Selen Yurdakul

Evaluation of the effect of L-thyroxin therapy on endothelial functions in patients with subclinical hypothyroidism

Subclinical hypothyroidism (SH) is characterized by normal serum free T4 (FT4), free T3 (FT3) levels and increased serum thyroid-stimulating hormone (TSH) levels. Endothelial dysfunction, which is an early step of atherosclerosis, has been reported in patients with subclinical hypothyroidism. The aim of this study is to evaluate endothelial functions and the effect of l-thyroxin (L-T4) therapy on endothelial functions in SH. Twenty-seven patients with SH and 22 healthy controls were evaluated in terms of endothelial functions, using brachial artery Doppler ultrasonography. After restorating euthyroidism, measurements were repeated. Baseline and nitroglycerin induced diameter (NID) of brachial artery were similar in patients with SH and the control group. Compared to the control group, the patients with SH showed significantly reduced flow-mediated diameter (FMD). Baseline and NID values were significantly higher after LT4 therapy in SH group. FMD also significantly increased after LT4 therapy. Hypothyroidism accelerates atherogenesis through modification of athero-sclerotic risk factors and direct effects on the blood vessels. In this study, we observed marked improvement in endothelial functions after L-T4 therapy in SH patients. We suggest that thyroid hormone replacement therapy may help to prevent atherosclerosis in this group of patients.

Vascular endothelial function assessed by a noninvasive ultrasound method and serum asymmetric dimethylarginine concentrations in mild-to-moderate plaque-type psoriatic patients

OBJECTIVES Our aim was to evaluate vascular endothelial function assessed by serum asymmetric dimethylarginine (ADMA) concentrations and noninvasive ultrasonographic parameters such as flow-mediated dilatation (FMD) and nitroglycerin-induced dilatation (NID) in mild-to-moderate plaque-type psoriatic patients, as rated by the Psoriasis Area and Severity Index. DESIGN AND METHODS Plaque-type psoriatic patients (n = 29) diagnosed with clinical and/or histopathological findings and control subjects (n = 25) without skin and systemic metabolic diseases were included in the study. RESULTS There was no statistically significant difference between patients and control subjects in respect to FMD (p = 0.441), NID (p = 0.557), or serum ADMA concentrations (p = 0.225). Also, among the acute-phase reactants, serum C-reactive protein and plasma fibrinogen levels were moderately higher in patients when compared to control subjects (p = 0.008 and p = 0.011, respectively). CONCLUSIONS Mild-to-moderate plaque-type psoriatic patients with low-to-medium grade systemic inflammation did not have evidence of vascular endothelial function.

Evaluation of the eff ect of L-thyroxin therapy on cardiac functions by using novel tissue Doppler-derived indices in patients with subclinical hypothyroidism

Objectives Subclinical hypothyroidism (SH) is characterized by normal serum free T4 (fT4), free T3 (fT3) levels and increased serum thyroid stimulating hormone (TSH) levels. The aim of this study was to assess the validity of tissue Doppler imaging (TDI) in evaluating cardiac eff ects of SH and to demonstrate the improving eff ects of L-thyroxin(L-T4) on TDI parameters. Methods Twenty-seven patients with SH and 22 healthy controls were evaluated by standard echocardiography and TDI. TDI-derived systolic velocities [isovolumic myocardial acceleration (IVA), peak myocardial velocity during isovolumic contraction (IVV), peak systolic velocity during ejection period (Sa)] and diastolic indices (peak early (Ea) and late diastolic (Aa) velocities, Ea/Aa, E/Ea ratios and Tei index) were measured. After restoring euthyroidism, all measurements were repeated. Results At baseline, left ventricular (LV) systolic velocities (IVV and IVA) and diastolic indices were signifi cantly impaired in the SH group. After L-T4 therapy, left ventricular systolic and diastolic functions were improved. Right ventricular (RV) systolic velocities were similar between the study group and the healthy controls but diastolic functions were impaired in the SH group, at baseline. Tei index of the RV was improved after L-T4 therapy. RV IVA remained unchanged after hormone replacement therapy. Conclusions SH is associated with biventricular systolic and diastolic dysfunction. IVA which is an accurate estimate of subclinical systolic dysfunction, was signifi cantly impaired in the left ventricle and had improved after L-T4 therapy. We found that IVA is able to detect early eff ects of subclinical hypothyroidism on LV systolic functions and L-T4 therapy can improve ventricular functions.

Doppler ultrasound imaging of the carotid and vertebral arteries

The prevalence of carotid artery diseases increases with age and exposure to cardiovascular risk factors. Significant carotid artery stenosis is closely associated with the development of stroke and cerebrovascular events. Doppler ultrasound imaging is a noninvasive and useful modality for the examination of carotid and vertebral arteries. However, proper investigation of the carotid artery system requires sufficient technical knowledge and experience. This review gives information about the techniques of appropriate examination of the carotid artery system.

Diagnostic algorithms in pulmonary hypertension

Pulmonary hypertension is a serious disease with a poor prognosis. The diagnosis and assessment of pulmonary hypertension is evolving rapidly with changes in the definition of the disease, diagnostic techniques and follow-up assessment. Different conditions associated with pulmonary hypertension and new diagnostic techniques have led to a need for a systematic diagnostic approach. This review article presents an update on alterations in the diagnostic algorithm.

Unexpected diagnosis in a liver donor candidate

Liver transplantation from living donors is a legal procedure in Turkey. The patient’s spouse and relatives within the fourth degree of consanguinity or affinity can be donors. During the surgery, about 40-60% of the donor’s liver is removed. A 38-year-old female liver donor candidate was referred to our cardiology clinic for preoperative evaluation. The patient had no symptoms. On physical examination, a grade 2/6 early diastolic murmur was heard at the third left sternal intercostal space. Her blood pressure was 140/70 mmHg. Transthoracic echocardiography revealed moderate aortic regurgitation (AR) with the suspicion of quadricuspid aortic valve (QAV). Left ventricular end-diastolic and endsystolic diameters were 5.6 cm and 4.0 cm, respectively. Ejection fraction was normal. Transesophageal echocardiography confirmed the diagnosis of QAV with four equal cusps (Type A) (Figures 1 and 2, Video 1) with moderate AR (Figure 3). The patient was removed from the donor list with a suggestion for regular outpatient cardiology clinic visits. Quadricuspid aortic valve is a rare congenital cardiac anomaly that is mostly diagnosed incidentally. AR usually develops due to fibrosis and incomplete coaptation of the