The usefulness of plateletcrit to predict cardiac syndrome X in patients with normal coronary angiogram.

INTRODUCTION: Cardiac syndrome X (CSX) is a clinical entity defined as the triad of typical angina pectoris on exercise, electrocardiographic or metabolic findings of ischemia and normal epicardial coronary arteries. Platelets, whose amount in the blood is indicated with plateletcrit (PCT), play an important role in inflammatory and thrombotic processes and the physiopathology of cardiovascular events. AIM: To investigate the association between cardiac syndrome X and PCT and platelet count. MATERIAL AND METHODS: A total of 113 patients with normal coronary angiogram were included in the study. Fifty patients with typical chest pain and evidence of myocardial ischemia in non-invasive tests formed the CSX patient group. The control group consisted of 63 age- and gender-matched patients with normal coronary arteries but without angina. RESULTS: The mean PCT value of the CSX group was significantly higher than that of the control group (0.22 ±0.06 vs. 0.19 ±0.04; respectively, p=0.03). Higher PCT was found to be associated with the presence of CSX in patients with normal coronary arteries by multivariate logistic regression analysis. CONCLUSIONS: We suggest that high PCT may predict the presence of cardiac syndrome X in patients with normal coronary arteries. The value of PCT appears additive to conventional expensive methods commonly used in CSX prediction.

Evaluation of left atrial mechanical function and atrial conduction abnormalities in Maras powder (smokeless tobacco) users and smokers.

OBJECTIVE: In Turkey, a type of smokeless tobacco called Maras powder (MP) is widely used in the south-eastern region. Smokeless tobacco is found in preparations for chewing and for absorption by the nasal and oral mucosae. The purpose of this study was to investigate whether MP damages intra- and inter-atrial conduction delay and left atrial (LA) mechanical function as much as cigarette smoking. METHOD: A total of 150 chronic MP users (50 males, 32.5 ± 5.4 years), smokers (50 males, 32.1 ± 6.0 years) and controls (50 males, 30.1 ± 5.8 years) were included in the study. LA volumes were measured echocardiographically according to the biplane area-length method. Atrial electromechanical coupling was measured with tissue Doppler imaging and LA mechanical function parameters were calculated. RESULTS: The LA passive emptying fraction was significantly decreased and LA active emptying volume (LAAEV) was significantly increased in the MP group (p = 0.012 and p = 0.024, respectively), and the LA active emptying fraction (LAAEF) was significantly increased in the smokers (p = 0.003). There was a positive correlation between the amount of MP used and smoking (pack years) with LAAEV and LAAEF (r = 0.26, p = 0.009 and r = 0.25, p = 0.013, respectively). Lateral atrial electromechanical intervals (PA) were significantly higher in MP users, and the septal mitral PA was statistically higher in the smokers (p = 0.05 and p = 0.04, respectively). CONCLUSION: We suggest that atrial electromechanical coupling intervals were prolonged and LA mechanical function was impaired in MP users and smokers, but there was no significant difference between the MP users and smokers. These findings may be markers of subclinical cardiac involvement and tendency for atrial fibrillation.

Relationship between severity of pulmonary hypertension and coronary sinus diameter.

INTRODUCTION AND OBJECTIVE: We investigated the relationship between coronary sinus (CS) diameter and pulmonary artery systolic pressure (PASP) in patients with pulmonary hypertension (PH) and normal left ventricular systolic function. METHODS: A total of 155 participants referred for transthoracic echocardiography were included in the study. The study population consisted of 100 patients with chronic PH and 55 control subjects. Patients with PH were divided into two groups according to PASP: those with PASP 36-45 mmHg, the mild PH group (n=53); and those with PASP >45 mmHg, the moderate to severe PH group (n=47). CS diameter was measured from the posterior atrioventricular groove in apical 4-chamber view during ventricular systole according to the formula: mean CS=(proximal CS+mid CS+distal CS)/3. RESULTS: Mean CS diameter was significantly higher in the moderate to severe PH group than in the controls and in the mild PH group (1.12±0.2 cm vs. 0.82±0.1 cm and 0.87±0.1 cm, respectively; p<0.001). It was significantly correlated with right atrial (RA) area (r=0.674, p<0.001), RA pressure (r=0.458, p<0.001), PASP (r=0.562, p<0.001), inferior vena cava diameter (r=0.416, p<0.001), right ventricular E/A ratio (r=-0.290, p<0.001), and E/Em ratio (r=0.235, p=0.004). RA area (ß=0.475, p<0.001) and PASP (ß=0.360, p=0.002) were found to be independent predictors of CS diameter. CONCLUSIONS: A dilated CS was associated with moderate to severe pulmonary hypertension, and RA area and PASP were independent predictors of CS diameter.

[Evaluation of subclinical atherosclerosis in chronic sinusitis patients]. / Kronik sinüzitli hastalarda subklinik aterosklerozun degerlendirilmesi.

OBJECTIVE: This study aimed to assess the impact of chronic sinusitis (CS) on carotid-intima-media thickness (CIMT), a marker of early atherosclerotic changes in the arterial bed. METHODS: The study included 50 patients with CS (25 male, 25 female, mean age 26.6 ± 5.34 years), and 50 healthy subjects (25 male, 25 female, mean age 25.8 ± 4.76 years), aged 18 to 35 years without atherosclerotic risk factors, normal body mass index and normal metabolic parameters. CIMT was measured in all patients by ultrasonography. CS was confirmed by medical history and computed tomography scan of the paranasal cavities. RESULTS: No significant difference existed between the groups in terms of age, sex, body mass index (BMI), waist circumference, plasma creatinine, glucose, low-density lipoprotein (LDL), high-density lipoprotein (HDL) cholesterol values (p>0.05). However, mean values of CIMT (mm) were significantly greater in CS patients than in healthy subjects (0.51 ± 0.09 vs. 0.40 ± 0.07, p<0.001). Duration of CS disease was 6.0 (3.0-13.0) years. Significant correlation was found between CIMT mean values and age, BMI, waist circumference, HDL and LDL-cholesterol values and duration of CS (r=0.413; p<0.001, r=0.353; p<0.001, r=0.355; p<0.001, r=-0.266; p=0.007, r=0.327; p<0.001 and r=0.425; p=0.002 respectively). Multiple linear regression analysis revealed that waist circumference, HDL and LDL-cholesterol and duration disease of CS were independent predictors of CIMT (ß=0.523; p=0.001, ß=-0.176; p=0.045, ß=0.297; p=0.002, and ß=0.436; p<0.001, respectively). CONCLUSION: Our cross-sectional study revealed the presence of a negative effect of CS on the atherosclerotic process. Therefore, it is believed that effective treatment of CS may be beneficial in slowing the process of atherosclerosis.

Coronary sinus dilatation is a sign of impaired right ventricular function in patients with heart failure.

OBJECTIVE: The coronary sinus (CS) has been largely ignored by physicians due to a lack of adequate data about the importance of CS enlargement in patients with heart failure (HF). We aimed to assess whether CS dilatation develops in patients with HF and to demonstrate its relation with global myocardial function of the right ventricle (RV). METHODS: In this cross-sectional study, 45 healthy subjects and 95 HF patients exhibiting left ventricular systolic dysfunction on echocardiographic examination (EF <45%) secondary to ischemic (n=56) or idiopathic dilated cardiomyopathy (DCM) (n=39) were enrolled. Patients with severe renal dysfunction and/or valve disease were excluded. CS was measured by echocardiography from the posterior atrioventricular groove in the apical four-chamber view. The RV myocardial performance index (MPI), which reflects both systolic and diastolic function of the ventricle, was detected using tissue Doppler imaging, and patients with an RV MPI >0.55 were defined as having impaired RV myocardial function. ANOVA, Kruskal-Wallis, Pearson's correlation, and multivariate logistic regression analyses were used for the statistical analysis. RESULTS: The CS and RV MPI values were significantly greater both in patients with ischemic and idiopathic DCM than in controls (8.79±1.7 mm and 8.33±2.1 mm vs. 5.74±0.6 mm, and 0.64±0.07 and 0.62±0.08 vs. 0.43±0.02; p<0.001 for both, respectively). For the prediction of HF patients with impaired RV function, the cut-off value for the diameter of the CS was 7.35 mm, with a sensitivity of 83% and a specificity of 79%. CONCLUSION: The CS diameter can be used as a novel echocardiographic marker that provides information about impaired RV function in patients with HF.

Negative effects of acute sleep deprivation on left ventricular functions and cardiac repolarization in healthy young adults.

BACKGROUND: Sleep deprivation (SD) is associated with an increased incidence of adverse cardiovascular events, we aimed to determine the impact of acute SD on structural and functional alterations of the left ventricle (LV) and on electrocardiogram (ECG) markers including T wave peak-to-end interval (TpTe), QT interval, and TpTe/QT ratio in healthy subjects after a night of SD. METHODS: The study population consisted of 40 healthy young adults (19 males, 21 females; mean age: 28.2 ± 3.86 years). Echocardiographic images and ECGs were obtained from the participants after a night of regular sleep (RS) and SD. The average sleep time of the subjects was 6.67 ± 1.76 hours during RS and 1.25 ± 0.74 hours during a night of SD. RESULTS: The myocardial performance index, isovolumic relaxation time, and deceleration time values were significantly higher after SD. In addition, the corrected TpTe interval, corrected QT interval (QTc) max, and TpTe/QT ratio were significantly increased after a night of SD when compared with a night of RS (78.5 ± 6.8 ms vs 70.7 ± 7.6 ms, P < 0.001; 407.5 ± 18.6 ms vs 395.07 ± 21.3 ms, P = 0.001; and 0.189 ± 0.014 ms vs 0. 0.179 ± 0.016 ms, P < 0.001, respectively). However, subjects had similar QTp interval values (defined as beginning of the QRS complex to peak of the T wave) after a night of SD as a night of RS (294.6 ± 19.0 vs 291.9 ± 18.5, P = 233). CONCLUSION: Our crossover study revealed the presence of subclinical LV diastolic functional changes and increased QT intervals, TpTe intervals, and TpTe/QT ratios in healthy young adults after one night SD. Therefore, the increased QT interval occurred secondary to the increased TpTe interval in this population.

Evaluation of early subclinical cardiotoxicity of chemotherapy in breast cancer.

OBJECTIVE: Cardiac effects of chemotherapy are usually recognized after clinical symptom or sign occurrence in patients with breast cancer. In this study, we aimed to determine the potential subclinical cardiotoxic effects of chemotherapy that were given lower dosage than well known cardiac safety dosage limits in patients with breast cancer during early period. METHODS: Fifty-one patients consecutively enrolled to this prospective cohort study. All patients were diagnosed as breast cancer at oncology hospital in University of Gaziantep. Before chemotherapy, all of the patients underwent to detailed ECG and echocardiography (ECHO) examinations. After 6 months, detailed ECG and ECHO examinations were repeated and compared with baseline values. Statistical analysis was performed using Shapiro-Wilk tests, Student t-test and Spearman correlation test. RESULTS: The average age of patients was 51 and one was male. Statistically significant decrease in ejection fraction was found after treatment (62.3%±3.3 and 59.9%±5.9, p=0.002). Evaluation of diastolic parameters; significant increase in the transmitral A flow velocity and significant decrease of E/A ratio were observed on Doppler ECHO analysis (77.4±19.1 cm/sec versus 86±18 cm/sec, p<0.001; 1.01±0.3 versus 0.9±0.2, p=0.03, respectively). On tissue Doppler analysis we observed that significant reduction in the value of E' and significantly increase E/E' ratio were present (12.5±3.6 cm/sec versus 10.7±2.9 cm/sec, p=0.001; 6.6±2.9 versus 7.7±3.3, p=0.04, respectively). CONCLUSION: Chemotherapy has detrimental subclinical effect on both of systolic and diastolic function in early six months period despite the prescription of lower dosage of chemotherapy than well-known cardiac safety dosage limits. Tissue Doppler imaging may be more sensitive than ECG, conventional ECHO and Doppler for determining the subclinical cardiac damage.

Neutrophil to lymphocyte ratio predicts poor functional capacity in patients with heart failure.

OBJECTIVES: We aimed to assess the relationship between neutrophil to lymphocyte ratio (N/L ratio) and functional capacity (FC) of patients with compensated heart failure (CHF). STUDY DESIGN: A total of 94 consecutive CHF patients and age-gender matched 70 subjects with normal echocardiographic examination were enrolled. Peripheral venous blood samples were drawn before echocardiography examination and treadmill test in all study population. The treadmill test based on modified Bruce protocol was used to determine the functional status of CHF patients. Poor FC was defined as <5 metabolic equivalant (MET) in the exercise test. Afterwards, patients with CHF were divided into two groups with respect to the top and bottom 3 of the N/L ratio. RESULTS: FC (3.2 ± 2.05 MET vs. 6.1 ± 2.04 MET, p<0.001), ejection fraction (%31.5 ± 7.64 vs. %34.8 ± 6.82, p=0.028) were found to be lower and N-terminal pro-brain natriuretic peptide (NT-proBNP) level (3360 ± 2742 pg/dl vs. 1613 ± 1334 pg/dl, p<0.001) pulmonary artery pressure (46.3 ± 11.50 mmHg vs. 41.5 ± 9.45 mmHg, p=0.049), left atrial diameters (4.6 ± 0.52 cm vs. 4.3 ± 0.43 cm, p=0.005), E/Ea ratio (12.2 ± 4.37 vs. 9.2 ± 3.20, p<0.001) were found to be higher in CHF patients with an N/L ratio >3 than with an N/L ratio <3. The N/L ratio, and log-NT-proBNP level were determined to be a predictive factor of poor FC (odds ratio [OR]=3.085, 95% confidence interval [CI]= 1.520-6.260, p=0.002 and OR=1.585, 95% CI=1.201-2.091, p=0.001, respectively). A cut-off point of 2.74 for the N/L ratio had 79.4% sensitivity and 80% specificity in predicting poor FC. CONCLUSION: N/L ratio can be used to predict poor FC in patients with CHF.

Aripiprazole induced non-cardiogenic pulmonary edema: a case report.

Aripiprazole is a second-generation antipsychotic drug with partial dopamine agonistic activity. Although the adverse cardiovascular effects of both typical and atypical antipsychotics are well known, similar data on aripiprazole, which was recently introduced, are scarce. Herein we report a 35-year-old female that presented to our emergency department with non-cardiogenic pulmonary edema. Chest X-ray and thoracic CT showed pulmonary edema and bilateral pleural effusion. Anamnesis showed that she had been taking sertraline 200 mg d-1 for obsessive-compulsive disorder for a long time and that aripiprazole10 mg d-1 was added for augmentation 2 months prior to presentation. We think that the CYP 2D6 inhibitor sertraline might have played a role in increasing the plasma concentration and toxicity of aripiprazole in the presented patient.

Effect of a successful percutaneous coronary intervention for chronic total occlusion on parameters of ventricular repolarization.

BACKGROUND: Coronary collaterals may be insufficient for restoring blood flow to normal levels in patients with chronic total occlusions (CTO), leading to myocardial ischemia and electrical inhomogeneity in the ventricles. We evaluated the effect of percutaneous CTO revascularization on parameters of ventricular repolarization, including the T wave peak-to-end interval (TpTe) interval, the TpTe/QT ratio, and QT dispersion. PATIENTS AND METHODS: A total of 114 patients who underwent CTO percutaneous coronary intervention (PCI) of any major coronary artery were divided into two groups: the successful CTO PCI group (n=90) and the failed CTO PCI group (n=24). Patients' 12-lead ECGs were analyzed within 24 h before revascularization and 24-48 h after the procedure for the following parameters: corrected QT interval (QTc) dispersion, TpTe interval (V2 and V5), and TpTe/QT ratio (V2 and V5). Subsequently, the successful CTO PCI group was divided into subgroups according to the Rentrop class, number of diseased vessels, and target vessels for further evaluation. RESULTS: There was no significant difference between the successful and the failed CTO PCI groups in terms of any baseline demographic or angiographic characteristic, or ventricular repolarization parameter. The post-PCI values of TpTe (85.3±12.8 vs. 74.8±10.4; P<0.001), the TpTe/QT ratio (0.21±0.02 vs. 0.19±0.02; P<0.001), and QTc dispersion (65.6±9.8 vs. 53.4±11.6; P<0.001) were significantly decreased compared with the pre-PCI values after successful CTO PCI. The patients in Rentrop class 1 and patients with multivessel disease had higher pre-PCI values for TpTe and the TpTe/QT ratio than those in the other groups (P<0.05). No significant differences were detected when the preprocedure values of TpTe, the TpTe/QT ratio, and QTc dispersion were compared according to the target vessel. CONCLUSION: In patients with CTO, a poor coronary collateral status and multivessel disease may further impair electrical homogeneity. Our results indicate that successful CTO PCI reduces the arrhythmic vulnerability of the myocardium on the basis of an analysis of the TpTe, the TpTe/QT ratio, and QTc dispersion.

Predictors of thrombus burden and no-reflow of infarct-related artery in patients with ST-segment elevation myocardial infarction: importance of platelet indices.

Preprocedural high-thrombus burden (HTB) of infarct-related artery (IRA) is a harbinger of procedural complications following primary percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI). The HTB of IRA can lead to poor outcomes by various mechanisms, including no-reflow phenomenon, increased myocardial necrosis and with subsequent reduced survival benefit at follow-up. In this study, we investigated the relationship between all platelet indices on admission and thrombus burden and the no-reflow phenomenon after primary PCI of IRA in patients with STEMI. We retrospectively enrolled 475 patients with STEMI undergoing primary PCI. Study population was divided into two groups according to the thrombolysis in myocardial infarction thrombus grade of IRA as low-thrombus burden or HTB. There were no statistically significant differences in platelet indices, including platelet count, platelet-large cell ratio (P-LCR), mean platelet volume (MPV) and platelet distribution with (PDW) among the groups. However, in the subgroup analysis, P-LCR, MPV and PDW were significantly higher in the no-reflow patients than reflow patients despite similar platelet count (P for all < 0.001). The cutoff value of P-LCR for predicting no-reflow was 26.5% with a sensitivity of 67.0% and a specificity of 62% (area under the curve, 0.689; 95% confidence interval, 0.614-0.765; P < 0.001). Furthermore, P-LCR, MPV and PDW had similar AUC (0.689, P < 0.001; 0.688, P < 0.001; and 0.677, P < 0.001; respectively) for predicting no-reflow phenomenon after primary PCI. As a result, all of the platelet indices have no effect on thrombus load of IRA, however, these parameters seem to impair epicardial perfusion after primary PCI.

Effect of smoking on Tp-e interval, Tp-e/QT and Tp-e/QTc ratios as indices of ventricular arrhythmogenesis.

BACKGROUND: Smoking may lead to ventricular arrhythmias and sudden cardiac death via altering ventricular recovery time dispersion indices such as QT interval and QT dispersion (QTd). The Tp-e/QT and Tp-e/QTc ratios are also known as predictors of ventricular arrhythmogenesis. The aim of this study was to evaluate the relationship between cigarette smoking and ventricular repolarisation dispersion using these novel electrocardiographic parameters. METHODS: One hundred and twenty-one chronic smokers and 70 age- and sex-matched non-smoker controls were included in our study. The Tp-e interval and Tp-e/QT ratio were measured by 12-lead electrocardiogram, and corrected for heart rate. RESULTS: QTd (34.2 ± 8.4, 27.2 ± 10.4, P<0.001) and corrected QTd (37.3 ± 8.9, 29.8 ± 11.2, P<0.001) were significantly increased in the smokers compared to the non-smoker control group. The Tp-e interval (76.5 ± 6.3, 70.3 ± 6.8, P<0.001), cTp-e interval (83.5 ± 8.0, 77.1 ± 8.7, P<0.001), Tp-e/QT (0.20 ± 0.03, 0.19 ± 0.02, P<0.001) and Tp-e/QTc ratios (0.19 ± 0.02, 0.17 ± 0.02, P<0.001) were increased in the patient group when compared to the controls. Significant positive correlations were also found between the level of smoking with the cTp-e interval (r=0.836, P<0.001), and Tp-e/QT (r=0.714, P<0.001) and Tp-e/QTc ratios (r=0.448, P<0.001). CONCLUSION: We found in our study that cTp-e interval, Tp-e/QT and Tp-e/QTc ratios were increased in smokers and significantly correlated to the amount of smoking.

Increased platelet distribution width is associated with ST-segment elevation myocardial infarction and thrombolysis failure.

We investigated 2 hypotheses: (1) a relationship between platelet indices and stable coronary artery disease (CAD) and acute ST-segment elevation myocardial infarction (STEMI) and (2) a relationship between platelet indices on admission and thrombolysis outcomes in patients with STEMI. A total of 260 patients were enrolled. The white blood cell (WBC) and platelet distribution width (PDW) were found to be increased in patients with STEMI (P for both < .001). White blood cell and PDW were independent predictors of acute STEMI. Mean platelet volume (MPV) and PDW were significantly higher in the thrombolysis failure group than in the thrombolysis success group (9.9 ± 1.8 vs 9.2 ± 1.5 fL, P = .021 and 17.7 ± 1.0 vs 16.4 ± 2.1 fL, P < .001, respectively). Mean platelet volume and PDW were independent predictors of thrombolysis failure. Patients with acute STEMI had higher PDW than did patients with stable CAD. In addition, higher PDW and MPV seem to correlate with thrombolysis failure in patients with STEMI.

[Long QT-induced ventricular tachycardia associated with Takotsubo cardiomyopathy]. / Takotsubo sendromu ile iliskili uzun QT'nin tetikledigi ventrikül tasikardisi.

Takotsubo cardiomyopathy (TC) is a syndrome characterized by transient left ventricular apical ballooning associated with electrocardiogram changes and mimicking acute myocardial infarction in patients without significant coronary disease on angiography. We report an unusual case of a patient who presented with TC associated with long-QT syndrome-induced ventricular tachycardia. QT interval prolongation was normalized and ventricular tachycardias were stopped within the same day with metoprolol treatment.

Acute inferior myocardial infarction in a young male patient associated with Behcet's disease and sildenafil.

Behcet's disease (BD) is a multisystemic inflammatory disorder of unknown origin, presenting with mucocutaneous, ocular, articular, vascular, gastrointestinal and central nervous system manifestations. Coronary involvement is very rare in patients with BD. Sildenafil, an oral drug used to treat erectile dysfunction, was shown to cause significant cardiovascular problems including acute myocardial infarction (MI) and sudden cardiac death. Acute MI associated with BD and sildenafil has not been reported previously. We present a case of a 23-year-old male patient with an acute inferior MI associated with BD diagnosed after admission of sildenafil, who was successfully treated with thrombus aspiration and tirofiban administration.

Prediction of coronary artery disease severity using CHADS2 and CHA2DS2-VASc scores and a newly defined CHA2DS2-VASc-HS score.

As the CHADS2 and CHA2DS2-VASc scores include similar risk factors for the development of coronary artery disease (CAD), they may provide crucial information regarding the severity of coronary artery lesions and the risk of thromboembolism. To increase the likelihood of determining CAD severity, we formulated the CHA2DS2-VASc-HS score comprising hyperlipidemia and smoking in addition to the components of the CHA2DS2-VASc score and male instead of female gender. We aimed to investigate whether these 3 risk scores can be used to predict CAD severity. A total of 407 consecutive patients who underwent coronary angiography were enrolled in the study. Presence of >50% stenosis in a coronary artery was assessed as significant CAD. Of the patients, 87 had normal coronary angiograms and served as group 1. The remaining 320 patients with coronary stenosis were further classified into 2 groups according to CAD with stenosis of <50% or ≥50%: 123 patients with mild CAD as group 2 and 197 patients with severe CAD as group 3. The CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-HS scores were significantly different among the 3 groups. The CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-HS scores correlated significantly with the number of diseased vessels (r = 0.406, p <0.001; r = 0.308, p <0.001; and r = 0.533, p <0.001, respectively) and the Gensini score (r = 0.383, p <0.001; r = 0.300, p <0.001; and r = 0.500, p <0.001, respectively). The CHA2DS2-VASc-HS score was found to be the best scoring scheme to predict CAD severity in the area under the curve comparison of these scoring systems. For prediction of severe CAD, the cut-off value of CHA2DS2-VASc-HS score was >2 with a sensitivity of 85.2% and a specificity of 57.5% (area under the curve 0.802, 95% confidence interval 0.760 to 0.839, p <0.001). In conclusion, our findings suggest that the CHADS2, CHA2DS2-VASc, and especially CHA2DS2-VASc-HS scores could be considered predictive of the risk of severe CAD.

Impaired circadian rhythm of blood pressure in normotensive patients with rheumatic mitral valve stenosis.

BACKGROUND: The aim of the present cross-sectional study was to evaluate either non-dipper-type or dipper-type circadian rhythm of blood pressure (BP) in normotensive rheumatic mitral stenosis (MS) patients. METHODS AND RESULTS: Eighty-eight normotensive rheumatic mitral valve disease (RMVD) patients and 41 normal participants were enrolled in the study. All participants underwent ambulatory blood pressure monitoring. Nocturnal BP dipping was calculated as follows: (awake BP-asleep BP)×100/awake BP. Patients with a nocturnal reduction in average daytime systolic BP and diastolic BP of less than 10% were classified as nondippers. Patients with RMVD were divided into two groups with respect to the top and bottom 1.5 cm of the mitral valve area (MVA). There was a highly significant relationship between the two groups with control in the frequency of a nondipping status (χ=22.721; d.f.=2; P<0.001). Afterwards, the Mann-Whitney U-test was used to compare the two groups and the control group. There was no difference in the frequency of nondipping between patients with an MVA of greater than 1.5 cm and the control group (P>0.05). However, the nondipping level was higher in patients with an MVA of less than 1.5 cm than in the control group and in patients with RMVD with an MVA of greater than 1.5 cm (P<0.001 and <0.001, respectively). CONCLUSION: The circadian BP rhythm is impaired and the incidence of nondipping BP is higher in patients with MS than in normal patients. Moreover, we believe that autonomic nervous system dysfunction in patients with MS may be detected efficiently using ambulatory blood pressure monitoring.