The effect of calcium channel blocker (CCB) treatment on retinal and choroidal vessels in a group of hypertensive patients.

PURPOSE: The present study was designed to observe the vasoreactivity in retina and choroid after calcium channel blocker (CCB) treatment in a group of hypertensive patients. METHOD: The study was based on 56 hypertensive patients (56 eyes) and 56 control subjects (56 eyes). Choroidal scans and the measurement of peripapillary retinal vessel diameters was performed at baseline and optical coherence tomography (OCT) scans were also performed at first month . Subfoveal choroidal thickness (SFCT) and the diameters of superior temporal artery (STA), inferior temporal artery (ITA), superior temporal vein (STV), inferior temporal vein (ITV) were compared between the groups. RESULTS: The baseline diameters of the STA, ITA were significantly decreased in the patient group compared with the control group (all p < .05). There was a significant increase at first month after the CCB treatment in comparison to baseline measurements (all p < .05). When compared with the controls, the diameter of venules showed a decrease at baseline but was not significant. After the treatment, the diameters of venules were insignificantly increased compared with baseline measurements (p = .178 and p = .275) and there were also no significant differences between the control group and the patient group in first month (all p > .05). The average choroidal thickness measurements of the hypertensive group was lower than the control group (p = .404) and there was a tendency to increase after the treatment (p = .055). CONCLUSION: This study demonstrates that, treatment with CCB seems to improve retinal arteries and has almost no affect on the choroidal thickness in newly diagnosed hypertensive patients.

Scanning of paroxysmal atrial fibrillation as an etiological risk factor in patients with acute ischemic stroke: prospective study.

BACKGROUND: Prevention of recurrence of stroke depends on recognition of the underlying mechanism of ischemia. OBJECTIVE: To screen patients who were hospitalized with diagnosis of acute ischemic stroke in terms of atrial fibrillation (AF) with repeated Holter electrocardiography recordings. DESIGN AND SETTING: Prospective study conducted at Konya Education and Research Hospital, Turkey. METHODS: Patients with a diagnosis of acute ischemic stroke, without atrial fibrillation on electrocardiography (ECG), were evaluated. Their age, gender, histories of previous ischemic attack, occurrences of paroxysmal atrial fibrillation (PAF) and other risks were assessed during the first week after acute ischemic stroke and one month thereafter. ECG recordings were obtained from 130 patients through 24-hour ambulatory Holter. Patients without PAF attack during the first Holter were re-evaluated. RESULTS: PAF was detected through the first Holter in 33 (25.4%) out of 130 acute ischemic stroke patients. A second Holter was planned for 97 patients: 53 (54.6%) of them could not attend due to COVID-19 pandemic; while 44 (45.3%) patients had the second Holter and, among these, 4 (9.1%) had PAF. The only parameter associated with PAF was older age. Four (10.8%) of the 37 patients with PAF had also symptomatic carotid stenosis. CONCLUSIONS: Detecting the presence of PAF by screening patients with no AF in the ECG through Holter ECG examinations is valuable in terms of changing the course of the treatment. It should be kept in mind that the possibility of accompanying PAF cannot be ruled out in the presence of other factors that pose a risk of stroke.

Scanning of paroxysmal atrial fibrillation as an etiological risk factor in patients with acute ischemic stroke: prospective study

Abstract BACKGROUND: Prevention of recurrence of stroke depends on recognition of the underlying mechanism of ischemia. OBJECTIVE: To screen patients who were hospitalized with diagnosis of acute ischemic stroke in terms of atrial fibrillation (AF) with repeated Holter electrocardiography recordings. DESIGN AND SETTING: Prospective study conducted at Konya Education and Research Hospital, Turkey. METHODS: Patients with a diagnosis of acute ischemic stroke, without atrial fibrillation on electrocardiography (ECG), were evaluated. Their age, gender, histories of previous ischemic attack, occurrences of paroxysmal atrial fibrillation (PAF) and other risks were assessed during the first week after acute ischemic stroke and one month thereafter. ECG recordings were obtained from 130 patients through 24-hour ambulatory Holter. Patients without PAF attack during the first Holter were re-evaluated. RESULTS: PAF was detected through the first Holter in 33 (25.4%) out of 130 acute ischemic stroke patients. A second Holter was planned for 97 patients: 53 (54.6%) of them could not attend due to COVID-19 pandemic; while 44 (45.3%) patients had the second Holter and, among these, 4 (9.1%) had PAF. The only parameter associated with PAF was older age. Four (10.8%) of the 37 patients with PAF had also symptomatic carotid stenosis. CONCLUSIONS: Detecting the presence of PAF by screening patients with no AF in the ECG through Holter ECG examinations is valuable in terms of changing the course of the treatment. It should be kept in mind that the possibility of accompanying PAF cannot be ruled out in the presence of other factors that pose a risk of stroke.

The relationship of soluble klotho level with uremic cardiomyopathy and ecocardiographic parameters in hemodialysis patients.

There are studies reporting that soluble kltho (sKlotho) deficiency plays a role in cardiovascular disease in addition to traditional risk factors such as diabetes, hypertension, anemia, smoking, and excessive volume burden. Our aim in this study was to investigate the relationship of sKlotho with uremic cardiomyopathy and echocardiographic parameters in patients receiving hemodialysis treatment. According to the median value, the sKlotho value was divided into two groups as ≥1.24 and <1.24 ng/ml. Ventricular wall thicknesses, ejection fractions, left atrium, M mode aorta systole, and diastole diameter measurements were taken. The left ventricular mass (LVM) was calculated using the Devereux formula. There were significant differences between the two groups in terms of age, number of patients with diabetes mellitus, comorbidity, dialysis time, sKlotho, phosphorus, parathormone, and albumin parameters. No significant difference was found between the two groups that were separated according to the median sKlotho value, when the echocardiographic parameters of interventricular septum thickness, left ventricular posterior wall thickness, left atrial diameter, left ventricular ejection fraction, and LVM index were compared. In conclusion, sKlotho is not a marker for showing and predicting uremic cardiomyopathy in hemodialysis patients.

Periaortic adipose tissue volume is associated with sclerotic changes in the adjacent aortic valve.

Aortic sclerosis is associated with increased cardiovascular mortality and morbidity. Numerous studies have shown that visceral adiposity is associated with development of atherosclerosis, especially in the adjacent vascular wall. Considering the similar pathophysiology of aortic sclerosis and atherosclerosis, it can be hypothesized that visceral adipose tissue adjacent to aortic valve may be associated with aortic sclerosis. In this study, we investigated the relationship between periaortic adipose tissue volume and sclerotic changes in the adjacent aortic valve. In this retrospective study, 80 patients with a concurrent MSCT and echocardiography in the last 6 months were enrolled. Echocardiographic examinations were retrospectively evaluated regarding the presence of aortic sclerosis. Periaortic adipose tissue volume was calculated on a computer assisted work station (Leonardo Workstation, Siemens, Erlangen, Germany) by an experienced radiologist. Patient group (61.63 ± 8.55 years and 50% male) and the control group (61.45 ± 5.68 years, 50% male) each consisted 40 participants. Patient group had significantly higher BUN (42.50 (15.00-211.00) vs. 34.00 (12.00-107.00) mg/dL, p = 0.003), uric acid (5.40 (3.40-14.70) vs. 4.30 (2.30-6.70) ng/mL, p = 0.005) and LDL-C levels (121.50 (60.00-215.00) vs. 86.50 (49.00-209.00) mg/dL, p = 0.001) when compared to control group. Patient group had also significantly higher periaortic adipose tissue volume (32.45 (11.70-51.23) vs. 16.00 (6.29-32.96) ml, p < 0.001). Multivariate regression analysis revealed that periaortic adipose tissue volume was independently associated with the presence of aortic sclerosis (OR 0.241, 95% CI 0.143-0.946, p = 0.001). In this study, we demonstrated for the first time that periaortic adipose tissue volume was independently associated with the presence of sclerotic changes in the adjacent aortic valve.

Serum endocan levels, carotid intima-media thickness and microalbuminuria in patients with newly diagnosed hypertension.

Background: Endocan is a particular protein of endothelial cells. The purpose of this study was to determine the relationship of serum endocan levels with carotid intima-media thickness (cIMT), inflammation, and microalbuminuria in patients with newly-diagnosed hypertension.Materials-Methods: This prospective study included 61 patients with newly-diagnosed hypertension (HT) and 30 controls. Endocan, microalbuminuria and cIMT measurements were taken from all patients.Results: The serum endocan levels, the mean cIMT and microalbuminuria levels of patients with HT were significantly higher than those of the control group (p < .0001, p = .015 and p < .001, respectively).Conclusion: We found that endocan levels were increased in our study. This increase in endocan levels shows a relation with cIMT and microalbuminuria, which are associated with endothelial dysfunction.

Enhanced serum levels of matrix Gla protein and bone morphogenetic protein in acute coronary syndrome patients.

BACKGROUND: Vascular calcification has been found to be associated with increased risk of cardiovascular (CV) morbidity and mortality. Various bone-associated proteins have been suggested to be related with this process. In this study, we aimed to evaluate whether serum levels of bone morphogenic protein-4 (BMP-4) and matrix Gla protein (MGP) differed in patients who were found to have normal epicardial coronary arteries or a culprit lesion in the coronary angiography leading to acute coronary syndrome (ACS). METHODS: Patients admitted to emergency department with the diagnosis of ACS who underwent primary percutaneous coronary intervention (PCI) between October 2015 and April 2016 were consecutively recruited as the patient group. Age and gender-matched subjects who underwent coronary angiography following non-invasive ischemia assessment made the control group. RESULTS: A total of 90 subjects (63.00±14.02 years, 70% male) were included in this study. MGP (<0.001) and BMP-4 (<0.001) levels were significantly elevated when compared to subjects with normal coronary arteries. Fasting blood glucose (P=.024), HDL-cholesterol (P=.002), C-reactive protein (CRP) (P=.001) levels, and left ventricular ejection fraction (LVEF) (P=.021) were significantly correlated with serum MGP levels. HDL-cholesterol (P=.001) and CRP (P=.030) levels were also significantly correlated with serum BMP-4 levels. In the model including HDL-cholesterol, CRP, MGP, and BMP-4 levels, only MGP (odds ratio[OR]: 1.018, P=.019) and BMP-4 (OR: 1.313, P=.023) were found to be independently associated with ACS. CONCLUSION: This study shows that serum BMP-4 and MGP are independently associated with ACS occurrence when adjusted for other CV risk factors. These biomarkers may have a diagnostic potential in ACS patients.

Subclinical Atherosclerosis in Patients with Prior Pulmonary Thromboembolism.

OBJECTIVE: Recent studies have indicated that endothelial dysfunction is common in patients with a prior history of pulmonary thromboembolism (PTE). Based on the established relationship between endothelial dysfunction and atherosclerosis, we aimed to investigate carotid intima-media thickness (cIMT) as a marker of subclinical atherosclerosis in patients who have a prior history of PTE. SUBJECTS AND METHODS: Medical records belonging to patients with a history of PTE and age- and gender-matched control subjects among those who underwent transthoracic echocardiography in Konya Training and Research Hospital were reviewed. Echocardiographic findings and cIMT measurements were recorded. cIMT measurements were compared between patient and control groups, and then independent correlates of cIMT were investigated using appropriate statistical methods. RESULTS: A total of 110 patients (64.02 ± 12.67 years, males: n = 79 [71.81%]; females: n = 31 [28.19%]) were found to be eligible for assessment. Of these patients, 55 (50.00%) had a history of PTE. Patients with a history of PTE had significantly greater cIMT (p = 0.040). In this group of patients, cIMT positively and significantly correlated with basal right ventricular (RV) diameter (r = 0.271, p = 0.022), RV diastolic area (r = 0.376, p = 0.002), and systolic pulmonary artery pressure (r = 0.248, p = 0.037). In the multivariate linear regression analysis, only RV diastolic area was independently associated with cIMT in patients with PTE (p = 0.010). CONCLUSION: Patients with a history of PTE have increased cIMT when compared to healthy subjects, and cIMT, which is a marker of subclinical atherosclerosis, is independently associated with RV diameter in these patients.

Impaired Left Ventricular Diastolic Functions and Thickened Epicardial Adipose Tissue in Rheumatoid Arthritis Patients is Correlated with DAS-28 Score.

BACKGROUND: Rheumatoid arthritis (RA) is a chronic inflammatory disease that is known to be associated with high cardiovascular (CV) morbidity and mortality. In this study, we aimed to demonstrate whether RA disease activity reflected with disease activity score-28 (DAS-28) had an impact on left ventricular diastolic functions and epicardial adipose tissue (EAT) thickness in RA patients with no traditional CV risk factors. METHODS: In this retrospective study, 41 patients newly diagnosed with RA were included. In addition to medical history, detailed physical examination findings and laboratory tests, left ventricular systolic and diastolic functions, chamber dimensions, and EAT thickness were evaluated with transthoracic echocardiography in the study population. RESULTS: This study included 41 subjects with a median age of 45 years (38.00-55.50), of which 29.27% were male. In the binomial logistic regression analysis, DAS-28 score was found to be an independent associate of diastolic dysfunction, Additionally, DAS-28 was found to be independently associated with EAT thickness. CONCLUSIONS: Patients with high DAS-28 score should be evaluated thoroughly for CV disease, and patients should undergo advanced diagnostic studies as required and receive appropriate treatment.

Morning blood pressure surge is associated with carotid intima-media thickness in prehypertensive patients.

OBJECTIVE: Morning blood pressure (BP) surge (MBPS) is defined as an excessive increase in the morning BP from the lowest systolic BP during sleep and is reported as a risk factor for cardiovascular events in current clinical studies. In this study, we aimed to investigate the relationship between MBPS and carotid intima-media thickness (C-IMT) in prehypertensive patients. PATIENTS AND METHODS: We evaluated the association between the rate of BP variation derived from ambulatory BP monitoring and C-IMT in patients with prehypertension. RESULTS: One hundred and seventy patients with prehypertension were included in the study. All office BP measurements and ambulatory 24-h, day-time, and night-time measurements were similar between each group. C-IMT [0.60 (range: 0.57-0.65) vs. 0.55 (range: 0.50-0.60) cm; P<0.001] and the mean platelet volume [8.7 (range: 7.9-9.1) vs. 7.9 (range: 7.3-8.8) fl; P=0.002] were significantly higher in the greater MBPS group than the lower group. In multivariate analysis, male sex [odds ratio (OR): 2.271, confidence interval (CI): 1.011-5.100, P=0.047], greater MBPS (OR: 8.474, CI: 3.623-19.608, P<0.001), and elevated mean platelet volume levels (OR: 3.359, CI: 1.978-5.705, P<0.001) were found to be independent predictors of greater C-IMT in prehypertensive patients. CONCLUSION: Our study suggests that greater MBPS is associated independently with C-IMT in prehypertensive patients.

Enhanced S100A9 and S100A12 expression in acute coronary syndrome.

AIMS: In this study, we aimed to investigate whether serum S100A8, S100A9 and S100A12 levels were markers of acute coronary syndrome (ACS). MATERIALS & METHODS: Patients who underwent coronary angiography and/or percutaneous coronary interventions between June 2015-October 2015 were consecutively recruited in this study and categorized three groups each containing 30 patients (normal coronary arteries, stable coronary artery disease, and acute coronary syndrome). Baseline characteristics, including co- morbidities and medications, were recorded and serum S100A8, S100A9, S100A12, and C- reactive protein levels were measured besides routine laboratory tests. RESULTS: A total of 90 patients (63.00 [56.00-73.00] years, 62.89% male) have been included. None of the groups differed from each other regarding baseline characteristics (p > 0.05). S100A9 levels were elevated in ACS when compared with the normal coronary arteries (p = 0.033) and S100A12 levels were found to be elevated in ACS when compared with both patients with normal coronary arteries and stable coronary artery disease (p = 0.001). S100A12 was identified as an independent associate of ACS (p = 0.002). CONCLUSION: These results suggest that S100A12 may serve as a marker of coronary plaque instability, and may have a therapeutic implication in ACS treatment.

Endothelial dysfunction in patients with pulmonary thromboembolism: neutrophil to lymphocyte ratio and platelet to lymphocyte ratio.

BACKGROUND AND AIMS: Pulmonary thromboembolism (PTE) is a common cardiovascular emergency. Activated leukocytes may produce free oxygen radicals and endothelial damage, and, thereby, increased inflammation and thrombogenesis. In this study, we aimed to investigate endothelial dysfunction in patients with PTE. METHODS: Between May 2012 and July 2013, a total of 71 patients with acute PTE (32 males, 39 females; mean age: 64.94 ± 15.27 years; range: 33 to 87 years) who were admitted to the Emergency and Thoracic Diseases Departments and 56 healthy controls (44 males, 12 females; mean age: 62.52 ± 9.80 years; range: 46 to 79 years) were included. Brachial artery flow-mediated dilation (BFMD) was performed. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were calculated. RESULTS: Significantly higher BFMD values were observed in patients with PTE (P < 0.05). Patients with PTE also had significantly higher NLR and PLR values, compared with the healthy control group (P < 0.05). CONCLUSION: The results of our study suggest that using non-invasive method such as ultrasonography combined with NLR and PLR in endothelial dysfunction diagnosis in PTE patients are both effective and inexpensive. We believe in PTE patients endothelial dysfunction may play a role in the development of probable cardiovascular events in future.

Heart Rate Acceleration and Recovery Indices are Not Related to the Development of Ventricular Premature Beats During Exercise Test.

BACKGROUND: Changes in heart rate (HR) during exercise and recovery from exercise are mediated by the balance between sympathetic and vagal activity. HR acceleration (HRA) and recovery (HRR) are important measures of cardiac autonomic dysfunction and directly correlated with sympathetic and parasympathetic activity. It is not known if the autonomic nervous system related to ventricular arrhythmias during exercise. The purpose was to evaluate the HRA and HRR in patients with and without premature ventricular complex (PVC) during exercise, and to examine the factors that might affect HRA and HRR. METHODS: The records of consecutive patients undergoing routine exercise test were reviewed. The characteristics and the HRA and HRR were compared between patients with and without PVC during exercise. RESULTS: A total of 232 patients (145 men) were recruited; 156 (103 men) developed PVCs during the exercise. Max HR was significantly lower in men with PVCs than in those without, which were not mirrored in women. There was no difference in HRA and HRR between the patients with and without exercise-induced PVCs in both genders. Compared to the men with PVCs, women had higher body mass index, shorter total exercise time, and higher HRA indices after the 3 and 6 minutes exercise. In patients with PVCs, the HRA and HRR indices were similar regardless of the presence of coronary artery disease and the phase of exercise test where PVC developed. CONCLUSIONS: Although exercise performance may be different between the genders, the HRA or HRR indices were not related to the development of PVC during exercise in both genders. KEY WORDS: Exercise-induced arrhythmias; Heart rate acceleration; Heart rate recovery.

Frequency and extent of coronary atherosclerotic plaques in patients with a coronary artery calcium score of zero: assessment with CT angiography.

PURPOSE: We aimed to evaluate the frequency and extent of coronary atherosclerotic plaques in patients with a coronary artery calcium (CAC) score of zero and establish the demographic characteristics and the cardiovascular risk factors that affect the formation of atheromatous plaques. MATERIALS AND METHODS: Coronary computed tomography (CT) angiography was performed in 288 cases with a CAC score of zero. The plaques that were detected using coronary CT angiography were categorized into two groups: nonsignificant (<50%) and significant (≥50%). Based on the coronary CT angiography results, the patients who had plaque and those who did not have plaque were compared in terms of the demographic characteristics and the presence of cardiovascular risk factors. RESULTS: Noncalcified plaques were detected in 50 cases (17.4%) on CT angiography, of which six cases (2.1%) had significant stenosis. The plaques were localized most frequently (38.2%) in the proximal left anterior descending artery. When all the plaques considered 50% of the plaques were localized in the proximal segments, 42.7% were in the mid-segments, and 7.3% were in the distal segments. Hypertension was a significant risk factor for coronary artery disease in both genders, and smoking was a significant risk factor in females. Additionally, diabetes mellitus was a borderline significant risk factor in both genders. CONCLUSION: In patients with a CAC score of zero, the frequency of noncalcified plaques is too high to be ignored. The distribution of these plaques in the coronary artery is similar to calcified plaque localizations. Patients who have a CAC score of zero and cardiovascular risk factors need to be evaluated with additional tests for the detection of noncalcified plaques.

Association between plasma asymmetrical dimethylarginine activity and saphenous vein graft disease in patients with coronary bypass.

BACKGROUND: Coronary vein graft disease is an important contributor to the morbidity after coronary artery bypass graft surgery. Graft occlusion is a serious complication, which limits the use of the saphenous vein as a coronary bypass conduit. Asymmetrical dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide synthase and it reduces the bioavailability of nitric oxide and begets endothelial dysfunction. The goal of this study was to examine the association between plasma ADMA activity and saphenous vein graft disease. METHODS: One hundred and three patients were enrolled in this study. Group 1 consisted of 42 patients (13 female, 29 male) who had diseased saphenous vein grafts and group 2 consisted of 61 patients (10 female, 51 male) with nondiseased saphenous vein grafts. ADMA activity was measured by the enzyme-linked immunosorbent assay kit. RESULTS: Mean ADMA activity in group 1 was significantly higher than in group 2 (2.0+/-0.6 vs. 1.1+/-0.5 micromol/l, P<0.001, respectively). Mean platelet volume was also significantly higher in group 1 than in group 2 (8.7+/-1.5 vs. 8.2+/-0.6 fl, P=0.03, respectively). In a multivariate linear regression analysis, ADMA activity (beta=2.902, P<0.001) and mean platelet volume (beta=0.595, P=0.03) were found to be independent predictors of saphenous vein graft disease. CONCLUSION: Our results showed that ADMA activity was higher in patients with saphenous vein graft disease. Increased ADMA activity might lead to the acceleration of saphenous vein graft disease. ADMA may be a precious marker for detecting late saphenous vein graft patency.

[The prevalence of angiographically significant coronary artery disease in patients with isolated secundum atrial septal defect]. / Izole sekundum tip atriyal septal defekt bulunan hastalarda anjiyografik olarak ciddi koroner arter hastaligi sikligi.

OBJECTIVES: Atrial septal defect (ASD) and coronary artery disease (CAD) may coexist in adults, especially in the elderly. The aim of this study was to determine the prevalence of CAD in patients undergoing both catheterization for ASD and selective coronary angiography and to evaluate the relationship of CAD with symptoms and risk factors. STUDY DESIGN: The study included 138 consecutive patients (40 males, 98 females; mean age 54+/-10 years; range 31 to 74 years) who underwent catheterization for isolated secundum ASD and selective coronary angiography at the same session. The mean shunt was 2.6+/-0.8 in the patient group. Significant CAD was defined as the presence of = or >50% stenotic lesions during angiography. RESULTS: Significant CAD was detected in 12 patients (8.7%). Patients with CAD exhibited a higher mean age (61+/-10 vs 54+/-10 years, p=0.016) and male preponderance (83.3% vs 23.8%, p<0.001). Risk factors and hemodynamic parameters did not differ between the two groups. Laboratory parameters were also similar except for a higher triglyceride level in patients without CAD (123+/-64 mg/dl vs 71+/-40 mg/dl, p=0.006). Angina pectoris was present in four patients (33.3%) in the CAD group, compared to 28 patients (22.2%) without CAD. For angina pectoris to predict CAD, the sensitivity, specificity, positive and negative predictive rates were 33.3%, 77.8%, 12.5%, and 92.5%, respectively. The corresponding figures were 50.0%, 33.3%, 6.7%, and 87.5% for at least one risk factor, and 16.7%, 82.5%, 8.3%, and 91.2% for combination of angina pectoris with at least one risk factor. CONCLUSION: Despite increased prevalence of CAD in adults, its prevalence is relatively low in patients with ASD. Thus, routine coronary angiography performed to detect CAD in patients with ASD increases complications and decreases cost-effectiveness.