Korkmaz L

Assessment of left ventricular diastolic function and the Tei index by tissue Doppler imaging in patients with primary hyperparathyroidism

Background  The aim of this study was to assess left ventricular (LV) systolic and diastolic function and myocardial performance (the Tei index) by tissue Doppler imaging (TDI) in patients with primary hyperparathyroidism (PHPT).

Association between nonalcoholic fatty liver disease and coronary artery disease complexity in patients with acute coronary syndrome: a pilot study.

Nonalcoholic fatty liver disease (NAFLD) is highly prevalent in patients with acute coronary syndrome (ACS). We assessed the association between NAFLD and SYNTAX Score (SS) in patients with ACS. Eighty consecutive patients with ACS were enrolled. Patients were evaluated using ultrasound to detect NAFLD and hepatosteatosis stage. The prevalence of NAFLD was 81.2%; median SS was 15. The SS was significantly higher in patients with NAFLD (18 ± 8 vs. 11 ± 5, P = .001). Univariate analysis showed that the stage of NAFLD correlated with SS (r = .6, P < .001). In multivariate binary logistic analysis, increased age (odds ratio [OR], 1.05; 95% confidence interval [CI],1.00-1.10) and presence of NAFLD (OR, 13.20; 95% CI, 2.52-69.15) were independent factors associated with supramedian SS. In conclusion, among patients with ACS, those with NAFLD have more complex CAD as assessed by SS.

Aortic pulse wave velocity in subjects with aortic valve sclerosis.

Background: Aortic stiffness is an independent risk factor for cardiovascular events and mortality. The measurement of pulse‐wave velocity (PWV) is the most simple, noninvasive, and robust method to determine aortic stiffness. Whether aortic stiffness contributes to aortic valve sclerosis (AVS) remains unknown. The aim of the present study was to examine the relationship between PWV and AVS in subjects free of clinically evident atherosclerotic disease. Methods: We enrolled 62 patients (48 men; age 65 ± 8 years) diagnosed with AVS and an additional 62 age‐, hypertension‐, diabetes mellitus‐, and history of smoking‐matched subjects without AVS. Applanation tonometry was applied to assess the augmentation index and aortic PWV. The subjects with symptomatic vascular disease were excluded from the study. AVS was defined by echocardiography as thickening and calcification of the normal trileaflet aortic valve without obstruction to the left ventricular outflow. Results: There was no significant difference between the two groups regarding the aortic PWV and augmentation index (11.7±3.3 vs 11.8±3.7, P=0.85; 28.0±9.4 vs 25.0±8.6, P=0. 17, respectively). The presence of AVS was significantly correlated with ejection fraction (r=0.211, P=0.011), male gender (r=0.362, P=0.0001), and age (r=0.200, P=0.026). Conclusions: The lack of an association between the aortic PWV and AVS suggests that AVS is a complex phenomenon consisting of several distinct processes, related to both atherosclerotic and nonatherosclerotic processes.

Increased leucocyte count could predict coronary artery calcification in patients free of clinically apparent cardiovascular disease.

OBJECTIVES Several studies have demonstrated that inflammation plays a major role in the development of atherosclerosis and that the inflammatory process might also be involved in coronary artery calcification (CAC). The main purpose of this study was to investigate the relation between leucocyte count and CAC and to determine whether a higher leucocyte count could indicate subclinical atherosclerosis in patients without overt cardiovascular disease. STUDY DESIGN A total of 284 consecutive patients (156 men, 128 women) without established cardiovascular disease were enrolled. CAC was measured using cardiac computed tomography. Leucocyte count was measured via routine blood examination. RESULTS Patients with CAC had higher leucocyte counts compared to those without calcification (7.87±1.85 vs. 6.01±1.84; p<0.001). Logistic regression analysis identified the following as independent predictors of CAC: leucocyte count (odds ratio [OR]: 1.7, 95% confidence interval [CI]: 1.3-2.1), smoking (OR: 2.4, 95% CI: 1.2-4.6) and age (OR: 1.2, 95% CI: 1.1-2.3). There was also a significant correlation between CAC and leucocyte count (r=0.57, p<0.001). CONCLUSION We demonstrated that leucocytes may play an important role in the evolution of CAC and may be used in the detection of subclinical atherosclerosis in asymptomatic subjects.

The relation between intensity and complexity of coronary artery lesion and oxidative stress in patients with acute coronary syndrome.

Objective: Oxidative stress plays a major role in the development of atherosclerosis. However, the relationship between oxidative stress and complexity and intensity of coronary artery disease is less clear. The aim of this study is to assess the relationship between oxidative stress markers and the complexity and intensity of coronary artery disease in patients with acute coronary syndrome (ACS). Methods: Sixty-seven consecutive patients with an early phase of ACS (<3 h) were included in this single-centre, cross-sectional, prospective study. Syntax and Gensini scores were calculated based on angiographic findings. Patients were divided into two CAD complexity groups according to their Syntax scores: low SYNTAX score (<22) and moderate to high SYNTAX score (>=22). Likewise patients were divided into two CAD severity groups according to the median Gensini score of 64: less intensive CAD with Gensini score (<64) and intensive CAD with Gensini score >=64. Blood samples were taken in 1 hour within administration in order to measure total oxidative status (TOS) and total antioxidant capacity (TAC) levels determined by Erel method. Oxidative stress index (OSI) was calculated by TOS/TAC. Results: There was no significant difference between the two SYNTAX groups for oxidative stress markers. Median TOS and OSI values were significantly high in the intensive CAD group (p=0.005, p=0.04, respectively). The Gensini score was positively correlated with TOS and OSI (p=0.003, p=0.02, respectively). Conclusion: Oxidative stress markers may be considered supportive laboratory parameters related to CAD intensity but not complexity in ACS patients.

Effect of transcatheter aortic valve implantation on QT dispersion in patients with aortic stenosis.

Background QT dispersion (QTd) is a predictor of ventricular arrhythmia. Ventricular arrhythmia is an important factor influencing morbidity and mortality in patients with aortic stenosis. Surgical aortic valve replacement reduced the QTd in this patients group. However, the effect of transcatheter aortic valve implantation (TAVI) on QTd in patients with aortic stenosis is unknown. The aim of this study was to investigate the effect of TAVI on QTd in patients with aortic stenosis. Methods Patients with severe aortic stenosis, who were not candidates for surgical aortic valve replacement due to contraindications or high surgical risk, were included in the study. All patients underwent electrocardiographic and echocardiographic evaluation before, and at the 6th month after TAVI, computed QTd and left ventricular mass index (LVMI). Results A total 30 patients were admitted to the study (mean age 83.2 ± 1.0 years, female 21 and male 9, mean valve area 0.7 ± 3 mm2). Edwards SAPIEN heart valves, 23 mm (21 patients) and 26 mm (9 patients), by the transfemoral approach were used in the TAVI procedures. All TAVI procedures were successful. Both QTd and LVMI at the 6th month after TAVI were significantly reduced compared with baseline values of QTd and LVMI before TAVI (73.8 ± 4 ms vs. 68 ± 2 ms, P = 0.001 and 198 ± 51 g/m2 vs. 184 ± 40 g/m2, P = 0.04, respectively). There was a significant correlation between QTd and LVMI (r = 0.646, P < 0.001). Conclusions QTd, which malign ventricular arrhythmia marker, and LVMI were significantly reduced after TAVI procedure. TAVI may decrease the possibility of ventricular arrhythmia in patients with aortic stenosis.

Fragmented QRS may predict increased arterial stiffness in asymptomatic hypertensive patients.

ObjectiveDetection of increased arterial stiffness could prevent patients from being mistakenly classified as being at a low or a moderate risk, when they actually are at a high risk. The main aim of present study was to investigate the relation between fragmented QRS (fQRS) on ECG and the cardio-ankle vascular index (CAVI), which is a novel parameter of arterial stiffness in asymptomatic hypertensive patients. Methods and resultsSeventy-five asymptomatic hypertensive patients with fQRS and 75 age-matched and sex-matched control individuals without fQRS were enrolled. Patients with fQRS had higher CAVI values compared with those without fQRS (8.6±1.4 vs. 7.9±1.3, P=0.01). In univariate analyses, there was a significant association between increased CAVI and age (P<0.001) and fQRS (P=0.003). Multivariate binary logistic regression analyses showed fQRS (95% confidence interval: 0.122–0.675, P=0.004) and age (95% confidence interval: 1.022–1.105, P=0.002) as the independent determinants of increased CAVI. The sensitivity and specificity of fQRS for predicting abnormal CAVI were 55 and 76%, respectively. ConclusionThe presence of fQRS on ECG may provide important predictive information on arterial stiffness in asymptomatic hypertensive patients.

Relationship between aortic valve sclerosis and different vascular damage markers: an observational study.

OBJECTIVE Although aortic valve sclerosis (AVS) and atherosclerosis may share same atherosclerotic process, there is still a controversy whether AVS may be related to atherosclerotic and nonatherosclerotic processes. The purpose of present study was to investigate this relation. METHODS In this cross-sectional and observational study, we enrolled 60 patients diagnosed with AVS and risk factor matched 76 subjects without AVS. Applanation tonometry was applied to assess the augmentation index and aortic pulse-wave velocity (PWV). Control and AVS group were examined by B-mode ultrasound to measure the intima-media thickness (IMT). Continuous variables were compared using unpaired t-test and Mann-Whitney U test. Logistic regression analysis was performed in order to find independent predictors of AVS. RESULTS PWV and augmentation index did not differ between control and AVS groups (11.2±3.6 vs 12±3.2, p=0.18 and 26±7.6 vs 27±9.8, p=0.2 respectively). But IMT was significantly higher in AVS group than in control one (0.76 mm±0.17 vs 0.6 mm±0.16; p<0.001). There was a significant positive bivariate correlation between the presence of AVS, IMT (r=0.43, p<0.001), male gender(r=0.31, p<0.001), augmentation index (r=0.17, p:0,04), and age (r=0.36, p<0.001). Logistic regression analysis demonstrated that only IMT (OR: 1.46, 95% CI: 1.1-1.9, p=0.009) and age (OR: 1.1, 95% CI: 1.01-1.16, p=0.013) were independent predictors of AVS. CONCLUSION Increased IMT but not PWV in subjects with AVS compared to control group may suggest that, AVS is probably a multifactorial disease, related to the both atherosclerotic and nonatherosclerotic processes.