N. Nazli

Advanced Age Is Associated with Endothelial Dysfunction in Healthy Elderly Subjects

Background: Aging is associated with an increased risk for atherosclerosis in which endothelial dysfunction is an early marker. Objective: The purpose of this study was to determine if endothelial function is altered with increasing age in healthy subjects. Method: The study population consisted of 30 elderly and 36 younger subjects free from major cardiovascular risk factors. Transthoracic echocardiography was performed for each subject to rule out structural heart disease. Endothelial function was evaluated by flow-mediated dilation (FMD) of the brachial artery via ultrasound. Results: Baseline characteristics of the elderly and the younger group were similar, except for age (mean age: 71.3 ± 5.8 vs. 26.5 ± 7.2). Transthoracic echocardiography was normal in all subjects. FMD of the elderly group was significantly lower than the younger group (7.9 ± 3.1 in the elderly, 10.8 ± 1.9 in the younger group, p < 0.001). A negative relationship was found between FMD and age (r = –0.528, p < 0.001). Conclusion: It can be concluded that endothelial function detected by FMD declines with increasing age in healthy human subjects. Advanced age is a predictor of impaired endothelial function.

Early myocardial functional alterations in patients with obstructive sleep apnea syndrome.

Background: There is limited information regarding myocardial alterations in patients with obstructive sleep apnea syndrome (OSAS) in the absence of pulmonary and cardiac comorbidity. In this study, we aimed to evaluate potential myocardial alterations of these patients and investigate the possible effects of OSAS‐related pathological variations on left and right ventricular functions. Methods: We studied 107 consecutive patients who were referred to our sleep laboratory for clinically suspected OSAS and 30 controls without any history or symptoms of sleep‐related disorders. Severity of OSAS was quantified by polysomnography. Patients with apnea–hypopnea index (AHI) < 5 were included in the OSAS (−) group (Group 1, n = 22). Subjects with AHI ≥ 5 were considered as OSAS and classified according to their AHI as mild‐to‐moderate (AHI ≥ 5 and AHI < 30) (Group 2, n = 45) and severe (AHI ≥ 30) OSAS groups (Group 3, n = 40). Conventional M‐mode, 2D, and Doppler mitral inflow parameters, tissue Doppler velocities, myocardial peak systolic strain, and strain rate values of various segments were measured and compared between groups. Results: Patients with OSAS displayed impairment of left ventricular diastolic function compared with controls. There were no significant differences between groups regarding parameters reflecting left ventricular systolic function. Myocardial strain analysis demonstrated significant decrement regarding apical right ventricular longitudinal peak systolic strain and strain rate values between groups in relation to the severity of OSAS. Conclusions: Patients with OSAS display a regional pattern of right ventricular dysfunction correlated with the severity of disease.

Determining the relationship between metabolic syndrome score and angiographic severity of coronary artery disease.

Background:  Cardiovascular disease is leading cause of mortality and morbidity in developed and developing countries. Metabolic syndrome (MS) is a risk factor for coronary artery disease (CAD). The effect of MS on angiographic severity of CAD is not well defined. The aim of this study was to examine the effect of MS on angiographic severity of CAD by using Gensini score.

Left and Right Ventricular Function Is Impaired in Behcet's Disease

Objectives: Subclinical cardiac involvement may occur in patients with Behçets disease (BD). The purpose of our study was to assess the noninvasive parameters of biventricular function derived from Doppler tissue imaging (DTI) of the tricuspid and mitral annular motion in BD. Methods: Twenty‐one patients with BD and 20 control subjects were enrolled in this study. All subjects were selected to exclude those with cardiovascular risk factors. Standard echocardiography and pulsed DTI were obtained in every patient. Results: Peak systolic (13.71 ± 2.09 vs 20.01 ± 1.57, P < 0.001), peak early diastolic (11.26 ± 2.52 vs 15.35 ± 2.06, P < 0.001) tricuspid annular velocities were significantly lower in patients than controls. Peak systolic (8.68 ± 1.4 vs 12.25 ± 1.7, P < 0.001), peak early diastolic (7.89 ± 1.07 vs 9.94 ± 1.12, P < 0.001), and peak end diastolic (8.30 ± 1.32 vs 9.23 ± 0.91, P = 0.013) lateral mitral annular velocities were significantly lower in patients than controls. Conclusions: We demonstrated that myocardial velocities, were affected in patients with BD. Therefore, we conclude that right and left ventricular function is impaired in patients with BD.

Iliac Artery Aneurysm in Behçet's Disease: A Case Report

Today, Behçets disease is known as a multisystem disorder.1-4 Eye lesions, mouth and genital aphthous lesions, and skin lesions are accepted as major lesions. The disease also attacks the locomotor system, central nervous system, gastrointestinal system and also arteries and veins. According to available data, some 30% of the patients have vascular lesions; mostly thrombosis of the veins. Arterial thromboses have been rarely reported; and only a few number of arte rial aneurysms are noted.5-13 Here we present an iliac artery aneurysm in a case of Behçets disease.

Coronary Artery Bypass Grafting Is Associated with a Significant Worsening of QT Dynamicity and Heart Rate Variability

Background: Imbalance in autonomic nervous system and impaired myocardial repolarization has been shown to increase the risk for arrhythmias in patients with coronary artery disease. This study evaluated the effects of coronary artery bypass grafting (CABG) on heart rate variability and QT interval dynamicity in subjects with coronary artery disease undergoing elective CABG surgery. Methods: The study group consisted of 68 consecutive patients (mean age ±SD: 61 ± 9 years) with coronary artery disease who underwent elective CABG. Twenty-four-hour Holter monitoring was performed 2–5 days before cardiac surgery and was repeated 10 days after CABG. ELATEC holter software was used to calculate heart rate variability and QT dynamicity parameters. All subjects had a complete history, laboratory examination and transthoracic echocardiography. Results: All patients had beta-blocking agent medication pre- and postoperatively. Standard deviation of all NN intervals for a selected time period, square root of the mean of the sum of the squares of differences between adjacent RR intervals, the proportion of differences in successive NN intervals greater than 50 ms, normalized low-frequency power, and normalized high-frequency power were significantly decreased after CABG surgery, whereas low-frequency/high-frequency ratio was significantly increased after CABG. QT/RR slopes over 24 h were significantly increased after CABG surgery for QT end and QT apex (QTapex/RR: 0.16 ± 0.13 vs. 0.28 ± 0.19, p < 0.001; QTend/RR: 0.18 ± 0.13 vs. 0.36 ± 0.23, p < 0.001). Conclusion: This prospective study showed for the first time that CABG was associated with a significant worsening of heart rate variability and QT dynamicity parameters in the postoperative period.

Impaired fibrinolytic capacity in rheumatic mitral stenosis with or without atrial fibrillation and nonrheumatic atrial fibrillation

Chronic atrial fibrillation (AF) has often been associated with systemic embolization, and patients with mitral stenosis (MS) have the highest thromboembolic risk. Increased risk of thromboembolism could be in part due to impaired fibrinolytic function. Global fibrinolytic capacity (GFC) is an innovative technique for evaluating the entire fibrinolytic system. The aim of our study was to evaluate fibrinolytic activity in patients with rheumatic and nonrheumatic chronic AF. To investigate fibrinolytic activity, we assessed GFC in peripheral blood samples of 32 patients with nonrheumatic AF (14 women; mean age, 56 ± 1 years), 30 patients with rheumatic MS and AF (23 women; mean age, 35 ± 9 years), and 32 patients with rheumatic MS and sinus rhythm (24 women; mean age, 36 ± 8 years). The control group comprised 30 healthy adult subjects in normal sinus rhythm. Patients with chronic AF (rheumatic and nonrheumatic) had lower GFC than did the controls (P = .0001). The rheumatic AF group also showed decreased levels of GFC compared with the nonrheumatic AF group, with the rheumatic MS and sinus rhythm group, and with controls (P = .03,P = .02,P = .0001, respectively). GFC was lower in patients with rheumatic MS and sinus rhythm than in controls (P = .003). Although there were correlations between GFC and mitral valve area, transmitral mean gradient, left atrial diameter, and mitral calcification in patients with rheumatic MS, multivariate analysis showed only transmitral gradient as an independent factor affecting GFC. Patients with AF have decreased GFC, a finding that suggests the presence of a hypofibrinolytic state. Fibrinolytic dysfunction was more pronounced in rheumatic MS patients with AF than in those with nonrheumatic AF. Moreover, patients with rheumatic MS and sinus rhythm had decreased global fibrinolytic activity. Hypofibrinolysis documented by decreased GFC can be one of the important causes of increased risk of embolism in patients with AF and rheumatic MS.

Evaluation of association between obstructive sleep apnea and coronary risk scores predicted by tomographic coronary calcium scoring in asymptomatic patients.

OBJECTIVE This cross-sectional observational study is designed to evaluate direct effects of obstructive sleep apnea syndrome (OSA) on presence and extent of coronary atherosclerosis by using tomographic coronary calcification scoring on a population asymptomatic for coronary artery disease. METHODS Ninety-seven consecutive patients (49.17 ± 0.86 years) who were evaluated with sleep study for the suspicion of obstructive sleep apnea syndrome underwent tomographic coronary calcium scoring test. Cardiovascular risk factors, current medications and sleep study recordings of all patients were recorded. Patients were classified into 4 groups according to the apnea-hypopnea index (AHI). Linear and logistic regression analyses were used for assessment of association between variables. RESULTS Coronary risk scores of patients, assessed by tomographic coronary calcium scoring, were observed to increase linearly from simple snoring group to severe OSA groups (p=0.046). When patients were classified according to their gender, AHI and parameters reflecting severity of OSA-related hypoxia were found to correlate significantly with coronary risk scores of women but not with scores of men. Linear regression analysis revealed age as the only independent associated variable with cardiovascular risk scores assessed by tomographic coronary calcification scoring (Beta coefficient: 0.27, 95% CI 0.007-0.087, p=0.018). Binary logistic regression analysis also revealed age as the only variable which independently predicted the presence of coronary calcification (OR:1.11, 95% CI 1.039-1.188, p=0.002). CONCLUSION These results suggest that presence of OSA may contribute to coronary artery disease risk of patients in association with its severity; however, association between OSA and subclinical atherosclerosis seems to be primarily dependent on age.

The effect of VVI pacing on P-wave dispersion in patients with dual-chamber pacemakers.

The incidence of atrial fibrillation is higher in patients with VVI pacing mode than DDD pacing mode, but the likely mechanism is not clearly understood. We aimed to evaluate whether short-term VVI pacing increases inhomogeneous atrial conduction by using P-wave dispersion. Forty-seven patients (32 men, 15 women, mean age 54 ± 13 years) with DDD pacemakers were enrolled in this study. Twelve-lead surface ECGs were obtained in all patients during VDD pacing after an observation period of 1 week. The mode was then changed to VVI and 12 lead surface ECGs were obtained after another 1-week observation period. P-wave durations were calculated in all 12 leads in both VDD and VVI pacing modes. The difference between the maximum and the minimum P-wave duration was defined as the P-wave dispersion (PWD = Pmax − Pmin). P-wave maximum duration (Pmax) calculated in VVI pacing mode was significantly longer than in VDD pacing mode (128 ± 19 vs 113 ± 16 ms, P < 0.001). There was no significant difference in the P-wave minimum durations (80 ± 13 ms vs 79 ± 12 ms, P = 0.7) between VVI pacing and VDD pacing. The P-wave dispersion value was higher in the VVI pacing mode than in the VDD pacing mode (48 ± 8 ms vs 34 ± 7 ms, P < 0.001). Short-term VVI pacing induces prolongation of Pmax and results in increased P-wave dispersion, which might be responsible for the development of atrial fibrillation more frequently in these patients than in those with the VDD pacing mode.

A Novel Method for the Diagnosis of Neurocardiogenic Syncope: Heart Rate Recovery Index

Objectives: Neurocardiogenic syncope is a common and challenging problem in clinical practice. Heart rate recovery after the first minute of exercise is mainly controlled by the parasympathetic nervous system. The aim of the present study was to evaluate heart rate recovery as an index of parasympathetic tonus for the diagnosis of neurocardiogenic syncope. Methods and Results: Ninety five patients (mean age 36.5 ± 11.8 years), who had vasovagal syncope episodes documented by tilt table testing and 70 healthy subjects (mean age 32.9 ± 9.1 years) were included in this study. Maximal exercise stress testing was performed in both groups and heart rate recovery values were calculated. Heart rate recovery was calculated by subtracting recovery heart rate in the first minute after exercise from peak heart rate. Heart rate recovery was significantly higher in the vasovagal syncope group than the control group during the first minute (42.1 vs. 30.9, p < 0.001). When the cutoff point for heart rate recovery was taken as 35, the sensitivity for the diagnosis of vasovagal syncope was 81% and the specificity was 78%. Conclusion: Results of our study show that heart rate recovery is greater in the first minute after exercise in vasovagal syncope patients and that it has a supportive role in the diagnosis of neurocardiogenic syncope.