVA) in both groups were significantly increased. Maximum and mean gradients, LA diameter, systolic pulmonary arterial pressure and mean LA pressures were decreased while septal and lateral A' were significantly increased in group A. In group B, no significant change in any variable was found except for the increase in MVA Conclusions: After successful MBV, increase in A' velocity was seen in parallel to the recovery of LA functions. Early improvements in left atrial systolic functions after successful MBV can easily be determined by colour tissue Doppler as a quick and reliable method.

Idiopathic and ischemic dilated cardiomyopathies (DCM) are the most common types of DCM, and both exhibit the same histopathological feature of fibrosis. Prolidase is an enzyme that serves a rate‐limiting function in collagen turnover. Several studies have shown increased prolidase activity in fibrosis, though controversy persists. In this study, we measured prolidase enzyme activity in patients with idiopathic or ischemic DCM and in healthy controls, making this, to our knowledge, the first study to do so. What we found is that serumprolidase activity was significantly lower in both DCM groups relative to healthy volunteers and lower in ischemic DCM than idiopathic. These intriguing results could be attributed either to decreased collagen turnover in the heart tissues in which DCM develops, a result of diminished functional heart tissue, or to decreased physical activity levels among DCM patients stemming from their heart failure. Either way, further studies are needed to verify and clarify our results. J. Clin. Lab. Anal. 24:213–218, 2010. © 2010 Wiley‐Liss, Inc.

Objective: Left ventricular (LV) systolic functions are generally depressed in Mitral Stenosis (MS). Recovery of LV systolic functions demonstrated with 2D echocardiography in some patients by mitral balloon valvuloplasty (MBV). Systolic mitral annular velocity (S') by Tissue Doppler Imaging (TDI) predicts LV systolic function. We aimed to evaluate early effects of MBV on LV systolic function by TDI.Methods: Forty-eight consecutive patients included to the study (39 female, 36±10 years). A full transthoracic echocardiographic study (TTE) including left ventricular ejection fraction assessment by teicholz method and mitral annular color TDI assessment was performed 24 hours before and after MBV in all patients. MBV performed by Inoue technique under guidance of TTE. Analysis of mitral lateral annular S' wave velocity was performed immediately after echocardiographic examination. Results: MBV performed successfully in 43 patients (Group A), and severe mitral regurgitation developed in 5 patients(Group B). Mitral valve area, and S’ wave velocity increased, mean and maximum mitral gradient, and left atrial diameter, and systolic pulmonary artery pressure (PAP) were reduced significantly by MBV in group A patients (p

Aim: We investigated the relationship between the severity of reciprocal ST depression and the extent of coronary artery disease in patients with inferior myocardial infarction. Method: Ninety-five consecutive patients (52 women 43 men, with a mean age of 54±5 years) who had acute inferior myocardial infarction were included in the study. Reciprocal changes in the ST segment were defined as ST depression of >1 mm in at least two out of four of the precordial leads V1–V4. All the patients had undergone coronary angiography within seven days of admission. The extension of coronary artery disease which was measured by Gensini and Reardon scores, was compared with the reciprocal changes on ECG recorded at the time of admission. Result: There was a significant correlation between reciprocal ST depression and disease extension (r=0.68 for Gensini score, r= 0.88 for Reardon score, p

Background: Pseudoexfoliation syndrome (PEX) is recognised by chronic deposition of abnormal pseudoexfoliation material on anterior segment structures of the eye, especially the anterior lens capsule. In recent years, several studies have shown the presence of vascular, cardiac and other organ pseudoexfoliative material in patients with ocular pseudoexfoliation. Aims : The purpose of this study is to determine whether an association exists between ocular pseudoexfoliation and coronary artery disease, aortic aneurysms and peripheric vascular disease. Patients and Methods: 490 patients who underwent coronary angiography (CAG) at Kosuyolu Cardiovascula Research and Training Hospital were included in the study. Patients were evaluated for conventional risk factors such as age, sex, family history, hypertension, diabetes, dislipidemia and smoking. Detailed eye examinations including evaluation of lens were done in all patients. The presence of PEX material in the anterior segment was best appreciated by slit lamp after pupillary dilation. The patients were divided into two groups according to the presence of PEX, and compared for the presence of CAD and other risk factors. Results: CAD was present in 387 patients. 103 patients had normal coronary angiography. 20 (5.2 %) of CAD patients and 4 (3.9%) of normal CAG patients were found to have PEX (p>0.05). There was no significant relationship between CAD and the presence of PEX (p>0.05). When patients were grouped according to the presence of PEX, only age was significantly different between the two groups (r: 0.25, p Conclusion: There is no significant relationship between the presence of PEX and CAD. Further studies in larger scales with elderly population may be more valuable.

The balance of oxidant and antioxidant status plays a key role in the coronary artery diseases (CAD). Thiol is one of the most important antioxidant barriers in humans, and thiol/disulphide homeostasis is a novel oxidative stress marker.We aimed to investigate the relation of serum thiol levels and thiol/disulphide homeostasis with the presence and severity of CAD.A total of 161 patients who underwent coronary angiography owing to stable angina pectoris were consecutively enrolled. They were divided into three groups. Group I - 47 age- and gender-matched subjects with normal coronary angiography (control); group II - 71 newly diagnosed CAD patients with noncritical stenosis; and group III - 43 newly diagnosed CAD patients with critical stenosis. Serum native thiol, total thiol, and disulphide levels were measured, and disulphide/thiol ratios were calculated. Gensini scores were calculated in CAD patients.While the highest thiol levels were found in group I, the lowest one was observed in group III (p0.001). Total and native thiol levels were significantly lower in group II than in group I (p0.001 for each), but they increased considerably in group II compared with group III (p = 0.031 and p = 0.028, respectively). Disulphide levels decreased in group II and III compared with group I (p0.001 for each). No statistically significant changes were observed in disulphide/thiol ratios (p0.05). Gensini scores were negatively correlated with total and native thiols, and positively with age and dyslipidaemia. Stepwise linear regression analyses showed that native thiol was an independent predictor in the final model for Gensini score. Receiver operating characteristic curve analysis demonstrated that thiol values of 310.7 or below could predict CAD with 89% sensitivity and 85% specificity (AUC = 0.918; 95% CI 0.870-0.965).While the disulphide/thiol ratio did not change significantly, decreased native thiol levels were associated with the presence and severity of CAD. This result indicates that the reduction of thiols may be an important factor in the development of CAD.

Objective To investigate whether obstructive sleep apnea syndrome (OSAS) has any effect on pulmonary artery stiffness (PAS) derived from echocardiographic calculation. Methods Fifty-two patients with newly diagnosed OSAS and forty-two subjects without OSAS matched by age and sex were enrolled in the study. OSAS was categorized according to apnea hypopnea index (AHI, event/h) as follows: normal (AHI 15). All participants were evaluated by echocardiography to determine PAS and right ventricle functions. PAS was calculated throughout pulmonary artery flow by the formula; PAS (kHz/sec) = maximal frequency shift/acceleration time. Results Demographic and clinical parameters were similar in both groups. PAS significantly increased in OSAS compared with the control group (26.9 ± 6.1 vs. 18.0 ± 3.5, P < 0.001). Additionally, PAS in severe and moderate OSAS was considerably high compared with that in mild OSAS and control group (P < 0.001). Right ventricular myocardial performance index (MPI) and mean pulmonary artery pressures (mPAP) were considerably higher in OSAS group than control group (P < 0.001). Tricuspid E/A, right ventricle tissue Doppler E’/A’, and right ventricular ejection time (RVET) decreased in OSAS group compared with control group (P < 0.001). There was a significantly positive correlation between PAS and AHI, mPAP, and MPI (P < 0.001), and a significantly negative correlation between PAS and tricuspid E/A, E’/A’, and RVET (P < 0.001). Linear regression analyses showed that PAS was an independent factor for mPAP (s = 0.595, P = 0.034). Conclusion Elastic properties of pulmonary artery deteriorate with severity of OSAS and may be responsible for right ventricular dysfunctions in OSAS.

OBJECTIVES Prolidase is an important factor in collagen metabolism, matrix remodelling and cell growth. Increased collagen turnover leading to increased ventricular stiffness plays an important role in the pathophysiology of left ventricular diastolic dysfunction (LVDD). This study aims to investigate whether serum prolidase activity is related to left ventricular diastolic function. METHODS We studied 144 participants, and divided them into four groups according to the phase of diastolic dysfunction (66 with normal function, 46 with impaired relaxation, 19 with pseudonormalization, and 13 with restrictive-like filling). Assessment of diastolic filling was carried out with the measurements of E wave, A wave, E-wave deceleration time, isovolumic relaxation time, lateral tissue Doppler E S, E and A wave. Serum prolidase activity was measured by spectrophotometrical methods. RESULTS Serum prolidase activity level was higher in patients with left ventricular diastolic dysfunction (LVDD) than without LVDD (P = 0.004). Also, prolidase activity values gradually increased from stage I through stage III in patients with LVDD. Multivariate analysis shows that LVDD is independently associated with age (β = 0.066, SE = 0.017, P = 0.006), hypertension (β = -1.252, SE = 0.354, P = 0.037) and prolidase activity (β = 0.021, SE= 0.088, P= 0.045). CONCLUSION Our data have shown that, in a selected group of patients, serum prolidase activity was positively and independently associated with the presence and severity of LVDD.

The most common primary cardiac tumor in adulthood is myxoma which is a benign mass pathologically. Patients with myxoma may be asymptomatic which are recognized incidentally and also they may be clinically presented with different signs and symptoms one of which is peripheral emboli. In this paper, a case of myxoma which is detected as a source of emboli in a young woman in sinus rhythm admitted with acute arterial occlusion, which is excised surgically is presented. Echocardiographic view of myxoma was remarkable which looks like la fetus in uterus. J Clin Exp Invest 2012; 3(2): 300-302

Renal artery aneurysms and pseudoaneurysms are rare vascular abnormalities. These anomalies, which are usually asymptomatic, may be associated with hypertension. Here, we present the successful treatment of a renal artery pseudoaneurysm in a patient with hypertension, with an overview of the literature.

Oxidative stress (OS) is important in the pathogenesis of atherosclerosis. Paraoxonase-1 (PON1) is an enzyme found in the circulation associated with high-density lipoprotein (HDL). HDL-associated enzyme PON1 has an important role in the attenuation of atherogenic low-density lipoprotein (LDL) oxidation. The aim of this study was to determine PON1 and arylesterase (AREST) enzyme levels in relation to insulin resistance (IR) or obesity among children and adolescents. The study included healthy school children and adolescents. Blood was drawn for the determination of blood glucose, lipid, PON1 and AREST enzyme levels. Overall, we observed a positive correlation between PON1 enzyme activity and high-density lipoprotein cholesterol (HDL-C) levels (r = 0.189, P = 0.014). The correlation appeared to be more significant in boys (r = 0.271, P = 0.009). For subjects with IR and obesity, PON1 enzyme activity did not correlate with HDL-C levels (r = 0.038, P = 0.790), instead PON1 levels correlated negatively with BMI (r = -0.309 and P = 0.026). Multiple linear regression analysis was performed to find the predictors of log PON1 activity. HDL-C level was the strongest predictor of PON1 activity in the lean control group, while BMI appeared to be the strongest predictor in the subjects with obesity or IR. In conclusion, determinants of PON1 enzyme activity are variable in children and adolescents based on IR and obesity. Future studies will shed light on the underlying mechanisms and biomarkers of OS in children and may reveal possible targets for therapeutic intervention.

A 46-year-old man presented with a complaint of effort dyspnea. On transthoracic echocardiography a circle appeared in LVOT. It was seen freely floating, disappearing in every systole and appearing again in diastole. Turbulence was seen inside the circle with color Doppler. Transesophageal echocardiography showed aortic cusps and their coaptation to be normal. Aortic root diameters were normal at the annulus, sinus of Valsalva, and sinotubular junction. There were no signs of dissection, infective endocarditis or abscess. But as the probe was advanced, left sinus of Valsalva was found to be prolapsed, and ruptured into LVOT. (Echocardiography 2011;28:E9-E11)

Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) syndromes is a rarely seen multisystem disorder with autosomal recessive inheritance due to thymidine phosphorylase gene mutation. It is characterized by progressive external ophthalmoplegia and/or pitosis, progressive gastrointestinal dismotility and abdominal pain, postprandial emesis, cachexia, demyelinating peripheral neuropathy, symmetrical and distal weakness especially in lower extremities and diffuse leucoencephalopathy in cranial magnetic resonance. Endocarditis is the infectious and inflammatory disease of the endothelial surface of the heart. MNGIE syndrome is a condition in which immune system is suppressed and infection risk increased. Herein we summarized a previously not reported endocarditis case in a patient with MNGIE syndrome who was under follow up for three years. In MNGIE syndrome of acute dyspnea, infective endocarditis should be kept in mind and prompt evaluation for surgical treatment should be done.

Autosomal dominant polycystic kidney disease (ADPKD) is a common disorder occurring in approximately 1 out of every 400 to 1,000 live births. An extremely rare association between ADPKD and coronary aneurysms has been determined. No connection between this association and acute coronary syndromes has been identified; however, a few reports have appeared in the literature. We present and demonstrate the very rare association of ADPKD and coronary aneurysm, and briefly review this unusual relationship.

Murat, Bektas/0000-0002-6564-7185; Yuksel, Murat/0000-0003-2636-5211 WOS: 000377435200008 PubMed: 25589093 Infection is one of the most devastating outcomes of cardiovascular implantable electronic device (CIED) implantation and is related to significant morbidity and mortality. In our country, there is no evaluation about CIED infection. Therefore, our aim was to investigate clinical characteristics and outcome of patients who had infection related to CIED implantation or replacement. The study included 144 consecutive patients with CIED infection treated at 11 major hospitals in Turkey from 2005 to 2014 retrospectively. We analyzed the medical files of all patients hospitalized with the diagnosis of CIED infection. Inclusion criteria were definite infection related to CIED implantation, replacement, or revision. Generator pocket infection, with or without bacteremia, was the most common clinical presentation, followed by CIED-related endocarditis. Coagulase-negative staphylococci and Staphylococcus aureus were the leading causative agents of CIED infection. Multivariate analysis showed that infective endocarditis and ejection fraction were the strongest predictors of in-hospital mortality.

OP-003 Conflicting effects of vitamin B12 deficiency have been shown on the cardiovascular system. We evaluated left ventricular (LV) myocardial functions with a new imaging method, four-dimensional (4D) real-time full-volume strain echocardiography (SE), and myocardial performance index (MPI or

Background: There is growing evidence that aortic distensibility (AD) is a subclinical marker of early atherosclerosis. Aortic intima-media thickness (IMT) was an earlier marker than carotid IMT of preclinical atherosclerosis. In this study, we aimed to assess the relationship between thoracic aortic IMT and AD. Methods: We studied 192 patients (mean age: 45.5 ± 8.4 years) who underwent transesophageal echocardiography (TEE) for various indications. Four different grades were determined according to IMT of thoracic aorta (Grade 1

Patients with ST-segment elevation myocardial infarction (STEMI) and a patent infarct-related artery (IRA) experience lower mortality and better clinical outcome, but little is known about the predictors of IRA patency before primary percutaneous coronary intervention (PCI) in the setting of STEMI.To assess possible predictors of patency of IRA before primary PCI in patients with STEMI.A total of 880 patients with STEMI undergoing primary PCI were prospectively included (646 male, 234 female; mean [± SD] age 58.5±12.4 years). Blood samples were obtained on admission to investigate biochemical markers. Preinterventional thrombolysis in myocardial infarction (TIMI) flow was assessed in all patients. The patients were divided into two groups according to the pre-PCI TIMI flow as impaired flow group (TIMI flow 0, 1 and 2) and normal flow group (TIMI flow 3). Transthoracic echocardiography was performed in all patients.Eighty-three (9.43%) patients had pre-PCI TIMI 3 flow in IRA. Uric acid levels and neutrophil to lymphocyte (N to L) ratio in the normal flow group were lower than in the impaired flow group (P0.001 for both). However, ejection fraction (EF) was higher in the normal flow group than in the impaired flow group. Multivariate logistic regression analysis showed that IRA patency was independently associated with serum uric acid level (β 0.673 [95% CI 0.548 to 0.826]; P0.001), N to L ratio (β 0.783 [95% CI 0.683 to 0.897]; P0.001) and EF (β 1.033 [95% CI 1.006 to 1.061]; P=0.016).Serum uric acid level, N to L ratio and EF are independent predictors of the pre-PCI patency of IRA in patients with STEMI undergoing primary PCI.

Amaç: Atriyum fibrilasyonu (AF) klinik pratiğimizde en sık rastlanan ritm bozukluğu olup ülkemizde bu konuda yapılmış çok merkezli bir epidemiyolojik çalışma bulunmamaktadır. Bu çalışmanın amacı ülkemizde ilk kez yapılmış olan çok merkezli, ileriye dönük Atrial Fibrillation in Turkey: Epidemiologic Registry (AFTER) çalışmasının kayıtlarından yararlanarak AF’ye klinik yönden yaklaşımımızı değerlendirmektir. Çalışma planı: Ülkemizde nüfus dağılımı göz önünde bulundurularak 17 ayrı üçüncü basamak merkezden, elektrokardiyografisinde en az bir defa AF atağı tespit edilmiş olan ardışık 2242 hasta çalışmaya alındı. Acil polikliniğine başvuran ya da yatmakta olan hastalar çalışmadan dışlandı. Hastaların epidemiyolojik verileri ve uygulanan tedaviler değerlendirildi. Bulgular: Çalışma popülasyonunu oluşturan hastaların %60’ı kadındı, hastaların ortalama yaşı 66.8±12.3 yıl olarak saptandı. Türk nüfusunda en sık görülen AF tipi non-valvular AF (%78) olup, AF’li hastaların %81’i ısrarcı-kalıcı AF’li idi. AF’ye en sık eşlik eden komorbid durum hipertansiyon (%67) olarak bulundu. Hastaların %15.3’ünde inme, geçici iskemik atak ve sistemik tromboemboli hikayesi mevcut iken kanama öyküsü hastaların %11.2’sinde kaydedildi. Çalışma süresinde hastaların %50’si warfarin, %53’ü de aspirin kullanıyordu. Oral antikoagülan ilaç kullanan hastaların %41.3’ünde etkin INR düzeyi saptandı. Oral antikoagülan ilaç kullanmamanın en sık nedeni (%69) hekim ihmali olarak saptandı. Sonuç: Bu veriler klinik pratiğimizde özellikle AF’li hastaların antitrombotik tedavileri konusunda daha dikkatli olunması gerektiğini göstermektedir. Objectives: Although atrial fibrillation (AF) is one of the most com- mon rhythm disorders observed in clinical practice, a multicenter epidemiological study has not been conducted in our country. This study aimed to assess our clinical approach to AF based upon the records of the first multicenter prospective Atrial Fibrillation in Tur- key: Epidemiologic Registry (AFTER) study. Study design: Taking into consideration the distribution of the population in our country, 2242 consecutive patients with at least one AF attack determined by electrocardiographic examination in 17 different tertiary health care centers were included in the study. Inpatients and patients that were admitted to emergency depart- ments were excluded from the study. Epidemiological data of the patients and the treatment administered were assessed. Results: The mean age of the patients was determined as 66.8±12.3 years with female patients representing 60% of the study popula- tion. While the most common AF type in the Turkish population was non-valvular AF (78%), persistent/permanent AF was determined in 81% of all patients. Hypertension (%67) was the most common co- morbidity in patients with AF. While a stroke or transient ischemic at- tack or history of systemic thromboembolism was detected in 15.3% of the patients, bleeding history was recorded in 11.2%. Also, 50% of the patients were on warfarin treatment and 53% were on aspi- rin treatment at the time of the study. The effective INR level was detected in 41.3% of the patients. The most frequent cause of not receiving anticoagulant therapy was physician neglect. Conclusion: These results demonstrate the necessity for improved quality of physician care of patients with AF, especially with regards to antithrombotic therapy.

We aimed to assess the role of oxidative stress (OS) and inflammation in the early evaluation of initial acute non -ST -elevation myocardial infarction (NSTEMI) compared with unstable angina pectoris (USAP).Forty-seven (54%) patients with NSTEMI and 40 (46%) with (USAP) were included in this cross-section observational study. We assessed the oxidative stress and inflammation parameters. Statistical analysis was performed using Fisher's exact test, Chi-square test, Mann-Whitney U test, Student's t-test, and Pearson correlation analysis for assess the correlations between variables.Plasma total oxidative stress (TOS) and OS index levels were significantly higher (p0.001 for both comparisons), in patients with NSTEMI. In addition, white blood cell count (WBC) and high-sensitive C-reactive protein (hs-CRP) levels were significantly higher in patients with NSTEMI (respectively; p0.001, p=0.02). Age, WBC and low- density lipoprotein cholesterol showed positive correlations with TOS level (Pearson correlation coefficient: r=0.290, p=0.006; r=0.431, p0.001; r=0.219, p=0.042 respectively), and also age showed positive correlation with OS index (Pearson correlation coefficient; r=0.246; p=0.021). However, the values of the troponin I and creatine kinase-MB fraction did not differ between the two groups (p0.05 for all).TOS, OSI, WBC and CRP levels are significantly higher in NSTEMI subject. These data suggest that inflammatory processes and oxidative stress together play a role in the pathogenesis of acute NSTEMI.

Objective: Endothelial dysfunction is considered the first stage in the development of atherosclerosis and assessed by flow-mediated dilatation (FMD) and aortic flow velocity propagation (AVP). Ankle-brachial index (ABI) is used to assess peripheral arterial disease and is associated with FMD but the relationship between ABI and AVP is unknown. In this study, we aimed to search the association between AVP, and ABI in patients with newly diagnosed hypertension. Methods: Sixty-eight patients with newly diagnosed hypertension and 34 healthy subjects were enrolled in the crosssectional observational study. The maximum ankle arterial pressures were divided by the maximum of the brachial arterial pressures to calculate the ABI. AVP was calculated from dividing the distance between points corresponding to the beginning and end of the propagation slope, to the duration between corresponding time points proximally descending aorta. Statistical analysis was performed using Student t-test, Chi-square test, Pearson correlation and linear regression analyses. Results: Age and gender of both groups were similar. Compared to control group E deceleration time of early diastolic flow velocity (184.0±32.2 vs. 217.1±38.6, p

Background: Elevated Gamma-glutamyltransferase (GGT) level is independently correlated with conditions associatedwith increased atherosclerosis, such as obesity, elevated serum cholesterol, high blood pressure and myocardial infarction. It is also demonstrated that serum gamma-glutamyltransferase activity is an independent risk factor for myocardial infarction and cardiac death in patients with coronary artery disease. Although the relationship between gamma-glutamyltransferase and coronary artery disease has been reported, not many studies have shown the relationship between changes ofgamma-glutamyltransferase in acute coronary syndromes and a well established coronary risk factor high sensitive C-reactive protein. (hs-CRP). Aims: In this study, how gamma-glutamyltransferase levels changed in acute coronary syndromes and its relationship with high sensitive C-reactive protein if any were studied. Patients & Methods: This trial was carried out at Kosuyolu Cardiovascular Training and Research Hospital and Van Yuksek Ihtisas Hospital, Turkey. 219 patients (177 males and 42 females) presenting with acute coronary syndrome, and 51 control subjects between September 2007 and September 2008 were included in the study. Serum gamma-glutamyltransferase, high sensitive C-reactive protein, serum lipoprotein levels and troponin I were determined. Results: Serum gamma-glutamyltransferase and high sensitive C-reactive protein levels were higher in acute coronary syndrome patients compared to control. There was also correlation between gamma-glutamyltransferase and high sensitive C-reactive protein levels. Conclusion: Serum gamma-glutamyltransferase and high sensitive C-reactive protein levels were higher in acute coronary syndrome patients. In subgroup analyses, the higher difference with Non-ST elevation myocardial infarction and ST elevation myocardial infarction groups than unstable angina oectoris group proposes a relationship between gamma-glutamyltransferase and severity of acute coronary syndromes.