Nursen Keles

Increased morning blood pressure surge and coronary microvascular dysfunction in patient with early stage hypertension

Morning blood pressure surge (MBPS) is defined as an excessive increase in blood pressure (BP) in the morning from the lowest systolic BP during sleep, and it has been reported as a risk factor for cardiovascular events in current clinical studies. In this study, we evaluated the association between the rate of BP variation derived from ambulatory BP monitoring data analysis and coronary microvascular function in patients with early stage hypertension. One hundred seventy patients with prehypertension and Stage 1 hypertension who fulfilled the inclusion and exclusion criteria were included in the study. We divided our study population into two subgroups according to the median value of coronary flow reserve (CFR). Patients with CFR values <2.5 were defined as the impaired CFR group, and patients with CFR values ≥2.5 were defined as the preserved CFR group, and we compared the MBPS measurements of these two subgroups. CFR was measured using transthoracic Doppler echocardiography (TTDE). Ambulatory 24-hour systolic and diastolic BP, uric acid, systolic MBPS amplitude, diastolic MBPS amplitude, high-sensitivity C-reactive protein, and mitral flow E/A ratio were statistically significant. These predictors were included in age- and gender-adjusted multivariate analysis; ambulatory 24-hour systolic BP (ß = 0.077, P < .001; odds ratio [OR] = 1.080; 95% confidence interval [CI] [1.037-1.124]) and systolic MBPS amplitude (ß = 0.043, P = .022; OR = 1.044; 95% CI [1.006-1.084]) were determined to be independent predictors of impaired CFR (Hosmer-Lemeshow test, P = .165, Nagelkerkes R(2) = 0.320). We found that increased changes in MBPS values in patients with prehypertension and Stage 1 hypertension seemed to cause microvascular dysfunction in the absence of obstructive coronary artery disease.

Is serum Klotho protective against atherosclerosis in patients with type 1 diabetes mellitus

OBJECTIVE Klotho deficiency is associated with several metabolic disorders. Two dimensional (2D) longitudinal strain (LS) of left ventricle (LV), carotid artery intima-media thickness (CIMT), flow-mediated dilation (FMD) of brachial artery and epicardial fat thickness (EFT) have been reported to be early predictors of atherosclerosis. We aimed to investigate the relationship between serum Klotho levels and these early predictors of atherosclerosis in patients with type 1 diabetes mellitus (DM). METHODS The study included 45 type 1 diabetic patients and 35 controls. Serum Klotho levels were determined by ELISA method. The patient group was also divided into two subgroups according to serum Klotho levels: high (HK) and low Klotho (LK) groups. EFT, CIMT and FMD were measured according to appropriate recommendations. Speckle tracking analysis was performed using the Echopac software. RESULTS The patient group had significantly lower serum Klotho (p=0.001), FMD (p<0.001) and LS of LV (p<0.001) values, but larger EFT (p<0.001) and CIMT (p<0.001) values than controls. LK subgroup had also significantly lower FMD (p<0.001) and LS of LV (p<0.001) but larger EFT (p=0.002) and CIMT (p<0.001) values than HK subgroup. CONCLUSION Serum Klotho may have a protective effect against atherosclerosis and endothelial dysfunction in type 1 DM.

Antioxidant and renoprotective effects of sphingosylphosphorylcholine on contrast-induced nephropathy in rats

Abstract Contrast induced nephropathy (CIN) is a major cause of morbidity, and increased costs as well as an increased risk of death. This study was evaluated effects of exogenous sphingosylphosphorylcholine (SPC) administration on CIN in rats. Eight animals were included in each of the following eight groups: control, control phosphate-buffered solution (PBS), control SPC 2, control SPC 10, CIN, CIN PBS, CIN SPC 2 and CIN SPC 10. The induced nephropathy was created by injected with 4 g iodine/kg body weight. SPC was administered 3 d at a daily two different doses of 2 μm/mL and 10 μm/mL intraperitoneally. The severity of renal injury score was determined by the histological and immunohistochemical changes in the kidney. Malondialdehyde (MDA), nitric oxide (NO) and superoxide dismutase (SOD) were determined to evaluate the oxidative status in the renal tissue. Treatment with 2 and 10 μM SPC inhibited the increase in renal MDA, NO levels significantly and also attenuated the depletion of SOD in the renal injuryCIN. These data were supported by histopathological findings. The inducible nitric oxide synthase positive cells and apoptotic cells in the renal tissue were observed to be reduced with the 2 and 10 μM SPC treatment. These findings suggested that 2 and 10 μM doses can attenuate renal damage in contrast nephropathy by prevention of oxidative stress and apoptosis. The low and high dose SPC may be a promising new therapeutic agent for CIN.

Retrobulbar blood flow and carotid intima–media thickness alteration may relate to subclinic atherosclerosis in patients with chronic inflammatory diseases

Abstract Objective: AA amyloidosis occurs in the setting of longstanding inflammation. An increased incidence of coronary artery disease (CAD) was noted in patients with chronic inflammatory disease (CID). Retrobulbar blood flow predicts future macrovascular events including CAD. Increase in carotid artery intima–media thickness is regarded as a marker for early atherosclerosis. The relationship between chronic inflammation and atherosclerosis is well known; however, the connection between amyloidosis-advanced CIDs and retrobulbar microvascular function and carotid intima–media thickness (CIMT) is unidentified. We aimed to investigate whether retrobulbar microcirculation and CIMT were impaired or not in amyloidosis-advanced CID patients compared to normal subjects. Methods: Fourteen patients with renal AA amyloidosis and a group of healthy volunteers were included in the study. Measurement of CIMT and retrobulbar blood flow velocities was performed with ultrasound scanner and color Doppler ultrasonography. Results: The CIMT of patients with renal amyloidosis was significantly thicker than that of the normal population (p < 0.001). The resistivity index of the ophthalmic artery (OA) of patients with renal amyloidosis was significantly higher than the study group (p < 0.001). Conclusion: This study demonstrates that accelerated atherosclerosis which can be shown by increased OA resistivity index and CIMT are found in amyloidal-related CID patients.

Public Health Efforts for Earlier Resistant Hypertension Diagnosis, Reduction of Salt Content in Food, Promotion of the Use of Polypills to Facilitate Better Adherence, and Reimbursement Policies

Resistant hypertension (RHT) is a clinical state in which despite concomitant intake of at least three antihypertensive drugs, one of these preferably being a diuretic at full doses, blood pressure remains uncontrolled. Firstly, it should be confirmed that the patients with resistant hypertension do have true RHT; this can be done by ruling out or correcting factors associated with pseudo-resistance which contain an inaccurate measurement of blood pressure (BP), inappropriate drug choices or doses, and the nonadherence to prescribed therapy or the white-coat effect. The complexity of the treatment regimen, socioeconomic status, lifestyle, and psychological influences affect adherence to medication.

A rarely seen congenital malformation in an elderly patient: Uhl’s anomaly

Received: 28.12.2016 Accepted: 19.01.2017 1Istanbul Medeniyet University, Göztepe Training and Research Hospital, Department of Cardiology, Istanbul, Turkey 2Istanbul Medeniyet University, Göztepe Training and Research Hospital, Department of Radyology, Istanbul, Turkey Yazışma adresi: Nurşen Keleş, Istanbul Medeniyet University, Göztepe Training and Research Hospital, Department of Cardiology, Istanbul, Turkey e-mail: drnursenkeles@yahoo.com.tr INTRODUCTION

Echocardiographic Epicardial Fat Thickness Measurement and Cardiovascular Risk Assessment in Patients with Systemic Lupus Erythematosus

received: 24.02.2016 Accepted: 06.04.2016 1Istanbul Medeniyet University, Göztepe Training and Research Hospital, Department of Cardiology 2Istanbul Medeniyet University, Göztepe Training and Research Hospital, Department of Internal Medicine 3Iskilip Atif Hoca State Hospital, Department of Cardiology Yazışma adresi: Nurşen Keleş, Istanbul Medeniyet University, Göztepe Training and Research Hospital, Department of Cardiology, Istanbul e-mail: drnursenkeles@yahoo.com.tr aBStract

Current Approaches to the Diagnosis and Treatment of Resistant Hypertension

Hipertansiyonu olan hastalar, lipid bozuklukları, glukoz tolerans bozukluğu veya diyabet, ailede erken kardiyovasküler olay öyküsü, obesite ve sigara içiciliği gibi diğer birçok risk faktörüne de sahiptirler. Hipertansiyon tanı ve tedavisine yönelik çok sayıda klavuz yayımlanmış olmasına rağmen, toplumların önemli bir kısmında hipertansiyon tedavisinde sınırlı bir başarı elde edilmiştir. Bu bağlamda tedavi altındaki hastaların yarısından daha az bir kısmında beklenen kan basıncı kontrolü elde edilebilmiştir1.

True Aneurysm of the Left Ventricle: An Unusual Location

Ventricular aneurysms mainly occur as a result of transmural myocardial infarction. In contrast to true aneurysms, which always contain myocardial elements in their walls, the walls of false aneurysms are composed of organized hematoma and pericardium. Therefore, false aneurysms are highly likely to rupture, and surgical treatment of these lesions is a priority. Hence, this type of aneurysm should be accurately diagnosed. Differentiation between these two pathologies remains difficult. Here we discuss an atypically located true aneurysm diagnosed by magnetic resonance imaging (MRI).

Imparied retrobulbar blood flow and increased carotid IMT in patients with Crohn's disease.

Crohn’s Disease [CD] is one of the Inflammatory Bowel Diseases that are chronic relapsing inflammatory diseases. Despite the major affected organ is intestine in CD, extra intestinal organs and tissues including cardiovascular system are also affected. Several studies have demonstrated that CD patients may have a higher risk of advancing atherosclerosis. The microvascular endothelial dysfunction plays an essential role for developing coronary atherosclerosis. Microvascular structural abnormalities in the retinal circulation may predict macrovascular events such as stroke and coronary heart disease. In order to assess the the microvascular circulation of the retina; retrobulbar blood flow velocities and resisitive indices [RI] of retrobulbar arteries are measured. The carotid intima media thickness [CIMT] correlates strongly with CV risk in the future. We aimed to investigate whether calculation of RI of retrobulbar arteries can be used as novel, easy and reproducible method to define atherosclerotic risk in CD patients along with CIMT. Thirty CD patients with remission period and thirty healthy volunteers were enrolled in the study. Measurement of carotid intima-media thickness and retrobulbar blood flow velocities were obtained with ultrasound scanner and colour Doppler ultrasonography. The RI of the OA [0.77 ± 0.06 vs. 0.65 ± 0.06, p < 0.001] and CIMT 0.52 [0.50–0.60] vs. 0.40 [0.40–0.50] in patients with CD was significantly higher than the control group. Increased OARI and CIMT values may reflect an increased risk of atherosclerosis and OARI measurement may be used as a screening test for microvascular circulation evaluation in patients with CD.