Ibrahim Ozdogru

Paraoxonase and arylesterase activities in coronary artery disease.

Background  Paraoxonase‐1 is an enzyme with three activities which are inversely related to cardiovascular diseases. Accordingly, the aim of the study was to investigate the paraoxonase, arylesterase activities and oxidative/anti‐oxidative status in coronary artery disease (CAD) and their correlation with the extent of CAD.

Protective effects of spironolactone against anthracycline-induced cardiomyopathy

The protective effect of beta‐blockers, ACE inhibitors, and ARBs on anthracycline cardiotoxicity has already been demonstrated, but the effect of aldosterone antagonism, which inhibits the last step of the renin–angiotensin–aldosterone system (RAAS), was questioned. This study sought to investigate whether spironolactone protects the heart against anthracycline‐induced cardiotoxicity.

Preload Dependence of Doppler Tissue Imaging Derived Indexes of Left Ventricular Diastolic Function

Doppler tissue imaging (DTI) has been proposed as a tool for the evaluation of diastolic function. Controversy exists regarding whether DTI measurements are influenced by preload. Changes in the circulating volume associated with hemodialysis result in preload reduction. To determine the influence of preload reduction on DTI and standard pulsed‐Doppler transmitral diastolic velocities, 30 patients (mean age 41 ± 14) with chronic renal insufficiency without overt heart disease were studied by DTI and standard pulsed Doppler before and after hemodialysis. From the apical window, DTI sample volume was placed at the lateral and septal mitral annulus and at the midsegment of lateral and septal myocardial wall of the left ventricle. Peak early diastolic annular and myocardial, and peak late diastolic annular and myocardial velocities were measured. Transmitral peak early and late diastolic velocities were also recorded by standard pulsed Doppler. The peak velocity of early diastolic mitral flow decreased from 100 ± 30 to 85 ± 34 cm/s (P < 0.001) after hemodialysis. Hemodialysis elicited marked reduction in early diastolic lateral mitral annular and midlateral myocardial velocities (6.9 ± 3.2 to 6.3 ± 2.9 cm/s, P < 0.04 and 6.7 ± 0.3 to 5.5 ± 2 cm/s, P < 0.001, respectively). Early diastolic, septal mitral annular, and midseptal myocardial velocities were also significantly decreased (5.8 ± 2.8 to 4.6 ± 2 cm/s, P < 0.006 and 6.2 ± 2 to 5.1 ± 1 cm/s, P < 0.008, respectively). Late diastolic mitral annular and myocardial velocities did not change. It is concluded that early diastolic mitral annular and myocardial velocities are affected by acute preload reduction. It is necessary to consider preload when diastolic function is assessed by DTI.

Effect of long-term and high-dose allopurinol therapy on endothelial function in normotensive diabetic patients

Abstract Objectives. Endothelial dysfunction is a well known risk factor for atherosclerosis. Uric acid levels are associated with endothelial dysfunction and atherosclerosis even if in physiological range. Xanthine oxidase inhibition with allopurinol decreases uric acid levels and oxidative stress and improves endothelial function. We have investigated the effect of high-dose and long-term allopurinol therapy on endothelial function in diabetic normotensive patients. Methods. This study is a randomized, single-blind, placebo-controlled trial. Both treatment and placebo groups consisted of 50 patients. In the treatment group, daily oral 900 mg allopurinol was started after randomization and maintained for 12 weeks. Brachial artery flow-mediated dilatation (FMD) and nitrate-induced dilatation (NID) were measured at baseline and after the allopurinol therapy to evaluate endothelial function. Results. HbA1c and uric acid levels decreased after allopurinol therapy (6.1 ± 2.1 vs 5.5 ± 1.0%, 5.0 ± 0.8 vs 3.3 ± 0.5 mg/dl, respectively, p = 0.01) but no change was observed in the placebo group (7.7 ± 1.9% vs 7.6 ± 2.0%, 5.3±2.1 vs 5.6 ± 0.8 mg/dl, respectively, p > 0.05). FMD and NID increased significantly in the treatment group (5.6 ± 2.1% vs 8.5 ± 1.2%, 10 ± 7.4% vs 14 ± 4.0%, 10 ± 7.4% vs 14 ± 4.0%, respectively, p = 0.01), whereas no change was observed in the placebo group (5.8 ± 1.8% vs 6.1 ± 0.8%, 12 ± 9.5 vs 10 ± 3.8%, respectively, p > 0.05). Conclusion. Long-term and high-dose allopurinol therapy significantly improved endothelial function in diabetic normotensive patients. In addition, allopurinol therapy contributes to the lower HbA1c levels.

Relationship between mean platelet volume levels and subclinical target organ damage in newly diagnosed hypertensive patients

Abstract Background. Significant numbers of asymptomatic hypertensive patients are attacked by subclinical target organ damage (TOD) such as proteinuria, left ventricular hypertrophy and carotid atherosclerosis. Platelets become activated in uncontrolled hypertension and play a crucial role in increased thrombotic tendency. Mean platelet volume (MPV) is one of the markers that correlate closely with platelet activity. We aimed to investigate the relationship between MPV levels and subclinical TOD in newly diagnosed hypertensive patients. Methods. 80 newly diagnosed hypertensive patients were enrolled to this cross-sectional study. Ambulatory blood pressure monitoring was performed for all patients. Left ventricular mass index (LVMI), carotid intima-media thickness (IMT) and urine albumin/creatinine ratio (UACR) were measured as indices of cardiac, vascular and renal damage, respectively. MPV was measured from blood samples collected in EDTA tubes and high-sensitivity C reactive protein (hs-CRP) was measured by using nephlometer. Results. MPV was significantly correlated with 24-h systolic–diastolic blood pressure (r = 0.52 and r = 0.55, respectively). Correlation analysis indicated that MPV was moderately related with UACR, LVMI, carotid IMT and hs-CRP (r = 0.50, r = 0.55, r = 0.60 and r = 0.69, respectively, p = 0.0001). Multivariable analysis identified that MPV levels were independently associated with severity of proteinuria, carotid IMT and LVMI (p = 0.001). Conclusion. Our findings suggested that MPV levels were associated with severity of subclinical TOD including; carotid atherosclerosis, left ventricular hypertrophy and renal damage, in hypertensive patients. In addition to this, MPV levels were significantly correlated with hs-CRP levels and 24-h ambulatory blood pressure measurements.

The mean platelet volume in patients with non-dipper hypertension compared to dippers and normotensives

Abstract Objectives. Increased platelet activation plays an important role in the development of atherosclerosis. Mean platelet volume (MPV) is a determinant of platelet activation. In our study, we aimed to determine whether MPV levels are elevated in non-dipper patients compared with dippers and healthy controls. In addition, we tried to find out if MPV levels are correlated with blood pressure measurements in hypertensive patients. Methods. This cross-sectional study included 56 hypertensive patients; 27 age- and sex-matched healthy volunteers were enrolled to study as a control subjects. Ambulatory blood pressure monitoring was performed for all patients. Hypertensive patients were divided into two groups: 28 dipper patients (10 male, mean age 51 ±8 years) and 28 non-dipper patients (11 male, mean age 53±10 years). MPV was measured in a blood sample collected in EDTA tubes and was also used for whole blood counts in all patients. Results. In non-dipper patients, 24-h systolic blood pressure (141.5±10.21 vs 132.3±7.7 mmHg, p<0.001), 24-h diastolic blood pressure (88.2±8.5 vs 81.0±8.2 mmHg, p<0.01) and 24-h average blood pressure (105.7±8.5 vs 97.7±7.4 mmHg, p<0.001) are significantly higher than dippers. Whereas daytime measurements were similar between dippers and non-dippers, there was a significant difference between each group during night-time measurements (night-time systolic 137.1 ±11.0 vs 120.2±8.0 mmHg, p<0.001; night-time diastolic 85.3±8.0 vs 72.8±7.9 mmHg, p<0.001). Non-dipper patients (9.61 ±0.42 fl) demonstrated higher levels of MPV compared with dippers (9.24±0.35 fl) and normotensives (8.87±0.33 fl) (p<0.001 and p<0.001, respectively). There was significant correlation between MPV and ambulatory diastolic and systolic blood pressure in non-dipper hypertensives. Conclusion. Our results suggest that MPV, a determinant of platelet activation, has a positively correlation with blood pressure and elevated in non-dipper compared with dippers and controls. Increased platelet activation could contribute to increase the atherosclerotic risk in non-dipper patients compared with dippers.

Acute effects of passive smoking on blood pressure and heart rate in healthy females.

ObjectsCarbon monoxide (CO) is suspected of playing a major role in cigarette smoke-induced cardiovascular diseases. Hypertension is one of the common chronic cardiovascular diseases that lead to heart attacks, strokes, chronic heart failure, and chronic renal failure. We aimed to investigate the immediate effects of passive smoking on blood pressure and heart rate during and after exposure in healthy females. In addition, we examined that whether carboxyhemoglobin (COHb) levels were correlated with heart rate and blood pressure measurements. MethodsThirty healthy nonsmoker female volunteers (mean age: 26±5 years) were prospectively enrolled in the study. Systolic and diastolic blood pressure and heart rate were obtained at baseline, 5th, 10th, 15th, 30th minute of exposure and at 5th, 15th, and 30th minute after exposure. Blood samples for measuring COHb were taken at baseline and after spending 30 min in the smoking room from all volunteers. Difference between baseline and second measurements of COHb were described as ΔCOHb. ResultsMean COHb level was significantly higher at the end of exposure when compared with baseline values (COHb 0.5±0.1 vs. 1.8±0.4%, P<0.05). Heart rate and systolic blood pressure measurements at 15th and 30th minute of exposure were higher than at baseline and 5th minute of exposure (88±3.2 and 90±3.7 vs. 76±3.9 and 78±4.5 beats/min, P<0.05; 135±1.1 and 136±4.0 vs. 113±5.7 and 115±3.5 mmHg, P<0.05). They elevated significantly at the same time interval. Diastolic blood pressure was significantly increased at 30th minute of exposure when compared with earlier measurements (90±5.1 vs. 74±2.2, 72±3.2 vs. 71±4.5 mmHg, P<0.05). Heart rate and systolic blood pressure decreased notably at 15th minute and returned to baseline values at 30th minute after exposure (80±1.2 and 76±3.2 vs. 88±4.5 beats/min, P<0.05; 120±4.4 and 115±1.9 vs. 135±2.2 mmHg, P<0.05). Diastolic blood pressure decreased significantly at 30th minute and returned to baseline values at 60th minute after exposure (75±3.6 and 70±2.5 vs. 89±4.3 mmHg, P<0.05). Heart rate and diastolic blood pressure measurements were moderately correlated and systolic blood pressure measurements were closely correlated with ΔCOHb values at the end of the exposure. ConclusionOur results suggested that passive smoking has remarkable acute effect on heart rate and blood pressure in young healthy females. Beside this, we found that ΔCOHb level is closely correlated with systolic blood pressure and moderately correlated with heart rate and diastolic blood pressure measurements.

Mean platelet volume predicts embolic complications and prognosis in infective endocarditis

OBJECTIVES This study was designed to examine the change in mean platelet volume (MPV) over the course of infective endocarditis (IE) and also the association between MPV and complications including embolic events in IE. METHODS Forty patients (26 male, mean age 46±15 years) who were hospitalized with a diagnosis of IE at the Department of Cardiology, Erciyes University, from March 2005 to August 2008, were retrospectively evaluated. The diagnosis of IE was made clinically and was confirmed with Dukes criteria. The erythrocyte sedimentation rate (ESR), high-sensitivity C-reactive protein (hs-CRP), and MPV were measured before treatment and periodically during the follow-up period, until discharge. RESULTS There were 27 cases of native valve endocarditis and 13 of prosthetic valve endocarditis. While 31 patients were treated medically, an operation was performed in nine patients because of unsuccessful medical therapy. On admission, mean MPV was 10.8±1.1 fl, ESR was 82±26mm/h, and hs-CRP was 110±72mg/l. Seven patients died: one intraoperatively, three patients postoperatively, and three patients during medical treatment. With the exception of these seven patients, ESR and hs-CRP were significantly reduced in all patients at discharge compared to levels at hospitalization (ESR 82±26 to 32±22, p=0.001 and hs-CRP 110±72 to 25±15, p=0.001). Similarly, we detected a significant decrease in MPV from hospitalization to discharge, i.e., from the active period of the disease to recovery (10.8±1.1 to 9.7±0.8 fl, p=0.002). In addition, MPV was found to be significantly higher in patients with observed embolic complications (11.5 vs. 10.3 fl, p=0.001), other complications (11.0 vs. 10.2 fl, p=0.001), and death (11.1 vs. 10.4 fl, p=0.005). CONCLUSION MPV can be used as an activity criterion in IE, like ESR and hs-CRP. Also, high MPV is associated with a poor prognosis and adverse outcomes, and predicts complications including embolic events.

The relationship between Helicobacter pylori IgG titre and coronary atherosclerosis.

Objectives — The role of Helicobacter pylori (HP) in the progression of atherosclerosis is con-troversial.We investigated the relation between HP IgG antibody titres and severity and intensity of coronary atherosclerosis and also clinical presentation of coronary artery disease (CAD). Methods — The patient group consisted of 353 patients with angiographically proven CAD, which contains 3 different subgroups: 163 patients with myocardial infarction (MI), 106 patients with unstable angina (USAP) and 84 patients with stable angina (SAP). Control group included 163 subjects with angiographically proven normal coronary arteries. Helicobacter pylori IgG antibody titres were measured by an enzyme immunoassay method in all patients. Gensini and Extent scores were used to evaluate the angiographic severity and extent of atherosclerosis. C-reactive protein levels were measured by Behring nephelometry system kits. Results — Seropositivity rates for HP were similar between groups (82.7% in the patient group and 86.6% in the control group (P > 0.05)). Also HP-IgG levels were similar among the MI, USAP and SAP groups. No significant correlation was observed between CRP levels and HP-IgG level titres. There was no significant correlation between HP-IgG level (r = 0.086, P = 0.2) and Gensini score but a significant poor correlation was observed between HP-IgG level and Extent score (r = + 0.156, P = 0.03). Conclusions — Helicobacter pylori IgG titres do not play an important role in the presentation of CAD and do not increase systemic inflammatory response. However, Helicobacter pylori IgG antibody titres may be correlated with the extent of CAD.

Relationship between platelet indices and spontaneous echo contrast in patients with mitral stenosis

AIMS To determine the association of platelet indices with spontaneous echo contrast (SEC) in patients with mitral stenosis. METHODS AND RESULTS A total of 232 consecutive patients with mitral stenosis who undergoing mitral balloon valvuloplasty were enrolled to the study. Patients were divided into two groups according to the formation of SEC in the left atrium. Group 1: mitral stenosis complicated with SEC; Group 2: mitral stenosis without SEC. Transthoracic echocardiography and transoesophageal echocardiography were performed for each patient. Complete blood counting parameters were measured and all routine biochemical tests were performed. There were 133 patients (mean age 42 ± 11 and 74% female) in the SEC(-) group and 99 patients (mean age 45 ± 10 and 64% female) in the SEC(+) group. Plateletcrit (0.25 ± 0.06 vs. 0.27 ± 0.07, P = 0.043) and mean platelet volume (MPV) levels (9.4 ± 1.1 vs. 10.4 ± 1.2, P < 0.001) were significantly higher in the SEC(+) group. When we divided the SEC(+) patients into four subgroups according to previously reported criteria, MPV levels increased to correlate with the degree of SEC (P < 0.001). At multivariate analysis, MPV levels [odds ratio (OR) 2.365, 95% confidence interval (CI) 1.720-3.251; P < 0.001] and PCT levels (OR 2.699, 95% CI 1.584-4.598; P= 0.033) are independent risk factors of SEC in patients with mitral stenosis. CONCLUSION In patients with mitral stenosis, cheaply and easily measurable platelet indices including MPV and PCT levels are associated with the presence of SEC and are independent risk factors of SEC.