Hayri Alici

Circadian Blood Pressure Variation in Normotensive Patients With Panic Disorder

Nondipper pattern of blood pressure (BP) is associated with cardiovascular risk. In this study, we compared dipper versus nondipper patterns between normotensive patients with panic disorder (PD) and a control group. A total of 25 normotensive patients with PD and 25 controls were enrolled. Twenty-four-hour ambulatory BP monitoring was performed in all patients. At least 10% of sleep-related nocturnal decrease in systolic and diastolic BP was accepted as dipper status, while decreases <10% were defined as a nondipper. Patients with PD had significantly higher incidence of nondipper BP pattern than controls. The reduction of nighttime BP in both systolic and diastolic and mean BP was significantly lower in patients with PD than in the control group (7.6% ± 4.3% vs 13% ± 3.9%, P < .001; 11% ± 7% vs 15% ± 5%, P = .004; 9% ± 5% vs 14% ± 4%, P = .002, respectively). Panic disorder is associated with nondipper BP pattern, causing impaired circadian BP in normotensive settings.

Evaluation of oxidative metabolism and oxidative DNA damage in patients with obsessive–compulsive disorder

There are limited published data about the role of oxidative stress in the pathophysiology of obsessive–compulsive disorder (OCD). In addition, oxidative stress and oxidative DNA damage have not been investigated together in OCD. In this study, we aimed to evaluate oxidative stress and oxidative DNA damage in patients with OCD.

Coronary artery tortuosity: comparison with retinal arteries and carotid intima-media thickness

BACKGROUND AND AIM We conducted a prospective study to investigate the possible relationship between the tortuosity of coronary arteries (TCA) and carotid intima-media thickness (CIMT), and also compare TCA to retinal artery tortuosity. METHODS One hundred and five participants with nonsignificant coronary plaque or normal coronary angiogram were included. To determine subclinical atherosclerosis, maximum CIMT was measured. Retinal tortuosity was evaluated ophthalmically. RESULTS Among all demographic variables and risk factors, only female gender and height were significantly associated with TCA (p = 0.001, p = 0.01, respectively). Retinal artery tortuosity and retinal artery atherosclerosis were more common inpatients with TCA compared to patients without TCA (p < 0.001, R = 0.6; p = 0.002, R = 0.4, respectively). CIMT was greater in participants with TCA than patients without TCA (p = 0.001), and also the presence of carotid artery plaque was more common in patients with TCA (p < 0.001). There was a significant correlation between the presence of subclinical atherosclerosis and TCA (p = 0.005, R = 0.3). Likewise, a significant correlation was found between subclinical atherosclerosis and retinal artery tortuosity (p = 0.02, R = 0.3). Multivariate analysis identified female gender (p < 0.008), retinal arterytortuosity (p < 0.001), and CIMT (p = 0.02) as independent predictors of TCA. CONCLUSIONS These results indicate that, whatever the mechanism is: 1) TCA is associated with female gender and short stature; 2) TCA is associated with subclinical atherosclerosis even in patients with entirely normal appearing coronary arteries on coronary angiography; 3) Retinal artery tortuosity is correlated with TCA and can be a surrogate for systemic arterial tortuosity.

Association of male pattern baldness with angiographic coronary artery disease severity and collateral development

ObjectiveWe aimed to investigate whether there is an association between male pattern baldness and angiographic coronary artery disease (CAD) severity and collateral development, which has not been reported previously.MethodsCoronary arteriograms, CAD risk factors, lipid parameters and presence and severity of baldness in 511 male patients were prospectively evaluated. Baldness was classified into five groups. Severity of CAD was evaluated with the Gensini scoring system and collateral development with Rentrop scores.ResultsAlthough subjects with a higher Gensini score had more frequent and severe baldness, they were older than the group with lower Gensini scores. Bald patients had a higher Gensini score when compared with their non-bald counterparts. In univariate analysis, age more than 60, body mass index more than 30, smoking and baldness were predictors of high Gensini scores. In multivariate analysis, only age more than 60, body mass index more than 30 and smoking were independent predictors of a high Gensini score. There were no differences in terms of presence and severity of baldness in subjects with and without adequate collateral development.ConclusionsThere was no relation between presence, severity and age of occurrence of male pattern baldness and Gensini and Rentrop scores, which are important measures of presence and severity of CAD.

Twin Circumflex Arteries with Left Sinus of Valsalva Origin: A Case Report

Coronary artery anomalies are not uncommon. The importance of coronary anomalies varies from unimportant to life threatening. Herein, we report for the first time twin circumflex coronary arteries originating separately from the left sinus of Valsalva.

Acquired hematological abnormalities in aortic stenosis.

Aortic stenosis (AS) is the most frequently acquired valve disease in old population. It’s incidence is to 1-2 % in 7th decade and rises to 6% in 8th decade. Together with the increased mean age in developed countries, incidence of AS also increases. Although predisposing reasons are not known completely, the thickening of valves may be the result of chronic inflammation. Risk factors are similar with arterial atherosclerosis. Aortic stenosis may lead to hematologic problems along with morbidity and mortality and it is mostly ignored. Hematologic abnormalities caused by AS are hemorrhage and anemia. These abnormalities appear with mechanisms, for which reasons cannot be explained completely, in calcific stenosis. Nevertheless, there are reports of hematologic problems in participants with severe AS, which improved with aortic valve replacement. In this article, we discuss hematologic problems in AS.

Evaluation of early subclinical cardiotoxicity of chemotherapy in breast cancer.

Objective: Cardiac effects of chemotherapy are usually recognized after clinical symptom or sign occurrence in patients with breast cancer. In this study, we aimed to determine the potential subclinical cardiotoxic effects of chemotherapy that were given lower dosage than well known cardiac safety dosage limits in patients with breast cancer during early period. Methods: Fifty-one patients consecutively enrolled to this prospective cohort study. All patients were diagnosed as breast cancer at oncology hospital in University of Gaziantep. Before chemotherapy, all of the patients underwent to detailed ECG and echocardiography (ECHO) examinations. After 6 months, detailed ECG and ECHO examinations were repeated and compared with baseline values. Statistical analysis was performed using Shapiro-Wilk tests, Student t-test and Spearman correlation test. Results: The average age of patients was 51 and one was male. Statistically significant decrease in ejection fraction was found after treatment (62.3%±3.3 and 59.9%±5.9, p=0.002). Evaluation of diastolic parameters; significant increase in the transmitral A flow velocity and significant decrease of E/A ratio were observed on Doppler ECHO analysis (77.4±19.1 cm/sec versus 86±18 cm/sec, p<0.001; 1.01±0.3 versus 0.9±0.2, p=0.03, respectively). On tissue Doppler analysis we observed that significant reduction in the value of E’ and significantly increase E/E’ ratio were present (12.5±3.6 cm/sec versus 10.7±2.9 cm/sec, p=0.001; 6.6±2.9 versus 7.7±3.3, p=0.04, respectively). Conclusion: Chemotherapy has detrimental subclinical effect on both of systolic and diastolic function in early six months period despite the prescription of lower dosage of chemotherapy than well-known cardiac safety dosage limits. Tissue Doppler imaging may be more sensitive than ECG, conventional ECHO and Doppler for determining the subclinical cardiac damage.

Reply to the Letter to the Editor Entitled “The Drugs Used for Panic Disorders May Affect the Circadian Variation in Blood Pressure Measurements and Autonomic System”

We thank Ozturk et al for their comments regarding our study. Cardiovascular diseases and hypertension were exclusion criteria in our study, and none of the patients were using b-blockers. If we look at the antidepressants which patients received, 6 patients used paroxetine, 3 venlafaxine, 2 escitalopram, 1 sertraline, 1 duloxetine, and 4 patients used alprazolam as additional treatment. We showed that night-time blood pressure (BP) dipping was less in patients with panic disorder, and night-time diastolic BP was higher in patients who received antidepressants than those who did not. Venlafaxine and duloxetine are antidepressants of the serotonin–norepinephrine reuptake inhibitor class and these are known to increase systolic and diastolic BP. There was no statistically significant difference between drugs in our study but we do not claim a definitive conclusion on this issue because of the small sample size. Are the antidepressants suspects for the nondipper BP pattern in panic disorder in our study? To clarify this question, we compared healthy controls with patients who did not use any drugs and again observed reduction in nocturnal BP dipping. This situation explains the circadian BP impairment, and additionally, antidepressant use may cause night-time BP increases in patients with panic disorder.

Clinical, Laboratory and Echocardiographic Features of Patients with Pericardial Effusion in Gaziantep Regions

PP-086 Pericardial effusion (PE) is called that increase in the amount of fluid between the pericardium surrounding the heart. PE may be due to primary pericardial diseases, or associated with different clinical situations such as malignancy, chronic renal failure, cardiovascular diseases,

Impact of Rheumatic Mitral Stenosis on Aortic Elastic Properties

BACKGROUND AND AIM OF THE STUDY Although mitral stenosis has profound effects on the circulation and hemodynamics, few data exist regarding its impact on aortic elastic properties. The study aim was to determine the association between mitral stenosis and aortic elastic properties by using strain and distensibility as a surrogate. METHODS Sixty-six patients with echocardiographic documentation of rheumatic mitral stenosis, and 25 age- and gender-matched healthy control subjects were enrolled in the study. Aortic elasticity parameters including strain and distensibility were measured by means of echocardiography. RESULTS The mean age of the patient and control groups were 41.8 +/- 12.0 and 38.9 +/- 5.0 years, respectively (p = 0.12). There was a significant impairment in distensibility and strain in the patient group compared to controls (0.276 +/- 0.167 versus 0.491 +/- 0.260 cm2 x dyn(-1), p = 0.001; 6.54 +/- 3.18% versus 9.19 +/- 4.78%, p = 0.015). There was a strong correlation between distensibility and left atrial diameter (p < 0.001; r = -0.39), left atrial volume index (p < 0.001; r = -0.56), mitral valve area (p < 0.001; r = 0.40), and mean transmitral gradient (p = 0.022; r = -0.18). Strain was also associated with left atrial diameter (p = 0.002; r = -0.32), left atrial volume index (p < 0.001; r = -0.41), mitral valve area (p = 0.002; r = 0.31), and mean transmitral gradient (p = 0.035; r = -0.18). CONCLUSION Mitral stenosis was shown to be associated with impaired aortic elasticity, but further studies are required to clarify the clinical significance of this finding.