Gulay Ozkececi

Can platelet indices predict obstruction level of pulmonary vascular bed in patients with acute pulmonary embolism

Computed tomography pulmonary arterial obstruction index ratio (CTPAOIR) is related with the severity of pulmonary embolism (PE). Platelet indices including mean platelet volume (MPV), platelet distribution width (PDW) are reported to be increased in acute PE.

Atherogenic index as a predictor of atherosclerosis in subjects with familial Mediterranean fever

BACKGROUND AND OBJECTIVE Numerous inflammatory and innate immune pathways are involved in atherogenesis. We aimed to investigate the atherogenic index and other lipid parameters in individuals with familial Mediterranean fever (FMF), as a predictor of atherosclerosis. MATERIALS AND METHODS A total of 60 patients with FMF and 60 healthy age- and sex-matched controls were included in this study. The patients with acute infection, chronic metabolic and rheumatic diseases, use of drugs other than colchicine and smoking history were excluded. CRP, ESR, total cholesterol, triglycerides, LDL-C, and HDL-C levels of patients and the control group were measured. Atherogenic index (TG/HDL-C) was calculated. RESULTS We found that the atherogenic index values of the patients were significantly higher than those of the control group. HDL-C levels were lower and ESR and TG levels were higher in patients. Total cholesterol, LDL-C and CRP levels did not differ significantly between the two groups. There was no significant difference in the values of total cholesterol, LDL-C, triglycerides (TG), HDL-C, and atherogenic indexes between the groups of patients with and without M694V mutation. CONCLUSIONS Elaboration of clinical models of inflammation-induced atherogenesis may further advance our knowledge of multiple inflammatory pathways implicated in atherogenesis and provide a useful tool for cardiovascular prevention. We believe that the atherogenic index also be used as a preliminary indication of accelerated atherosclerosis in FMF. However, large-scale prospective studies on this issue are needed.

Is impaired sleep quality responsible for a nondipping pattern even in normotensive individuals

ObjectiveWe aimed to evaluate the relationship between sleep quality and a dipping–nondipping pattern in normotensive individuals. Materials and methodsOur study was carried out on 100 normotensive individuals; 50 of these individuals had a dipping pattern and 50 had a nondipping pattern, and were chosen from among patients in whom ambulatory blood pressure monitoring was applied before for any reason. All study participants underwent the Pittsburgh Sleep Quality Index survey to evaluate sleep disturbances. ResultsThe overall scores and all the components of the Pittsburgh Sleep Quality Index scores were significantly higher in the nondipper normotensive group compared with the dipper normotensive group. ConclusionIn conclusion, the nondipping blood pressure pattern appears to be associated with poor sleep quality not only in hypertensive patients but also in normotensive healthy individuals. When evaluating patients with poor sleep quality, the possibility that they may have a nondipping pattern even if they are normotensive should be kept in mind.

The relationship between vitamin D and PTH levels and cardiovascular risk in the elderly hypertensives.

Abstract Introduction and objective: In this study, we aimed to investigate the relationship between vitamin D, parathyroid hormone (PTH) and cardiovascular risk (CVR) in hypertensive patients aged 65 years and over. Patients and methods: This study was performed with 84 hypertensive patients and 68 normotensive control group in Afyon Kocatepe University Faculty of Medicine Hospital. The determined cardiovascular risk degrees and the stages of blood pressure were compared with the levels of 25-(OH) vitamin D and PTH. Results: Mean systolic and diastolic blood pressure (BP) levels of the patients with vitamin D deficiency (VDD) were significantly higher than those without VDD (p < 0.001 for both). Mean systolic and diastolic BP levels of the patients with hyperparathyroidism were significantly higher than those without hyperparathyroidism (p = 0.012, p = 0.036, respectively). CVR was reversely correlated with vitamin D but the correlation with hyperparathyroidism did not reach statistically significant level (r = –0.752, p < 0.001) and (r = 0.210, p = 0.055), respectively. Conclusion: These results indicate that the presence of hypertension is associated with VDD, as well as the stage of hypertension contributes to insufficiency, hyperparathyroidism and increased CVR. Clinicians should be aware and perhaps more aggressive for the treatment of HT and VDD in patients over 65 years of age.

Mean platelet volume, in predicting severity of mitral regurgitation and left atrial appendage thrombosis.

The incidence of thromboembolism is higher in mitral regurgitation. Mean platelet volume (MPV), which is calculated automatically in the complete blood count tests, indicates platelet production, function and activation. Elevated MPV levels in cardiovascular diseases and some heart valve diseases have been shown before. We aimed to investigate the relationship between MPV and mitral regurgitation, and to evaluate the MPV levels according to the presence of atrial fibrillation or left atrial appendage thrombus in patients with mitral regurgitation for the first time. The study included 57 patients who had undergone transthoracic and transesophageal echocardiography for the classic symptoms and diagnosed with primary (organic) mitral regurgitation. The control group was composed of 46 age, sex and BMI-matched healthy individuals who had undergone transthoracic echocardiography and obtained normal findings. Echocardiographic evaluation was performed according to the recommendations of the American Echocardiography Society. Mean MPV values in patients with mitral regurgitation were significantly higher than the control group (P < 0.001). MPV levels and the thrombus risk were correlated with the severity of the disease. When the patients with mitral regurgitation were classified according to the presence of atrial fibrillation and left atrial appendage thrombus, patients with atrial fibrillation had higher MPV levels compared to patients with normal sinus rhythm (P < 0.001). In addition, highest MPV levels were found in patients with both atrial fibrillation and thrombosis (P < 0.001). In conclusion, measurement of MPV may be considered as a quick and reliable guide in the assessment of mitral regurgitation and thrombus, without any cost or any advanced expensive technology.

Arterial stiffness in obstructive sleep apnoea: Is there a difference between daytime and night-time?

Obstructive sleep apnoea syndrome (OSAS) is a common chronic systemic disease in the general population, with known associated cardiovascular outcomes. We aimed to investigate arterial stiffness in OSAS patients and compare daytime and night‐time values with control subjects.

Right pulmonary artery agenesis with patent ductus arteriosus and Eisenmenger syndrome: A rare case diagnosed during the postpartum period

Unilateral absence of a pulmonary artery a very rare congenital disorder. We here present a case of a 22-year-old female patient with agenesis of the right pulmonary artery accompanying patent ductus arteriosus and Eisenmenger syndrome, diagnosed by chest X-ray and multidetector computed tomography 5 days after giving birth.

The effect of sleep apnea severity on cardiac autonomic activity during night time in obstructive sleep apnea patients

CONTEXT AND OBJECTIVE Impaired autonomic cardiac function is an important consequence of obstructive sleep apnea (OSA). This impairment is mainly due to intermittent hypoxia episodes following apneas. However, the impact of apnea severity on autonomic cardiac function remains unclear. The aim of this study was to evaluate the relationship between the severity of sleep apnea and heart rate turbulence (HRT) and heart rate variability (HRV) in OSA. DESIGN AND SETTING Observational cross-sectional study conducted in the Departments of Cardiology and Pulmonary Diseases, Afyon Kocatepe University, Turkey. METHODS 106 patients with OSA and 27 healthy volunteers were enrolled. Based on apnea hypopnea index (AHI) values, obstructive sleep apnea severity was classified as follows: mild OSA (AHI ≥ 5 and < 15), moderate OSA (AHI ≥ 15 and ≤ 30) and severe OSA (AHI > 30). HRV and HRT parameters were assessed via 24-hour digital Holter electrocardiogram recordings for all subjects. RESULTS HRV and HRT results were significantly lower among OSA patients than among control subjects (P < 0.05). However, there were no significant differences in HRT and HRV between the three patient subgroups. Correlations did emerge between AHI and the NN-interval parameter RMSSD and between oxygen desaturation and turbulence slope (respectively: r = -0.22, P = 0.037; and r = -0.28, P = 0.025). CONCLUSION HRT and HRV results deteriorate in OSA. Correlations between apnea severity and these parameters seem to be present.

Heart rate variability and heart rate turbulence in patients with polycystic ovary syndrome

Objective: Cardiac autonomic dysfunction may develop in patients with polycystic ovary syndrome (PCOS). Heart rate variability (HRV) and heart rate turbulence (HRT) are used in assessing cardiac autonomic functions. The goal of this study was to compare the cardiac autonomic functions in patients with PCOS and healthy controls. To our knowledge, this is the first study evaluating cardiac autonomic functions in patients with PCOS with respect to both HRV and HRT. Methods: Twenty-three patients with PCOS (mean age 22.8±3.9 years) and 25 healthy female volunteers who were matched for age and body mass index (BMI) (mean age 23.5±6.2 years) were enrolled in this as case-control study. Twenty-four hour ambulatory electrocardiogram recordings of all participants were taken using Pathfinder software. The time domain parameters of HRV and HRT, including turbulence onset (TO) and turbulence slope, were calculated. Diagnosis of PCOS was made with physical and laboratory findings of hirsutism or biochemical hyperandrogenism and chronic anovulation. Diabetes mellitus, other hormon disorders or hormon therapy, pregnancy, atrial fibrilation, obesite, chronic diseases, disorders of the autonomic nervous system, a history of drug use affecting the autonomic nervous system were excluded. Results: There were no significant differences in HRV and HRT parameters between the two groups. Cardiovascular risk factors, such as BMI, blood pressure, fasting blood glucose, and lipid parameters, were also similar. Triangular index measure of HRV was negatively correlated with high density lipoprotein cholesterol levels (r=-0.47, p<0.05), while age and BMI were significantly correlated with TO (r=0.31 and 0.47, respectively; p<0.05 for all). Conclusion: Cardiac autonomic functions were not found to be altered in patients with PCOS in comparison with healthy controls. These results may be explained with the absence of concomitant cardiovascular risk factors with the patients being in the early stage of the disease.

Is abnormal glucose metabolism during pregnancy related to endothelial dysfunction

Abstract Objective: Endothelial dysfunction is an independent risk factor for cardiovascular events. We aimed to investigate the relationship between endothelial dysfunction and gestational diabetes mellitus and impaired glucose tolerance. Methods: Pregnant women who had impaired glucose metabolism in the 75-g oral glucose tolerance test (OGTT) and their age- and body mass index-matched controls were included in the study and assessed for flow-mediated vasodilatation to evaluate endothelial dysfunction. Results: A total of 51 patients participated in the study. There were 20 patients in the control group, 13 in the impaired glucose tolerance group and 18 in the gestational diabetes mellitus group. Flow-mediated vasodilatation measured at the 60th and 120th seconds were significantly lower in the impaired glucose tolerance and gestational diabetes mellitus groups than in the control group (8.5 ± 5.7 and 8.9 ± 6.5 versus 14.9 ± 9.0, p = 0.022 and 6.2 ± 6.7 and 5.2 ± 5.0 versus 12.0 ± 8.3, p = 0.011, respectively). Conclusions: Patients with gestational diabetes mellitus and impaired glucose tolerance have impaired endothelial dysfunction. Delivery might have protective effects on endothelial functions. The significance of impaired endothelial dysfunction for pregnant women must be investigated, and if needed, lifestyle changes might be suggested, according to the determined importance of the endothelial dysfunction.