A new diagnostic tool for masked hypertension: impaired sleep quality.

INTRODUCTION: The aim of this study was to evaluate the relationship between masked hypertension and impaired sleep quality. Additionally, we evaluated the diagnostic role and prevalence of poor sleep quality among patients with newly diagnosed masked hypertension. MATERIAL AND METHODS: A total of 112 individuals, 72 patients with newly diagnosed masked hypertension and 40 normotensive healthy volunteers, were included in this study. All patients underwent evaluation comprising 12-lead electrocardiography, transthoracic echocardiography, 24-hour Holter ECG, and basic laboratory tests. Additionally, all participants completed questionnaires, including the Pittsburgh Sleep Quality Index (PSQI). RESULTS: The total PSQI score was significantly higher in the masked hypertension group than in the normotensive healthy volunteers (4.13 ±2.43 vs. 2.33 ±1.67, p < 0.001). A PSQI score > 5 was found in 45.8% (n = 33) of patients in the masked hypertension group and 15% (n = 6) of patients in the normotensive group (p < 0.001). The non-dipper pattern was found in 17.5% of the healthy volunteer group and 59.94% (n = 41) of the masked hypertension group (p < 0.001). When we compared the dipping pattern of the masked hypertension groups, there was a significant difference in PSQI score between the dipper and non-dipper groups (4.87 ±3.21 vs. 3.58 ±2.33, p < 0.001). Multiple logistic regression analyses showed that masked hypertension, LV mass, and LV mass index score were independent predictors of poor PSQI. CONCLUSIONS: This study demonstrates impaired sleep quality in subjects with masked hypertension, particularly those with a non-dipper pattern. Additionally, this study indicates that impaired sleep quality may help diagnose masked hypertension, particularly in the non-dipper group.

Evaluation of Pregnancy-Associated Plasma Protein-A Levels in Patients with Chronic Obstructive Pulmonary Disease and Associations with Disease Severity.

Chronic obstructive pulmonary disease (COPD) represents a systemic disorder characterized by chronic airflow limitation and an increased inflammatory response of the airways. Comorbidities are frequent in COPD and it is crucial to predict these in early stage for adequate management of COPD. Recent studies have reported that elevated levels of pregnancy-associated plasma protein-A (PAPP-A), a zinc-binding metalloproteinase, detected in patients with asthma, lung cancer, and pulmonary embolism and independently associated with cardiovascular events. We aimed to assess serum PAPP-A levels in COPD and the associations between disease severity. The study population consisted of 75 COPD patients and 35 healthy subjects as a control group. PAPP-A levels were measured by using ultrasensitive enzyme-linked immunosorbent assay. Elevated levels of PAPP-A were observed in patients with COPD on comparison with the controls (p = 0.000). The levels in stage 1 (34.73 ± 22.97) and stage 2 (48.29 ± 53.35) were significantly higher than stage 3 (20.58 ± 22.98) and stage 4 (27.36 ± 21.46) (p = 0.049). Increased PAPP-A levels may be a useful marker in management of COPD that seeks to prevent the development of comorbidities such as adverse cardiovascular diseases.

Detection of atrial electromechanical dysfunction in obesity.

INTRODUCTION: Obesity is associated with atrial fibrillation and is known as an independent risk factor. The aim of our study was to investigate if there was any association between the body mass index and atrial electromechanical intervals in obese and non-obese patients. METHODS: Seventy patients were enrolled in the study. Body mass index (BMI), functional capacity, and fasting blood sugar were evaluated; then, these patients were divided into two groups, patients who had a BMI ≥ 30 were known as obese (35 patients) and those who had a BMI < 30 were known as non-obese patients. All patients were evaluated by transthoracic echocardiography. LA volumes were measured by the discs method in the apical four-chamber view. LA active and passive emptying volumes and fraction were calculated. Using TDI, atrial electromechanical coupling (PA) was measured from the lateral mitral annulus (PA lateral), septal mitral annulus (PA septum), and right ventricular tricuspid annulus (PA tricuspid). RESULTS: LA diameter was significantly higher in obese patients (P = 0.021). LA passive emptying volume and fraction were significantly decreased in obese patients (P = 0.038 and P = 0.011). LA active emptying volume and fraction were significantly increased in obese patients (P = 0.001 and P = 0.001). Left intraatrial and interatrial electromechanical delay were significantly higher in obese patients (18.9 ± 3.8 vs 11.9 ± 2.0, P < 0.001 and 29.5 ± 4.1 vs 17.9 ± 2.5, P < 0.001). Also interatrial electromechanical delay correlated positively with BMI. CONCLUSION: This study revealed that delayed atrial electromechanical interval and impaired LA mechanical functions were related to BMI in obese-patients. These findings may be an early sign of subclinical atrial dysfunction and arrhythmias in obese patients.

Cardiac autonomic function in healthy young smokers.

The present study examined the heart rate turbulence (HRT) and heart rate variability (HRV) parameters in healthy young smokers (<40 years) to assess the effects of smoking on cardiac autonomic function. The study included 75 smokers with a history of habitual smoking for at least 1 year (41 males and 34 females; mean age, 29.3 ± 7.3 years) and 30 nonsmokers (hospital staff; 16 males and 14 females; mean age, 29.0 ± 6.1 years). Addiction to smoking was evaluated using the modified Fagerström test for nicotine-dependence index (NDI). HRT, HRV, basic clinical and echocardiographic, and Holter test parameters were compared between groups. No significant differences between the two groups were found in the basic clinical and echocardiographic variables. Turbulence onset (TO) was significantly higher in the smoking group than in the controls, and turbulence slope was significantly lower in the smokers, than in the controls (p < 0.05). Standard deviation of all normal-to-normal (NN) interval index (SDNNI) was the only HRV parameter that was significantly different between the smoking and control groups (p < 0.05). The NDI was positively correlated with the TO (p < 0.05). Smoking impairs the baroregulatory function in healthy young smokers, particularly the HRT parameters and SDNNI. Our findings highlight the importance of complete smoking cessation.

Post-treatment plasma omentin levels in patients with stage III colon carcinoma.

PURPOSE: Gastrointestinal carcinomas are ~1.5-2-fold more prevalent in obese populations compared to nonobese ones. Possible factors playing an important role in the association between obesity and cancer include insulin, insulin like growth factor-I, sex steroids and adipocytokines. This study investigated the omentin levels, a novel adipocytokine, in patients with stage III colon carcinomas (CC). METHODS: The study investigated 45 patients with stage III CC who had been treated with surgery and adjuvant oxaliplatin, leucovorin and 5-fluorouracil chemotherapy. The study control group was composed of 35 healthy individuals. RESULTS: The median age of the CC and control groups was 62 (range 32-74) and 56 (range 43-71) years, respectively (p=0.206). There were no significant differences between the CC and control groups in terms of gender (p=0.218), body mass index (BMI) (p=0.218), fasting blood glucose (p=0.487), total cholesterol (TC) (p=0.521), low-density lipoprotein (LDL) (p=0.722), high-density lipoprotein (HDL) (p=0.078), triglycerides (TC) (p=0.698), hemoglobin (p=0.096) and creatinine levels (p=0.130). The median plasma omentin concentration was 618 pg/mL (range 151-758) in the CC group and 376 pg/mL (155-662) in the control group (p<0.001). No significant correlation was found between omentin and the other parameters examined in the CC group. CONCLUSION: Omentin levels are significantly elevated in stage III CC patients treated with surgery and chemotherapy. This elevation was independent of the basic risk factors associated with elevated omentin levels. Future studies of the pathophysiological causes of omentin elevation may facilitate the evaluation of the interactions between CC and adipose tissue.

Red cell distribution width and mean platelet volume in patients with irritable bowel syndrome.

INTRODUCTION: Possible pathophysiological mechanisms of irritable bowel syndrome (IBS) are interactions between microbial flora of the gut and the mucosal/systemic immune system, post-infectious status and inflammation. Mean platelet volume (MPV) and red cell distribution width (RDW) have been reported as inflammatory markers in patients with inflammatory bowel disease, but they have not been studied in functional gastrointestinal disorders. AIM: To investigate whether there was an association between haemogram parameters (RDW and MPV) and IBS. MATERIAL AND METHODS: Forty patients with IBS and 44 healthy controls were included to this retrospective study. Patients diagnosed with IBS according to Rome III criteria were included as the IBS group. They were all screened for psychiatric or organic bowel diseases for the sake of precise diagnosis. RESULTS: Both RDW (p < 0.001) and MPV (p = 0.046) were increased in patients with IBS compared to controls. This increase in RDW and MPV was independent of the type of IBS. CONCLUSIONS: The RDW and MPV should be laboratory indicators of IBS. More prospective studies with larger cohorts are needed to confirm our results.

Plasma omentin levels in drug-free patients with schizophrenia.

AIMS: We aimed to investigate plasma omentin concentrations in non-obese, drug-free patients with schizophrenia in comparison with healthy volunteers. METHOD: Thirty-two patients with schizophrenia and 33 control subjects were recruited. Plasma omentin levels were determined by enzyme-linked immunosorbent assay. RESULTS: Plasma levels of omentin (ng/ml) were found to be markedly lower in patients with schizophrenia (median = 7.7, 25th percentile = 6.3, 75th percentile = 604.9) than in controls (median = 486, 25th percentile = 326, 75th percentile = 794.2, p < 0.01). No significant difference was found between drug-free (n = 23) and drug-naive (n = 9) patients with respect to plasma omentin levels. Omentin concentrations correlated negatively with severity of illness, suggesting that patients with more severe pathology had lower fasting levels of omentin (n = 32; r = -0.387; p = 0.029). CONCLUSION: The present results suggest that plasma omentin levels are decreased in physically healthy, non-obese, antipsychotic-free patients with schizophrenia when compared with physically and mentally healthy individuals. To our knowledge, this is the first study that demonstrated the association between omentin and schizophrenia.

Serum levels of omentin are not altered in drug-naive patients with major depression: a pilot study.

BACKGROUND: Decreased plasma levels of omentin, a relatively novel adipokine, are shown to be associated with metabolic abnormalities and proinflammatory states. Although other adipokines such as leptin and adiponectin have been extensively investigated in patients with major depressive disorder (MDD), no studies have evaluated omentin levels in major depression. Therefore, this study sought to test the hypothesis that drug-naive patients with MDD would have lower serum omentin levels than a healthy control group similar in age, sex, and body mass index. SUBJECTS AND METHODS: Thirty patients with MDD (10 men) and 30 healthy control subjects (10 men) were studied. Plasma concentration of omentin, along with other biochemical parameters, was measured after a period of fasting. The severity of depression was determined by the Beck Depression Inventory. RESULTS: No significant difference was found between patients with MDD (723.3±233.8 ng/ml) and healthy comparison subjects (670.7±351.8 ng/ml) in mean plasma concentrations of omentin (p>0.05). There was no significant correlation between plasma omentin levels and depression severity (r=-0.147; p>0.05). CONCLUSIONS: This is the first investigation of omentin levels in patients with MDD. The hypothesis that circulating omentin levels would be different in depressed patients than in healthy controls is not supported by our data.

Detection of atrial electrical and mechanical dysfunction in non-dipper pre-hypertensive subjects.

INTRODUCTION: A relationship between atrial conduction time and hypertension was shown in previous studies. Increased atrial electromechanical intervals used to predict atrial fibrillation by measured tissue Doppler imaging (TDI). So we aimed to search if there was any association between the non-dipping status and atrial electromechanical intervals in pre-hypertensive patients. METHODS: Forty-one non-dipper and 33 dipper pre-hypertensive subjects enrolled in the study. Systolic and diastolic blood pressures were measured with a mercury sphygmomanometer. Twenty-four hours blood pressure was measured with cuff-oscillometric method. All patients were evaluated by transthoracic echocardiography. Using tissue Doppler imaging (TDI), atrial electromechanical coupling (PA) was measured from the lateral mitral annulus (PA lateral), septal mitral annulus (PA septum) and right ventricular tricuspid annulus (PA tricuspid). RESULTS: Systolic and diastolic blood pressures were significantly higher in subjects with non-dipper phenomenon than dipper ones at night. Twenty-four hours average systolic and diastolic blood pressures were higher in non-dipper pre-hypertensive subjects, but this elevation was not significant. Left and right intraatrial (PA lateral-PA septum and PA septum-PA tricuspid) and interatrial (PA lateral-PA tricuspid) electromechanical coupling intervals were measured significantly higher in non-dipper pre-hypertensive patients (31.3 ± 3.9 versus 24.1 ± 2.3, p = 0.001; 19.5 ± 4.3 versus 13.8 ± 2.1, p = 0.001; and 11.4 ± 2.8 versus 8.8 ± 1.5, p = 0.001). Also, interatrial electromechanical delay was negatively correlated with dipping levels. CONCLUSION: This study showed that prolonged atrial electromechanical intervals were related non-dipper pattern in pre-hypertensive patients. Prolonged electromechanical intervals may be an early sign of subclinical atrial dysfunction and arrhythmias' in non-dipper pre-hypertensive patients.

Serum omentin levels in patients with obstructive sleep apnea.

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is associated with increased rates of cardiovascular diseases (CVD). The basic mechanisms involved in the increased cardiovascular risk of OSAS remain unclear. Recent discoveries of fat-secreted substances which serve endocrine roles improve our understanding of the relationship between OSAS, CVD, and the metabolic syndrome. In this study, we aimed to examine associations between omentin levels and OSA. METHODS: Forty-six newly diagnosed OSA patients and 35 non-apneic controls were enrolled in this study. Demographical data, cigarette smoking status, previous history of chronic diseases including CVD and metabolic diseases and drugs, and habits were obtained using a standardized questionnaire. All patients underwent polysomnographic evaluation. Omentin was measured the following morning. RESULTS: The mean age was 48.1 ± 12.5 (24-74) years in the OSA group and 42.8 ± 14.1 (21-69) years in the control group. Of the 81 patients, 46 (34 males and 12 females) were classified as having OSA and 35 patients (20 males and 15 females) as control. Plasma levels of omentin were found to be markedly higher in OSA patients (570.8 ng/ml) than in the control group (432.0 ng/ml; p < 0.001). In addition, plasma levels of omentin were found to be high in all OSA subgroups than in controls. The plasma omentin levels were significantly correlated only with age in patients with OSA. CONCLUSIONS: We conclude that circulating omentin levels are elevated in OSA patients. To the best of our knowledge, this is the first clinical study that demonstrated the association between omentin and OSA.

A new diagnostic marker for acute pulmonary embolism in emergency department: mean platelet volume.

OBJECTIVE: To investigate the diagnostic importance of mean platelet volume (MPV) on acute pulmonary embolism (APE) in the emergency Department (ED). METHODS: Subjects were selected from patients admitted to ED with clinically suspected APE. Demographic, anthropometric and serologic data were collected for each patient. RESULTS: A total of 315 consecutive patients were analyzed, including 150 patients (53.44 ± 15.14 y; 92 men/58 women) in APE group and 165 patients (49.80 ±13.76y; 94 men/71 women) in the control group. MPV in the APE group was significantly higher than in the control group (9.42±1.22 fl vs. 8.04±0.89 fl, p<0.0001). The best cut-off values for MPV when predicting APE in patients with clinically suspected APE presenting at the ED were 8.55 fl (sensitivity 82.2%; specificity 52.3%). CONCLUSIONS: MPV is a helpful parameter for the diagnosis of APE in ED, for the first time in the literature.

Platelet parameters in hepatic hydatid cysts.

Background. Hepatic hydatid cyst infection is caused by microorganisms named Echinococcus which belong to family Taeniidae. Platelets are considered as a mediator in inflammation and infectious diseases because of the various proinflammatory substances that they contain. Design and Methods. Thirty-three patients who were admitted to Dogubayazit State Hospital's General Surgery Clinic with a diagnosis of hepatic cyst hydatid were enrolled in this retrospective study. Laboratory data of the patients in pre- and postoperative periods were obtained from computerized medical records database of the hospital. Results. Preoperative mean platelet volume (MPV) of the patients was significantly increased compared to postoperative MPV values. Conclusion. We claim that MPV is a useful follow-up marker after surgery in patients with hydatid cyst.

Could thrombocyte parameters be an inflammatory marker in the brucellosis?

AIM: To investigate links between platelet parameters mean platelet volume (MPV), platelet count (PC), platelet distribution width (PDW), platelet mass (PM) and brucella tube agglutination titers (BSTAT) in patients with brucellosis. Initially, PC, MPV, PM and PDW calculations were compared between periods before and after treatment. The correlation between inflammation markers (erythrocyte sedimentation rate, ESR, white blood cell count, WBC, and C reactive protein, CRP) and platelet parameters was subsequently investigated. METHODS: This self-controlled study included 40 patients who had positive BSTAT at least at a titer of 1/160. Platelet parameters and inflammation values (CRP, ESR) at the time of positive BSTAT at least at a titer of 1/160 (pre-treatment) were compared with control of the same parameters at the time when BSTAT became negative or when the titers reduced 4 folds (post-treatment). RESULTS: Mean platelet volume values (7.90+1.96) were significantly elevated in post treatment period when compared to pre treatment (7.58+1.96), (p= 0.023). Post treatment CRP, ESR and PC were significantly reduced when compared to pretreatment values (p=0.000, p=0.000 and p=0.025, respectively). In the pretreatment period, a direct correlation between ESR and PC values (r=0.036, p=0.025), and inverse correlations between ESR with MPV (r=-0.337, p=0.038) was found. A dependent predictive factor in multivariate logistic regression analysis for BSTAT was not found. CONCLUSION: We suggest that PC and MPV may be inflammatory markers in brucellosis.

Predictive value of mean platelet volume in young patients with non-ST-segment elevation acute coronary syndromes: a retrospective observational study.

OBJECTIVE: Platelets play an important role in both initiation and propagation of acute coronary syndromes. We sought to evaluate the predictive value of mean platelet volume (MPV) in young patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS). METHODS: This is a retrospective observational study; evaluating the MPV values of 79 NSTE-ACS patients aged under 45 years and 45 control subjects having normal coronary anatomy. NSTE-ACS group was composed of 41 non-ST elevation myocardial infarction (NSTEMI) and 38 unstable angina pectoris (USAP) patients. MPV was measured using an automated hematologic analyzer called Coulter counter. The predictive value of MPV was evaluated using logistic regression analysis and comparison of MPV between NSTE-ACS and control groups was performed by Mann-Whitney U test. RESULTS: The MPV was found to be significantly higher in the NSTE-ACS compared with control group (8.49±1.22 versus 7.78±0.65 fL, p=0.001). In logistic regression analysis, MPV was found to be an independent predictor of NSTE-ACS (OR=3.1, 95% CI 1.2-8.2, p=0.022). The MPV values of NSTEMI group were not significantly different from USAP group (8.78±1.38 versus 8.17±0.95 fL, p=0.66). Similarly, the MPV values of the 3 groups (Control, USAP and NSTEMI) were found to be significantly different (7.78±0.65, 8.18±0.95, 8.78±1.38 fL respectively, p=0.001). CONCLUSION: In conclusion, MPV was found to be elevated in NSTE-ACS patients compared with control subjects in young population. In addition, increased MPV was established to be an independent predictor of NSTE-ACS.

Detection of subclinical atrial dysfunction by two-dimensional echocardiography in patients with overt hyperthyroidism.

BACKGROUND: Hyperthyroidism is an important cardiovascular risk factor in the development of atrial fibrillation and heart failure. Increased atrial electromechanical intervals are used to predict atrial fibrillation, measured by tissue Doppler imaging (TDI). AIMS: To evaluate atrial electromechanical delay (EMD) and left atrial (LA) mechanical function in patients with overt hyperthyroidism. METHODS: Thirty-four patients with overt hyperthyroidism and 34 controls were included. A diagnosis of overt hyperthyroidism was reached with decreased serum thyroid-stimulating hormone (TSH) and increased free T4 (fT4) concentrations. Using TDI, atrial electromechanical coupling (PA) was obtained from the lateral mitral annulus (PA lateral), septal mitral annulus (PA septum) and right ventricular tricuspid annulus (PA tricuspid). LA volumes (maximum, minimum and presystolic) were measured by the disks method in apical four-chamber view and indexed to body surface area. LA active and passive emptying volumes and fractions were calculated. RESULTS: LA diameter was significantly higher in hyperthyroid patients (P=0.001). LA passive emptying volume and fraction were significantly decreased in hyperthyroid patients (P=0.038 and P<0.001). LA active emptying volume and fraction were significantly increased in hyperthyroid patients (P<0.001 and P<0.001). Left and right intra-atrial (PA lateral-PA septum and PA septum-PA tricuspid) and interatrial (PA lateral-PA tricuspid) EMDs were significantly higher in hyperthyroid patients (29.2 ± 4.4 vs 18.1 ± 2.6, P<0.001; 18.7 ± 4.3 vs 10.6 ± 2.0, P<0.001; and 10.5 ± 2.9 vs 7.1 ± 1.2, P<0.001, respectively). Stepwise linear regression analysis demonstrated that fT4 and TSH concentrations were independent predictors of interatrial EMD (ß=0.436, P<0.001 and ß=-0.310, P=0.005, respectively). CONCLUSION: This study showed prolonged atrial electromechanical intervals and impaired LA mechanical function in patients with overt hyperthyroidism, which may be an early sign of subclinical cardiac involvement and dysrhythmias in overt hyperthyroidism.

Glycated haemoglobin is correlated with the severity of coronary artery disease independently of traditional risk factors in young patients.

INTRODUCTION: In this study, we aimed to investigate the relationship between glycated haemoglobin (HbA1c) levels and the severity of coronary artery disease (CAD) in < 40 years old patients. MATERIAL AND METHODS: The study population consisted of 211 premature coronary atherosclerotic patients (pCAP) (aged 36.4 ± 2.5 years) and 160 control subjects (36.4 ± 2.4 years). The severity of CAD was evaluated by the Gensini scoring system. HbA1c levels and the other basic biochemical parameters were analysed, and relations with severity of CAD were evaluated. RESULTS: There were statistically significant differences in serum HbA1c levels between the two groups (pCAP = 6.1 ± 1.8%, control = 4.7 ± 1.2%, p < 0.001). HbA1c levels significantly positively correlated with the Gensini score in pCAP (r = 0.662, p < 0.001). In linear multivariate regression analysis (including age, sex, HbA1c, smoking, diabetes mellitus and hypertension as dependent parameters), only HbA1c was found to be an independent risk factor for the presence of severe CAD (Beta = 0.374, p < 0.001). In ROC curve analysis, the optimal cut-off value of HbA1c to predict severe CAD was 6.52%, with 74.4% sensitivity and 75.1% specificity (area under the curve 0.781, 95% confidence interval 0.661 to 0.901, p < 0.001). CONCLUSIONS: HbA1c levels were found to be correlated with the Gensini score in pCAP with and without diabetes. In this respect, glucose metabolism abnormalities, indicated by HbA1c, may play an important role in premature CAD.

Preeclampsia: is it because of the asymptomatic, unrecognized renal scars caused by urinary tract infections in childhood that become symptomatic with pregnancy?

Preeclampsia is an important disease of pregnancy whose exact etiology is still unknown despite continuing developments in medicine. Although most commonly it is believed to be caused by a defective placentation, in this paper, we hypothesize that the primary underlying problem in the development of preeclampsia can be in kidneys in a greater proportion of cases than it is believed today. The increased intravascular volume and the increased work load of kidneys together with the resulting glomerular hypertrophy may precipitate nephrotic syndrome, which in this case is called "preeclampsia" in a previously affected kidney. Urinary tract infections in childhood leaving silent, unrecognized small scars in the kidneys may be the underlying renal cause which disrupts its silence with an increased work load of kidneys prominently occurring after the midtrimester. The histopathologic finding in kidneys with renal scars after childhood urinary tract infections and in preeclampsia is focal segmental glomerulosclerosis in the majority of cases and this similarity strengthens our hypothesis.

Atrial conduction time and atrial mechanical function in patients with impaired fasting glucose.

BACKGROUND: Prolonging atrial conduction time, as measured by tissue Doppler imaging (TDI), is an independent predictor of new onset or recurrent atrial fibrillation (AF). We investigated atrial conduction time and cardiac mechanical function in patients with impaired fasting glucose (IFG) using echocardiography. METHODS: Thirty patients with IFG (19 males and 11 females; age, 46.9 ± 9.5 years) and 30 control subjects (18 males and 12 females; age, 46.7 ± 8.2 years) were included. Atrial conduction time was determined from the lateral mitral annulus (PA lateral), septal mitral annulus (PA septal), and lateral tricuspid annulus (PA tricuspid) by TDI. Inter- and intra-atrial electromechanical delays (EMDs) were calculated. Left atrial (LA) volumes were determined according to the biplane area-length method. LA mechanical function parameters were calculated. RESULTS: LA passive emptying volume and LA passive emptying fraction decreased significantly in patients with IFG as compared with control subjects (p < 0.001 and p < 0.001, respectively). PA lateral and PA septal durations were significantly higher in patients with IFG than in the control group. However, no difference in PA tricuspid duration was observed between the two groups. Inter- and intra-atrial EMDs were significantly higher in patients with IFG as compared with the control subjects (median [interquartile range], 34.0 [17.0] vs. 17.0 [4.0], p < 0.001 and 15.0 [8.5] vs. 7.5 [2.0], p < 0.001, respectively). Positive correlations were detected between both inter- and intra-atrial EMD and glucose levels (r = 0.76, p < 0.001 and r = 0.68, p < 0.001, respectively). Additionally, a multiple linear regression analysis revealed that glucose levels were independently associated with inter-atrial EMD (ß = 0.753, p < 0.001). CONCLUSION: We showed that IFG was associated with inter- and intra-atrial EMD. Our findings suggest that IFG is an etiological factor for the development of AF.

Coronary artery ectasia is associated with atrial electrical and mechanical dysfunction: an observational study.

OBJECTIVE: The aim of our study was to investigate total atrial conduction time and left atrial (LA) mechanical function in patients with isolated coronary artery ectasia (ICAE). METHODS: Sixty patients with ICAE without any visible coronary stenosis were enrolled to this cross-sectional observational study. The control group consisted of 40 age- and gender-matched patients. Left atrial mechanical functions were measured by the method of discs in the apical-four chamber echocardiographic view. LA mechanical function parameters were calculated. P wave dispersion was measured on electrocardiography (ECG). The total atrial conduction time (PA-tissue Doppler imaging (TDI) duration) was assessed by measuring the time interval between the beginning of the P wave on the surface ECG and point of the peak A wave on TDI from LA lateral wall just over the mitral annulus. Student t, Mann-Whitney U, Pearson's, and Spearman's correlation analysis and multiple regression analysis were used for statistical analysis. RESULTS: The clinical and laboratory characteristics were similar in two groups. Both groups were similar in terms of Vmax and LA total emptying volume (29.0 ± 7.3 vs. 31.9 ± 6.5 mL/m², p=0.082 and 19.9 ± 5.1 vs. 20.0 ± 5.2 mL/m², p=0.821). However, LA passive emptying volume and LA passive emptying fraction were significantly decreased with ICAE patients (11.1 ± 3.2 vs. 13.5 ± 3.8 ml/m², p=0.005 and 35.2 ± 7.2 vs. 47.8 ± 9.4 mL/m², p<0.001). But LA active emptying volume and LA active emptying fraction were significantly increased in ICAE patients (9.1 ± 2.6 vs. 6.4 ± 3.0 mL/m², p<0.001 and 45.3 ± 8.1 vs. 40.7 ± 6.7 mL/m², p=0.002). PA-TDI duration was measured significantly higher in patients with ICAE than control group (131.8 ± 5.7 vs. 114.4 ± 9.1 ms, p<0.001). Multiple linear regression analyses showed that ectatic segment number was an independent factor of PA-TDI duration (ß=0.581, 95% CI=4.046-6.295, p<0.001). CONCLUSION: Our study demonstrated presence of LA electrical and mechanical dysfunction in patients with ICAE. LA dysfunction may be associated with cardiac pathologies as arrhythmias, decrease in cardiac output and congestive failure.