Omer Gedikli

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.

Intra-left ventricular systolic asynchrony in patients with overt hyperthyroidism

Hyperthyroidism causes a variety of adverse effects on the cardiovascular system. Left ventricular (LV) asynchrony is defined as loss of the simultaneous peak contraction of corresponding cardiac segments. The aim of this study was to assess systolic asynchrony in patients with overt hyperthyroidism. Asynchrony was evaluated in 27 patients with overt hyperthyroidism and 21 controls. All the patients and controls were subjected to a tissue synchronization imaging (TSI). The time to regional peak systolic tissue velocity (Ts) in LV by the six-basal-six-mid-segmental model was measured on ejection phase TSI images and four TSI parameters of systolic asynchrony were computed. All TSI parameters of LV asynchrony increased in hyperthyroid patients compared to controls: the standard deviation (SD) of the 12 LV segments Ts (35.7xa0±xa014.4 vs 20.1xa0±xa010.1, Pxa0<xa00.0001); the maximal difference in Ts between any 2 of the 12 LV segments (111.9xa0±xa040.7 vs 65.9xa0±xa030.7, Pxa0<xa00.0001); the SD of the 6 basal LV segments (31.2xa0±xa018.2 vs 16.8xa0±xa09.7, Pxa0=xa00.01); and the maximal difference in Ts between any 2 of the 6 basal LV segments (76.6xa0±xa042.0 vs 44.4xa0±xa025.7, Pxa0=xa00.005). Patients with overt hyperthyroidism present evidence of LV asynchrony by TSI.

Mitral annular velocity by Doppler tissue imaging for the evaluation of atrial stunning after cardioversion of atrial fibrillation

Objective Atrial and/or appendage stunning (AS) usually occur after successful cardioversion of atrial fibrillation (AF). Several parameters except mitral annular velocity were previously evaluated to determine AS. We investigated whether mitral annular velocity was useful for determining of AS. Methods This study consisted of 52 consecutive patients with AF <3xa0months who converted to the sinus rhythm. Mitral inflow and annular velocities were measured before and after cardioversion. Left atrial appendage (LAA) size and flow were assessed. The average velocity of septal and lateral segments of mitral annulus was considered as the final annular velocity. Thrombus and/or spontaneous echo contrast (SEC) were also investigated. Results Of 52 patients, 29 (56%) had AS but 23 did not. There was no significant difference in age, gender, and cardioversion type between two groups. Hypertension was more prevalent in patients without AS compared to those with AS (Pxa0=xa00.02). Mitral annular systolic and E-wave velocities were comparable in both groups (Pxa0>xa00.05). Mitral annular A-wave velocity (3.1xa0±xa02.9 vs. 7.1xa0±xa02.2xa0cm/s, Pxa0<xa00.001), and its velocity-time integral (0.27xa0±xa00.22 vs. 0.74xa0±xa00.19xa0cm, Pxa0<xa00.001) were significantly lower in patients with AS compared with those without AS. The annular A-wave velocity ≤3.3xa0cm/s predicted AS with a sensitivity of 59% and specificity of 76%. It was correlated with mitral inflow A velocity (rxa0=xa00.85, Pxa0<xa00.001), LAA emptying velocity (rxa0=xa00.41, Pxa0=xa00.003) and presence of SEC (rxa0=xa0−0.52, Pxa0<xa00.001). Conclusion After cardioversion of AF, mitral annular A-wave velocity may be a new marker to determine AS.

Impairment in flow-mediated vasodilatation of the brachial artery in acromegaly.

Objective: The aim of this study was to assess flow-mediated dilatation (FMD) of the brachial artery in patients with acromegaly. Subjects and Methods: We prospectively evaluated 25 patients with acromegaly (14 females, 11 males; aged 42 ± 12 years; growth hormone (GH) levels 34 ± 14 ng/ml) and 27 control subjects (15 females, 12 males; aged 45 ± 8 years; GH levels 3 ± 1.5 ng/ml). The patients and controls were matched for age, gender, body mass index, cigarette smoking, blood pressure, lipid levels, diabetes mellitus, hypertension, and its duration. Endothelial function, measured as FMD of the brachial artery using ultrasound, was calculated in the 2 groups. The endothelial function was evaluated by assessing 1-min postischemic FMD of the brachial artery. Results: The FMD was lower in patients with acromegaly (9.97 ± 3.5%) than in controls (16.1 ± 3.4%), and the difference was statistically significant (p = 0.0001). Conclusion: Endothelial dysfunction may develop in the preclinical phase of atherosclerosis in patients with acromegaly. Endothelium-dependent FMD may be impaired in acromegalic patients, and measurement of endothelial function may identify high-risk individuals earlier.

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.

The relationship between epicardial fat tissue thickness and frequent ventricular premature beats

BACKGROUNDnVentricular premature beats (VPBs) are one of the most common rhythm abnormalities. Structural heart diseases such as myocardial hypertrophy and left ventricular dysfunction are associated with VPBs. However, the exact mechanism of VPBs in patients without structural heart disease has not been revealed yet. Epicardial fat tissue (EFT) is a visceral fat around the heart. Increased EFT thickness is associated with myocardial structural and ultrastructural myocardial abnormalities, which may play a role in the development of VPBs.nnnAIMSnTo evaluate the possible relationship between EFT thickness and frequent VPBs.nnnMETHODS AND RESULTSnThe study population consisted of 50 patients with VPBs and 50 control subjects. Frequent VPBs were defined as the presence of more than 10 beats per hour assessed by 24-h Holter electrocardiography monitoring. EFT thickness was measured by transthoracic echocardiography. Multivariable logistic regression analysis was used to assess factors related with frequent VPBs. Baseline demographic and biochemical features including age, gender, and rates of hypertension and diabetes mellitus were similar in both groups. EFT thickness was significantly higher in patients with frequent VPBs than in controls (3.3 ± 1.3 mm vs. 2.2 ± 0.8 mm, p < 0.001). In multivariable logistic regression analysis, EFT thickness was independently associated with VPB frequency (B = 1.030, OR = 2.802, p < 0.001).nnnCONCLUSIONSnPatients with frequent VPBs had increased EFT thickness compared to control subjects. EFT thickness was independently associated with frequent VPBs.