Mahmut Sahin

Treatment and control of hypertension in Turkish population: a survey on high blood pressure in primary care (the TURKSAHA study)

Although the management and the control rates of hypertension are generally low throughout the world, there are substantial differences between the countries. The aim of this study was to determine the control rate of blood pressure and the characteristics of the patients who have been admitted to primary care units in Turkey. Our study included 16 270 patients aged above 18 years who were diagnosed as hypertensive in representative nationwide sample of 1000 primary care units in Turkey. The mean age of the patients was 60±11 years (60.1% women). Of 16 270 patients, 15 187 (93.3%) were on an antihypertensive treatment, whereas 1083 (6.7%) were receiving no treatment. The patients who were women, diabetic, smoker, obese, and those who had a concomitant cardiovascular disease (CVD) had a higher rate of antihypertensive treatment. Of 15 187 treated patients, 4912 (30.2%) had a controlled systolic blood pressure, 7063 (43.4%) a controlled diastolic blood pressure, and in 3931 (24.2%), both were under control. A logistic regression analysis demonstrated that age (OR 1.33), diabetes (OR 4.96), body mass index (OR 1.41) and the presence of a CVD (OR 1.19) were predictors for blood pressure being under control. The blood pressure control rates ranged between 16.6 and 30.5% among seven geographical regions. In the primary care units in Turkey, the blood pressure control rate is consistently low in treated hypertensive patients. In addition, there are differences between the geographical regions in both the proportion of those receiving medications and the blood pressure control rates.

Heart fAilure Prevalence and Predictors in TurkeY (HAPPY) Çalışması

OBJECTIVES The aim of this study was to determine the prevalence of heart failure (HF) in adult residents of Turkey based on echocardiography and N-terminal B type natriuretic factor. STUDY DESIGN 4650 randomly selected residents aged ≥ 35 years were enrolled. Height, weight, waist and hip circumference, and blood pressure measurements were taken, and a 12-lead ECG was performed. Advanced age, hypertension (HT), diabetes mellitus (DM), obesity, and chronic renal failure (CRF) were assessed. History of any heart disease, any abnormal ECG, or an NT-proBNP ≥ 120 pg/mL was accepted as echocardiography indication. Patients with systolic and/or diastolic dysfunction, or NT-proBNP ≥ 2000 pg/mL were classified as having HF if their functional capacity was NYHA ≥ Class II, and were classified as having asymptomatic left ventricular dysfunction (ASVD) if their functional capacity was NYHA <Class I. RESULTS The absolute and estimated prevalences were 2.9% and 6.9% for HF, and 4.8% and 7.9% for ASVD, respectively. Advanced age, male gender, history of heart disease, HT and CRF were independent predictors of HF. In patients with ejection fraction (EF) <50%, HF prevalence was higher in men, while HF prevalences were higher in women when EF ≥ 50%. In global sum, HF and ALVD prevalence were similar in male and females. CONCLUSION The prevalences of HF and ASVD are higher in Turkey when compared with western countries, despite a younger Turkish population. The established predictors of HF are valid for Turkey as well. There is a significant ASVD population in Turkey with similar characteristics and risk factors to HF. Focusing on the early detection and treatment of ASVD may prevent the progression to HF, and therefore would decrease the prevalence of HF in Turkey.

Longitudinal Diastolic Myocardial Functions Are Affected by Chronic Smoking in Young Healthy People: A Study of Color Tissue Doppler Imaging

Aims: Many cardiac and hemodynamic alterations occur after acute consumption of cigarettes. The aim of this study is to evaluate the effect of chronic smoking on longitudinal myocardial functions of left ventricle in young, healthy people by using color tissue Doppler imaging modalities. Methods and Results: Ninety‐nine healthy participants were studied. There were 65 smokers and 34 nonsmokers. All subjects were between 20 and 35 years old. Sample volumes were placed on the mid left ventricle in the inner half of the myocardium at the septum, lateral, inferior, and anterior walls. The peak systolic strain (S‐S), peak systolic strain rate (S‐SR), peak early diastolic SR (E‐SR), peak late diastolic SR (A‐SR), peak systolic tissue velocity (S‐TV), peak early diastolic TV (E‐TV), and peak late diastolic TV (A‐TV) values were measured. For the systolic parameters S‐S, S‐SR, and S‐TV values were not different between the groups. For the diastolic parameters smokers had lower E‐SR and E‐TV values than nonsmokers (P = 0.03 for both). Although there was a trend toward higher A‐SR and A‐TV values in the smokers, they were not reaching the statistical significance. Conclusion: Chronic smoking in young, healthy people causes significant alterations in the longitudinal diastolic myocardial function parameters as assessed by color tissue Doppler imaging.

The Role of Adrenergic Activity in Slow Coronary Flow and Its Relationship to TIMI Frame Count

The aim of this study was to investigate the role of adrenergic activity in patients with slow coronary flow (SCF) and its relationship to TIMI frame count on the pathogenesis of SCF. Plasma noradrenalin and adrenalin concentrations at rest were compared in 51 patients diagnosed with SCF through coronary angiography and TIMI frame count; and 44 healthy controls with normal coronary flow (NCF). Furthermore, the relationship between TIMI frame count and noradrenalin and adrenalin levels was investigated. Plasma noradrenalin (127.9 ±9.2 and 79.3 ± 7.3 ng/mL, p < 0.0001) and adrenalin levels (63.9 ± 2.6 and 44.7 ± 2.8 ng/mL, p < 0.0001) were higher in patients with SCF when compared to patients with NCF. Noradrenalin and adrenalin levels were effected with SCF-dominant vessels with respect to TIMI frame count (p = 0.012 and p < 0.0001). Patients with SCF in 1, 2, or 3 vessels had different noradrenalin and adrenalin levels (p <0.003 and p < 0.0001). Patients with TIMI frame count above the 75th percentile had significantly higher noradrenalin and adrenalin levels when compared with those between the 25th—50th percentiles and below (p < 0.001 and p = 0.011, respectively). Correlation analysis established that both adrenalin and noradrenalin levels were correlated with TIMI frame counts of left anterior descending (LAD) and circumflex (Cx) arteries. Exercise testing revealed ischemia in 6 patients. Their TIMI frame counts were above the 75th percentile, and they had higher noradrenalin and adrenalin levels when compared with those without ischemia (p = 0.029, p = 0.045). Higher noradrenalin and adrenalin levels and correlation between TIMI frame count and ischemia in patients with SCF suggest that increased adrenergic activity may be the manifestation of slow coronary flow.

Evaluation of the Relationship Between Arterial Blood Pressure, Aortic Stiffness and Serum Endothelin-1 Levels in Patients with Essential Hypertension

This study has attempted to evaluate the relationship between aortic stiffness, blood pressure (BP) and serum endothelin-1 (ET-1) levels in patients with essential HT. Totally 152 subjects, consisting of 103 patients diagnosed with HT at least 1 year previously and 49 healthy individuals, were enrolled in this study. They were subdivided, on the basis of BP measurements made at home, into three groups as the hypertensives with dysregulated BP (n = 56), the hypertensives with regulated BP (n = 47) and the normotensive controls (n = 49). Statistically significant differences were observed between the three groups with respect to aortic elasticity parameters (p < 0.01 for aortic strain, aortic distensibility and aortic stiffness). Serum ET-1 levels in the three groups were similar (p = 0.101), but a significant correlation was observed between the ET-1 values and the aortic elasticity parameters (p = 0.004). Alteration of the aortic elasticity parameters in patients with HT not only correlates with the serum ET-1 levels indicating endothelial dysfunction but also gives direct clues about status of BP regulation.

The relation between endothelin-1 levels and myocardial injury in chronic ischemic heart failure.

We evaluated whether there was any relation between myocardial injury and endothelin-1 (ET-1) levels, which has been suggested as a contributor to the progression of ischemic heart failure. One hundred and twenty-one patients with chronic ischemic heart failure and 37 healthy individuals were included in the study. Cardiac troponin-I (cTn-I) and ET-1 levels of all subjects were measured on admission. Echocardiographic evaluations were also performed. The positivity of cTn-I increased significantly as the severity changed from New York Heart Association (NHYA) Class I to IV (P < 0.01). This was also true for quantitative cTn-I levels (P < 0.05). The ET-1 levels of patients were higher than controls on admission (P < 0.001). The ET-1 levels increased significantly upon the progression from NHYA Class I to IV (P < 0.001). Moreover, patients with cTn-I positivity had higher ET-1 levels (P < 0.05) and a lower ejection fraction (P < 0.001). A negative correlation was found between ejection fraction and the ET-1 levels (r = −0.312, P = 0.019). In patients with cTn-I positivity, the cTn-I levels showed a positive correlation with the ET-1 levels (r = 0.328, P = 0.014) and a negative correlation with ejection fraction (r = −0.671, P < 0.001). In chronic ischemic heart failure, an increase in ET-1 may exert an influence on the progression of cardiac failure by leading to myocardial injury which may be demonstrated by higher cTn-I levels.

Prevalence and Characteristics of Coronary-Cameral Communications in Adult Patients: Coronary Angiographic Analysis of 16,573 Patients

Objective: To analyze the coronary angiograms of patients with symptomatic heart disease in order to determine the frequency and characteristics of coronary-cameral communications (CCCs) in a single center. Subjects and Methods: The coronary angiograms of 16,573 patients with symptomatic heart disease performed from November 2001 to January 2011 were analyzed. The diagnosis of coronary fistula and coronary-cameral microcommunications (CCMCs) was made according to previously defined criteria. Results: Of the 16,573 patients, 15 (0.09%; 8 males and 7 females, mean age 63 ± 12 years) had CCCs, while coronary fistulas were identified in 2 (0.01%). In the first patient, the coronary fistula arose from the branches of the left anterior descending (LAD) artery and the right coronary artery (RCA) and drained into the right ventricle. In the second patient, the fistula originated from branches of the LAD artery, the circumflex (Cx) artery and the RCA and drained into the left ventricle. In 7 patients, the CCMCs originated from the LAD artery. In 3 patients, the Cx artery was the origin. The CCMCs originated from the RCA in 2 patients. In 1 patient the CCMC took its origin from the RCA and the Cx artery, while in 2 patients the CCMCs were associated with intracardiac masses in the left atrium and the right atrium, respectively. Conclusion: The prevalence of CCCs in adult patients was low and that of large coronary fistulas was even lower; coronary fistulas are probably very rare in adult patients because the majority of them are detected and treated during childhood.

Huge cardiac cyst hydatid causing cardiac symptoms and electrocardiographic changes

Here we present a huge cardiac cyst hydatid case with wonderful echocardiographic and computed tomographic images, causing cardiac symptoms and electrocardiographic changes.

Lipoprotein(a) levels in patients with unstable angina and their relationship with atherothrombosis and myocardial damage

The aim of the study was to compare lipoprotein(a) [Lp(a)] levels in patients with cTroponin‐I (cTn‐I)‐positive or ‐negative unstable angina and to investigate their relationship with atherothrombosis. A total of 202 consecutive patients were enrolled in the study. Lp(a), fibrinogen, plasminogen, PAI‐1 and t‐PA levels were measured and C‐reactive protein (CRP) assays were performed on admission for all patients, and venous blood samples were drawn 12 and 24 h later for cTn‐I measurements. The patients were divided into cTn‐I‐negative (cTn‐I < 1 ng/ml) and ‐positive (cTn‐I ≥ 1 ng/ml) unstable angina groups. Lp(a) levels of the cTn‐I‐positive patients were higher than those of the cTn‐I‐negative patients (52.9 ± 6.0 and 15.7 ± 2.5 mg/dl, p < 0.0001). There was a positive correlation between Lp(a) and cTn‐I levels (r = 0.692; p = 0.0001). Increase in coagulation activity and impairment in fibrinolytic activity were significant in the cTn‐I‐positive patients. Elevated Lp(a) levels may have a role in the development of myocardial damage in patients with unstable angina.

Left Ventricular Myocardial Deformation Parameters Are Affected by Coronary Slow Flow Phenomenon: A Study of Speckle Tracking Echocardiography

The coronary slow flow phenomenon (CSFP) is defined as a delayed distal vessel contrast opacification in the absence of obstructive epicardial coronary artery disease during coronary angiography. There is conflicting data in medical literature regarding the effects of CSFP on the left ventricular functions assessed by conventional echocardiography or tissue Doppler imaging. Therefore, we aimed to evaluate whether there is any abnormality in the myocardial deformation parameters (strain, strain rate (SR), rotation, twist) of the left ventricle obtained by speckle tracking echocardiography (STE) in patients with CSFP.