Muntecep Asker

Frequency of Left Atrial Thrombus and Spontaneous Echocardiographic Contrast in Acute Myocardial Infarction

Left ventricular systolic dysfunction may precipitate blood stasis as well as thrombus formation in the left atrial appendage of patients with acute myocardial infarction, even in the presence of sinus rhythm. Thus, left atrial thrombi may be an alternative source for systemic embolism in acute myocardial infarction.

Aneurysm of Sinus of Valsalva Dissecting into Interventricular Septum: A Late Complication of Aortic Valve Replacement

A 43‐year‐old man who had a Carbomedics prosthetic aortic valve replacement in 1997 was admitted to our hospital with complaints of shortness of breath and dyspnea on exertion in 2000. The patient was hospitalized due to atrioventricular (AV) complete block and a permanent pacemaker was implanted. At that time echocardiography indicated an aneurysm at the left sinus of Valsalva. In 2003, the patient was re‐admitted to our clinic with complaints of shortness of breath and fatigue. Echocardiography showed a sinus of Valsalva aneurysm dissecting into interventricular septum. Operation confirmed dissection of the interventricular septum and communication between this cavity and the aneurysm of the left sinus of Valsalva. The postoperative course was uneventful and the patient was discharged in a satisfactory condition. This is the first reported case of aneurysm of the sinus of Valsalva dissecting into interventricular septum late and complicating aortic valve replacement.

Platelet-to-Lymphocyte Ratio May Predict the Severity of Calcific Aortic Stenosis

Background Platelet-to-lymphocyte ratio (PLR) is an emerging inflammatory indicator which is closely associated with adverse cardiovascular events. Therefore, we aimed to investigate the relationship between PLR and the severity of calcific aortic stenosis (AS). Material/Methods The study was designed as a retrospective study. A total of 86 consecutive patients with calcific AS were divided into two groups as mild-to-moderate AS and severe AS according to the transaortic mean pressure gradient. PLR levels were calculated from the complete blood count (CBC). Results Platelet to lymphocyte ratio was significantly higher in severe and mild-to-moderate AS groups when compared to the control subjects (151±31.2, p<0.001, 138±28.8 vs. 126±26.5, p=0.008, respectively). In the subgroup analysis of AS patients, PLR was found to be higher in the severe AS group compared to mild-to-moderate group (p<0.001). A significant correlation was found between PLR and transaortic mean pressure gradient in patients with AS (r=0.421, p<0.001). Conclusions Our study results demonstrated that increased PLR correlates with the severity of calcific AS.

Assessment of corneal endothelial cell density in patients with keratoconus not using contact lenses

PURPOSE To assess the corneal endothelial cell density (ECD) in keratoconus patients with no history of contact lens use. SETTING Yuzuncu Yil University, School of Medicine and Van Training and Research Hospital, Department of Ophthalmology, Van, Turkey. DESIGN Cross-sectional controlled study. METHODS The eyes of 65 patients with the diagnosis of keratoconus with no history of contact lens wear and the eyes of 40 healthy controls were prospectively examined using the Heidelberg Retinal Tomography Rostock Cornea Module (HRT3/RCM). The average ECD from the two groups were then compared. RESULTS Of the cases with keratoconus, 44 (67.7%) were men and 21 (32.3%) were women. The mean age was 20.9±6.8 (range=10-41) years. Of the controls, 28 (70%) were men and 12 (30%) were women. The mean age was 23.9±5.8 (range=14-35) years. Of the 65 eyes with keratoconus, 19 (29.2%) had mild keratoconus, 21 (32.3%) had moderate keratoconus, and 25 (38.5%) had severe keratoconus. The mean ECD was 2731.6±303.2 cells/mm2 in cases with keratoconus and 2664.9±319.5 cells/mm2 in controls. There was no difference between the densities (unpaired t-test, P=0.4). No significant relationships were found between the ECD data and central corneal thickness or steepest keratometric. CONCLUSIONS Endothelial cell density was unaltered in keratoconic patients without a history of contact lens use when compared with healthy controls. Change in ECD is independent from the central corneal thickness and the stage of keratoconus.

A Novel Echocardiographic Method for Assessing Arterial Stiffness in Obstructive Sleep Apnea Syndrome

Background and Objectives Obstructive sleep apnea syndrome (OSAS) is associated with increased arterial stiffness and cardiovascular complications. The objective of this study was to assess whether the color M-mode-derived propagation velocity of the descending thoracic aorta (aortic velocity propagation, AVP) was an echocardiographic marker for arterial stiffness in OSAS. Subjects and Methods The study population included 116 patients with OSAS and 90 age and gender-matched control subjects. The patients with OSAS were categorized according to their apnea hypopnea index (AHI) as follows: mild to moderate degree (AHI 5-30) and severe degree (AHI≥30). Aortofemoral pulse wave velocity (PWV), carotid intima-media thickness (CIMT), brachial artery flow-mediated dilatation (FMD), and AVP were measured to assess arterial stiffness. Results AVP and FMD were significantly decreased in patients with OSAS compared to controls (p<0.001). PWV and CIMT were increased in the OSAS group compared to controls (p<0.001). Moreover, AVP and FMD were significantly decreased in the severe OSAS group compared to the mild to moderate OSAS group (p<0.001). PWV and CIMT were significantly increased in the severe group compared to the mild to moderate group (p<0.001). AVP was significantly positively correlated with FMD (r=0.564, p<0.001). However, it was found to be significantly inversely related to PWV (r=-0.580, p<0.001) and CIMT (r=-0.251, p<0.001). Conclusion The measurement of AVP is a novel and practical echocardiographic method, which may be used to identify arterial stiffness in OSAS.

Evaluation of Airway Wall Thickness Via High-Resolution Computed Tomography in Mild Intermittent Asthma

INTRODUCTION: This study aims to evaluate bronchial thickness via thorax high-resolution computed tomography (HRCT) in subjects with mild intermittent asthma in comparison with healthy control subjects. METHODS: A total of 37 out-patients (mean ± SD age = 36.7 years (9.7 years); 54.8% males) with mild intermittent asthma and 13 healthy control subjects (mean ± SD age = 25.0 years (2.9 years); 61.5% males) were included in this case control study. Data on demographics, pulmonary function test results, and segmental and subsegmental thorax HRCT results were recorded. The ratio of bronchial wall thickness to bronchial lumen diameter (T/D) and bronchial wall area percentage (WA%) were calculated for all cases. RESULTS: Subject and control groups were similar in terms of pulmonary function test results, and total and subsegmental T/D values. Mean ± SD subsegmental WA% values at the level of inferior pulmonary vein (55.6% [16.8%] vs 41.7% [7.4%], P = .047) and 2 cm above the diaphragm (49.8% [15.8%] vs 38.6% [10.4%], P = .046) were significantly higher in subjects than control subjects. No significant correlation of overall and subsegmental T/D and WA% values to age in both groups, and to asthma duration in subjects. CONCLUSION: Our findings revealed an increase in bronchial wall thickness in peripheral airways in subjects with mild intermittent asthma regardless of the duration of asthma. This may indicate a need to also administer anti-inflammatory or bronchodilator therapy, which is effective in peripheral airways during the early period of the disease.

[Procedural success and short- and mid-term results of percutaneous closure of persistent arterial duct with the Amplatzer Duct Occluder II].

OBJECTIVES We evaluated the effectiveness and reliability of percutaneous closure of persistent arterial duct (PAD) with the Amplatzer Duct Occluder II (ADO II), together with short- and mid-term results. STUDY DESIGN The study included 16 patients (10 girls, 6 boys; median age 6 years; range 5 months to 12 years) who underwent percutaneous PAD closure with the ADO II device. The ductus diameter was less than 6 mm in all the cases. According to the Krichenko classification, 10 patients had type A, five patients had type E, and one patient had residual PAD. The patients were assessed by aortography and echocardiography. The mean follow-up was 13.9 months (range 2 to 23 months). RESULTS Closure of PAD was successfully performed via the arterial approach in all the patients. The median ductus waist diameter was 3 mm (range 2 to 5 mm), the median device waist diameter was 4 mm (range 3 to 6 mm), and the waist length was 4 or 6 mm. The mean fluoroscopy time and the mean procedure time were 10.6 min (range 4 to 39 min) and 30 min (range 18 to 80 min), respectively. Immediate aortography following the procedure showed shunt only through the device lumen. No residual shunt or increases in aortic and left pulmonary flow velocities were observed in echocardiographic examinations. No complications occurred during the procedure and follow-up. CONCLUSION In all the cases, the ADO II device was found effective and reliable for closure of PADs of less than 6 mm.

The effect of low-sodium dialysate on ambulatory blood pressure measurement parameters in patients undergoing hemodialysis

Background End stage renal disease is related to increased cardiovascular mortality and morbidity. Hypertension is an important risk factor for cardiovascular disorder among hemodialysis (HD) patients. The aim of this study was to investigate the effect of low-sodium dialysate on the systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels detected by ambulatory BP monitoring (ABPM) and interdialytic weight gain (IDWG) in patients undergoing sustained HD treatment. Patients and methods The study included 46 patients who had creatinine clearance levels less than 10 mL/min/1.73 m2 and had been on chronic HD treatment for at least 1 year. After the enrollment stage, the patients were allocated low-sodium dialysate or standard sodium dialysate for 6 months via computer-generated randomization. Results Twenty-four hour SBP, daytime SBP, nighttime SBP, and nighttime DBP were significantly decreased in the low-sodium dialysate group (P<0.05). No significant reduction was observed in both groups in terms of 24-hour DBP and daytime DBP (P=NS). No difference was found in the standard sodium dialysate group in terms of ABPM. Furthermore, IDWG was found to be significantly decreased in the low-sodium dialysate group after 6 months (P<0.001). Conclusion The study revealed that low-sodium dialysate leads to a decrease in ABPM parameters including 24-hour SBP, daytime SBP, nighttime SBP, and nighttime DBP and it also reduces the number of antihypertensive drugs used and IDWG.

Serum levels of trace minerals and heavy metals in severe obstructive sleep apnea patients: correlates and clinical implications

PurposeThe aim of the present study was to evaluate the serum levels of trace minerals and heavy metals in obstructive sleep apnea (OSA) patients and to investigate whether there is a correlation between levels of trace minerals and demographic and biochemical variables.MethodsThis clinical, case–control study was performed on 61 OSA patients and 36 healthy controls. Demographic, radiological, biochemical variables, as well as serum levels of trace minerals (magnesium, copper, iron, zinc, manganese, cobalt) and heavy metals (lead, cadmium) were compared in OSA and control groups. In addition, correlation of serum levels of these substances to demographic, biochemical, and radiological parameters was tested.ResultsNot only serum levels of cholesterol, triglycerides, cadmium, cobalt, copper, iron, magnesium, manganese, lead, and zinc were found to be higher, but also carotid intima-media thickness (CIMT) was increased in OSA patients. Increase in CIMT was found to be correlated with levels of cobalt, copper, iron, magnesium, manganese, and zinc.ConclusionOur results have shown that serum levels of trace minerals and heavy metals were higher in OSA. This difference may ensource from deterioration of the balance of these substances due to oxidative stress and inflammation. Significance of these findings with respect to the etiopathogenesis, diagnosis, and treatment of OSA warrants further trials.

An overlooked cause of resistant hypertension: upper airway resistance syndrome - preliminary results

OBJECTIVE: Upper airway resistance syndrome is a sleep-disordered breathing syndrome that is characterized by repetitive arousals resulting in sympathetic overactivity. We aimed to determine whether upper airway resistance syndrome was associated with poorly controlled hypertension. METHODS: A total of 40 patients with resistant hypertension were enrolled in the study. All of the patients underwent polysomnographic examinations and 24-hour ambulatory blood pressure monitoring to exclude white coat syndrome and to monitor treatment efficiency. Among 14 upper airway resistance syndrome patients, 2 patients had surgically correctable upper airway pathologies, while 12 patients were given positive airway pressure therapy. RESULTS: All patients underwent polysomnographic examinations; 22 patients (55%) were diagnosed with obstructive sleep apnea and 14 patients (35%) were diagnosed with upper airway resistance syndrome, according to American Sleep Disorders Association criteria. The patients with upper airway resistance syndrome were younger and had a lower body mass index compared with other patients, while there were no difference between the blood pressure levels and the number of antihypertensive drugs. The arousal index was positively correlated with systolic blood pressure level (p = 0.034; rs = 0.746), while the Epworth score and AHI were independent of disease severity (p = 0.435, rs = 0.323 and p = 0.819, rs = -0.097, respectively). Eight patients were treated with positive airway pressure treatment and blood pressure control was achieved in all of them, whereas no pressure reduction was observed in four untreated patients. CONCLUSIONS: We conclude that upper airway resistance syndrome is a possible secondary cause of resistant hypertension and that its proper treatment could result in dramatic blood pressure control.