Kenan Demir

The relationship between uric acid and erectile dysfunction in hypertensive subjects

Abstract Background. Endothelial dysfunction plays a major role in erectile dysfunction (ED). Uric acid (UA) is a marker of endothelial dysfunction. We hypothesized that increased UA levels may be associated with ED and aimed to investigate whether there is a relationship between, UA and ED in hypertensive patients. Methods. A total of 200 hypertensive patients who have a normal treadmill exercise test were divided into two groups based on the Sexual Health Inventory for Men (SHIM) test (< 21 defined as ED n = 110, and ≥ 21 defined as normal erectile function n = 90). The differences between the ED and normal erectile function groups were compared and determinants of ED were analyzed. Main results. The prevalence of ED was found to be 55.0%. Office blood pressure level was comparable between groups. UA levels were significantly increased in the ED group (6.20 ± 1.56 vs 5.44 ± 1.32, p = 0.01). In a regression model, age [odds ratio (95% confidence interval): 1.08 (1.04–1.14), p = 0.001], smoking [odds ratio: 2.33 (1.04–5.20), p = 0.04] and UA [odds ratio: 1.76 (1.28–2.41), p = 0.04] were independent determinants of ED. An UA level of > 5.2 mg/dl had 76.2% sensitivity, 43.7% specificity, 62.9% positive and 59.4% negative predictive value for determining ED. Conclusion. UA is an independent determinant of ED irrespective of blood pressure control and questioning erectile function for hypertensive patients with increased UA levels may be recommended.

Can neutrophil/lymphocyte ratio predict recurrence of non-valvular atrial fibrillation after cardioversion?

OBJECTIVE High neutrophil/lymphocyte ratio (NLR) has been associated with post-operative AF development in patients who underwent cardiac surgery. In this study, effectiveness of NLR for prediction of recurrence after electrical cardioversion (CV) in non-valvular AF was investigated. METHODS A total of 149 patients who underwent a successful CV were included in this prospective cohort study. Baseline complete blood cell count, routine biochemical tests, high sensitive C-reactive protein (hs-CRP), and echocardiographic measurements were examined. After CV, patients were monitored over six months for recurrence. Baseline characteristics of recurrence group were compared with sinus rhythm group by using Student`s t -test. Logistic regression analysis was used to determine predictors of recurrence. RESULTS Recurrence occurred in a total of 46 patients (30.9%). Median AF duration [16 (IQR:14.25) vs. 12 (IQR:11) months, p=0.01], baseline hs-CRP [9.80 (IQR: 8.50) mg/dL vs. 4.28 (IQR: 5.65) mg/dL, p=0.002] and left atrium (LA) diameter (4.5±0.4 cm, 4.3±0.5 cm, p=0.023) were significantly higher in the recurrence group than sinus rhythm group. Median NLR was comparable in recurrence and sinus groups [2.38 (IQR: 2.09) vs. 2.23, (IQR: 1.23) p=0.96, respectively]. There was a weak correlation between NLR and hs-CRP (r=0.22, p=0.05) and age (r=0.24, p=0.02). In multiple logistic regression analysis, hs-CRP [OR: 1.34 (1.09-1.65 95% CI) p=0.006], LA diameter [OR: 11.92 (1.84-77.07 95% CI) p=0.01], spontaneous echo contrast positivity, [OR: 5.40 (1.04-12.02 95% CI) p=0.045] and systolic blood pressure [OR: 1.05 (1.01-1.10 95% CI) p=0.03] were independent predictors of AF recurrence. CONCLUSION NLR failed to predict AF recurrence after a successful electrical CV, but hs-CRP remained an inflammatory marker of AF recurrence.

Atorvastatin given prior to electrical cardioversion does not affect the recurrence of atrial fibrillation in patients with persistent atrial fibrillation who are on antiarrhythmic therapy.

Objective: In this study, our aim was to evaluate the effect of a higher dose of atorvastatin on the recurrence rate of atrial fibrillation (AF) after electrical cardioversion (EC) in addition to antiarrhythmic therapy. Subjects and Methods: 48 patients with persistent AF were included in this study. The patients were randomized to an atorvastatin 40-mg treatment group and a control group. Atorvastatin was started 3 weeks before EC and was continued for 2 months after EC. EC was performed using biphasic shocks after 3 weeks of treatment with the orally administered anticoagulant warfarin. Lipid and inflammatory parameters (high-sensitivity C-reactive protein, white blood cell count and fibrinogen level) were evaluated at the baseline and before EC. The endpoint of this study was electrocardiographically confirmed recurrence of AF of >10 min. Results: There were no significant differences in baseline characteristics and lipid and inflammatory marker levels between the treatment and control groups. Total cholesterol and low-density lipoprotein levels were significantly decreased in patients taking atorvastatin for 2 months compared with baseline values (174 ± 31 vs. 129 ± 25 mg/dl, p = 0.001, and 112 ± 23 vs. 62 ± 20 mg/dl, p = 0.001, respectively), while no significant change occurred in control patients (168 ± 26 vs. 182 ± 29 mg/dl, p = 0.07, and 99 ± 18 vs. 108 ± 26 mg/dl, p = 0.1, respectively). At the end of the 2-month follow-up period, 9 patients (20.5%) experienced AF recurrence, and there was no significant difference in AF recurrence rate between the treatment and control groups (26 vs. 13%; p = 0.2). Conclusion: Atorvastatin therapy prior to EC does not prevent the recurrence of arrhythmia in patients with persistent AF who are receiving antiarrhythmic therapy.

A comparison of blood pressure and pulse pressure values obtained by oscillometric and central measurements in hypertensive patients

Abstract Objective. Wide pulse pressure (PP) affects the accuracy of oscillometric blood pressure measurements (OBPM): however, the degree of this impact on different patient groups with wide PPs is unclear. This study will investigate the accuracy of OBPM in achieving target BP and PP in isolated systolic hypertension (ISH) group compared with mixed hypertension (MHT) group. Method. A total of 115 patients (70 with ISH and 45 with MHT) were enrolled in the study. Upper arm and wrist OBPM, obtained by OmronM3 and OmronR6 devices respectively, were compared with the simultaneously measured values from the ascending aorta. The ISH was defined as a systolic blood pressure (SBP) ≥140 mmHg and a diastolic blood pressure (DBP) <90 mmHg. MHT was defined as a SBP≥140 mmHg and a DBP≥90 mmHg. Results. The mean central arterial blood pressure (BP) and central PP were higher in the ISH group than those in the MHT group. The upper arm OBPM underestimated the central SBP in two groups (−5 mmHg, −3 mmHg, p=0.5, respectively), but overestimated DBP in the ISH group compared with MHT patients (6.8 mmHg, 1 mmHg, p=0.04, respectively). Wrist OBPM similarly underestimated to the central SBP in each group (−16 mmHg, −19 mmHg, p=0.15), whereas the sum of overestimation of DBP was significantly higher in the ISH than in the MHT group (+6 mmHg, − 1 mmHg, p=0.001, respectively). Also, each of the devices underestimated the central PP in the ISH group (about 10 mmHg) as being higher than that of the MHT group. Conclusion. Oscillometric devices may be used for self-BP measurement in patients with ISH without clinically important disadvantages compared with the patients with MHT. For PP measurement in patients with ISH, there were substantial differences between intra-arterial and indirect arm BP measurements.

Circadian Rhythm of Infarct Size and Left Ventricular Function Evaluated with Tissue Doppler Echocardiography in ST Elevation Myocardial Infarction.

BACKGROUND We aimed to investigate the circadian rhythm on left ventricular (LV) function and infarct size, according to the onset of ST elevation myocardial infarction (STEMI), with echocardiography in patients with first STEMI successfully revascularised with primary percutaneous coronary intervention (PCI). METHODS We conducted a retrospective analysis of 252 STEMI patients. Patients were divided into the four, six-hour periods of the day. Conventional and tissue Doppler imaging (TDI) echocardiography were performed within 48hours after onset of chest pain. The average of peak systolic myocardial velocities (Sm) in each of the four myocardial segments and LV ejection fraction (LVEF) were calculated. RESULTS A negative linear correlation was shown between CK-MB levels and Sm (r= -0.209, p=0.001). There was an oscillation between time of day and average of Sm. The lowest Sm and largest infarct size were in the period of 06:00-noon compared with period of noon-18:00 and 18:00-midnight (p=0.029 and p=0.031, respectively). A secondary analysis showed that both LVEF and Sm were lower in the midnight-noon group compared with the noon-midnight group (44.9±7.3% versus 47.3±7.9%, p=0.018, and 7.6±1.4cm/s versus 8.2±1.6cm/s, p=0.003, respectively). CONCLUSIONS This study has shown that there was a circadian rhythm of infarct size and LV function evaluated by echocardiography according to time of STEMI onset. The largest infarct size and poor LV function occurred in the midnight-noon period, in particular in the 06:00-noon period.

Does Spironolactone Have a Dose‐Dependent Effect on Left Ventricular Remodeling in Patients with Preserved Left Ventricular Function After an Acute Myocardial Infarction?

AIMS The aim of this study was to investigate the effects of spironolactone on left ventricular (LV) remodeling in patients with preserved LV function following acute myocardial infarction (AMI). METHODS AND RESULTS Successfully revascularized patients (n = 186) with acute ST elevation MI (STEMI) were included in the study. Patients were randomly divided into three groups, each of which was administered a different dose of spironolactone (12.5, 25 mg, or none). Echocardiography was performed within the first 3 days and at 6 months after MI. Echocardiography control was performed on 160 patients at a 6-month follow-up. The median left ventricular ejection fraction (LVEF) increased significantly in all groups, but no significant difference was observed between groups (P = 0.13). At the end of the sixth month, the myocardial performance index (MPI) had improved in each of the three groups, but no significant difference was found between groups (F = 2.00, P = 0.15). The mean LV peak systolic velocities (Sm ) increased only in the control group during the follow-up period, but there is no significant difference between groups (F = 1.79, P = 0.18). The left ventricular end-systolic volume index (LVESVI) and the left ventricular end-diastolic volume index (LVEDVI) did not change significantly compared with the basal values between groups (F = 0.05, P = 0.81 and F = 1.03, P = 0.31, respectively). CONCLUSION In conclusion, spironolactone dosages of up to 25 mg do not augment optimal medical treatment for LV remodeling in patients with preserved cardiac functions after AMI.

The relation between neutrophil-to-lymphocyte ratio and coronary chronic total occlusions.

BackgroundNeutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation that correlates with cardiac events. This study assessed the association between NLR and the presence of chronic coronary total occlusion (CTO).MethodsThe study population included 225 patients, a control group (n = 75), a coronary artery disease group (n = 75), and a CTO group (n = 75). NLR was compared in the three groups.ResultsNLR levels were significantly higher in the CTO than in the other two groups (p < 0.001). Bivariate correlation analysis showed a positive correlation between NLR and SYNTAX Score, and multivariate logistic regression analysis found that NLR was an independent predictor of CTO. ROC analysis showed that an NLR cut-off of 2.09 could distinguish between patients with and without CTO (AUC = 0.74; 95% CI, 0.68–0.81), with a specificity of 69.3% and a sensitivity of 61%.ConclusionNLR may be useful as a marker of CTO.

Assessment of atrial electromechanical delay and P-wave dispersion in patients with type 2 diabetes mellitus.

OBJECTIVES Diabetes mellitus is an independent and strong risk factor for development of atrial fibrillation (AF). Electrophysiologic and electromechanical abnormalities are associated with a higher risk of AF. In this study we aimed to determine the correlation of atrial conduction abnormalities between the surface electrocardiographic and tissue Doppler echocardiographic measurements in type 2 diabetes mellitus (T2DM) patients. METHODS A total of 88 consecutive T2DM patients and 49 age-, gender-, and body mass index-matched healthy volunteers were included in the present study. Baseline characteristics were recorded and 24-hour ambulatory blood pressure monitoring, transthoracic echocardiography, and 12-lead surface electrocardiography were performed for all study participants. Atrial electromechanical delay (EMD) intervals were measured. RESULTS Maximum P-wave duration and P-wave dispersion (Pd) were significantly higher in patients with T2DM (105.7±10.2ms vs. 102.2±7.5ms, p=0.02; 40.6±7.6ms vs. 33.6±5.9ms, p<0.001, respectively). Interatrial, intraatrial, and intraleft atrial EMD were significantly higher in the T2DM patients when compared with the controls (16.5±7.8ms vs.11.2±4.4ms, p<0.001; 9.0±7.3ms vs. 6.0±3.8ms, p=0.002, and 7.4±5.2ms vs. 5.1±3.2ms, p=0.002 respectively). Correlation analysis showed a positive correlation between interatrial EMD and Pd (r=0.429, p<0.001) and left atrial volume (r=0.428, p<0.001). CONCLUSIONS In this study, there was significant EMD and Pd in patients with T2DM as compared with healthy volunteers. Additionally, interatrial EMD was correlated with Pd and left atrial volume index.

Clinical Characteristics and Outcome of Cardiovascular Implantable Electronic Device Infections in Turkey

Infection is one of the most devastating outcomes of cardiovascular implantable electronic device (CIED) implantation and is related to significant morbidity and mortality. In our country, there is no evaluation about CIED infection. Therefore, our aim was to investigate clinical characteristics and outcome of patients who had infection related to CIED implantation or replacement. The study included 144 consecutive patients with CIED infection treated at 11 major hospitals in Turkey from 2005 to 2014 retrospectively. We analyzed the medical files of all patients hospitalized with the diagnosis of CIED infection. Inclusion criteria were definite infection related to CIED implantation, replacement, or revision. Generator pocket infection, with or without bacteremia, was the most common clinical presentation, followed by CIED-related endocarditis. Coagulase-negative staphylococci and Staphylococcus aureus were the leading causative agents of CIED infection. Multivariate analysis showed that infective endocarditis and ejection fraction were the strongest predictors of in-hospital mortality.

Is there any difference between the early age myocardial infarction and late age myocardial infarction in terms of psychiatric morbidity in patients who have survived acute myocardial infarction

OBJECTIVE We aimed to compare the rates of psychiatric morbidity in patients who had early age and late age MI in patients who have survived acute myocardial infarction? METHODS One hundred sixteen patients who were hospitalized in the coronary care unit were included in the study. Psychiatric assessment of the patients was carried out within 1-6months post-MI. Psychiatric interviews were conducted with the Structured Clinical Interview for DSM-IV (SCID-I). Also used were the Beck Depression Inventory (BDI), Spielberger State-Trait Anxiety Inventory (STAI), and Health Anxiety Inventory (HAI). RESULTS A total of 116 patients were divided into two groups according to age as an early age myocardial infarction group (EA-MI) and a late age myocardial infarction group (LA-MI). The EA-MI group included 24 patients 45years of age and under. The LA-MI group included 92 patients over 45years of age. Current psychiatric disorders, lifetime psychiatric disorders and lifetime depressive disorders were significantly more frequent in the EA-MI group than in the LA-MI group. CONCLUSION EA-MI patients have experienced a depressive episode prior to the onset of the MI, whereas in the LA-MI group, the patients typically experienced depressive episodes after MI. Our findings suggest that depression may increase the risk of MI at an early age.