Comparison of the effect of uric acid/albumin ratio on coronary slow flow with other inflammation-based markers.

Background: Many inflammation-based markers (IBMs) have been shown to be closely related to coronary slow flow (CSF), but the effect of the uric acid/albumin ratio (UAR) on CSF and its relationship with other IBMs are not clearly known. In this study, we aimed to compare the effects of UAR and other IBMs on CSF. Methods: After the exclusion criteria, 126 patients with CSF detected on coronary angiography and 126 subjects with normal coronary flow as the control group were included in the study. Results: UAR was determined as an independent predictor for CSF. In addition, the UAR was superior to other IBMs in detecting CSF (p < 0.05 for all). Conclusion: This study is the first to investigate the effect of UAR on CSF in comparison with other IBMs.

The non-HDL-C/HDL-C ratio is a strong and independent predictor of the no-reflow phenomenon in patients with ST-elevation myocardial infarction.

BACKGROUND: No-reflow (NR) is the inability to achieve adequate myocardial perfusion despite successful restoration of attegrade blood flow in the infarct-related artery after primary percutaneous coronary intervention. The non-HDL-C/HDL-C ratio has been shown to be superior to conventional lipid markers in predicting most cardiovascular diseases. In this study, we wanted to reveal the predictive value of the NR by comparing the Non-HDL-C/HDL-C ratio with traditional and non-traditional lipid markers in patients who underwent primary percutaneous coronary intervention (pPCI) due to ST-elevation myocardial infarction (STEMI). METHODS: A total of 1284 consecutive patients who underwent pPCI for STEMI were included in this study. Traditional lipid profiles were detected and non-traditional lipid indices were calculated. Patients were classified as groups with and without NR and compared in terms of lipid profiles. RESULTS: No-reflow was seen in 18.8% of the patients. SYNTAX score, maximal stent length, high thrombus burden, atherogenic index of plasma and non-HDL-C/HDL-C ratio were determined as independent predictors for NR (p < 0.05, for all). The non-HDL-C/HDL-C ratio predicts the development of NR in STEMI patients with 71% sensitivity and 67% specificity at the best cut-off value. In ROC curve analysis, the non-HDL-C/HDL-C ratio was superior to traditional and non-traditional lipid markers in predicting NR (p < 0.05, for all). CONCLUSION: The non-HDL-C/HDL-C ratio can be a strong and independent predictor of NR in STEMI patients and and therefore non-HDL-C/HDL-C ratio may be a useful lipid-based biomarker that can be used in clinical practice to improve the accuracy of risk assessment in patients with STEMI.

Comparison of the effect of uric acid/albumin ratio on coronary colleteral circulation with other inflammation-based markers in stable coronary artery disease patients.

BACKGROUND: The Uric acid/Albumin ratio (UAR) has recently been identified as a prominent marker in cardiovascular diseases. In this study, we aimed to reveal the effect of UAR on coronary collateral circulation (CCC) in patients with stable coronary artery disease (CAD) patients by comparing it with conventional inflammation-based markers. METHODS: In this study, 415 consecutive patients who underwent coronary angiography for stable angina pectoris and were found to have chronic total occlusion in at least one coronary artery were retrospectively included. The study population was divided into two groups as good CCC (Rentrop 2-3) and poor CCC (Rentrop 0-1) according to the Rentrop classification, and the groups were compared in terms of UAR and other traditional inflammation-based markers. RESULTS: In the poor CCC group, C-reactive protein/albumin ratio (CAR), monocyte/high-density lipoprotein cholesterol ratio (MHR), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), systemic immune-inflammation index (SII) and UAR were found to be significantly high (p < .05, for all). UAR negatively correlated with rentrop classification (r = -0.383, p < .001). In multivariate regression analysis, MHR, NLR, SII and UAR were determined as independent predictors for poor CCC (p < .05, for all). The ability of UAR to predict poor CCC was superior to uric acid and albumin alone (p < .0001, for both). In addition, UAR was found to be superior to other inflammation-based markers in predicting poor CCC (p < .005, for all). CONCLUSION: UAR was identified as a strong and independent predictor of CCC. In this context, UAR may be a useful biomarker in the risk prediction of patients with stable CAD.

Usefulness of CHA2DS2-VASc Score to predict clinical outcomes of patients undergoing carotid artery stenting.

The CHA2DS2-VASc score predicts stroke and mortality risk in several cardiovascular diseases regardless of atrial fibrillation. In this study, we aimed to investigate the ability of CHA2DS2-VASc score to predict in-hospital and long-term outcomes in patients undergoing carotid artery stenting (CAS). The study population included 558 patients undergoing CAS. The patients were stratified into three groups based on their CHA2DS2-VASc scores [low (≤ 2, n = 123), moderate (3-5, n = 355) and high (6-8, n = 80)]. In-hospital and 3-year outcomes were compared between the groups. In-hospital rates of ipsilateral and major strokes and death were significantly different between the groups (1.6% vs. 3.9% vs. 16.2%; 1.6% vs. 4.5% vs. 16.2%; 0.8% vs. 3.1% vs. 13.8%, p < 0.001 for all, respectively). At 3 years of follow-up, rates of ipsilateral and major strokes and death were significantly increased in patients with highscore compared to those with moderate and low scores (1.6% vs. 5.8% vs. 13%, p = 0.005; 0.8% vs. 5.2% vs. 13%, p = 0.001; 1.6% vs. 8.4% vs. 15.9%; p = 0.002, respectively). After adjusting for multi-model Cox regression analysis, CHA2DS2-VASc score persisted as an independent prognostic factor for mortality and major stroke in patients undergoing CAS. Higher CHA2DS2-VASc score predicted increased risk of in-hospital and 3- year stroke and mortality in patients undergoing CAS.

Biventricular Myocardial Performance Is Impaired in Proportion to Severity of Obstructive Sleep Apnea.

Obstructive sleep apnea (OSA) is an independent risk factor for cardiovascular morbidity and death. Little information is available regarding the relationship between the severity of OSA and myocardial performance in OSA patients who have normal ejection fractions. We prospectively investigated this relationship, using the tissue-Doppler myocardial performance index (TD-MPI). We conducted overnight, full-laboratory polysomnographic examinations of 116 patients, and calculated the left and right ventricular TD-MPIs. Patients were classified into 3 groups in accordance with their apnea-hypopnea index (AHI) levels: AHImild (≥5 to <15), AHImoderate (≥15 to <30), and AHIsevere (≥30). Left and right ventricular TD-MPI values were higher in the AHIsevere group than in the AHImild and AHImoderate groups (all P <0.05). In addition, right ventricular TD-MPI values in the AHImoderate group were higher than those in the AHImild group (P <0.05). Right ventricular TD-MPI was significantly associated with AHI (ß=0.468, P <0.001), left ventricular TD-MPI, and right ventricular early-to-late filling velocities (E/A ratio) in multiple linear regression analysis. On the other hand, left ventricular TD-MPI was significantly associated with right ventricular TD-MPI and left ventricular E/A ratio (both P <0.05). Our results show that OSA severity, determined by means of AHI, is independently associated with impaired right and left ventricular function as indicated by TD-MPI in patients who have OSA and normal ejection fractions.

Predictors of successful percutaneous coronary intervention in chronic total coronary occlusions.

INTRODUCTION: Percutaneous coronary intervention (PCI) of chronic total coronary occlusions (CTOs) is one of the most challenging procedures of interventional cardiology and is associated with increased risk of significant complications. However, debate continues in regard to which factors adversely influence the success rate of PCI and whether the benefits of revascularization of CTO outweigh the risks and challenges. AIM: To analyze the relationship between lesion characteristics and overall success rates as well as in-hospital outcomes after PCI for CTO. MATERIAL AND METHODS: We retrospectively examined the procedural outcomes of 173 consecutive native coronary artery CTO PCIs performed from February 2012 to March 2013 (78% men; mean age: 60.3 ±12.1 years). RESULTS: The CTO target vessel was the right coronary artery (53.8%), circumflex (10.4%) and left anterior descending artery (35.8%), respectively. The retrograde approach was used in 13.9% of all procedures. Successful revascularization was achieved in 83.2% of patients. Major complications occurred in 13.3% of patients. In multivariate analysis, bridge collaterals, severe calcification and tortuosity as well as tandem occlusions were independent predictors of procedural failure, whereas existence of micro-channels was the only predictor of procedural success. CONCLUSIONS: Revascularization of coronary CTOs may be performed with high success and low major complication rates. Bridge collaterals, severe calcification and tortuosity, tandem/multiple occlusions and micro-channels were independent predictors of successful CTO revascularization.

Aortic stiffness increases in proportion to the severity of apnoea-hypopnea index in patients with obstructive sleep apnoea syndrome.

BACKGROUND AND AIMS: Obstructive sleep apnoea syndrome (OSA) and aortic stiffness are associated with an increased risk of cardiovascular morbidity and mortality. Although aortic stiffness increased in patients with OSA, the relationship between severity of OSA indicated with apnoea-hypopnea index (AHI) and aortic stiffness was not investigated in previous studies. The aim of this study is to investigate the relationship between the severity of OSA and aortic stiffness. METHODS: In the present study, 90 consecutive OSA patients definite diagnosed with sleep test were prospectively included (mean age 54.5 ± 11.6 years). Aortic pulse wave velocity (PWV) and augmentation index (AIx) were calculated using the single-point method via the Mobil-O-Graph® ARCsolver algorithm. Aortic distensibility (AD) was calculated from the echocardiographically derived ascending aorta diameters and haemodynamic pressure measurements. Overnight full-laboratory polysomnography examination was conducted on each subject. Patients were classified into two groups according to their median AHI values (AHIlow and AHIhigh groups). RESULTS: PWV values were higher and AD values were lower in AHIhigh group compared with AHIlow group (P < 0.05, for all). AHI was associated with body mass index (BMI), systolic blood pressure, pulse pressure, aortic diameter, AD, AIx and PWV in bivariate analysis (P < 0.05, for all). Multivariate linear regression analysis showed that AHI was independently associated with BMI (ß = 0.175, P = 0.047), PWV (ß = 0.521, P < 0.001) and aortic distensibility (ß = -0.223, P = 0.020). CONCLUSIONS: Aortic stiffness is associated both with the presence and the severity of OSA.

Mean platelet volume is associated with disease severity in patients with obstructive sleep apnea syndrome.

OBJECTIVE: Obstructive sleep apnea syndrome is associated with cardiovascular diseases and thromboembolic events. The mean platelet volume (MPV) is a predictor of cardiovascular thromboembolic events. The aim of the present study is to investigate the association between the MPV and disease severity in patients with obstructive sleep apnea syndrome. METHODS: We prospectively included 194 obstructive sleep apnea syndrome patients without cardiovascular disease (mean age 56.5±12.5 years) who were undergoing sleep tests. An overnight full laboratory polisomnography examination was conducted on each patient. The patients were divided into 3 groups according to the apnea-hypopnea index (AHI): (1) AHIlow group: 5≤AHI<15, (2) AHImid group: 1530. RESULTS: The highest MPV values were found in the AHIhigh group compared with other groups (p<0.05 for all). Multiple linear regression analysis indicated that the MPV was associated with the AHI (ß=0.500, p<0.001) and the high sensitivity C-reactive protein (hs-CRP) level (ß=0.194, p=0.010). CONCLUSION: The MPV is independently associated with both disease severity and inflammation in patients with obstructive sleep apnea syndrome.

Mean platelet volume is associated with disease severity in patients with obstructive sleep apnea syndrome

OBJECTIVE: Obstructive sleep apnea syndrome is associated with cardiovascular diseases and thromboembolic events. The mean platelet volume (MPV) is a predictor of cardiovascular thromboembolic events. The aim of the present study is to investigate the association between the MPV and disease severity in patients with obstructive sleep apnea syndrome. METHODS: We prospectively included 194 obstructive sleep apnea syndrome patients without cardiovascular disease (mean age 56.5±12.5 years) who were undergoing sleep tests. An overnight full laboratory polisomnography examination was conducted on each patient. The patients were divided into 3 groups according to the apnea-hypopnea index (AHI): (1) AHIlow group: 5≤AHI<15, (2) AHImid group: 15<AHI≤30, and (3) AHIhigh group: AHI>30. RESULTS: The highest MPV values were found in the AHIhigh group compared with other groups (p<0.05 for all). Multiple linear regression analysis indicated that the MPV was associated with the AHI (β=0.500, p<0.001) and the high sensitivity C-reactive protein (hs-CRP) level (β=0.194, p=0.010). CONCLUSION: The MPV is independently associated with both disease severity and inflammation in patients with obstructive sleep apnea syndrome. .

Perioperative evaluation for the patients with obstructive sleep apnea syndrome.

Obstructive sleep apnea syndrome, that has been more frequently diagnosed lately and whose importance has been gradually understood better, is a widespread health problem. This syndrome has been accompanied by obesity frequently. In the obstructive sleep apnea syndrome, it has been known that hypoxia and sometimes hypercarbia additionally has been observed, nevertheless cardiovascular problems have been observed more frequently in the aforementioned patient group in comparison with other individuals. Anesthetic substituents applied during the invasive operations and some medicine used for analgesia may cause the increase of the aforesaid hypoxia and cardiovascular problems in the obstructive sleep apnea syndrome. Nowadays, with the improvements in accessing to health agencies and consequently with the increase in the number of surgical applications, this review has been prepared with the thought of helping to clinicians about the approach and the pre-anesthetic and post-anesthetic precautions required to be taken within the mentioned patient group.

Gamma Glutamyl Transferase Activity is Associated With Both Paraoxonase Activity and Aortic Stiffness in Hypertensive Patients.

BACKGROUND: We aimed to investigate relationship between gamma glutamyl transferase (GGT) activity with paraoxonase 1 (PON1) activity and aortic stiffness (AS) parameters such as pulse wave velocity (PWV) and augmentation index (AIx). METHODS: Measurements were obtained from 324 patients with newly diagnosed essential hypertension (mean age: 55.0 ± 8.2 years). The patients were divided into two groups according to their median GGT values. PWV and AIx were calculated using the single-point method via the Mobil-O-Graph® ARCsolver algorithm. RESULTS: PWV, Aix, and high-sensitive C-reactive protein (hs-CRP) values were higher and PON1 activity values were lower in GGThigh group compared with GGTlow group (P < 0.05, for all). Multiple linear regression analysis showed that GGT activity was independently associated with PWV (ß = 0.496, P < 0.001) and PON1 activity (ß = -0.343, P < 0.001) as well as hs-CRP (ß = 0.334, P < 0.001). CONCLUSION: These results may support that increased GGT activity would be associated with both impaired antioxidant system and increased AS in hypertensive patients.

Paraoxonase-1 activity and oxidative stress in patients with anterior ST elevation myocardial infarction undergoing primary percutaneous coronary intervention with and without no-reflow.

BACKGROUND: Reperfusion and ischemic injuries are pathogenetic mechanisms of no-reflow. Oxidative stress plays a critical role during ischemia as well as during the reperfusion phase following ST elevation myocardial infarction (STEMI). We sought to investigate the relationship between no-reflow with paraoxonase-1 (PON-1) activity and oxidative stress markers (total antioxidant capacity (TAC), total oxidant status (TOS), oxidative stress index (OSI), lipid hydro-peroxide (LOOH)) in patients with anterior STEMI undergoing primary percutaneous coronary intervention (PCI). METHODS: In this study, 319 consecutive anterior STEMI patients undergoing primary PCI were prospectively included (mean age 56.5 ± 12.5 years). The patients were divided into two groups as normal flow (n = 231) and no-reflow (n = 88) groups. Serum PON-1 activity was measured spectrophotometrically. TAC and TOS levels were determined by using an automated measurement method. LOOH levels were measured by ferrous oxidation with xylenol orange assay. RESULTS: PON-1 activity and TAC levels were significantly lower and TOS, OSI and LOOH levels were significantly higher in patients with no-reflow compared to normal flow group (p < 0.05, for all). On multivariate logistic regression analysis, PON-1 activity (ß = 0.976, 95% CI = 0.962-0.990, p = 0.001) and OSI (ß = 1.094, 95% CI = 1.042-1.148, p < 0.001) as well as diabetes, infarction time, thrombus score and initial SYNTAX score were independently associated with no-reflow. CONCLUSION: In patients with no-reflow compared with normal flow, oxidants are increased, while serum PON-1 activity and antioxidants are decreased. This result shows that increased oxidative stress has a role in the pathogenesis of no-reflow.

N-terminal pro-brain natriuretic peptide levels and abnormal geometric patterns of left ventricle in untreated hypertensive patients.

N-terminal pro-brain natriuretic peptide (NT-proBNP) predicts cardiovascular events and mortality in hypertensive patients. Relationship between NT-proBNP level and left ventricular (LV) hypertrophy is well known in hypertensive patients. However, the studies investigating relationship between LV geometric patterns and serum NT-proBNP level have conflicting results and are in a limited number. The goal of the present study is to investigate relation between NT-proBNP and abnormal LV geometric patterns in untreated hypertensive patients. Measurements were obtained from 273 patients with untreated essential hypertension (mean age = 51.7 ± 5.8 years) and 44 healthy control subjects (mean age; 51.3 ± 4.7). Four different geometric patterns (NG: normal geometry; CR: concentric remodelling; EH: eccentric hypertrophy; CH: concentric hypertrophy) were determined according to LV mass index (LVMI) and relative wall thickness. NT-proBNP and other biochemical markers were measured in all subjects. The highest NT-proBNP levels were determined in the CH group compared with the control group and other geometric patterns (p < 0.05). NT-proBNP levels of all geometric patterns were higher than the control group (p < 0.05, for all). NT-proBNP levels were similar between CR and NG groups (p > 0.05). NT-proBNP was independently associated with LV geometry (ß = 0.304, p = 0.003) and LVMI (ß = 0.266, p = 0.007) in multiple linear regression analysis. Serum NT-proBNP level was independently associated with LVMI and LV geometry in untreated hypertensive patients with preserved ejection fraction.

Serum 25-hydroxyvitamin D level and extent and complexity of coronary artery disease.

BACKGROUND: There are limited number of studies about relationship between serum vitamin D level and presence and severity of coronary artery disease (CAD). We assessed the relationship between the extent and complexity of CAD assessed by SYNTAX score and 25-hydroxyvitamin D level in patients with stable CAD. METHODS: In the study, 209 consecutive patients with stable CAD (age: 63.1 ± 10.0 years) and 102 healthy control subjects (age 61.3 ± 13.7 years) were included. Serum 25-hydroxyvitamin D was measured using a direct competitive chemiluminescent immunoassay and other biochemical markers were measured in all subjects. All subjects underwent coronary angiography and SS was calculated. RESULTS: The mean serum 25-hydroxyvitamin D level of CAD group was lower than the control group (P < 0,001). Multivariate regression analysis showed that serum 25-hydroxyvitamin D level was independently associated with SYNTAX score (ß = -0.396, P < 0.001), hypertension (ß = -0.183, P = 0.003), high sensitive C-reactive protein (ß = -0.141, P = 0.014), and body mass index (ß = -0.135, P = 0.023) in patient group. CONCLUSION: 25-Hydroxyvitamin D level was associated with extent and complexity of CAD. 25-Hydroxyvitamin D may play a role in pathogenesis and severity of coronary atherosclerosis.

Serum 25-hydroxyvitamin D level is associated with arterial stiffness, left ventricle hypertrophy, and inflammation in newly diagnosed hypertension.

OBJECTIVES: Vitamin D may modulate vascular inflammation, vascular smooth muscle cell proliferation, the renin-angiotensin system, and cardiomyocyte proliferation, myocardial fibrosis, and proliferation. These mechanisms may play a role on arterial stiffness and left ventricle hypertrophy (LVH) in hypertensive patients. We aimed to evaluate the association between serum vitamin D with arterial stiffness and LVH in patients with hypertension. METHODS: We studied 133 patients with newly diagnosed hypertension [mean (SD) age, 62.9 (10.6) years]. Pulse wave velocity (PWV), which reflects arterial stiffness, was calculated using the single-point method via the Mobil-O-Graph ARCsolver algorithm. Left ventricular mass index (LVMI) was determined according to Deverux formula. The patients were divided into the following 2 groups according to serum vitamin D level: vitamin Dlow group with less than 20 ng/mL and vitamin Dhigh group with greater than or equal to 20 ng/mL. RESULTS: The highest PWV, high-sensitivity C reactive protein, and LVMI values were observed in vitamin Dlow group compared with vitamin Dhigh group. Multiple linear regression analysis showed that vitamin D level was independently associated with LVMI (ß = -0.235, P = 0.002) and PWV (ß = -0.432, P < 0.001). Adjustment for age, sex, parathyroid hormone level, body surface area, and mean blood pressure did not modify these associations. Vitamin D level was also independently associated with high-sensitivity C reactive protein (ß = -0.143, P = 0.047). However, adjustment for parathyroid hormone level or body surface area and mean blood pressure attenuate this association. CONCLUSIONS: Serum 25-hyroxyvitamin D is independently related with arterial stiffness, LVH, and inflammation. Vitamin D may play a role on pathogenesis of arterial stiffness and LVH in patient with newly diagnosed hypertension.

Biventricular myocardial noncompaction presenting with complete atrioventricular block.

Noncompaction of ventricular myocardium has been recognized as a distinct form of cardiomyopathy with its own clinical presentation and natural history. Concomitance of either valvular pathologies or complete atrioventricular block with noncompaction of ventricular myocardium has rarely been reported. Herein, we present a case with biventricular noncompaction with significant interventricular septum involvement presenting with complete atrioventricular block, who was formerly diagnosed to have mitral and aortic insufficiency.

The association of serum prolidase activity with the presence and severity of coronary artery disease.

OBJECTIVES: Prolidase is a cytosolic exopeptidase that cleaves iminodipeptides with carboxy-terminal proline or hydroxyproline and plays major role in collagen turnover. Collagen is the essential content in atherosclerotic plaque playing a key role in the stability/instability of and progression of coronary artery disease (CAD). Consequently, in this study we sought to determine serum prolidase activity and markers of oxidative stress such as lipid hydroperoxide and total free sulfhydryl in CAD. DESIGN AND METHODS: We have evaluated 199 patients with CAD and 122 control cases with clinical, electrocardiographic, and laboratory investigation. We have measured serum prolidase activity and serum total free sulfhydryl levels spectrophotometrically. Serum lipid hydroperoxide levels were determined with ferrous ion oxidation-xylenol orange method. We assessed the association of serum prolidase activity with the presence and severity of CAD and clinical characteristics, and laboratory parameters. RESULTS: Serum prolidase activity (52.5+/-5.6 vs. 46.7+/-5.1 U/l, respectively, P<0.001) and serum lipid hydroperoxide levels were significantly increased in patients with CAD compared with control cases whereas, serum total free sulfhydryl levels were significantly decreased in patients with CAD compared with control cases. Serum prolidase activity and total free sulfhydryl levels were independent predictors of the presence of CAD [(chi=75.532, ss=0.212, P=0.003) and (chi=25.969, ss=-30.486, P=0.019), respectively] and Gensini score [(beta=0.276, P<0.001) and (beta=-0.274, P<0.001), respectively]. Independent predictors of serum prolidase activity were serum high-density lipoprotein cholesterol (beta=-0.138, P=0.023) and urea levels (beta=0.146, P=0.036), and Gensini score (beta=0.317, P<0.001). CONCLUSION: Findings of this study have shown that serum prolidase activity is significantly associated with the presence and severity of CAD, and elevated serum prolidase activity might be an independent predictor of coronary atherosclerosis.

Paraoxonase and arylesterase activities in untreated dipper and non-dipper hypertensive patients.

OBJECTIVES: Paraoxonase, a high density lipoprotein (HDL) associated enzyme, was shown to be reduced in patients with cardiovascular diseases. We aimed to examine serum paraoxonase and arylesterase activities, and oxidative stress markers such as lipid hydroperoxide (LOOH) and total antioxidant status (TAS) in dipper and non-dipper hypertensive patients. DESIGN AND METHODS: Forty-six non-dipper hypertensives (NDH group), 40 dipper hypertensives (DH group) and 28 healthy control subjects were included in the study. Clinical and echocardiographic assessment and ambulatory blood pressure monitoring were performed in all subjects. Serum paraoxonase and arylesterase activities were measured spectrophotometrically. LOOH levels were measured by ferrous oxidation with xylenol orange assay. TAS was determined by using an automated measurement method. RESULTS: Paraoxonase and arylesterase activities and TAS levels were significantly lower in patients with NDH compared to both DH and control groups (p<0.001, for both). Also, LOOH levels were found at high level in patients with NDH compared to control and DH groups. In NDH group, both paraoxonase and arylesterase activities were independently correlated with LDL cholesterol, TAS and LOOH levels. In DH group, both paraoxonase and arylesterase activities were independently correlated with HDL cholesterol and LOOH levels. CONCLUSIONS: Reduced paraoxonase and arylesterase activities in NDH might indicate increased oxidative stress, which plays an important role in the development of cardiovascular diseases. Low serum activities of paraoxonase and arylesterase might be considered as prospective prognostic markers of the development of cardiovascular diseases in dipper and non-dipper hypertensive patients.

Relation between P-wave dispersion and left ventricular geometric patterns in newly diagnosed essential hypertension.

AIM: P-wave durations and P-wave dispersion (PD) are considered to reflect the heterogeneous conduction in atria. The aim of this study was to investigate PD and P-wave duration in different left ventricle geometric patterns of hypertensive patients. METHODS: One hundred forty-nine consecutive patients with newly diagnosed essential hypertension and 29 healthy control groups were included in the study. The maximum and minimum P-wave duration (Pmax and Pmin, respectively) and PD were measured from the 12-lead surface electrocardiogram. Echocardiographic examination was also performed in all subjects. Four different geometric patterns were identified in hypertensive patients according to left ventricular mass index (LVMI) and relative wall thickness. RESULTS: P-wave dispersion was longer in concentric remodeling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH) groups when compared with the control group (P = .009, P < .001, P < .001, respectively). P-wave dispersion of normal left ventricle (NLV) geometric pattern was not different from that of the control group. Patients with NLV geometric pattern had shorter PD than patients who had CH and EH (NLV vs CH, P < .001; NLV vs EH, P = .025). P-wave dispersion of the NLV group was not different from that of the CR group. Patients with CR had also shorter PD than patients who had CH (P = .002). In bivariate analysis, there was a significant correlation between PD with left ventricle geometry, body surface area, LVMI, and relative wall thickness. In multiple linear regression analysis, PD was independently correlated only with LVMI (beta = .425, P < .001). CONCLUSIONS: P-wave dispersion is independently associated with LVMI rather than left ventricle geometry and relative wall thickness in hypertensive patients. Thus, it is increased particularly in patients with CH and EH.