Fatma Erdem

Electrophysiological validation of total atrial conduction time measurement by tissue doppler echocardiography according to age and sex in healthy adults.

We sought to validate total atrial conduction time (TACT) measurement via tissue Doppler imaging (TDI) by comparing the electrophysiological study (EPS) measurements of healthy subjects, according to age and sex.

Cardiac autonomic function in healthy young smokers.

The present study examined the heart rate turbulence (HRT) and heart rate variability (HRV) parameters in healthy young smokers (<40 years) to assess the effects of smoking on cardiac autonomic function. The study included 75 smokers with a history of habitual smoking for at least 1 year (41 males and 34 females; mean age, 29.3 ± 7.3 years) and 30 nonsmokers (hospital staff; 16 males and 14 females; mean age, 29.0 ± 6.1 years). Addiction to smoking was evaluated using the modified Fagerström test for nicotine-dependence index (NDI). HRT, HRV, basic clinical and echocardiographic, and Holter test parameters were compared between groups. No significant differences between the two groups were found in the basic clinical and echocardiographic variables. Turbulence onset (TO) was significantly higher in the smoking group than in the controls, and turbulence slope was significantly lower in the smokers, than in the controls (p < 0.05). Standard deviation of all normal-to-normal (NN) interval index (SDNNI) was the only HRV parameter that was significantly different between the smoking and control groups (p < 0.05). The NDI was positively correlated with the TO (p < 0.05). Smoking impairs the baroregulatory function in healthy young smokers, particularly the HRT parameters and SDNNI. Our findings highlight the importance of complete smoking cessation.

Benefit of Metformin in COPD: An Effect on Autonomic Nervous System?

With great interest we read the recent article by Hitchings et al. on the safety of metformin in patients with type-2 diabetes mellitus and COPD (1). Th ey found that in patients at high risk for lactate accumulation, metformin therapy was associated with a minor elevation of lactate concentration of doubtful clinical signifi cance. An additional fi nding was that metformin was associated with a longer survival, which was diffi cult to interpret because of possible unmeasured confounders. We would like to propose a mechanism of metformin by which metformin may have a benefi cial eff ect in terms of survival of COPD patients. Studies have shown that alterations in autonomic nervous system are present in COPD, with or without arterial COPD (2–6), which may contribution to the severity of disease and survival. Metformin is an anti-diabetic agent that has been shown to reduce insulin resistance and hyperglycemia, and also reduce the incidence of diabetes (7). Studies have also shown that metformin has benefi cial eff ects on autonomic control (8,9) and can improve cardiac sympathovagal balance in obese patients with type-2 diabetes (8). We think it can be hypothesized that the preceding eff ects of metformin on the autonomic nervous system might have played a role in the survival data reported by Hitchings et al. (1).

Successful thrombolytic therapy in a patient with congenital corrected transposition of the great arteries

OBJECTIVE The aim of this report is to emphasize the importance of thrombolytic therapy in selected patients, such as those with congenital heart defects in whom a coronary artery anomaly can be observed. CASE REPORT We present here a 63 year-old female patient who was admitted to our emergency department with ST segment elevation myocardial infarction and a history of a congenital heart defect. We treated the patient successfully with thrombolytic therapy instead of primary percutaneous intervention, because of the suspicion of a coronary artery anomaly. On the following day, we performed coronary angiography on the patient, which revealed the anomalous origin of the coronary arteries, with the left and right coronary arteries originating from the right sinus of Valsalva and the circumflex artery originating from the left sinus of Valsalva. This anomaly in this patient group is described for the first time. CONCLUSION Coronary artery anomaly may be observed in patients with congenitally corrected transposition of the great arteries, and in the case of requiring emergency reperfusion, thrombolytic treatment can be an alternative strategy in this patient group.

Evaluation of diastolic function in patients with normal perfusion and type 2 diabetes mellitus with gated single-photon emission computed tomography

Early identification of diastolic dysfunction of patients with diabetes is important in preventing cardiac events. In this study, we aimed to show that both myocardial perfusion and diastolic function parameters can be evaluated in diabetic patients with possible silent cardiac symptoms using gated single-photon emission computed tomography (G-SPECT). We examined eighty patients: Forty with and forty without diabetes. The patients were compared in terms of systolic and diastolic parameters obtained using G-SPECT. 99mTc-sestamibi was used to obtain 8-frame images in each cardiac cycle, with calculation of the left ventricular ejection fraction (LVEF), peak filling rate (PFR), mean filling rate during the first third of diastolic time (MFR/3), and time to peak filling (TTPF) using the QGS software. G-SPECT results were compared in forty diabetic and forty nondiabetic patients of similar age and sex. Of the diastolic function parameters, PFR was found to be lower in patients with than without diabetes (2.31 ± 0.68 vs. 2.76 ± 0.68, respectively; P = 0.004). The TTPF and MFR/3 in both groups were similar. PFR was negatively correlated with end-diastolic volume and end-systolic volume (ESV) and positively correlated with LVEF. This correlation was stronger in patients with diabetes. The diastolic parameter PFR, obtained using G-SPECT, was significantly lower in patients with than without diabetes. We believe that these parameters should be noted for the early diagnosis or prevention of heart disease in patients with a risk of diastolic dysfunction.

Evaluation of Atrial Conduction Times, Epicardial Fat Thickness and Carotid Intima-Media Thickness in Patients With Ankylosing Spondylitis

Objectives This study aims to determine the relationship between atrial electromechanical delay (EMD), carotid intima-media thickness (CIMT), and epicardial fat thickness (EFT) in ankylosing spondylitis (AS), which has a complicated inflammatory nature. Patients and methods The study population included 42 consecutive patients with AS (28 males, 14 females; mean age 39.3±8.5 years; range 22 to 60 years) and 40 healthy subjects as controls (24 males, 16 females; mean age 37.2±8.7 years; range 22 to 60 years) (p>0.05). All patients underwent a standard tissue Doppler echocardiography to assess the left ventricular diastolic dysfunction, atrial EMD, CIMT, and EFT. All values were compared between the groups. Results Interatrial (29.5±5.8 ms vs. 17.9±5.3 ms) left and right intraatrial EMD (18.2±4.6 ms and 11.7±3.5 ms vs. 11.9±3.2 ms and 7.1±3.2 ms, respectively) intervals were longer in AS patients than in healthy controls (all p<0.001). Left and right CIMT (0.50±0.11 mm and 0.44±0.06 mm vs. 0.51±0.11 mm and 0.43±0.04 mm, respectively) and EFT (0.73±0.15 cm and 0.63±0.07 cm) values were higher in AS patients than in healthy controls (all p<0.01). Conclusion To our best knowledge, this is the first report evaluating the atrial EMD, CIMT, and EFT values together in AS patients. As indicators of cardiovascular involvement, all parameters were higher in AS patients.

A new diagnostic tool for masked hypertension: impaired sleep quality

Introduction The aim of this study was to evaluate the relationship between masked hypertension and impaired sleep quality. Additionally, we evaluated the diagnostic role and prevalence of poor sleep quality among patients with newly diagnosed masked hypertension. Material and methods A total of 112 individuals, 72 patients with newly diagnosed masked hypertension and 40 normotensive healthy volunteers, were included in this study. All patients underwent evaluation comprising 12-lead electrocardiography, transthoracic echocardiography, 24-hour Holter ECG, and basic laboratory tests. Additionally, all participants completed questionnaires, including the Pittsburgh Sleep Quality Index (PSQI). Results The total PSQI score was significantly higher in the masked hypertension group than in the normotensive healthy volunteers (4.13 ±2.43 vs. 2.33 ±1.67, p < 0.001). A PSQI score > 5 was found in 45.8% (n = 33) of patients in the masked hypertension group and 15% (n = 6) of patients in the normotensive group (p < 0.001). The non-dipper pattern was found in 17.5% of the healthy volunteer group and 59.94% (n = 41) of the masked hypertension group (p < 0.001). When we compared the dipping pattern of the masked hypertension groups, there was a significant difference in PSQI score between the dipper and non-dipper groups (4.87 ±3.21 vs. 3.58 ±2.33, p < 0.001). Multiple logistic regression analyses showed that masked hypertension, LV mass, and LV mass index score were independent predictors of poor PSQI. Conclusions This study demonstrates impaired sleep quality in subjects with masked hypertension, particularly those with a non-dipper pattern. Additionally, this study indicates that impaired sleep quality may help diagnose masked hypertension, particularly in the non-dipper group.

In reference to Snoring and carotid artery intima-media thickness.

We read with great interest the recent article by Deeb et al. regarding the relationship that exists between snoring and intima-media thickness (IMT) of the carotid arteries. The authors very clearly discussed the relationship between primary snoring and IMT of the carotid arteries. They concluded that the relationship between increased carotid IMT and serious health conditions, and nonapneic snoring may be a precursor to changes of the carotid artery. In addition to their fluent discussion, we aim to emphasize the possible other effective mechanism of snoring and carotid artery IMT: the contribution of autonomic nervous system function. Previous studies clearly showed that obstructive sleep apnea syndrome (OSAS) and snoring lead to nocturnal intermittent hypoxia, increased negative intrathoracic pressure, increased sympathetic nervous system activity, and elevation of reactive oxygen radicals. All of these factors cause vascular atherosclerosis. Previously, we showed that a close relationship between OSAS and impaired autonomic nervous system function is detected by different methods in OSAS patients without coronary artery diseases or other comorbidities. Together with this, nocturnal intermittent hypoxiarelated impairment in autonomic nervous system function is thought to play a central role in the risk of cardiovascular death. Several studies in the literature showed that IMT of the carotid artery and impaired cardiac autonomic function are inversely related. Galetta et al. clearly illustrated the relationship between the imbalance of cardiac autonomic activity and the development of carotid artery IMT. They discussed that the imbalance of cardiac autonomic activity plays an important role in the development of atherosclerosis through three possible mechanisms: increased heart rate with a consequent increase in oxygen consumption, increased shear stress leading to plaque fissure, and enhanced atherosclerosis through increased macrophage low-density lipoprotein cholesterol oxidation. We believe that the effect of snoring and IMT on autonomic nervous system function may play a role in the results described in article by Deeb et al. We hope that the above-mentioned items will add to the value of their well-written article regarding the relationship that exists between snoring and IMT of the carotid arteries.

An evaluation on the role of MPV on idiopathic sudden hearing loss etiology.

With the great interest, we have read the study in your journal entitled ‘‘Increased levels of mean platelet volume: a possible relationship with idiopathic sudden hearing loss’’ by Ulu et al. [1]. We would like to make some comments about this study. In recent years, the number of the studies, which state the increase of mean platelet volume (MPV), plays a role on the etiopathogenesis of many illnesses, gradually increases [2, 3]. In the near future, some studies, which investigate the relations between MPV and idiopathic sudden hearing loss (ISHL) about which there are too few publications, have been reported [1, 4]. Although a good number of assertive results have been announced in these studies, sufficient usage area of MPV value measurement has not occurred in the follow-up and treatment of patients clinically as there is no fully standardized method of this parameter. Some of the factors that affect the standardization of MPV measurement are the environment of blood-taking, type and amount of anticoagulant in the blood collection tube, the duration between blood-taking and examination, being 7–10 days of thrombocytes lifetime, the device of examination and the calibration time of the device. It has been reported that there are measurement differences up to 40 % even among the devices in the studies, in which different devices were used [5, 6]. In your study, the fact that MPV value has been found higher in the patients with ISHL in proportion as control group is agreeable to literature information. In contrast with your study, Karli et al. [4] found no difference between patient group with SHL and control group. Besides this, it has not been stated how much healing rate was and whether MPV value was measured or not after treatment according to audiometric examinatorial results applied on the patients in the first month after the medical treatment in which prednisone (1 mg/kg/day) was given during 15 days. As a result of this, we do not think that the etiology of ISHL can be explained with thrombotic/ischemic events. Moreover, if we consider that MPV measurement may be affected from many factors stated above, we think it is an assertive statement that this value can be used as an instructive marker for ISHL. While hemoglobin and thrombocyte count values between control and working groups were stated in the study, the values of preoperative and postoperative patient groups and the changes in these values were not stated. As a consequence, even if MPV has been associated with many illnesses recently, it does not seem possible for now to associate these results with disease etiopathogenesis in the limited studies that state MPV value as high in the patients with ISHL. To make better comments about this issue, we think that the results should be presented by evaluating pre and post of treatment, on more test subjects and in longer term. This comment refers to the article available at doi:10.1007/s00405-013-2348-9.

PP-119 Treatment of Atrial Fibrillation with Pulmonary Vein Isolation: A Single Center Experience

The American Journal of Cardiology MARCH 26e29, 2015 11 IN AND C Acute procedural success rate ( 3 PV isolation) was 97.2 % with radiofrequency technique (82.2% paroxysmal AF, 18.8% persistan AF). Major complications were observed in one of patients which treated with radiofrequency technique (cardiac perforation). PVI with radiofrequency, mean procedural and fluoroscopy times were 124.2 25.2 (110-210) min and 15.3 6.3 (14-23) min. Additionally, 4 of patients which treated with radiofrequency technique mitral isthmus and roof ablation line were performed together with PVI. At the time of followup, 93.28% of patients were free from AF recurrence. Conclusion: The efficacy and safety of radiofrequency and cryoballoon AF ablation technique was shown due to the acceptable success and low complication rates in either paroxysmal or permanent AF patients. A number of the complications early in the experience of PVI isolation have been addressed, especially with radiofrequency PVI, but further experience is required to increase the efficacy and safety of these techniques.