B. Kaya

Tissue Doppler echocardiography can be a useful technique to evaluate atrial conduction time

BACKGROUND The main purpose of this study is to determine the correlation of inter- and intraatrial conduction times between the electrophysiological and tissue Doppler echocardiographic measurements, and to evaluate the appropriateness of tissue Doppler echocardiography for this measurement. METHODS One-hundred and one patients were included in the study who underwent electrophysiological study for clinical arrhythmias. Inter- and intraatrial conduction times were measured from intracardiac electrograms. Atrial conduction times were also measured by tissue Doppler echocardiography by evaluating atrial electromechanical delay between lateral mitral annulus, septal mitral annulus, and right ventricular tricuspid annulus. The correlation between electrophysiological and echocardiographic atrial conduction times were analyzed. RESULTS We found a weak correlation between the measurements of interatrial conduction times with the electrophysiological and tissue Doppler techniques (r = 0.308; p = 0.002). The correlation for intraleft atrial conduction times was moderate (r = 0.652; p 〈 0.001). There was no correlation between the measurements of intra-right atrial conduction times. CONCLUSIONS We concluded that tissue Doppler echocardiography can be used for the measurement of interatrial and intra-left atrial conduction times. Tissue Doppler echocardiography can be a suitable technique to evaluate atrial substrate.

Tissue Doppler and myocardial deformation imaging to detect myocardial dysfunction in pediatric cancer patients treated with high doses of anthracyclines

To detect subtle changes in myocardial function in pediatric cancer patients treated with high dose anthracyclines.

Predictors of atrial fibrillation recurrence after atrial fibrillation ablation with cryoballoon.

BACKGROUND Catheter ablation of atrial fibrillation is recommended for patients with symptomatic paroxysmal atrial fibrillation (PAF) despite anti-arrhythmic drugs (AADs). Radiofrequency ablation is widely accepted as an effective treatment for PAF. Cryoenergy by cryoballoon technique is an alternative to radiofrequency (RF) ablation. Cryoballoon ablation is safe, and has a similar success rate in comparison to RF ablation. AF recurrence with cryoballoon ablation is roughly 30%. The aim of this study is to determine the predictors of AF recurrence after cryoballoon ablation. METHODS AND RESULTS Sixty one patients with symptomatic PAF despite AADs without structural heart disease were included. Cryoballoon ablation was performed in 60 patients (36 males, mean age: 54.6 ± 10.7, mean left atrium size: 3.74 ± 0.39 mm). Transthoracic echocardiography including tissue Doppler imaging was performed in all subjects during sinus rhythm at baseline and after the ablation. Intra-atrial and inter-atrial electromechanical delays, and PA-lateral were measured. All patients were scheduled for 24 h Holter recording at baseline and at 3, 6, 9 months follow-up. Venous samples were collected to measure CK-MB, Troponin-T (TnT), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels at baseline and 24 h after ablation. Median follow up was 10 (8-12) months. Forty eight (80%) patients were in sinus rhythm during the follow up. In receiver operating curve (ROC) analysis, intraleft atrial electromechanical delay and PA-lateral achieve an area under the curve (AUC) 0.97 (p < 0.001) and 0.69 (p < 0.001) for the ability to predict AF recurrence. A cut-off value for baseline intra left atrial electromechanical delay of 29.5 ms predicted AF recurrence with sensitivity of 85% and specifity of 98%. A cut-off value for PA-lateral of 125 ms predicted AF recurrence with sensitivity of 80% and specifity of 90%. In ROC analysis, age achieves an AUC 0.822 (p = 0.006) for the ability to predict AF recurrence. A cut-off value for age of 64 predicted AF recurrence with sensitivity of 71% and specifity of 90%. Early recurrence of AF (HR = 60, 95% CI 18.61-417.86, p < 0.001) predicted also late recurrence of AF. CONCLUSIONS The increase in AF recurrence by increased intraleft atrial electromechanical delay, PA-lateral and older age show the importance of substrate in AF mechanism. Early recurrence was the strongest predictor of late recurrence of AF; therefore, existence of blanking period for cryoballoon ablation should be questioned.

Quantitative analysis of ezetimibe in human plasma by gas chromatography-mass spectrometry

A new, specific and sensitive GC-MS method with electron impact ionization technique was developed for quantitative analysis of ezetimibe (EZE) in human plasma. Prior to GC analysis, EZE was derivatized with N-methyl-N-trimethylsilyl-trifluoroacetamide (MSTFA), which is a trimethyl silylating reagent. The derivatization reaction was optimized and parameters such as catalyst, derivatization time, temperature, solvent and the volume of silylating reagent were investigated. Trimethylsilyl ether derivative of EZE was determined in selected ion monitoring (SIM, mass-to-charge ratio (m/z): 326) mode. The method was validated with respect to LOD and LOQ, precision, accuracy, linearity, specificity, stability, and recovery. The LOQ and LOD were found as 15 and 10 ng/mL, respectively. The linearity of the method ranged from 15 to 250 ng/mL. The correlation coefficient of the calibration curve was 0.9977 +/- 0.0004 (+/- S.E.M.). The intra- and inter-day precisions (RSD) were less than 6% and accuracies (bias) for intra- and inter-day accuracy were found between -4.04 and 9.71% at four different concentration levels (15, 40, 100, 250 ng/mL). The proposed method was successfully applied to real human plasma samples for determination of total EZE.

The efficacy and safety of irbesartan in primary hypertension even if a dose is missed: Results from the NO PROBLEM Study

Abstract Objectives. This study aimed to demonstrate that irbesartan is successful in reducing diastolic blood pressure (BP) even following a missed dose after 6–8-weeks’ treatment as measured by 24-hour ambulatory BP monitoring (ABPM). Methods. Eighty-eight patients (64 females, mean age: 53.4 ± 10.6 years) with primary hypertension were included in this national, single-center, single-arm, open-label, prospective clinical study. Irbesartan (150 or 300 mg/day) was administered for 8 weeks. All patients were asked to cease treatment for 1 day during weeks 6–8. Changes in diastolic and mean 24-hour BP on the day of cessation and diastolic BP values during visits were efficacy parameters. Adverse events were also recorded. Results. Systolic, diastolic, and mean BP values measured via ABPM before and on the day of a missed dose did not differ significantly. Irbesartan effectively controlled BP of the patients. BP normalization rates were 54% for 150 mg/day irbesartan only and 77% for both doses (150 or 300 mg/day) of irbesartan. None of the patients experienced serious adverse events throughout the study period. Conclusions. Irbesartan is successful and safe in the control of BP levels even following a missed dose at the end of a 6–8-week treatment period.

Effect of antihypertensive therapy on endothelial markers in newly diagnosed Stage 1 hypertension: a randomized single-centre study

OBJECTIVE This study was aimed to investigate the effects of olmesartan or nebivolol treatment on blood pressure and some endothelial function markers in newly diagnosed patients with stage 1 essential hypertension. METHODS This randomized open label study included 85 newly diagnosed patients with stage 1 hypertension (50 males, mean age: 52 ± 9 years). Blood pressure, flow mediated vasodilatation (FMD) and echocardiographic measurements of the patients were taken before and 8 weeks after the beginning of treatment with olmesartan or nebivolol. Nitric oxide, plasminogen activator inhibitor 1 (PAI-1) and C reactive protein (CRP) levels measured in serum samples before and after treatment, were compared. Basal variables that can affect the antihypertensive response were evaluated by multivariate logistic regression analysis. RESULTS The reduction observed in the systolic and diastolic blood pressures after antihypertensive treatment was significant (p<0.05). FMD was significantly improved after treatment in both nebivolol and olmesartan groups; however, there was no significant difference between nebivolol and olmesartan groups (p=0.6). While CRP and PAI-1 levels decreased, nitric oxide levels increased in both nebivolol and olmesartan treatment groups; but these changes were not statistically significant. No drug related complication was observed. CONCLUSION This study has indicated that olmesartan and nebivolol causes similar changes in blood pressure response, FMD and endothelial function biomarkers improved. These results suggest that antihypertensive treatment, independent of the medication used, is associated with endothelial function improvement.

[EUROASPIRE-IV: European Society of Cardiology study of lifestyle, risk factors, and treatment approaches in patients with coronary artery disease: Data from Turkey].

Sexual activity is an important component of patient and partner quality of life for men and women with cardiovascular disease, including many elderly patients. Older adults desire sexual intimacy when there is a partner and a health status that allows sexual relationships. Older individuals desire to love and enjoy sexual activity in relation to personal circumstances, and when health status allows them to experience close relations, most often within marriage especially in our country. Normal changes occur in the phases of sexual cycle with aging, male erectile dysfunction and female sexual dysfunction increase with age. Elderly patients are often affected by multiple organic diseases which can interfere with sexual function especially cardiovascular disease. Treating those disorders or modifying lifestyle-related risk factors may help prevent sexual dysfunction in the elderly. Sexuality is important for older adults and physicians should give their patients opportunity to voice their concerns with sexual function and offer them alternatives for evaluation and treatment. Asking about sexual health remains difficult or embarrassing for many physicians; in addition, many patients find it difficult to raise sexual issues with their doctor.

Septal reduction therapy using nonalcohol agent in hypertrophic obstructive cardiomyopathy: Single center experience

Percutaneous septal reduction therapy by either alcohol or nonalcohol agents is an alternative approach to surgery in drug‐refractory symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM). Nonalcohol agents have some advantages and disadvantages over alcohol during the procedure. Nowadays, a novel non‐alcohol agent, named as Ethylene‐vinyl alcohol (EVOH) copolymer (Onyx® and Squid®), is used during septal ablation. Thus, in this study, we aimed to evaluate both acute and long‐term efficacy and safety profile of EVOH during septal ablation in HOCM.

Preliminary results from a nationwide adult cardiology perspective for pulmonary hypertension: RegiStry on clInical outcoMe and sUrvival in pulmonaRy hypertension Groups (SIMURG)

Objective: The present study was designed to evaluate the characteristics of pulmonary hypertension (PH) and adult cardiology practice patterns for PH in our country. Methods: We evaluated preliminary survey data of 1501 patients with PH (females, 69%; age, 44.8±5.45) from 20 adult cardiology centers (AdCCs). Results: The average experience of AdCCs in diagnosing and treating patients with PH was 8.5±3.7 years. Pulmonary arterial hypertension (PAH) was the most frequent group (69%) followed by group 4 PH (19%), group 3 PH (8%), and combined pre- and post-capillary PH (4%). PAH associated with congenital heart disease (APAH-CHD) was the most frequent subgroup (47%) of PAH. Most of the patients’ functional class (FC) at the time of diagnosis was III. The right heart catheterization (RHC) rate was 11.9±11.6 per month. Most frequently used vasoreactivity agent was intravenous adenosine (60%). All patients under targeted treatments were periodically for FC, six-minute walking test, and echo measures at 3-month intervals. AdCCs repeated RHC in case of clinical worsening (CW). The annual rate of hospitalization was 14.9±19.5. In-hospital use of intravenous iloprost reported from 16 AdCCs in CWs. Bosentan and ambrisentan, as monotreatment or combination treatment (CT), were noted in 845 and 28 patients, respectively, and inhaled iloprost, subcutaneous treprostinil, and intravenous epoprostenol were noted in 283, 30, and four patients, respectively. Bosentan was the first agent used for CT in all AdCCs and iloprost was the second. Routine use of antiaggregant, anticoagulant, and pneumococcal and influenza prophylaxis were restricted in only two AdCCs. Conclusion: Our nationwide data illustrate the current status of PH regarding clinical characteristics and practice patterns.

AB0430 What is the role of ambulatory blood pressure monitoring in sle

Background Patients with systemic lupus erythematosus (SLE) are at increased risk for the development of atherosclerotic cardiovascular disease (CVD). Hypertension (HT) which is frequently seen in SLE is a major risk factor for CVD. Ambulatory blood pressure monitoring is useful for both the diagnosis and the evaluation of HT. Objectives This study was conducted to compare the results of office, home and ambulatory blood pressure monitoring measurements in SLE patients. Methods We studied 86 SLE patients. Office, home and 24-hour ambulatory blood pressure measurements were performed in all patients. Results of the blood pressure measurements were evaluated according to current guidelines (1). Disease activity in SLE patients was defined by using the Safety of Estrogens in Lupus Erythematosus National Assessment-Sistemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) scores. Results The mean age of the SLE patients (90.7% female) was 43±12 years. Of them 34 (39.5%) patients had a history of HT. In SLE patients with HT blood pressure control was not achieved in 12 (35.3%)patients with office measurements, in 16 (47.1%)patients with home measurements and in 13 (38.2%)patients with 24-hour ambulatory measurements. Among patients with no prior history of HT, there were 7 (13.5%)new diagnoses of hypertension by office measurements, 8 (15.4%)new diagnoses by home measurements and 9 (17.3%)new diagnoses by ambulatory monitoring. In the group with no prior history of HT, we observed that the concordance between the office and 24-hour ambulatory measurements was extremely low (Kappa: 0.116, p= 0.40). The concordance between self measurements at home and ambulatory measurements was moderate but less than ideally expected (Kappa: 0.504, p< 0.001). The results for patients with a history of HT were similar with Kappa values of 0.178 and 0.476 when comparing ambulatory measurements with office and home measurements, respectively. The SELENA-SLEDAI values for the concordant and discordant pairs were similar for both home versus ambulatory and clinic versus ambulatory comparisons (both p> 0.05, Mann-Whitney U test). Conclusions The concordance between the blood pressure evaluation methods is low in SLE patients. 24-hour ambulatory blood pressure monitoring should be the preferred method for accurate evaluation of HT in patients with high risk for cardiovascular diseases. References European Guidelines on cardiovascular disease prevention in clinical practice (version 2012): the Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice.2012;19(4):585-667. Disclosure of Interest None Declared