Onur Sinan Deveci

Is psoriasis a pre-atherosclerotic disease? Increased insulin resistance and impaired endothelial function in patients with psoriasis

Backgroundu2002 Several studies have shown an association between psoriasis and atherosclerotic risk factors. In this study, we aimed to evaluate endothelial function by flow‐mediated dilation (FMD) and insulin resistance by Homeostasis model assessment‐insulin resistance (HOMA‐IR).

Aspirin Resistance Is Associated with Glycemic Control, the Dose of Aspirin, and Obesity in Type 2 Diabetes Mellitus

OBJECTIVEnAspirin resistance (AR) is increased in diabetic patients. It is not known whether glycemic control has effect on AR.nnnDESIGNnTo test the hypothesis that glycemic control might have influence on aspirin resistance, we measured aspirin resistance and glycated hemoglobin (HbA1c) in diabetic patients. We also measured aspirin resistance in nondiabetic subjects and compared the results with the diabetic group.nnnMETHODSnWe examined AR in 108 diabetic patients and 67 nondiabetic subjects with impedance platelet aggregometry. Glycemic control was evaluated according to both fasting blood glucose (FBG) and HbA1c levels.nnnRESULTSnAccording to the analyses, diabetic patients had significantly higher AR (P < 0.01), alanine aminotransferase (P < 0.005), and body mass index (P < 0.05) and significantly lower high-density lipoprotein cholesterol (P < 0.005) levels compared with nondiabetic controls. A correlation analysis revealed that AR was positively correlated with body mass index (r = 0.190, P < 0.01), fasting blood glucose (r = 0.224, P < 0.001), and HbA1c levels (r = 0.297, P < .0001). Using low-dose aspirin (100 mg/d) was a risk factor for aspirin-resistant status in both diabetic patients (odds ratio 1.26, 95% confidence interval 1.01-1.58, P < 0.05) and overall study group (odds ratio 1.3, 95% confidence interval 1.08-1.56, P < 0.01).nnnCONCLUSIONSnThese data suggest that glycemic control, obesity, and the dose of aspirin have influence on AR in diabetic subjects. Further studies with larger groups are needed to clarify the role of glycemic control on AR.

Permanent Pacemaker and Implantable Cardioverter Defibrillator Infections: Seven Years of Diagnostic and Therapeutic Experience of a Single Center

Increasing evidence‐based indications for the implantation of permanent pacemakers (PMs) and implantable cardioverter defibrillators (ICDs) have led to an increase in the rate of device infections. The aim of the present study was to evaluate infection frequency, clinical characteristics, risk factors, and microbiologic and therapeutic features in patients with PM/ICD infections.

Clinical and echocardiographic correlates of improvement in left ventricular diastolic function after cardiac resynchronization therapy

AIMSnCardiac resynchronization therapy (CRT) improves systolic function in heart failure (HF). However, the effects of CRT on left ventricular (LV) diastolic function are not fully understood. The aim of this study was to determine clinical and echocardiographic correlates of improvement in LV diastolic function after CRT.nnnMETHODS AND RESULTSnFifty-four patients (mean age, 61.9 +/- 10.5; 43 men; mean LV ejection fraction 24.6 +/- 4.0%) with severe HF were enrolled in the study. Pulsed-wave Doppler-derived mitral inflow indices and colour M-mode flow propagation velocities were obtained. Tissue Doppler imaging included measurements of systolic and diastolic (e) velocities at four mitral annular sites and mitral E/e ratio for estimating LV filling pressure. Plasma brain natriuretic peptide (BNP) levels were assessed 1 day before the CRT. Response to CRT was defined as a decline in LV end-systolic volume > or =10%. In responder group, septal E/e (18.66 +/- 8.78 vs. 12.81 +/- 5.95, P < 0.01), E/Vp (2.44 +/- 1.10 vs. 1.59 +/- 0.65, P < 0.001), left atrial volume index (43.95 +/- 17.73 vs. 41.99 +/- 18.24 mL/m(2), P < 0.001), and plasma BNP levels [270.5 (20-2766) vs. 47.2 pg/mL (8-802)] decreased significantly. There was no significant difference in indices of diastolic function and plasma BNP levels among non-responders. Spearmans correlation analyses revealed a negative correlation between decline in plasma BNP levels and Deltaseptal E/e (r = -0.517, P = 0.001), Deltamitral E/Vp (r = -0.650, P = 0.001), and DeltaLAVI (r = -0.505, P = 0.001), respectively.nnnCONCLUSIONnLeft ventricular diastolic indices after CRT improved in the responder group, but there was no significant change in these indices among non-responders. Left ventricular diastolic performance after CRT is associated with the decline in BNP levels.

A Novel Echocardiographic Marker in Hypertensive Patients: Is Diastolic Dysfunction Associated With Atrial Electromechanical Abnormalities in Hypertension?

J Clin Hypertens (Greenwich). 2010;12:687–692. ©2010 Wiley Periodicals, Inc.

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

Background:u2002 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.

Evaluation of early atherosclerosis markers in patients with nonalcoholic fatty liver disease.

Objectives Nonalcoholic fatty liver disease (NAFLD) is characterized by the excessive accumulation of fat in the liver cells. It is strongly associated with cardiovascular risk factors for atherosclerosis. Flow-mediated dilation (FMD) and carotid intima-media thickness (CIMT) are noninvasive methods for the evaluation of endothelium. They are considered early markers of atherogenesis. The aim of this study was to evaluate early atherosclerosis markers in patients with NAFLD. Methods We examined 161 patients. All the patients underwent hepatic ultrasonography, transthoracic echocardiography, and brachial artery and carotid artery imaging. Fasting blood samples were drawn from all patients for the determination of lipids, insulin, C-peptide, and fasting blood glucose. HOMA-IR was calculated. Results Among the 161 patients, 44 had normal hepatic ultrasonography, 42 had stage 1 hepatosteatosis, 53 had stage 2 hepatosteatosis and 22 had stage 3 hepatosteatosis. FMD was reduced in patients with NAFLD as compared with the healthy controls (5.9±3.1 vs. 9.6±2.7%, P<0.001). There was a significant negative moderate correlation between ultrasonographic hepatosteatosis grade and FMD (r=−0.556, P<0.001). The mean CIMT was significantly increased in patients with NAFLD as compared with the controls (0.40±0.19 vs. 0.27±0.18, P<0.001). There was a significant positive weak correlation between ultrasonographic hepatosteatosis grade and mean CIMT (r=0.376, P<0.001). Conclusion This study showed that NAFLD is associated with impaired CIMT and FMD, which are early markers of atherosclerosis. These findings may play a crucial role in understanding the pathophysiology of the atherosclerotic process in patients with NAFLD.

The reproducibility of heart rate recovery after treadmill exercise test.

Background: Although predictive value of heart rate recovery (HRR) has been tested in large populations, the reproducibility of HRR in treadmill exercise test has not been assessed prospectively. This prospective study examined whether HRR index has test–retest stability in the short term.

Relationship between atrial septal aneurysms and atrial electromechanical delay.

Atrial septal aneurysm (ASA) is a saccular deformity located in the atrial septum. Atrial arrhythmias are common in patients with ASA. Atrial electromechanical delay (AEMD) can be used to evaluate development of atrial arrhythmias in various settings. The aim of the study was to investigate the relationship between ASA, cardiac arrhythmias and AEMD. Seventy patients with ASA served as the study group (30 men; mean age, 33.6xa0±xa010.9xa0years) and 70 healthy volunteers served as the control group (34 men; mean age, 31.4xa0±xa07.8xa0years). ASAs were diagnosed by transthoracic echocardiography based on the criteria of a minimal aneurysmal base of ≥15xa0mm; and an excursion of ≥10xa0mm. Inter-AEMD and intra-AEMDs of both atrium were measured from parameters of tissue Doppler imaging. There was no significant difference between the study and control groups in terms of age, gender, left atrium diameter, and left ventricular ejection fraction. Inter-AEMD (50.7xa0±xa022.5xa0ms vs. 36.9xa0±xa012.0xa0ms) and intra-left AEMD (44.6xa0±xa017.4xa0ms vs. 30.7xa0±xa011.6xa0ms) were significantly higher in patients with ASA with respect to control group. Inter-AEMD (63.6xa0±xa020.1xa0ms vs. 45.1xa0±xa021.5xa0ms, Pxa0=xa00.001), intra-left AEMD (55.3xa0±xa015.6xa0ms vs. 40.1xa0±xa016.2xa0ms, Pxa0=xa00.001), diameter of the ASA (19.9xa0±xa03.6xa0mm vs. 17.1xa0±xa02.7xa0mm, Pxa0=xa00.001) and P wave dispersion (18.5xa0±xa06.7xa0ms vs. 11.8xa0±xa07.3xa0ms, Pxa0=xa00.001) were significantly greater in the subgroup with arrhythmias compared to the subgroup without arrhythmias. Inter-AEMD and intra-left AEMD were found to be significantly prolonged in patients with ASA. Being a non-invasive, inexpensive and simple technique AEMD may provide significant contributions to assess the risk for paroxysmal supraventricular arrhythmia in patients with ASA.

The Relationship Between Microalbuminuria and the Presence and Extent of Coronary Atherosclerosis

Objective: To evaluate the relationship between microalbuminuria (MA) and the presence and extent of coronary artery disease (CAD). Methods: Four hundred and two consecutive patients were divided into 4 groups based on the presence of diabetes mellitus (DM) and MA: DM(+)/MA(+), DM(+)/MA(-), DM(-)/MA(+), and DM(-)/MA(-). Severity of CAD was assessed by the Gensini scoring system. Results: The Gensini score was 57 ± 38.2 vs 16.5 ± 19.5 (P < .001) in the DM(+)/MA(+) and DM(+)/MA(-) groups and 45 ± 39.8 vs 9.9 ± 16.6 (P < .001) in the DM(-)/MA(+) and DM(-)/MA(-) groups. Spearman correlation analysis demonstrated a positive relation between urine albumin/creatinine ratio (ACR) and extent of CAD both in the diabetic and nondiabetic patients (r = .584, P = .001; r = .545, P = .001). Microalbuminuria was found to be an independent predictor for the presence (OR for MA: 3.728; 95% CI, 1.931-7.196; P < .001) and severity of CAD (P < .001, β = .563). Conclusion: A strong relationship between MA and the severity of CAD was reported.