Mustafa Yılmaz

Assessment of epicardial adipose tissue and carotid/femoral intima media thickness in insulin resistance

BACKGROUND Metabolic syndrome is a combination of multiple cardiovascular (CV) risk factors including insulin resistance (IR). Carotid, femoral intima media thickness (IMT), and epicardial fat thickness (EFT) are considered as novel cardiometabolic risk factors. We aimed to test the hypothesis that carotid, femoral IMT, and EFT are increased in patients with IR. METHODS We enrolled consecutively and prospectively 113 patients with IR. Then we collected data from an age- and sex-matched control group of 112 individuals without IR. Homeostasis model assessment (HOMA) index value >2.5 was accepted as IR. Patients with diabetes mellitus, CV diseases, systolic heart failure, chronic liver or renal diseases were excluded. On B-mode duplex ultrasound the mean IMT at the far wall of both left and right common carotid/femoral arteries were measured manually. EFT was measured on the free wall of the right ventricle at end-diastole from the parasternal long-axis views by standard transthoracic 2D echocardiography. RESULTS Both carotid IMT and EFT were significantly higher in patients with IR compared to controls (0.80±0.21mm vs 0.60±0.21mm; p<0.001 and 7.34±1.96mm vs 5.22±1.75mm; p<0.001, respectively). However, there were no significant differences in femoral IMT between the groups (0.74±0.20 vs 0.69±0.17; p=0.062). In multivariate linear regression analysis age (β=0.223, p=0.010), 2-h blood glucose (β=0.198, p=0.021), and IR (β=0.369, p<0.001) were independent predictors of EFT. On the other hand age (β=0.363, p<0.001) and IR (β=0.321, p<0.001) were independent predictors of carotid IMT. CONCLUSIONS Patients with IR have increased carotid IMT and EFT, but not femoral IMT. This apparent incoherence may be due to the involvement of carotid arteries prior to femoral arteries in patients with IR.

Advanced tubal pregnancy at 30 weeks

A case of advanced tubal pregnancy at 30 weeks is described. The placenta was implanted on the salpinx. Most tubal pregnancies become symptomatic within the first 12 weeks. A small number of tubal pregnancies have progressed beyond this. We present this unusual case of a 30‐week tubal pregnancy situated in the proximal half of the tube that created a diagnostic dilemma.

Investigation of the relationship between asthma and subclinical atherosclerosis by carotid/femoral intima media and epicardial fat thickness measurement

ABSTRACT Objective: Since asthma and atherosclerosis may share similar pathophysiological mechanism, this study is planned to investigate whether epicardial fat thickness (EFT), carotid and femoral intima media thicknesses, which are markers of subclinical atherosclerosis, are increased in patients with asthma. Methods: The study was designed as a cross-sectional study. A total of 154 participants (83 patients with asthma and 71 healthy volunteers) were enrolled into the study. Epicardial fat, carotid, and femoral intima media thicknesses were measured and recorded in both groups. The statistical difference between the two groups was examined. Results: Both carotid and femoral intima media thicknesses were significantly higher in patients with asthma compared to control group (5.52 ± 0.4 mm−1 vs. 5.36 ± 0.4 mm−1; p = 0.038 and 5.64 ± 0.4 mm−1 vs. 5.46 ± 0.5 mm−1; p = 0.036, respectively). However, there was not a significant difference in EFT between the groups [5.9 mm (5.3–6.6; IQR = 1.3) vs. 5.6 mm (4.7–6.5; IQR = 1.8); p = 0.1]. On comparison of control group and asthma subgroups (mild, moderate, and severe), there was a statistically significant difference among these four groups in terms of carotid and femoral intima media thicknesses (p = 0.002 and p < 0.001, respectively). Subgroup analyses showed that this difference was mainly due to patients with severe asthma. Conclusions: Carotid and femoral intima media thicknesses in asthmatic patients were found to be increased compared to the normal population. As a result, the risk of subclinical atherosclerosis in asthmatic patients may be high.

Assessment of epicardial fat and carotid intima media thickness in gestational hypertension

Gestational hypertension (GHT) is a common disorder of pregnancy characterized by new onset hypertension without the presence of detectable proteinuria after 20 weeks of gestation. Epicardial fat thickness (EFT) and carotid intima media thickness (CIMT) are suggested as new predictors of subclinical atherosclerosis. Although the relationship between these parameters and essential hypertension has been demonstrated, this association in patients with GHT is still unknown. We aimed to investigate CIMT and EFT in patients with GHT.