Talat Tavli

SERUM TESTOSTERONE, GROWTH HORMONE, AND INSULIN-LIKE GROWTH FACTOR-1 LEVELS, MENTAL REACTION TIME, AND MAXIMAL AEROBIC EXERCISE IN SEDENTARY AND LONG-TERM PHYSICALLY TRAINED ELDERLY MALES

The aim of the study was to investigate the effect of regular exercise on maximum oxygen uptake capacity (VO2max), reaction time (RT), testosterone (T), growth hormone (GH), insulin-like growth factor-I (IGF-I) in athletes compared to sedentary controls. VO2max, RT, T, GH, and IGF-I levels were 31.2 ± 6.2 ml/min/kg, 106.7 ± 23.2 s, 8.3 ± 1.3 ng/mL, 1.6 ± 0.7 ng/mL, 106.5 ± 27.0 ng/mL in master athlete group and 18.8 ± 5.1 ml/min/kg, 148.3 ± 39.3 s, 5.4 ± 1.7 ng/mL, 0.8 ± 0.3 ng/mL, 90.2 ± 23.8 ng/mL in sedentary control group, respectively. The differ-ences between regularly exercising males and the control group of sedentary males were found to be statistically significant. The results showed that long-term exercise decreased RT and increased VO2max, T, and GH in elderly males; elevated serum T and GH levels may be advantageous for brain functions

Detection of endothelial dysfunction in preeclamptic patients by using color Doppler sonography

Abstract. Our goal in this study was to detect endothelial function in normal and preeclamptic patients by using color Doppler sonography and plasma fibronectin levels. The increased ratio of the brachial artery diameter during shear stress, and plasma fibronectin levels were measured in 15 preeclamptic and 11 normal, gestational-age matched pregnant patients. The test was repeated at the postpartum second and sixth weeks in the preeclamptic group. In addition, the plasma fibronectin levels of all patients were measured. The increased ratios were 4.26±0.69% vs 12.18±1.97% in the preeclamptic and normal patients, respectively (P=0.003). At the second and sixth postpartum weeks, the ratios were 6.67±0.89% and 9.27±1.16% in the preeclamptic group, revealing a significant improvement in the sixth week (P=0.001). Fibronectin levels were 0.80±0.11xa0g/L vs 0.45±0.06xa0g/L in preeclamptic and normal patients (P=0.01). The correlation coefficient between the fibronectin levels and increase rate was r=-0.38 and P=0.05. We conclude that endothelial dysfunction, which is fundamental to preeclampsia, can be detected by using color Doppler sonography.

Cardiovascular risk factors and noninvasive assessment of arterial structure and function in obese Turkish children

Obesity is associated with a number of risk factors, such as hyperlipidemia, hyperinsulinemia, hypertension, and early atherosclerosis. Evidence indicates that atherosclerosis begins in childhood and progresses over decades. In this work, we examined the relationship between cardiovascular risk factors and ultrasonographic signs of subclinical atherosclerosis in 77 obese children and adolescents compared to 40 non-obese healthy peers. Carotis intima media thickness (cIMT), carotid artery compliance (CAC), brachial artery flow-mediated dilatation (FMD), and established cardiovascular risk factors were studied. In the obese patients, cIMT was significantly increased (0.57xa0mm vs 0.45xa0mm, pu2009<u20090.001) whereas CAC (1.84% vs 3.29%, pu2009<u20090.001) and FMD (9.67 % vs 14.81%, pu2009<u20090.001) were significantly decreased. In multiple linear regression analysis, a relation was observed between cIMT, CAC, brachial FMD on one hand, and body mass index (BMI) on the other. Among the lipid anomalies, only hypertriglyceridemia was found to be positively correlated with cIMT. Additionally, we found a significant association between waist circumference (WC) and FMD. These findings indicate that obesity in children is associated with arterial wall alterations and endothelial dysfunction. In hyperlipidemic situations, only hypertriglyceridemia was found to be positively correlated with cIMT. This finding has consistently indicated TG to be a risk factor for the development of atherosclerosis. To our knowledge this is the first study to determine the relation between FMD and WC, which is used as a parameter of obesity in childhood.

Spectral and Time-Domain Analyses of Heart-Rate Variability During Head-Upright Tilt-Table Testing in Children with Neurally Mediated Syncope

Neurocardiac syncope (NS) is a common cause of syncope in children. The mechanism, though related to abnormalities in autonomic function, has not been fully elucidated, particularly in pediatric patients. This study assessed the heart-rate variability (HRV) response to head-upright tilt-table test (HUT) in children with NS and normal volunteers. Spectral and time-domain analysis of HRV was used to assess changes in autonomic function in 27 children (9 male, mean age 12.3 ± 1.6 years) with a history of at least one episode of syncope and positive passive HUT and 27 age-matched normal volunteers with negative passive HUT before and during postural tilt and to attempt to relate such changes to specific types of hemodynamic response to tilt. Frequency-domain measurements of the high-(HF) and low-(LF) frequency bands and the ratio LF/HF were derived from Holter recordings and computed by fast Fourier analysis for 5-min intervals. Time-domain measurements of the SDNN, SDNNI, SDANN, RMSSD, and triangular index were derived from 24-h Holter recordings. There were no significant differences between clinical characteristics, time-domain, and basal frequency domain parameters of the groups. Mean values of LF and LF/HF ratio was increased and HF was decreased significantly in response to tilt in both patient and control groups. Mean values of LF and LF/HF ratio were higher and HF was lower compared to controls immediately after tilt. LF and LF/HF ratio showed a statistically significant decrease and a significant increase in HF during syncope in patients. The three subgroups of patients had similar patterns of changes in autonomic activity. The results of this study show that although the basal autonomic function was similar to that of the control group, patients with NS have a different pattern of response to the HUT. In our study, patients with NS demonstrated an exaggerated response to the HUT. This exaggerated response may be the factor that activates the pathological reflexes of NS. The pathological mechanism leading to NS appears to be independent of the specific type of hemodynamic response to HUT.

Effect of losartan on exercise tolerance and echocardiographic parameters in patients with mitral regurgitation.

Objectives. The aim of this study was to assess the effects of losartan treatment on exercise tolerance and echocardiographic parameters in patients with mitral regurgitation (MR) secondary to mitral valve prolapse or rheumatic heart disease. Methods. Twenty-seven patients (14 males, 13 females, mean age 51±11, range 21—76) with moderate MR due to mitral valve prolapse or rheumatic heart disease were examined by means of Doppler echocardiography.The subjects were submitted to treadmill exercise tests using the modified Bruce protocol at baseline, after six hours and after the six-week treatment period to be evaluated based on their exercise tolerance. Mitral Regurgitant Volume (MRV), effective regurgitant orifice diameter, left atrial volume, left ventricle (LV) end-diastolic volume index, LV end-systolic volume index, LV ejection fraction (LVEF), left ventricle mass index were calculated at baseline and after six weeks of treatment with single dose of losartan (50 mg/day). Results. Total treadmill exercise time increased from 477.7±147.9 to 535.7±149.0 seconds after six hours (p<0.01) and to 559.6±142.8 seconds after six weeks of treatment. Also, metabolic equivalent values increased following six hours of first dose and six weeks of losartan treatment (from 10.9±2.9 to R11.8±3.1, p=0.006 and 12.4±3.1, p=0.002; respectively). However, peak exercise systolic blood pressure (BP) was reduced after six hours and six weeks of treatment, and resting diastolic BP did not change after six hours but reduced at the end of the treatment period. MR volume decreased significantly from 29.3±14.1 ml to 25.1±14.8 ml, (p=0.025) without significant change in regurgitant orifice diameter (0.72±0.37 cm vs. 0.66±0.37 cm, p=NS), left atrium diameter and area while LVEF increased from 51.70±13.37 to 54.11—11.75 (p=0.015) with losartan. Conclusion. We conclude that the angiotensin II receptor antagonist losartan improves exercise tolerance and echocardiographic parameters in patients with moderate MR.

Effects of low-dose combination therapy with an angiotensin-converting enzyme inhibitor and a diuretic on flow-mediated vasodilation in hypertensive patients: a 6-month, single-center study

BACKGROUNDnCombination therapy with an angiotensin-converting enzyme (ACE) inhibitor and a diuretic has been shown to be highly effective in hypertension. Clinical trials have demonstrated that ACE inhibitors may improve endothelial cell dysfunction in hypertension. However, the effectiveness of the combination treatment in endothelial cell dysfunction is unknown.nnnOBJECTIVEnThis study investigated the effects of a new low-dose combination, perindopril 2 mg plus indapamide 0.625 mg, on brachial artery flow-mediated vasodilation (FMD) and left ventricular diastolic function in hypertension.nnnMETHODSnPatients aged 18 to 75 with newly diagnosed stage I or II hypertension were eligible. Endothelium-dependent brachial artery FMD and endothelium-independent vasodilation were assessed at baseline. Patients were treated with oral perindopril 2 mg plus indapamide 0.625-mg tablets once daily for 6 months. FMD measurements were then repeated. Percentage changes in FMD from baseline to 6 months, as well as left ventricular diastolic function parameters (isovolumic relaxation time [IVRT] and mitral diastolic E-wave deceleration time [EDT]), indicated the effectiveness of the intervention.nnnRESULTSnTwenty-nine Turkish patients were enrolled (17 women, 12 men; mean [SD] age, 54.5 [9.5] years [range, 38-75 years]). The mean (SD) baseline FMD was 7.00% (2.39%) (endothelial cell dysfunction) and increased significantly to 8.68% (2.78%) at 6 months (Pxa0=xa00.02); FMD improved in 15 patients (51.7%). At baseline and 6 months of therapy, mean (SD) IVRT was 101.7 (12.4) ms and 95.5 (7.7) ms, respectively (P<0.001), and EDT was 234.7 (33.9) ms and 217.9 (25.6) ms, respectively (P<0.001).nnnCONCLUSIONSnIn this small sample of hypertensive patients, a low-dose combination ACE inhibitor and diuretic significantly improved brachial artery FMD and left ventricular diastolic function. The improvement in FMD values was independent of the stage of hypertension. These findings suggest a relationship between improvement in endothelial cell function and diastolic function.

Diastolic spectrum of left-ventricular hypertrophy : The impact of etiology and coronary artery disease on Doppler transmitral velocity

UNLABELLEDnDiastolic filling of hypertrophied left ventricles has frequently been observed by Doppler methods. We hypothesized that filling characteristics in hypertrophy vary with etiology and concurrent ischemia. For patients with hypertrophy, the left-ventricular ejection fraction was > 0.47 +/- 0.16, end-diastolic pressure was > 15 +/- 2 mm Hg, end-diastolic volume index was < 96 +/- 12 ml/m2 and left-ventricular mass index was 127 +/- 7 g/m2. Peak E (early) and peak A (late) diastolic velocities and E-wave deceleration time, respectively, were as follows (significant unless otherwise indicated): normal subjects (NS), 79 +/- 9 and 82 +/- 19 cm/s, and 151 +/- 7 ms; cardiomyopathic hypertrophy, 63 +/- 16, 83 +/- 15 (NS) and 193 +/- 63, aortic stenosis without coronary disease, 110 +/- 10, 128 +/- 12 and 158 +/- 22 (NS); aortic stenosis with coronary disease, 57 +/- 12, 86 +/- 26 (NS) and 187 +/- 39; hypertension without coronary disease, 107 +/- 9, 128 +/- 9 and 143 +/- 22 (NS); hypertension with coronary disease, 58 +/- 12, 84 +/- 26 (NS) and 189 +/- 29.nnnCONCLUSIONSnHypertrophied left ventricles filled with two diastolic Doppler patterns: a relaxation abnormality with low peak E and delayed deceleration in hypertrophic cardiomyopathy, and a compliance abnormality with tall peak E and normal deceleration in pressure overload hypertrophy. When coronary artery disease occurred with pressure overload hypertrophy, impaired relaxation was the dominant pattern. Therefore, in addition to the known physiologic influences on diastolic filling, the etiology and presence of coronary artery disease modulate the configuration of transmitral velocities into hypertrophied ventricles.