Merih Baykan

Effects of Prehypertension on Arterial Stiffness and Wave Reflections

The Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure classifies blood pressure (BP) as normal, prehypertension, and hypertension. Although it has been shown that there is a relationship between hypertension and arterial stiffness, there is not sufficient data about arterial stiffness in patients with prehypertension. The present study was designed to evaluate arterial stiffness and wave reflections in subjects with prehypertension. We evaluated arterial stiffness and wave reflections of 45 subjects with prehypertension and an age-matched control group of 40 normotensive individuals, using applanation tonometry (Sphygmocor, AtCor Medical, Sydney, Australia). Aortic pulse wave velocity (PWV) was measured as indices of elastic-type aortic stiffness. The heart rate-corrected augmentation index (AIx@75) was estimated as a composite marker of wave reflections and arterial stiffness. Aortic PWV (10 ± 2.5 vs. 8.6 ± 1.7, m/s, pu2009 =u2009 0.004) and AIx@75 (21 ± 8.3 vs. 10 ± 9.1, %, p = 0.0001) were significantly higher in subjects with prehypertension than in the control group. In multiple linear regression analysis, we found that the presence of the prehypertension was a significant predictor of aortic PWV (βu2009 = u20090.26, p u2009= u20090.009) and AIx@75 (βu2009 =u2009 0.46, p u2009= u20090.0001). Our results suggest that arterial functions were impaired even at the prehypertensive stage.

Relationship Between Arterial Stiffness and Myocardial Damage in Patients With Newly Diagnosed Essential Hypertension

BACKGROUNDnArterial stiffness increases in hypertensive individuals. Arterial stiffness is associated with impairment of systolic and diastolic myocardial function in hypertension (HT). However, the relationship between arterial stiffness and serum heart-type fatty acid-binding protein (H-FABP) levels, a sensitive marker of myocardial damage, has not been previously examined in patients with HT. We investigate the relationship between serum H-FABP levels and arterial stiffness in patients with newly diagnosed HT.nnnMETHODSnWe studied 46 (48.5 +/- 10.6, years) never-treated patients with HT and age-matched control group of 40 (47 +/- 8.6, years) normotensive individuals. H-FABP levels were determined in all subjects. We evaluated arterial stiffness and wave reflections of study population, using applanation tonometry (Sphygmocor). Carotid-femoral pulse wave velocity (PWV) was measured as indices of elastic-type, aortic stiffness. The heart rate-corrected augmentation index (AIx@75) was estimated as a marker of wave reflections.nnnRESULTSnCarotid-femoral PWV (10.5 +/- 2.2 vs. 8.7 +/- 1.6, m/s, P = 0.0001) and AIx@75 (22.7 +/- 9.5 vs. 15 +/- 11, %, P = 0.001) were significantly higher in patients with HT than control group. H-FABP levels were increased in hypertensive patients compared with control group (21.1 +/- 14.8 vs. 12.9 +/- 8.5, ng/ml, P = 0.002). In multiple linear regression analysis, we found that the body mass index (beta = 0.42, P = 0.0001) and carotid-femoral PWV (beta = 0.23, P = 0.03) were significant determinants of H-FABP levels.nnnCONCLUSIONnArterial stiffness is associated with serum H-FABP levels, a sensitive marker of myocardial damage, in patients with newly diagnosed HT.

Assessment of left ventricular systolic asynchrony in patients with clinical hypothyroidism.

Background: Hypothyroidism has a large number of adverse effects on the cardiovascular system such as impaired cardiac contractility. Left ventricular (LV) asynchrony is defined as loss of the simultaneous peak contraction of corresponding cardiac segments. Objective: To assess systolic asynchrony in patients with overt hypothyroidism. Methods: Asynchrony was evaluated in 31 patients with overt hypothyroidism and 26 controls. Clinical hypothyroidism was defined as serum thyroid‐stimulating hormone (TSH) more than 4.2 μIU/mL with reduced free T4 less than 1.10 ng/dL. All the patients and controls were subjected to an echocardiographic study including tissue synchronization imaging (TSI). The time to regional peak systolic velocity (Ts) in LV via the six‐basal‐six‐mid‐segmental model was measured on ejection phase TSI images, and four TSI parameters of systolic asynchrony were computed. LV asynchrony was described by these four TSI parameters. Results: The demographic characteristics and conventional echocardiographic parameters of both groups were similar (except total and LDL cholesterol, TSH, free T3, and free T4). All TSI parameters of LV asynchrony were prolonged in hypothyroid patients compared to controls. The standard deviation (SD) of the 12 LV segments Ts was (53.5 ± 14.1 vs. 29.3 ± 15.5, P < 0.0001); the maximal difference in Ts between any 2 of the 12 LV segments was (154.5 ± 37.3 vs. 91.9 ± 45.2, P < 0.0001); the SD of Ts of the 6 basal LV segments was (47.9 ± 15.9 vs. 27.1 ± 16.4, P < 0.0001); and the maximal difference in Ts between any 2 of the 6 basal LV segments was (118.4 ± 37.9 vs. 69.3 ± 39.0, P < 0.0001). The prevalence of LV asynchrony was significantly higher in patients with hypothyroidism compared with controls (83.9% vs. 26.9%, P < 0.0001). Conclusion: Patients with overt hypothyroidism show evidence of LV asynchrony by TSI. (ECHOCARDIOGRAPHY 2010;27:117‐122)

Association of Stage of Left Ventricular Diastolic Dysfunction with P Wave Dispersion and Occurrence of Atrial Fibrillation after First Acute Anterior Myocardial Infarction

Objectives:u2003The aim of this study was to investigate the association of stage of left ventricular diastolic dysfunction after acute myocardial infarction (AMI) with P maximum, P dispersion, and atrial fibrillation (AF) occurrence rate.

Cutis laxa-like pseudoxanthoma elasticum with ossification

Pseudoxanthoma elasticum (PXE) is a heritable disorder of elastic fibers characterized by yellowish, coalescing papules on the flexural area, which is loose and wrinkled. A 35‐year‐old woman presented cutis laxa‐like marked wrinkling and yellowish papules, and a skin biopsy revealed ossification and fragmentation of elastic fibers in the dermis. Ophthalmologic examination revealed a peau d’orange appearance of the retina. She was also found to have a mitral stenosis and hypertension. This is an unusual case of concurrent ossification and cutis laxa‐like PXE.

Assessment of left ventricular systolic and diastolic function by Doppler tissue imaging in patients with preinfarction angina

BACKGROUNDnThe aim of this study was assessment of left ventricular (LV) systolic and diastolic function by pulsed wave Doppler tissue imaging (DTI) in patients with or without preinfarction angina in acute myocardial infarction.nnnMETHODSnWe prospectively evaluated 31 consecutive patients (4 women, 27 men; age 58 +/- 10 years) with a first acute myocardial infarction. LV systolic and diastolic function was assessed by classic methods and DTI on the third day during acute myocardial infarction. Patients were divided into 2 groups according to the presence (group 1; n = 10) or absence (group 2; n = 21) of preinfarction angina. Mitral inflow velocities and early diastolic mitral annular velocity (Em), late diastolic mitral annular velocity (Am), peak systolic mitral annular velocity, Em/Am, the ratio of early diastolic mitral inflow velocity (E) to Em, and myocardial performance index were calculated by DTI.nnnRESULTSnGroup 1 had significantly higher Em and Em/Am than group 2 (11.3 +/- 3.34 cm/s vs 7.4 +/- 2.07 cm/s, P <.0001; 1.01 +/- 0.38 cm/s vs 0.6 +/- 0.2 cm/s, P =.001, respectively). The E/Em ratio and myocardial performance index were significantly lower in group 1 than in group 2 (5.1 +/- 2.92 vs 8.10 +/- 3.15, P=.018; 0.49 +/- 0.15 vs 0.65 +/- 0.24, P =.042, respectively). Wall-motion score index was lower in those with preinfarction angina than in those without (1.6 +/- 0.36 vs 1.9 +/- 0.39; P =.04, respectively). Peak systolic mitral annular velocity and Am were not statistically different between groups (9.4 +/- 1.84 vs 8.3 +/- 2.03, P =.172; 11.7 +/- 3.07 vs 12.1 +/- 3.34, P =.72, respectively). There were no significant differences between the 2 groups regarding transmitral E velocity, atrial contraction mitral inflow velocity (A), E/A ratio, isovolumetric relaxation time, and deceleration time of the mitral E wave (P =.91, P =.08, P =.58, P =.81, and P =.71, respectively).nnnCONCLUSIONnLV diastolic function was better in patients with preinfarction angina than in patients without. This condition could not be detected by conventional mitral inflow Doppler velocities, but could be detected by DTI. This preliminary evidence shows that DTI is better than conventional mitral Doppler indices in the assessment of a favorable LV diastolic function in patients with preinfarction angina.

The Relationship Between Endothelial Damage and Aortic Augmentation Index

Augmentation index (AIx), a measure of wave reflection, is regulated by a number of factors, including endothelial function and vascular smooth muscle tone. The relationship between local endothelium-derived factors and AIx is well known; however, association between endothelial damage markers and AIx has not been sufficiently studied. This study investigates whether endothelial damage markers—von Willebrand factor (vWF) soluble thrombomodulin (sTM)—are associated with wave reflections. We studied 46 (48.5 ± 10.6, years) never-treated patients with hypertension (HT) and an age-matched control group of 40 (47 ± 8.6, years) normotensive individuals. von Willebrand factor and sTM levels were determined in all subjects. We evaluated the aortic AIx of the study population using applanation tonometry (Sphygmocor, AtCor Medical, Sydney, Australia). The heart rate-corrected augmentation index (AIx@75) was estimated as a marker of wave reflections. Endothelial damage markers and AIx@75 were significantly higher in hypertensive patients than in controls. In the whole population, the vWF level (β = 0.24, p = 0.01) was an independent determinant of AIx@75 in multivariate analysis. However, the sTM level was not associated with AIx@75. We found that the vWF level was an independent determinant of AIx@75. Our results suggest that increased an vWF level contributes significantly to increased wave reflections.

Relationship Between Changes in R-wave Amplitude During Left Ventriculography and the Seriousness of Coronary Heart Disease

Serious complications, such as myocardial infarction or death, may occur particularly in patients with severe coronary heart disease during coronary angiographies. Therefore, prediction of severe coronary heart disease before or during the initial steps of the procedure can provide a decrease in frequency of such complications. To predict the seriousness of coronary heart disease during left ventriculography, before, during, and after the application of contrast matter, electrocardiography (ECG) records were taken and R‐wave amplitudes were measured. Lead Oil was used for calculations. The patients were classified according to vessel lesions and were compared with the control group. Before and after left ventriculography, there was no significant difference between the groups with normal coronary arteries and one, two, or three vessel lesions. Although there was no significant difference obtained from the comparison of the control group and the groups with one‐vessel and two‐vessel lesions (9.7 mm, 9.2 mm, 10.1 mm, respectively, P > 0.05); there was statistical difference between the group with three‐vessel lesions and the control group during left ventriculography i6.4 mm, 9.7 mm, respectively, P < 0.05). Nonionic contrast material was used in all procedures. The decrement of R‐wave amplitude that is observed during left ventriculography can predict three‐vessel disease, which is a more serious condition for the patients. These patients should be monitored more carefully during coronary angiographies. A.N.E. 2002;7(2):114–119