Tarik Kivrak

Neutrophil to lymphocyte and platelet to lymphocyte ratio in patients with dipper versus non-dipper hypertension

Abstract Background: Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are associated with worse outcome in various diseases. Non-dipping blood pressure pattern is associated with higher cardiovascular mortality. The aim of this study was to explore the association between NLR and PLR in patients with dipper versus non-dipper hypertension. Methods: The study included 166 patients with hypertension. Eighty-three patients (40 male, mean age: 49.1 ± 10.5 years) had dipper hypertension, while 83 patients (41 male, mean age: 52.3 ± 12.7 years) had non-dipper hypertension. Results: Baseline demographic characteristics were similar in both groups. Patients with non-dipper hypertension had significantly higher NLR compared to dipper hypertension (2.3 ± 0.9 versus 1.8 ± 0.5, p < 0.001). Patients with non-dipper hypertension had significantly higher PLR compared to dipper hypertension (117.7 ± 35.2 versus 100.9 ± 30.5, p = 0.001). In univariate analysis, hyperlipidemia, smoking, presence of diabetes, PLR more than 107 and NLR more than 1.89 were among predictors of dipper and non-dipper status. In logistic regression analyses, only hyperlipidemia (odds ratio: 2.96, CI: 1.22–7.13) and PLR more than 107 (odds ratio: 2.62, CI: 1.13–6.06) were independent predictors of dipper and non-dipper status. A PLR of 107 or higher predicted non-dipper status with a sensitivity of 66.3% and specificity of 68.7%. Conclusion: We demonstrated that patients with non-dipper hypertension had significantly higher NLR and PLR compared to dipper hypertension, which has not been reported previously. Moreover PLR more than 107 but not NLR was independent predictor of non-dipper status.

Arterial stiffness in patients with non-alcoholic fatty liver disease is related to fibrosis stage and epicardial adipose tissue thickness

OBJECTIVE Non-alcoholic fatty liver disease (NAFLD) is associated with atherosclerosis and reduced vascular compliance. The purpose of this study was to examine the relationships between arterial stiffness measures, the histological severity of NAFLD, and epicardial fat thickness (EFT). METHODS A total of 100 patients with biopsy-proven NAFLD and 50 age- and sex-matched controls were enrolled. The histological severity was assessed in all NAFLD patients. Measurements of arterial stiffness [pulse-wave velocity (PWV) and augmentation index (AIx)] were carried out using a Mobil-O-Graph arteriograph system. EFT was assessed by means of echocardiography. RESULTS Compared with controls, NAFLD patients had significantly higher PWV and AIx values. Stepwise linear regression analysis demonstrated that the liver fibrosis score and EFT were independent predictors of both PWV and AIx values in NAFLD patients. CONCLUSIONS Patients with NAFLD have an increased arterial stiffness, which reflects both the severity of liver fibrosis and increased EFT values.

Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio are Predictors of Heart Failure

Background Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are inflammatory markers used as prognostic factors in various diseases. The aims of this study were to compare the PLR and the NLR of heart failure (HF) patients with those of age-sex matched controls, to evaluate the predictive value of those markers in detecting HF, and to demonstrate the effect of NLR and PLR on mortality in HF patients during follow-up. Methods This study included 56 HF patients and 40 controls without HF. All subjects underwent transthoracic echocardiography to evaluate cardiac functions. The NLR and the PLR were calculated as the ratio of neutrophil count to lymphocyte count and as the ratio of platelet count to lymphocyte count, respectively. All HF patients were followed after their discharge from the hospital to evaluate mortality, cerebrovascular events, and re-hospitalization. Results The NLR and the PLR of HF patients were significantly higher compared to those of the controls (p < 0.01). There was an inverse correlation between the NLR and the left ventricular ejection fraction of the study population (r: -0.409, p < 0.001). The best cut-off value of NLR to predict HF was 3.0, with 86.3% sensitivity and 77.5% specificity, and the best cut-off value of PLR to predict HF was 137.3, with 70% sensitivity and 60% specificity. Only NLR was an independent predictor of mortality in HF patients. A cut-off value of 5.1 for NLR can predict death in HF patients with 75% sensitivity and 62% specificity during a 12.8-month follow-up period on average. Conclusion NLR and PLR were higher in HF patients than in age-sex matched controls. However, NLR and PLR were not sufficient to establish a diagnosis of HF. NLR can be used to predict mortality during the follow-up of HF patients.

Right ventricular and atrial functions in systemic sclerosis patients without pulmonary hypertension

BackgroundSystemic sclerosis (SSc) is a systemic connective tissue disease and cardiac involvement is one of the most important causes of death. Right ventricular (RV) systolic dysfunction is a poor prognostic finding in SSc patients. Assessment of RV function has some difficulties because of its crescent shape and extensive trabeculations. Two-dimensional (2D) speckle-tracking echocardiography (STE) is an angle-independent quantitative technique to evaluate myocardial function. The aim of this study was to assess the RV and right atrial (RA) functions of SSc patients without pulmonary hypertension by using 2D STE.Patients and methodsA total of 40 patients with SSc (mean age 48.5 ± 11.4 years, 28 female) and 40 healthy volunteers (mean age 45.9 ± 7.6 years, 21 female) were included in the study. All subjects underwent transthoracic echocardiography for evaluation of RV and RA functions with 2D STE.ResultsAlthough left ventricular systolic and diastolic functions, systolic pulmonary artery pressure (PAP), and RA measurements were similar in both groups, tricuspid annular plane systolic excursion (TAPSE) and maximum systolic myocardial velocity (S’) were decreased in SSc patients. The RV free wall global longitudinal strain (GLS) of SSc patients was lower than the controls (− 18.5 ± 4.9 % vs. − 21.8 ± 2.4 %, p < 0.001) and the RA reservoir and conduit functions were also decreased in SSc patients compared with controls (34.4 ± 9.9 % vs. 39.7 ± 11.2 %, p = 0.027 and 15.0 ± 5.7 % vs. 18.7 ± 6.4 %, p = 0.009, respectively). Disease duration was inversely correlated with RVGLS and TAPSE (r: − 0.416, p = 0.018 and r: − 0.383, p = 0.031, respectively).ConclusionThe use of 2D STE can be helpful in the detection of impairment in RV and RA functions in SSc patients with normal PAP.ZusammenfassungHintergrundDie systemische Sklerose (SSc) ist eine systemische Bindegewebserkrankung, und die Herzbeteiligung stellt eine der Haupttodesursachen dar. Eine rechtsventrikuläre (RV) systolische Funktionseinschränkung ist ein Befund, der bei SSc-Patienten für eine schlechte Prognose steht. Die Untersuchung der RV-Funktion ist aufgrund der Halbmondform und ausgedehnter Trabekulierungen des RV schwierig. Die zweidimensionale (2-D-)Speckle-Tracking-Echokardiographie (STE) ist eine winkelunabhänigige quantitative Untersuchungstechnik für die Myokardfunktion. Ziel dieser Studie war es, die Funktion des RV und des rechten Vorhofs (RA) bei SSc-Patienten ohne pulmonale Hypertonie mittels 2-D-STE zu ermitteln.Patienten und MethodenIn die Studie wurden 40 Patienten mit SSc (Durchschnittsalter: 48,5 ± 11,4 Jahre, 28 w) und 40 gesunde Kontrollen (Durchschnittsalter: 45,9 ± 7,6 Jahre, 21 w) aufgenommen. Bei allen Teilnehmern wurden die RV- und RA-Funktion mittels transthorakaler Echokardiographie in Kombination mit 2-D-STE untersucht.ErgebnisseDie linksventrikuläre systolische und diastolische Funktion, der systolische Pulmonalarteriendruck (PAP) und die RA-Messungen waren in beiden Gruppen zwar ähnlich, aber die systolische Exkursion auf der Ebene des Trikuspidalrings (TAPSE) und die maximale systolische Myokardgeschwindigkeit (S‘) waren bei SSc-Patienten vermindert. Der globale longitudinale Strain (GLS) der freien RV-Wand war bei SSc-Patienten geringer als bei den Kontrollen (− 18,5 ± 4,9 % vs. − 21,8 ± 2,4 %; p < 0,001) und auch die Reservoir- und Conduitfunktion war bei den SSc-Patienten gegenüber den Kontrollen vermindert (34,4 ± 9,9 % vs. 39,7 ± 11,2 %; p = 0,027 bzw. 15,0 ± 5,7 % vs. 18,7 ± 6,4 %; p = 0,009). Die Krankheitsdauer stand in inverser Korrelation mit dem RV-GLS und TAPSE (r − 0,416; p = 0,018 bzw. r − 0,383; p = 0,031).SchlussfolgerungDer Einsatz der 2-D-STE könnte zur Erkennung einer Einschränkung der RV- und RA-Funktion bei SSc-Patienten mit normalem PAP von Nutzen sein.

Evaluation of Alexithymia, Somatosensory Sensitivity, and Health Anxiety Levels in Patients with Noncardiac Chest Pain

Objective. Noncardiac chest pain (NCCP) is seen more frequently in young population and in these patients loss of function is evolving in social and professional areas. The aim of the study is to evaluate the levels of anxiety and somatic perception in patients with chest pain presenting to cardiology clinic. Methods. Fifty-one patients with noncardiac chest pain and 51 healthy controls were included in the study. All participants performed self-report based health anxiety inventory (HAI), somatosensory amplification scale (SAS), and Toronto alexithymia scale (TAS). Results. The patient group had significantly higher scores on the SAS, HAI-1, and HAI-T scales compared to controls (P < 0.001, P = 0.006, and P = 0.038, resp.). SAS, HAI-1, and HAI-T scores were significantly higher in female patients than male (P = 0.002, 0.036, and 0.039, resp.). There were significant differences in all TAS subscale scores between two groups. Patients, who had total TAS score more than 50, also presented higher levels of health anxiety (P = 0.045). Conclusions. Anxiety, somatic symptoms, and the exaggerated sense of bodily sensations are common in patients with NCCP. These patients unnecessarily occupy the cardiology outpatient clinics. These negative results can be eliminated when consultation-liaison psychiatry evaluates these patients in collaboration with cardiology departments.

Relation of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratio with coronary artery disease severity in patients undergoing coronary angiography.

BACKGROUND Atherosclerosis is a chronic systemic inflammatory disease. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are systemic inflammatory markers that are correlated with poor cardiovascular outcomes. AIM To explore the relation of NLR and PLR with severity of coronary artery disease (CAD). METHODS The study population consisted of 180 consecutive patients who underwent elective coronary angiography (CAG). While 100 patients (22 female, mean age: 60.6 ± 12.6 years) had abnormal CAG, 80 patients (44 female, mean age: 57.2 ± 10.9 years) had normal CAG. NLR and PLR were calculated as the ratio of neutrophil count to lymphocyte count and as the ratio of platelet count to lymphocyte count, respectively. RESULTS Although age distribution was similar between the two groups (p = 0.073), female gender was significantly higher in the normal CAG group (p < 0.001). Patients with abnormal CAG had significantly higher NLR and PLR when compared to patients with normal CAG (3.7 ± 2.6 vs. 2.2 ± 1.7, p < 0.001 and 125.9 ± 72.3 vs. 102.6 ± 33.8, p = 0.027, respectively). NLR and PLR were significantly correlated with SYNTAX score and GENSINI score. In logistic regression analyses, only NLR (odds ratio: 1.576, confidence interval: 1.198-2.072, p = 0.001) was an independent predictor of CAD. An NLR of 2.3 or higher predicted the CAD with a sensitivity of 66% and specificity of 70%. CONCLUSIONS NLR and PLR seem to be a simple method to predict severity of CAD in patients undergoing elective CAG, and it may be part of cardiovascular examination before CAG.

Right ventricular and atrial functions in systemic sclerosis patients without pulmonary hypertension. Speckle-tracking echocardiographic study.

BackgroundSystemic sclerosis (SSc) is a systemic connective tissue disease and cardiac involvement is one of the most important causes of death. Right ventricular (RV) systolic dysfunction is a poor prognostic finding in SSc patients. Assessment of RV function has some difficulties because of its crescent shape and extensive trabeculations. Two-dimensional (2D) speckle-tracking echocardiography (STE) is an angle-independent quantitative technique to evaluate myocardial function. The aim of this study was to assess the RV and right atrial (RA) functions of SSc patients without pulmonary hypertension by using 2D STE.Patients and methodsA total of 40 patients with SSc (mean age 48.5 ± 11.4 years, 28 female) and 40 healthy volunteers (mean age 45.9 ± 7.6 years, 21 female) were included in the study. All subjects underwent transthoracic echocardiography for evaluation of RV and RA functions with 2D STE.ResultsAlthough left ventricular systolic and diastolic functions, systolic pulmonary artery pressure (PAP), and RA measurements were similar in both groups, tricuspid annular plane systolic excursion (TAPSE) and maximum systolic myocardial velocity (S’) were decreased in SSc patients. The RV free wall global longitudinal strain (GLS) of SSc patients was lower than the controls (− 18.5 ± 4.9 % vs. − 21.8 ± 2.4 %, p < 0.001) and the RA reservoir and conduit functions were also decreased in SSc patients compared with controls (34.4 ± 9.9 % vs. 39.7 ± 11.2 %, p = 0.027 and 15.0 ± 5.7 % vs. 18.7 ± 6.4 %, p = 0.009, respectively). Disease duration was inversely correlated with RVGLS and TAPSE (r: − 0.416, p = 0.018 and r: − 0.383, p = 0.031, respectively).ConclusionThe use of 2D STE can be helpful in the detection of impairment in RV and RA functions in SSc patients with normal PAP.ZusammenfassungHintergrundDie systemische Sklerose (SSc) ist eine systemische Bindegewebserkrankung, und die Herzbeteiligung stellt eine der Haupttodesursachen dar. Eine rechtsventrikuläre (RV) systolische Funktionseinschränkung ist ein Befund, der bei SSc-Patienten für eine schlechte Prognose steht. Die Untersuchung der RV-Funktion ist aufgrund der Halbmondform und ausgedehnter Trabekulierungen des RV schwierig. Die zweidimensionale (2-D-)Speckle-Tracking-Echokardiographie (STE) ist eine winkelunabhänigige quantitative Untersuchungstechnik für die Myokardfunktion. Ziel dieser Studie war es, die Funktion des RV und des rechten Vorhofs (RA) bei SSc-Patienten ohne pulmonale Hypertonie mittels 2-D-STE zu ermitteln.Patienten und MethodenIn die Studie wurden 40 Patienten mit SSc (Durchschnittsalter: 48,5 ± 11,4 Jahre, 28 w) und 40 gesunde Kontrollen (Durchschnittsalter: 45,9 ± 7,6 Jahre, 21 w) aufgenommen. Bei allen Teilnehmern wurden die RV- und RA-Funktion mittels transthorakaler Echokardiographie in Kombination mit 2-D-STE untersucht.ErgebnisseDie linksventrikuläre systolische und diastolische Funktion, der systolische Pulmonalarteriendruck (PAP) und die RA-Messungen waren in beiden Gruppen zwar ähnlich, aber die systolische Exkursion auf der Ebene des Trikuspidalrings (TAPSE) und die maximale systolische Myokardgeschwindigkeit (S‘) waren bei SSc-Patienten vermindert. Der globale longitudinale Strain (GLS) der freien RV-Wand war bei SSc-Patienten geringer als bei den Kontrollen (− 18,5 ± 4,9 % vs. − 21,8 ± 2,4 %; p < 0,001) und auch die Reservoir- und Conduitfunktion war bei den SSc-Patienten gegenüber den Kontrollen vermindert (34,4 ± 9,9 % vs. 39,7 ± 11,2 %; p = 0,027 bzw. 15,0 ± 5,7 % vs. 18,7 ± 6,4 %; p = 0,009). Die Krankheitsdauer stand in inverser Korrelation mit dem RV-GLS und TAPSE (r − 0,416; p = 0,018 bzw. r − 0,383; p = 0,031).SchlussfolgerungDer Einsatz der 2-D-STE könnte zur Erkennung einer Einschränkung der RV- und RA-Funktion bei SSc-Patienten mit normalem PAP von Nutzen sein.

Depression and anxiety are associated with abnormal nocturnal blood pressure fall in hypertensive patients

Abstract Background: Previous studies have shown that depression and anxiety were independent risk factors for hypertension. Non-dipper hypertension is associated with higher cardiovascular mortality. The aim of this study was to evaluate the anxiety and depression scores in patients with dipper and non-dipper hypertension. Methods: The study sample consisted of 153 hypertensive patients. All patients underwent 24-h blood pressure monitoring. Patients were classified into two groups according to their dipper or non-dipper hypertension status. We evaluated results of the Hospital Anxiety and Depression Scale between groups. Results: Seventy-eight patients (38 male, mean age: 51.6 ± 12.5 years) had dipper hypertension while 75 patients (27 male, mean age: 55.4 ± 14.1 years) had non-dipper hypertension (p = 0.141, 0.072, respectively). Clinical characteristics were similar for both groups. Patients with non-dipper hypertension had significantly higher depression and anxiety scores compared to patients with dipper hypertension. Dipper and non-dipper status significantly correlated with anxiety (p: 0.025, r: 0.181) and depression score (p: 0.001, r: 0.255). In univariate analysis, smoking, alcohol usage, presence of diabetes, hyperlipidemia, anxiety score >8 and depression score >7 were predictors of dipper versus non-dipper status. In multivariate logistic regression analyses only depression score >7 was independent predictor of dipper versus non-dipper status (odds ratio: 2.74, confidence intervals: 1.41–5.37). A depression score of 7 or higher predicted non-dipper status with a sensitivity of 62.7% and specificity of 62.8%. Conclusion: Non-dipper patients have significantly higher anxiety and depression scores compared to dipper patients. Evaluation of anxiety and depression in patients with hypertension might help to detect non-dipper group and hence guide for better management.

Evaluation of Improvement in Exercise Capacity after Pulmonary Endarterectomy in Patients with Chronic Thromboembolic Pulmonary Hypertension: Correlation with Echocardiographic Parameters

BACKGROUND The study evaluates the alterations in exercise capacity of chronic thromboembolic pulmonary hypertension (CTEPH) patients after pulmonary endarterectomy (PEA) and investigates the echocardiographic parameters associated with the degree of functional recovery. METHODS Thirty consecutive patients with the diagnosis of CTEPH (17 males; mean age, 45.9 ± 15.1 years) who had been referred for PEA operation were included in the study. Each patient underwent transthoracic echocardiography and 6-minute walk test (6-MWT) before and 6 months after PEA. RESULTS After PEA, 6-MWT distances significantly increased (242.8 ± 112.8 m vs. 423.6 ± 89.1 m, p < 0.001), whereas systolic pulmonary artery pressures and right ventricular dimensions significantly decreased (86 ± 25.1 mm Hg vs. 41.9 ± 15.6 mm Hg, p < 0.001 and 42.1 ± 10.1 mm vs. 35.3 ± 5.6 mm, p < 0.001, respectively). Magnitude of change in 6-MWT distance (Δ-6-MWT) was found to be correlated with concomitant change in tricuspid annular plane systolic excursion and left ventricular myocardial performance index (r: 0.518, p: 0.004 and r: -0.385, p: 0.043, respectively). Linear regression analysis revealed preoperative 6-MWT distance as an independent negative predictor of delta-6-MWT (beta: -0.89, t: -3.97, p: 0.001). CONCLUSION CTEPH patients with more severely depressed exercise capacity at baseline displayed relatively greater degree of functional recovery after PEA in our study. Improvement in functional capacity was found to be correlated with improvement in parameters reflecting right ventricular functions rather than improvement in pulmonary artery pressure after PEA operation.

Acute myocardial infarction due to liquid nicotine in a young man.

Introduction Myocardial infarction is rare in people under the age of 30. The pathogenesis of coronary artery disease (CAD) is known to be different in this age group than their older counterparts. Atherosclerotic burden is less and thrombotic burden is more prominent in younger patients. Nicotine has toxic effects on the endothelium, might alter vascular reactivity, cause vasospasm and activate platelets. We present here a rare case of acute myocardial infarction in a 24-year-old man due to liquid nicotine which has not been reported previously.