Abdulkadir Kiris

Effects of Prehypertension on Arterial Stiffness and Wave Reflections

The Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure classifies blood pressure (BP) as normal, prehypertension, and hypertension. Although it has been shown that there is a relationship between hypertension and arterial stiffness, there is not sufficient data about arterial stiffness in patients with prehypertension. The present study was designed to evaluate arterial stiffness and wave reflections in subjects with prehypertension. We evaluated arterial stiffness and wave reflections of 45 subjects with prehypertension and an age-matched control group of 40 normotensive individuals, using applanation tonometry (Sphygmocor, AtCor Medical, Sydney, Australia). Aortic pulse wave velocity (PWV) was measured as indices of elastic-type aortic stiffness. The heart rate-corrected augmentation index (AIx@75) was estimated as a composite marker of wave reflections and arterial stiffness. Aortic PWV (10 ± 2.5 vs. 8.6 ± 1.7, m/s, p  =  0.004) and AIx@75 (21 ± 8.3 vs. 10 ± 9.1, %, p = 0.0001) were significantly higher in subjects with prehypertension than in the control group. In multiple linear regression analysis, we found that the presence of the prehypertension was a significant predictor of aortic PWV (β  =  0.26, p  =  0.009) and AIx@75 (β  =  0.46, p  =  0.0001). Our results suggest that arterial functions were impaired even at the prehypertensive stage.

Investigation of effects of different treatment modalities on structural and functional vessel wall properties in patients with ankylosing spondylitis

AIM Ankylosing spondylitis (AS) is a chronic systemic inflammatory disease that is associated with increased cardiovascular burden. The aim of this study was to investigate vascular structural and functional changes in patients with AS, with special emphasis on the effects of different treatment modalities, through evaluation of level of vascular stiffness (pulse wave velocity [PVW]) and carotid intima media thickness (IMT-C). METHODS A total of 67 AS patients, and age, sex, body mass index (BMI) smoking status, lipid profiles and blood pressure-matched healthy control subjects (n=34) were studied. Of these, 34 patients were on anti-TNF alpha and 33 on non steroid anti inflammatory drugs (NSAIDs). The IMT-C and PWV values of the right common carotid artery were measured by high-resolution ultrasound. RESULTS The AS patients (n=67) had significantly higher PWV values than the controls [9.0 ± 1.49 m/sec vs. 8.27 ± 0.90 m/sec, P=0.004; 95% confidence interval (CI), -1.22 to -0.24]. Multiple stepwise linear regression analysis revealed that PWV could only be explained by systolic blood pressure (P<0.05) and IMT (P<0.05) in AS. Even though IMT-C in anti-TNF alpha treated group was higher compared to the NSAID treated group, it was not statistically significant (P=0.5). CONCLUSION PWV was found to be higher in AS patients than in the control group, and there was no significant difference between the average PWV values of AS patients treated with anti -TNF alpha or NSAIDs.

Immediate procedural and long-term clinical outcomes following drug-eluting stent implantation to ostial saphenous vein graft lesions

Background: Ostial saphenous vein graft (OSVG) lesions were excluded from all the clinical trials demonstrating significantly lower restenosis rates with drug-eluting stents (DES) compared to bare metal stents (BMS). This study aimed to evaluate the efficacy of DES in OSVG lesions by assessing angiographic and 12-month clinical outcomes. Methods: 70 consecutive patients (70 OSVG lesions) underwent coronary stent implantation between May 2003 and April 2006: 37 lesions received DES and 33 lesions BMS. Endpoints were all cause and cardiovascular mortality, myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), examined separately and as a combined end-point (major adverse cardiac events, MACE). Results: Procedural (94.6% for DES and 87.9% for BMS) and angiographic (100% for DES and 100% for BMS) success did not differ between the two groups. The only in-hospital events were non-Q wave MI (DES 8.1% versus BMS 12.1%, P=0.69). At 30-day follow-up, there were no other events. Overall, at 1-year follow-up, the BMS group had a higher TLR (30.3% versus 5.4%, P=0.015), TVR (33.3% versus 10.8%, P=0.045) and MACE rate (36.4% versus 10.8%, P=0.024) compared to the DES group. Conclusions: Drug-eluting stent implantation to OSVG lesions achieves better clinical results than BMS but is still associated with a relatively high incidence (10.8%) of revascularization at 1-year follow-up.

Relationship Between Arterial Stiffness and Myocardial Damage in Patients With Newly Diagnosed Essential Hypertension

BACKGROUND Arterial stiffness increases in hypertensive individuals. Arterial stiffness is associated with impairment of systolic and diastolic myocardial function in hypertension (HT). However, the relationship between arterial stiffness and serum heart-type fatty acid-binding protein (H-FABP) levels, a sensitive marker of myocardial damage, has not been previously examined in patients with HT. We investigate the relationship between serum H-FABP levels and arterial stiffness in patients with newly diagnosed HT. METHODS We studied 46 (48.5 +/- 10.6, years) never-treated patients with HT and age-matched control group of 40 (47 +/- 8.6, years) normotensive individuals. H-FABP levels were determined in all subjects. We evaluated arterial stiffness and wave reflections of study population, using applanation tonometry (Sphygmocor). Carotid-femoral pulse wave velocity (PWV) was measured as indices of elastic-type, aortic stiffness. The heart rate-corrected augmentation index (AIx@75) was estimated as a marker of wave reflections. RESULTS Carotid-femoral PWV (10.5 +/- 2.2 vs. 8.7 +/- 1.6, m/s, P = 0.0001) and AIx@75 (22.7 +/- 9.5 vs. 15 +/- 11, %, P = 0.001) were significantly higher in patients with HT than control group. H-FABP levels were increased in hypertensive patients compared with control group (21.1 +/- 14.8 vs. 12.9 +/- 8.5, ng/ml, P = 0.002). In multiple linear regression analysis, we found that the body mass index (beta = 0.42, P = 0.0001) and carotid-femoral PWV (beta = 0.23, P = 0.03) were significant determinants of H-FABP levels. CONCLUSION Arterial stiffness is associated with serum H-FABP levels, a sensitive marker of myocardial damage, in patients with newly diagnosed HT.

Circulating levels of relaxin and its relation to cardiovascular function in patients with hypertension

Background. The role of endogenous relaxin on hypertensive cardiovascular damage remains unknown. We investigated the relaxin level and its relation to cardiovascular function in patients with never treated hypertension (HT). Methods. We studied 42 (47.8±10 years) never treated patients with HT and 40 age‐matched (47±8.6 years) normotensive individuals. Serum relaxin levels were determined in all subjects using enzyme‐linked immunosorbent assay. Left ventricular (LV) diameters were evaluated by transthoracic echocardiography. Ejection fraction and LV mass index were measured. Diastolic functions were evaluated with both conventional and tissue Doppler echocardiography. We evaluated central aortic pressures, heart rate‐corrected augmentation index (AIx@75), a marker of wave reflections, and aortic pulse wave velocity (PWV) as indices of elastic‐type aortic stiffness of the study population using applanation tonometry (SphygmoCor). Results. Relaxin levels were significantly lower in hypertensive patients as compared with controls (36.5±7.3 vs 49.7±39.8 pg/ml, p=0.03). The relaxin level was negatively correlated with brachial and central aortic pressure. However, serum relaxin was not significantly associated with LV diameters, ejection fraction, LV mass index, LV diastolic function, AIx@75 or aortic PWV in our study. Conclusion. Serum relaxin is decreased in patients with HT. However, low endogenous relaxin is not related to cardiovascular function.

Fragmented QRS is associated with subclinical left ventricular dysfunction in patients with chronic kidney disease.

Objective We aimed to investigate the association of fragmented QRS (fQRS) with subclinical left ventricular (LV) dysfunction in patients with chronic kidney disease (CKD). Methods and results Patients with CKD who had a normal LV ejection fraction (≥ 50%) were enrolled. The tissue Doppler-derived Tei index was measured for all patients. A Tei index of ≥ 0.5 was considered abnormal. Subclinical LV dysfunction was defi ned as the presence of an abnormal Tei index in the absence of impaired LV ejection fraction (< 50%). The fQRS was defi ned as the presence of an additional R wave (R’) or notching of R or S wave or the presence of fragmentation in two contiguous ECG leads. The study group consisted of 82 patients (45 male, mean age 54 ± 14 years). Overall, prevalence of fQRS was 60% among CKD patients who had a preserved LV ejection fraction. Of these, 52 (63%) had an abnormal (≥ 0.5) and 30 (37%) a normal Tei index (< 0.5). The prevalence of fQRS was signifi cantly higher in patients with an abnormal Tei index than in patients with a normal Tei index (71% vs. 40%, P= 0.006). Patients with an abnormal Tei index had a lower E/A ratio as compared to patients with a normal Tei index (P = 0.03). Groups were similar with respect to all other variables. In multivariate logistic regression analysis, the presence of fQRS was independently associated (OR 3.52, 95% CI 1.28-9.64) with the presence of an abnormal Tei index after adjustment for potential confounders. Conclusion Fragmented QRS is independently associated with subclinical LV dysfunction in patients with CKD and normal ejection fraction.

Association between mean platelet volume and coronary artery calcification in patients without overt cardiovascular disease: an observational study.

OBJECTIVE Platelets have an important role in the pathogenesis of atherothrombosis. It has been shown that platelet size measured by mean platelet volume (MPV), correlates with their reactivity and is still regarded as an easy, useful tool for indirect monitoring of platelet activity in different situations. Coronary artery calcification (CAC) has long been known to occur as a part of the atherosclerotic process. The aim of this study was to determine whether an association exists between MPV and CAC. METHODS In this observational study, we enrolled 259 participants with at least one cardiac risk factor but with unknown cardiovascular disease. Coronary calcification was assessed by multislice computerized tomography and MPV was measured in a blood sample collected in EDTA tubes. Statistical analysis was performed using Kruskal-Wallis, Chi-square, correlation tests and multiple regression analysis. RESULTS Calcium scores ranged from 0 to 735. There was a significant relation between CAC and MPV (r=0.24, p=0.02), age (r=0.32, p<0.001), hypertension (r=0.19, p=0.03), diabetes (r=0.16, p=0.005), smoking (r=0.17, p=0.001). In linear regression analysis, MPV (β=0.4, 95%CI 19.8- 31.1, p<0.001), age (β=0.13, 95%CI 0.23-2.4, p=0.01) and smoking (β=0.12, 95%CI 3.2-15.1, p=0.02) independently associated with CAC. In addition, there were significant differences in MPV between significant CAC group compared to the minimal and none (10.2 ± 2.4 versus 8.1 ± 0.9 and 7.6 ± 1.3; p<0.001). CONCLUSION We have found significant association between MPV and CAC. Although this study is purely correlative and no causative conclusions can be drawn, it may suggest that higher MPV may reflect increased atherosclerotic burden and cardiovascular risk.

A comparison of the effects of ramipril and losartan on blood pressure control and left ventricle hypertrophy in patients with autosomal dominant polycystic kidney disease

Background: Hypertension is frequently seen in autosomal dominant polycystic kidney disease (ADPKD), and it has a negative effect on renal progression. Hypertension and left ventricle hypertrophy (LVH) are related in terms of pathogenesis and their effects on renal progression. In this study, we aimed to compare the effects of losartan and ramipril on blood pressure (BP) control, LVH, and renal progression in patients with hypertensive ADPKD. Methods: Thirty-two ADPKD patients with ages ranging between 18 and 70 years who were stage 1–2 hypertensive were included in this study. Routine biochemical tests and echocardiography were obtained at first examination of the patients. Following these, the patients were randomized. One group was given losartan and the other ramipril. They were followed up for 1 year, and their echocardiographies and routine biochemical tests were repeated at the end of the year. Results: BP values decreased in both the groups at the end of the first year (p < 0.001). There was a statistically significant difference in LVH in both the groups at the end of the first year than at the beginning (losartan, p = 0.007; ramipril, p < 0.001). Conclusions: In this study, effective BP control was obtained with losartan and ramipril and LVH was found to be regressed significantly in the hypertensive patients with ADPKD. These two groups of antihypertensive drugs may also have beneficial effects on the retardation of renal progression and in reducing cardiovascular mortality in hypertensive patients with ADPKD.

Isolated interrupted aortic arch: in a 40-year-old adult.

Interrupted aortic arch (IAA) is a scarce and generally lethal congenital malformation. Patients with complete IAA scarcely reach adult age without previous surgical intervention. In this case, we presented a 40-year-old isolated IAA case with hypertension and angina pectoris. IAA just distal to left subclavian artery and markedly developed collateral circulation was demonstrated via cardiac catheterization (CC) and multi-slice computed tomography angiography (MSCT).

Relationship between cardiac troponin-T and right ventricular Tei index in patients with hemodynamically stable pulmonary embolism: an observational study.

OBJECTIVE The role of increased troponin level in risk stratification of acute pulmonary embolism (PE) is well documented. However, relation between right ventricular (RV) myocardial performance (Tei) index and cardiac troponin-T (cTn-T) has not been well investigated. The purpose of this observational prospective study was to assess the relationship between the RV Tei index and cTn-T in patients with acute normotensive PE. METHODS Thirty-eight patients with acute PE diagnosed by computed spiral tomography pulmonary angiography were enrolled to this prospective observational study. All study population underwent a comprehensive echocardiographic study including tissue Doppler imaging within first 12 hours of admission. cTn-T levels were measured on admission. Follow-up echocardiography was performed routinely at the 7th day of hospitalization. Echocardiographic evaluation was repeated at 90 days in patients with insufficient improvement of RV Tei index. The difference between the baseline and follow-up data was analyzed using the paired sample t-test or Wilcoxon test according to normality of distribution. RESULTS The mean of the RV Tei index was 0.46 ± 0.14 and the mean systolic pulmonary artery pressure (sPAP) was 40 ± 20 mmHg. Increased cTn-T level was detected in 37% of the patients (normal value 0.01< ng/mL). Significant correlations were observed between RV Tei index and sPAP with cTn-T levels (r=0.467 and r=0.468, p<0.001, respectively). In logistic regression analysis, RV Tei index was associated with positive cTn-T values (OR-136, 95% CI: 1.3-14657, p=0.039). After the anticoagulant treatment, RV Tei index and sPAP were significantly improved. CONCLUSION RV Tei index is frequently impaired in patients with acute PE and a significant recovery is seen after the treatment. Therefore, RV Tei index may be used both the diagnosis of RV dysfunction and the assessment of treatment effectiveness. RV Tei index is may predict myocardial injury in PE.