Uğur Kocabaş

Early myocardial functional alterations in patients with obstructive sleep apnea syndrome.

Background: There is limited information regarding myocardial alterations in patients with obstructive sleep apnea syndrome (OSAS) in the absence of pulmonary and cardiac comorbidity. In this study, we aimed to evaluate potential myocardial alterations of these patients and investigate the possible effects of OSAS‐related pathological variations on left and right ventricular functions. Methods: We studied 107 consecutive patients who were referred to our sleep laboratory for clinically suspected OSAS and 30 controls without any history or symptoms of sleep‐related disorders. Severity of OSAS was quantified by polysomnography. Patients with apnea–hypopnea index (AHI) < 5 were included in the OSAS (−) group (Group 1, n = 22). Subjects with AHI ≥ 5 were considered as OSAS and classified according to their AHI as mild‐to‐moderate (AHI ≥ 5 and AHI < 30) (Group 2, n = 45) and severe (AHI ≥ 30) OSAS groups (Group 3, n = 40). Conventional M‐mode, 2D, and Doppler mitral inflow parameters, tissue Doppler velocities, myocardial peak systolic strain, and strain rate values of various segments were measured and compared between groups. Results: Patients with OSAS displayed impairment of left ventricular diastolic function compared with controls. There were no significant differences between groups regarding parameters reflecting left ventricular systolic function. Myocardial strain analysis demonstrated significant decrement regarding apical right ventricular longitudinal peak systolic strain and strain rate values between groups in relation to the severity of OSAS. Conclusions: Patients with OSAS display a regional pattern of right ventricular dysfunction correlated with the severity of disease.

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.

Evaluation of association between obstructive sleep apnea and coronary risk scores predicted by tomographic coronary calcium scoring in asymptomatic patients.

OBJECTIVE This cross-sectional observational study is designed to evaluate direct effects of obstructive sleep apnea syndrome (OSA) on presence and extent of coronary atherosclerosis by using tomographic coronary calcification scoring on a population asymptomatic for coronary artery disease. METHODS Ninety-seven consecutive patients (49.17 ± 0.86 years) who were evaluated with sleep study for the suspicion of obstructive sleep apnea syndrome underwent tomographic coronary calcium scoring test. Cardiovascular risk factors, current medications and sleep study recordings of all patients were recorded. Patients were classified into 4 groups according to the apnea-hypopnea index (AHI). Linear and logistic regression analyses were used for assessment of association between variables. RESULTS Coronary risk scores of patients, assessed by tomographic coronary calcium scoring, were observed to increase linearly from simple snoring group to severe OSA groups (p=0.046). When patients were classified according to their gender, AHI and parameters reflecting severity of OSA-related hypoxia were found to correlate significantly with coronary risk scores of women but not with scores of men. Linear regression analysis revealed age as the only independent associated variable with cardiovascular risk scores assessed by tomographic coronary calcification scoring (Beta coefficient: 0.27, 95% CI 0.007-0.087, p=0.018). Binary logistic regression analysis also revealed age as the only variable which independently predicted the presence of coronary calcification (OR:1.11, 95% CI 1.039-1.188, p=0.002). CONCLUSION These results suggest that presence of OSA may contribute to coronary artery disease risk of patients in association with its severity; however, association between OSA and subclinical atherosclerosis seems to be primarily dependent on age.

The efficacy and safety of irbesartan in primary hypertension even if a dose is missed: Results from the NO PROBLEM Study

Abstract Objectives. This study aimed to demonstrate that irbesartan is successful in reducing diastolic blood pressure (BP) even following a missed dose after 6–8-weeks’ treatment as measured by 24-hour ambulatory BP monitoring (ABPM). Methods. Eighty-eight patients (64 females, mean age: 53.4 ± 10.6 years) with primary hypertension were included in this national, single-center, single-arm, open-label, prospective clinical study. Irbesartan (150 or 300 mg/day) was administered for 8 weeks. All patients were asked to cease treatment for 1 day during weeks 6–8. Changes in diastolic and mean 24-hour BP on the day of cessation and diastolic BP values during visits were efficacy parameters. Adverse events were also recorded. Results. Systolic, diastolic, and mean BP values measured via ABPM before and on the day of a missed dose did not differ significantly. Irbesartan effectively controlled BP of the patients. BP normalization rates were 54% for 150 mg/day irbesartan only and 77% for both doses (150 or 300 mg/day) of irbesartan. None of the patients experienced serious adverse events throughout the study period. Conclusions. Irbesartan is successful and safe in the control of BP levels even following a missed dose at the end of a 6–8-week treatment period.

Successful fibrinolytic treatment in an old patient with acute aortic prosthetic thrombosis

Thrombosis of mechanical heart valve prosthesis is a rare fatal complication after heart valve replacement. This report describes an old female patient with aortic prosthetic valve thrombosis who had a successful fibrinolytic treatment.

Successful fibrinolytic treatment in a pregnant woman with acute mitral prosthetic valve thrombosis.

Pregnant patients with mechanical prosthetic heart valves pose a great problem for medical management. The problem is even greater in a pregnant woman with mechanical valve thrombosis. This article describes a pregnant woman with prosthetic mitral valve thrombosis who had a successful fibrinolytic treatment. Copyright

Prevalence of coronary artery disease before valvular surgery in patients with rheumatic valvular disease.

BackgroundAlthough many patients with valvular heart disease have concomitant coronary artery disease (CAD), there are limited data on the association between rheumatic valvular disease (RVD) and CAD. In this study, we aimed to investigate the prevalence of CAD in a group of patients with RVD and undergoing coronary angiography before valvular surgery. MethodsIn this retrospective analysis, we enrolled a total of 1075 patients (658 women, 61.2%; mean age: 53.2±9.9 years) who underwent coronary angiography for the evaluation of CAD before valvular surgery between January 2003 and May 2010. ResultsThe overall prevalence of significant CAD was 11.1%. Patients with significant CAD were older than patients without significant CAD (55.16±10.4 vs. 51.45±9.1; P<0.001). In addition, hypertension, smoking, diabetes mellitus, and dyslipidemia were more prevalent among patients with significant CAD (P<0.05). After adjustment for several risk factors, only aortic stenosis remained the predictor of significant CAD (odds ratio: 1.66; 95% confidence interval: 1.26–2.19; P<0.001). However, aortic regurgitation was inversely associated with the presence of CAD (odds ratio: 0.56; 95% confidence interval: 0.21–1.01; P<0.001). ConclusionThe overall prevalence of CAD in our population with RVD was low. Rheumatic aortic stenosis is associated with an increased prevalence of CAD, whereas the prevalence of CAD is lower in those patients with aortic regurgitation.

Alterations of von Willebrand Factor and Ristocetin Cofactor Activity During Atrial Fibrillation

The aim of this study was to assess the plasma levels of von Willebrand factor antigen and ristocetin cofactor activity, which are well-known markers of endothelial function, in atrial fibrillation (AF) with or without mitral stenosis (MS). Forty-two patients (16 patients with MS and AF [MS(+)AF(+)], 13 patients with nonvalvular AF [MS(−)AF(+)], and 13 patients with MS and sinus rhythm [MS(+)AF(−)]) were included. Von Willebrand factor antigen levels and ristocetin cofactor activities in all participants were assessed. Overall, von Willebrand factor antigen levels and ristocetin cofactor activities in the AF(+) patients were higher than in the AF(−) patients (P = .003 and P = .002, respectively). Von Willebrand factor antigen levels and ristocetin cofactor activities in the 3 groups were found to be different (P = .012 and P = .01, respectively). Von Willebrand factor antigen levels were similar between the MS(+)AF(+) and MS(−)AF(+) groups and were higher than that of the MS(+)AF(−) group. Ristocetin cofactor activity in the MS(−)AF(+) group was significantly higher than in the other 2 groups. The ristocetin cofactor activity and von Willebrand factor antigen levels were significantly higher in diabetic or hypertensive patients than in nondiabetic or normotensive patients. According to the results of this study, circulating von Willebrand factor antigen levels and plasma ristocetin cofactor activities are affected by the presence of AF, MS, and associated comorbidities including type 2 diabetes mellitus and systemic hypertension. Further studies are needed to assess the role of von Willebrand factor antigen and ristocetin cofactor activity in predicting vascular thrombotic events in AF, MS, systemic hypertension, and diabetes mellitus.

A Novel Method for the Diagnosis of Neurocardiogenic Syncope: Heart Rate Recovery Index

Objectives: Neurocardiogenic syncope is a common and challenging problem in clinical practice. Heart rate recovery after the first minute of exercise is mainly controlled by the parasympathetic nervous system. The aim of the present study was to evaluate heart rate recovery as an index of parasympathetic tonus for the diagnosis of neurocardiogenic syncope. Methods and Results: Ninety five patients (mean age 36.5 ± 11.8 years), who had vasovagal syncope episodes documented by tilt table testing and 70 healthy subjects (mean age 32.9 ± 9.1 years) were included in this study. Maximal exercise stress testing was performed in both groups and heart rate recovery values were calculated. Heart rate recovery was calculated by subtracting recovery heart rate in the first minute after exercise from peak heart rate. Heart rate recovery was significantly higher in the vasovagal syncope group than the control group during the first minute (42.1 vs. 30.9, p < 0.001). When the cutoff point for heart rate recovery was taken as 35, the sensitivity for the diagnosis of vasovagal syncope was 81% and the specificity was 78%. Conclusion: Results of our study show that heart rate recovery is greater in the first minute after exercise in vasovagal syncope patients and that it has a supportive role in the diagnosis of neurocardiogenic syncope.

Preliminary observations on the effect of amitriptyline treatment in preventing syncope recurrence in patients with vasovagel syncope.

Purpose: Vasovagal syncope is a common and challenging problem that may result in injury and causes susbstantial anxiety among patients and their relatives. However, treatment of vasovagal syncope with standard pharmacologic approaches is not satisfactory. The aim of this study is to investigate the effect of amitriptyline, a tricyclic antidepressant drug, by using its anticholinergic effects in preventing syncopal episodes in patients with vasovagal syncope.