Yavuz Uğurlu

Non-dipping pattern in untreated hypertensive patients is related to increased pulse wave velocity independent of raised nocturnal blood pressure

Abstract Background. Non-dipper pattern, characterized by diminished nocturnal decline in blood pressure (BP), is associated with an increase in cardiovascular events. Carotid–femoral pulse wave velocity (CF-PWV) has been accepted as the gold standard measurement of arterial stiffness. CF-PWV is a well-recognized predictor of an adverse cardiovascular outcome with higher predictive value than classical cardiovascular risk factors. In this study, we investigated the association between PWV as the surrogate of arterial stiffness and non-dipper pattern in untreated hypertensive patients. Methods. The present study was cross-sectional and observational. Hypertensive patients were diagnosed according to ambulatory BP measurements (mean BP

Relationship of fragmented QRS complexes with inadequate coronary collaterals in patients with chronic total occlusion.

130/80 mmHg). Eighty-four hypertensive patients, consulted for initial evaluation of hypertension, were enrolled. CF-PWV as the indicator of arterial stiffness was measured by a validated tonometry system (SphygmoCor). Patients with the history of any cardiovascular disease were excluded from the study. Results. Fifty-six patients had non-dipper pattern and 28 patients had dipper pattern in the study. Baseline characteristics were not significantly different between the two groups, except the CF-PWV (non-dipper vs dipper; 8.91 ± 2.53 vs 7.66 ± 1.08 m/s, p = 0.002), female gender (55% vs 32%, p = 0.045) and nocturnal BP measurements (for mean BP; 106 ± 11 vs 92 ± 8 mmHg, p < 0.001). Multiple logistic regression analysis including age, gender, BP and PWV measurements, revealed female gender (odds ratio, OR = 5.112, 95% confidence interval, CI 1.282–20.4, p = 0.021), nocturnal mean BP (OR = 1.243, 95% CI 1.107–1.396, p < 0.001) and CF-PWV (OR = 1.992, 95% CI 1.240–3.198, p = 0.004) as the independent predictors of non-dipper hypertensive pattern. Conclusion. Our results suggest that diminished nocturnal decline in BP is independently associated with PWV and nocturnal BP rather than daytime BP. Non-dipper pattern, mainly related to increased PWV and impaired modulation of vascular smooth muscle tone during the night, may justify an increased cardiovascular risk in these patients.

Epicardial adipose tissue is independently associated with increased left ventricular mass in untreated hypertensive patients: an observational study.

Background Fragmented QRS (fQRS) complexes are defined as various RSR′ patterns (≥1 R′ or notching of S wave or R wave) in two contiguous leads corresponding to a major coronary artery territory. In previous studies, fQRS has been associated with increased morbidity and mortality, sudden cardiac death and recurrent cardiovascular events (CVEs). The causative relationship between fQRS and cardiac fibrosis has been shown in prior studies. The association between inadequate (poor) coronary collaterals and presence of fQRS has not comprehensively been studied in patients with chronic total occlusion (CTO) until now. We tested the hypothesis that the presence of fQRS is associated with inadequate coronary collateral growth. Methods This study had a cross-sectional observational design. The study population consisted of patients who underwent coronary angiography with the suspicion of coronary artery disease at our institution in an outpatient manner. Patients who had CTO in at least one major epicardial coronary artery were included. Coronary angiograms of 148 eligible patients from our database were analyzed again. Ninety-three patients had good and 55 had poor collateral development according to the Cohen–Rentrop method. Results Patients with poor collateral development had higher plasma glucose (130 ± 54 vs. 116 ± 33 mg/dl, P = 0.047) and an older age (65 ± 10 vs. 61 ± 10 years, P = 0.042) in comparison to patients with good collateral growth. The presence and number of fQRS were higher in the poor collateral group than the good collateral group (64 vs. 32%, P < 0.001 and 2.3 ± 2.4 vs. 1.2 ± 2.0, P = 0.002, respectively). Left ventricular ejection fraction was significantly lower in the poor collateral group than the good collateral group (45 ± 11 vs. 51 ± 13, P = 0.014). There was a significant correlation between number of fQRSs and the echocardiographic wall-motion abnormality score (r = 0.662, P < 0.001). In multivariate analysis, only the presence of fQRS was independently related to poor collateral development (odds ratio, 3.559; 95% confidence interval, 1.708–7.415, P = 0.001). Conclusion We found that fQRS was independently related to inadequate coronary collaterals in patients with CTO. fQRS, which may be derived from the effects of myocardial ischemia or scar on myocardial electricity at the cellular level, can represent inadequate coronary collateral development in patients with CTO.

Successful thrombolysis using recombinant tissue plasminogen activator in cases of severe pulmonary embolism with mobile thrombi in the right atrium.

OBJECTIVE Epicardial adipose tissue (EAT) secretes various inflammatory mediators and growth factor, and has endocrine and paracrine effects on myocardium and body. We planned the present study in order to evaluate the possible relationship between EAT and left ventricular mass (LVM), a potent predictor of cardiovascular mortality and morbidity, independent of age, blood pressure and the metabolic parameters in patients with hypertension (HT). METHODS The present study was cross-sectional and observational, including consecutive 107 untreated essential hypertensive patients who underwent a complete transthoracic echocardiographic examination as well as measurements of LVM and EAT. Blood pressure, routine blood chemistry, C-reactive protein, and patient characteristics were also recorded. Univariate and then multiple linear regression analyses were used for analysis of independent variables associated with EAT. RESULTS LVM significantly correlated with waist circumference, EAT, glucose, uric acid, high-density lipoprotein (HDL) cholesterol, and systolic and diastolic blood pressure. When we divided study population into two groups according to median mean blood pressure (BP) (Mean BP ≤116 vs. >116 mmHg), EAT was the only associated factor for LVM in patients below median BP (Beta: 0.518, p<0.001). Linear regression analyses revealed EAT to be independently associated with LVM (Beta: 0.419; p<0.001) and LVM index (Beta: 0.384, p<0.001) as well as high-density lipoprotein (Beta: -0.264, p=0.006). CONCLUSION EAT was related to increased LVM independent of BMI, waist circumference, weight, systolic and diastolic blood pressure and other risk parameters, in patients with HT. Determination of increased EAT by echocardiography may have an additional value as an indicator of cardiovascular risk and total visceral adipose tissue.

Independent determinants of ascending aortic dilatation in hypertensive patients: smoking, endothelial dysfunction, and increased epicardial adipose tissue.

Hereby, we report two cases of acute pulmonary embolism with concomitant right-sided thrombus, which were successfully treated using recombinant tissue plasminogen activator (rtPA). These patients had life-threatening acute right ventricular failure, which dramatically improved within hours following thrombolysis. These cases emphasize the clinical utility of rtPA for the treatment of life-threatening pulmonary embolism.

Esophageal rupture complicated by acute pericarditis

BackgroundAscending aortic aneurysm is an uncommon condition with lethal consequences. Lately, epicardial adipose tissue (EAT) is acknowledged as an organ with important effects on the vascular system. In this study, we aimed to investigate whether EAT, cardiovascular risk factors, and vascular structure and functions are independently related to ascending aortic dilatation. Methods and resultsVascular structure and functions were determined by carotid intima–media thickness, pulse wave velocity, and brachial artery flow-mediated dilation. Study parameters were compared between 46 patients with a dilated ascending aorta (diameter≥37 mm) and 58 individuals with a normal aortic diameter of <37 mm. Ascending aortic diameter significantly correlated with age (r=0.420, P<0.001), waist circumference (r=0.235, P=0.032), EAT (r=0.507, P<0.001), mean carotid intima–media thickness (r=0.354, P<0.001), flow-mediated dilation (r=−0.513, P<0.001), and diastolic blood pressure (r=0.365, P<0.001). Although C-reactive protein was related to BMI (r=0.485, P<0.001), waist circumference (r=0.368, P=0.001), and EAT (r=0.315, P=0.003), it was not correlated with ascending aortic diameter (r=0.092, P=0.403). Linear regression analysis revealed EAT thickness (&bgr;: 0.483, P<0.001), smoking (&bgr;: 0.366, P=0.002), and flow-mediated dilation (&bgr;: −0.332, P=0.007) as the determinants of ascending aortic dilatation. ConclusionOn the basis of our findings, smoking, endothelial dysfunction, and increased EAT may be suggested as risk factors for ascending aortic dilation due to local or systemic effects in hypertensive patients.

A rare complication: Undeflatable balloon of the stent

Esophageal perforation is a serious condition with a high mortality rate. Delayed detection of esophageal perforation may result in devastating complications such as mediastinitis and pericarditis. Esophageal perforation is rarely due to aspiration of foreign bodies. Here we report the case of a 59-year-old male patient with complicated esophageal perforation due to ingestion of a chicken bone, whose first signs are considered to be acute non-specific pericarditis.

Prominent ST-segment elevation in leads V1—V4 due to isolated right ventricular branch occlusion after primary percutaneous coronary intervention for right coronary artery

Percutaneous coronary intervention is an important modality in the treatment of coronary artery disease. These procedures are usually completed successfully, but occasionally serious complications are encountered. In this paper, we present the case of an undeflatable stent balloon, which is an extremely rare complication that has not been described in the literature.

Increased epicardial adipose tissue in patients with slow coronary flow phenomenon

Isolated right ventricular myocardial infarction (RVMI) rarely occurs. It accounts for only 3% of all infarctions. In the literature, there are several reported isolated RVMI cases with precordial ST-segment elevation. We describe a 55-year-old man with prominent ST-segment elevation in leads V1-V4 in whom isolated RVMI developed due to occlusion of the right ventricular branch during primary percutaneous coronary intervention to the right coronary artery for acute inferior myocardial infarction.