The relationship between the S-wave in lead 1 and recurrence of RVOT PVC ablation.

BACKGROUND: Radiofrequency catheter ablation (CA) is a common non-pharmacological treatment option for ventricular premature contractions (PVCs) originating from right ventricular outflow tract (RVOT). In this study, we aimed to investigate the relationship between recurrence after CA for RVOT-PVC and S-wave in lead 1 that was shown to be associated with RVOT depolarization. METHODOLOGY: A total of 104 patients who were referred to our clinic for CA for idiopathic RVOT-PVC between 2012 and 2015years were enrolled. All ECG parameters were measured before and after the ablation procedure. RESULTS: Ablation was successful in 100 patients (96,1%). These patients with successful ablation were followed for a mean duration of 1078days. 13 patients (13%) had recurrence. Univariate logistic regression analysis revealed age (odds ratio: 1.916, p:0,012), presence of post-procedural S1 (odds ratio:1.040 p:0,028), post-procedural S1 area (oddsratio:1.023 p:0,041), ΔS1 area (odds ratio:1.242 p:0,004) as predictors for recurrence. Multivariate logistic regression analysis detected age (odds ratio:1.053 p:0,032) and ΔS1 area (odds ratio:0.701 p:0,009) as predictors for recurrence. CONCLUSION: Radiofrequency CA for RVOT-PVC can be performed with high procedural success and low complication rates. Age and ΔS1 area might be helpful for prediction of recurrence after CA.

Pocket haematoma after cardiac electronic device implantation in patients receiving antiplatelet and anticoagulant treatment: a single-centre experience.

Objective In modern cardiology practice, implantation of cardiac electronic devices in patients taking anticoagulant or antiplatelet therapy is a common clinical scenario. Bleeding complications are of particular concern in this patient population and pocket haematoma is one of the most frequent complications. We sought to determine the relationship between periprocedural antiplatelet/anticoagulant therapy and pocket haematoma formation in patients undergoing cardiac implantable electronic device (CIED) implantation. Methods We conducted a retrospective study including 232 consecutive patients undergoing CIED implantation in the department of cardiology of the Medipol University Hospital. Patients were divided into six groups: clopidogrel group (n = 12), acetylsalicylic acid (ASA) group (n = 73), ASA + clopidogrel group (n = 29), warfarin group (n = 34), warfarin + ASA group (n = 21) and no antiplatelet-anticoagulant therapy group as the control group (n = 63). CIED implantations were stratified under four subtitles including implantable cardioverter/defibrillator (ICD), cardiac resynchronization therapy (CRT), permanent pacemaker and the last group as either device upgrade or generator replacement. Results The mean age of the patients was 63 ± 14 years and 140 patients were male (60.3%). A pocket haematoma was documented in 6 of 232 patients (2.6%). None of the patients with pocket haematoma needed pocket exploration or blood transfusion. The type of the device did not have a significant effect on pocket haematoma incidence (P = 0.250). Univariate logistic regression showed that platelet level and ASA plus clopidogrel use were significantly associated with haematoma frequency after CIED implantations, respectively (OR: 0.977, CI 95% [0.958-0.996]; OR: 16.080, CI 95% [2.801-92.306]). Multivariate analysis revealed that dual antiplatelet treatment (ß = 3.016, P = 0.002, OR: 2.410, 95% CI [3.042-136.943]) and baseline platelet level (ß = -0.027, p:0.025, OR: 0.974, 95% CI [0.951-0.997]) were independent risk factors for pocket haematoma formation. Conclusion Dual antiplatelet therapy and low platelet levels significantly increased the risk of pocket haematoma formation in patients undergoing CIED implantations.

Native Electrocardiographic QRS Duration after Cardiac Resynchronization Therapy: The Impact on Clinical Outcomes and Prognosis.

BACKGROUND: We investigated whether reversed electrical remodeling (RER), defined as narrowing of the native electrocardiographic QRS duration after cardiac resynchronization therapy (CRT), might predict prognosis and improvement in echocardiographic outcomes. METHODS AND RESULTS: A total of 110 CRT recipients were retrospectively analyzed for the end points of death and hospitalization during 18 ± 3 months. Native QRS durations were recorded at baseline and 6 months after CRT (when pacing was switched off to obtain an electrocardiogram) to determine RER. CRT response and mitral regurgitation (MR) improvement were defined as ≥15% reduction in left ventricular end-systolic volume and absolute reduction in regurgitant volume (RegV) at 6 months, respectively. Overall, 48 patients (44%) had RER, which was associated with functional improvement (77% vs 34%; P < .001) and CRT response (81% vs 52%; P < .001) compared with those without RER. The change in the intrinsic QRS duration correlated with the reduction in RegV (r = 0.51; P < .001) and in tenting area (r = 0.34; P < .001). RER was a predictor of MR improvement (P = .023), survival (P = .043), and event-free survival (P = .028) according to multivariate analyses. CONCLUSIONS: Narrowing of the intrinsic QRS duration is associated with functional and echocardiographic CRT response, reduction in MR, and favorable prognosis after CRT.

Predicting Ventricular Arrhythmias in Cardiac Resynchronization Therapy: The Impact of Persistent Electrical Dyssynchrony.

BACKGROUND: Although response to cardiac resynchronization therapy (CRT) has been conventionally assessed with left ventricular volume reduction, ventricular arrhythmias (ventricular tachycardia/ventricular fibrillation [VT/VF]) are of critical importance associated with unfavorable outcomes even in the "superresponders" to therapy. We evaluated the predictors of VT/VF and the association of residual dyssynchrony during follow-up. METHODS: Ninety-five patients receiving CRT were followed-up for 9 ± 3 months. Post-CRT dyssynchrony was defined as a prolonged QRS duration (QRSd) for persistent electrical dyssynchrony (ED), and a Yu index ≥ 33 ms for persistent mechanical dyssynchrony. The first VT/VF episode, including nonsustained VT detected on device interrogation and/or appropriate antitachycardia pacing or shock for VT/VF, were the end points of the study. RESULTS: Forty-five patients who reached the study end points had significantly lower mean ΔQRS (baseline QRSd - post-CRT QRSd) values than those without VT/VF (-20.8 ± 28.9 ms vs -6.6 ± 30.7 ms, P = 0.022). Both the baseline and post-CRT QRSds, along with the Yu index values, were not different in two groups. Patients with VT/VF were statistically more likely to have persistent ED (38% vs 9%, P = 0.021). Kaplan-Meier curves showed that a negative ΔQRS was associated with a higher incidence of VT/VF during follow-up (P = 0.016). A multivariate Cox model revealed that QRS prolongation was an independent predictor of VT/VF after CRT (P = 0.029). CONCLUSIONS: A negative ΔQRS, also called persistent ED, is associated with VT/VF. Narrowest possible QRSd might be a reliable goal of both implantation and optimization of devices to reduce arrhythmic events after CRT.

Impact of Intracoronary Adenosine on Myonecrosis in Patients with Unstable Angina Pectoris Undergoing Percutaneous Coronary Intervention.

BACKGROUND: In this study, we aimed to investigate the impact of prophylactic intracoronary adenosine administered during percutaneous coronary intervention (PCI) due to unstable angina pectoris on myonecrosis by measuring post-procedural levels of cardiac troponin I (cTnI) and creatine kinase-myocardial band (CK-MB). METHODS: A total of 122 patients with unstable angina undergoing PCI were included in this single-center, double-blind, randomized study. The patients were randomly allocated to adenosine and placebo groups. In the adenosine group, a single-dose of intracoronary adenosine (100 µg for the right coronary artery and 150 µg for the left coronary artery) was administered. Primary endpoint was post-PCI myonecrosis, which was defined as abnormal levels of periprocedural cTnI. Secondary endpoints were defined as elevated cTnI levels [5 × upper limit of normal (ULN)], abnormal CK-MB levels, angiographic coronary flow measured by Thrombolysis In Myocardial Infarction (TIMI) frame count (TFC), the cumulative incidence of in-hospital death and in-hospital urgent target vessel revascularization (TVR). RESULTS: Clinical and angiographic characteristics of both adenosine (61 patients, 61 ± 9 years) and placebo (61 patients, 59 ± 10 years) groups were similar (p > 0.05 for all). Post-procedural abnormal cTnI levels in the adenosine group were significantly lower than the placebo group (32 % vs. 55 %, p: 0.011). cTnI >5 × ULN (21 % vs. 31 %, p: 0.217) and abnormal CK-MB levels (11 % vs. 19 %, p: 0.263) were similar in both groups. Post-procedural TFCs in the adenosine group were significantly lower than the placebo group (24 ± 4 vs. 27 ± 5, p: 0.004). In-hospital events including death and urgent TVR were not observed in either group. CONCLUSION: Intracoronary administration of single-dose adenosine in patients with unstable angina undergoing PCI is associated with decreased periprocedural myonecrosis and improved coronary blood flow.

Effect of Pulmonary Vein Anatomy and Pulmonary Vein Diameters on Outcome of Cryoballoon Catheter Ablation for Atrial Fibrillation.

BACKGROUND: In this study, we aimed to determine pulmonary vein (PV) variation patterns in patients undergoing cryoballoon ablation for atrial fibrillation (AF) and their impacts on procedural success and recurrence and also to identify predictors for recurrence. METHODS: We enrolled 54 patients with AF and having symptoms despite medical therapy. Prior to the procedure, PV variation and left atrium (LA) size were evaluated in all patients by computed tomography scan. Ablation procedure was performed with single balloon and predictors for AF recurrence were determined. RESULTS: The study population consisted of 54 patients (male: 50 [27%], mean age: 53 ± 12) with AF. Paroxysmal AF and persistent AF were detected in 55.6% (30) and 44.4% (24) of the patients, respectively. Mean procedural and fluoroscopy times were 73 ± 19 minutes and 16 ± 4 minutes, respectively. The number of the patients with PV variation of right pulmonary vein (RPV) with >2 ostia and accessory PV was 27.8% (15) and 18.5% (10). During the follow-up, 20.4% (11) of patients had AF recurrence. Patients with recurrence had greater transverse LA size (62 ± 6 mm vs 57 ± 5 mm, P: 0014), longitudinal LA size (65 ± 5 mm vs 61 ± 6 mm, P: 0025), LA volume (78 ± 17 mL vs 65 ± 14 mL, P: 0011), fluoroscopy time (20.4 ± 4.6 minutes vs 15.7 ± 3.5 minutes, P: 0001), RPV with >2 ostia (72.7% vs 27.3%, P: 0001), right upper pulmonary vein (RUPV) diameter (21.6 ± 2.8 cm vs 15.8 ± 2.1 cm; P < 0001), and persistent AF (33.3% vs 66.7%, P: 0046). In multivariate analysis, RUPV diameter (ß: 1006; P: 0010; odds ratio [OR]: 2736; 95% confidence interval [CI]: [1267-5906]) and fluoroscopy time (ß: 0327; P: 0050; OR: 1386; 95% CI: [1000-1921]) were determined as independent predictors for AF recurrence. CONCLUSIONS: Transverse and longitudinal LA size, LA volume, fluoroscopy time, presence of persistent AF, RUPV size, and the number of RPV ostia are associated with AF recurrence following cryoballoon-based ablation. RUPV size and fluoroscopy time are predictors for recurrence.

Evaluation of adult versus pediatric transesophageal echocardiography probe efficiency for guiding septal puncture during atrial fibrillation ablation.

PURPOSE: Transesophageal echocardiography (TEE) has a pivotal role in invasive cardiology practice in terms of guiding a variety of procedures. It is challenging to perform TEE examination with sedated patients due to difficulties in cooperation and positioning the patient properly, therefore the risk of complications is escalated. We aimed to assess the impact of pediatric TEE probe utilization on procedural success and complication rates; in comparison with conventional adult TEE probe. METHODS: Fifty-eight patients undergoing atrial fibrillation (AF) ablation with TEE guidance were enrolled and patients were grouped based on probe size: Group 1 (n = 35) included patients undergoing the procedure with adult TEE probe guidance and Group 2 (n = 23) included patients with pediatric TEE probe guidance. Procedural success, postprocedural odynophagia and periprocedural intra-oral bleeding frequency, number of intubation attempts, TEE imaging time, and midazolam doses for both groups were compared. RESULTS: Odynophagia frequency was significantly higher in Group 1 (25.7% [n = 9] vs. 0%, P = 0.008) besides oral mucosal bleeding was also higher in Group 1, although the difference did not reach statistical significance (5.7% [n = 2] vs. 0%, P = 0.513). Number of repeated attempts was lower in Group 2 (median, 1; range [3-1] vs. 1, [1-1], P = 0.038). Image resolutions and septal puncture success rates were similar for both groups. Total imaging time with TEE was significantly shorter in Group 2 (6.4 ± 1.8 min vs. 3.6 ± 0.9 min, P < 0.001). Midazolam dose was lower in Group 2 (7.0 ± 1.7 vs. 6.2 ± 1.7, P = 0.065). CONCLUSION: Using TEE probes with smaller size for guiding invasive percutaneous procedures performed in cardiac catheterization laboratory decreased TEE-associated complication rates and enhanced patient comfort without any negative effect on procedural success.

Serum uric acid and carotid artery intima media thickness in patients with masked hypertension.

BACKGROUND: Serum uric acid is related to hypertension and cardiovascular diseases. Masked hypertension is associated with an increase in cardiovascular risk. The aim of our study was to evaluate the serum uric acid level and its relationship with carotid intima-media thickness (IMT) in patients with masked hypertension. SUBJECTS AND METHODS: A total of 114 untreated masked hypertension patients (62 men, 52 women; mean age 44.6 +/- 7.9 years) and 38 controls (20 men, 18 women; mean age 44.8 +/- 7 years) were included in the study. All patients underwent 24-hour ambulatory blood pressure. Serum uric acid and carotid IMT were measured. RESULTS: Serum uric acid was significantly higher in masked hypertension patients when compared to the control group (5.14 +/- 1.42 mg/dl, 4.84 +/- 1.45 mg/ dl, P = 0.01). Masked hypertension patients had significantly higher carotid IMT than control subjects (0.58 +/- 0.09, 0.52 +/- 0.09, P < 0.001). The masked hypertension group was also divided into two groups according to the median value of the serum uric acid levels (median value: 5 mg/dl). Carotid IMT was significantly higher in patients with a higher uric acid when compared to those with a lower uric acid (P < 0.001). We also found that the serum uric acid level was a good predictor of increased carotid IMT at the receiver-operating characteristic curve.The area under the curve was 66% (95% confidence interval, 0.56-0.77), and the serum uric acid level was significantly predictive of a high carotid IMT (P = 0.001). CONCLUSIONS: Our data suggest that the uric acid levels were significantly higher in the masked hypertension group and elevated uric acid levels were associated with increased carotid IMT, indicating that elevated serum uric acid levels might contribute to the increase in cardiovascular risk in masked hypertension.

Usefulness of neutrophil-to-lymphocyte ratio for predicting acute pericarditis outcomes.

BACKGROUND: In daily practice, C-reactive protein (CRP) may be used to predict recurrence and treatment response in patients with acute pericarditis; however, the predictive role of CRP might be insufficient for clinical prediction in some patients. In this study, we aimed to investigate the relationship between neutrophil-to-lymphocyte ratio (NLR) and the composite endpoint of pericarditis recurrence and/or tamponade within 1 year in patients with acute pericarditis. METHODS: A total of 104 patients diagnosed with acute idiopathic pericarditis (mean age 42.8 ± 15.2 years, 55.8% male) were included in the study. Physical examination findings of these patients, electrocardiography, echocardiography, chest X-ray and laboratory findings were evaluated and analysed. During the 1-year follow-up, the composite of cardiac tamponade and/or pericarditis recurrence was investigated as the primary endpoint of the study. RESULTS: Compared to the group without the composite outcome, the group with the composite outcome had significantly higher rates of moderate and severe pericardial effusion (p < 0.01) and higher white blood cell (WBC) count (p:0.001), platelet count (p = 0.003), NLR (2.14 (1.49-3.02) vs 6.60 (5.50-8.68); p < 0.001) and high-sensitivity C-reactive protein (hs-CRP) (8.01 (5.1-24.5 vs 69.5 (40.8-128); p:0.001). Higher hs-CRP (p < 0.001), WBC (p:0.001), NLR (p < 0.001) and platelets (p:0.02) were associated with pericarditis recurrence. NLR and hs-CRP were independently associated with the composite endpoint (p < 0.001 and p < 0.001, respectively). CONCLUSION: NLR and hs-CRP were found to be independent predictors for the composite endpoint of tamponade and/or recurrence in acute pericarditis patients during the 1-year follow-up. Similar to hs-CRP, NLR may also be used for risk assessment in patients with idiopathic pericarditis.

Do mobile phones pose a potential risk to autonomic modulation of the heart?

BACKGROUND: It has long been speculated that mobile phones may interact with the cardiac devices and thereby cardiovascular system may be a potential target for the electromagnetic fields emitted by the mobile phones. Therefore, the present study was designed to test possible effects of radiofrequency waves emitted by digital mobile phones on cardiac autonomic modulation by short-time heart rate variability (HRV) analysis. METHODS AND RESULTS: A total of 20 healthy young subjects were included to the study. All participants were rested in supine position at least for 15 minutes on a comfortable bed, and then time and frequency domain HRV parameters were recorded at baseline in supine position for 5 minutes. After completion of baseline records, by using a mobile GSM (Global System for Mobile Communication) phone, HRV parameters were recorded at turned off mode, at turned on mode, and at calling mode over 5 minutes periods for each stage. CONCLUSION: Neither time nor frequency domain HRV parameters altered significantly during off mode compare to their baseline values. Also, neither time nor frequency domain HRV parameters altered significantly during turned on and calling mode compared to their baseline values. Short-time exposure to electromagnetic fields emitted by mobile phone does not affect cardiac autonomic modulation in healthy subjects.

Comparison of atrial electromechanical coupling interval and P-wave dispersion in non-dipper versus dipper hypertensive subjects.

BACKGROUND: The lack of nocturnal BP fall less than 10% of the daytime, called non-dipper hypertension, is associated with increased cardiovascular morbidity and mortality. The aim of our study was to investigate atrial conduction time in patients with non-dipper hypertension using electromechanical coupling interval and P-wave dispersion (PWD), measured with the surface electrocardiogram and tissue Doppler echocardiographic imaging (TDI). METHODS: Age- and sex-matched 43 dipper hypertensive patients (19 male, 24 female, mean age: 53.9 ± 10.5 years), 40 non-dipper patients (18 male, 22 female, mean age 54.3 ± 9.6 years) and 46 healthy subjects (22 male, 24 female, mean age: 52.8 ± 9.6 years) were included in the study. The difference between the maximum and minimum P-wave durations was calculated and defined as PWD. Atrial electromechanical coupling (PA), inter-atrial and intra-atrial electromechanical delays were measured with TDI. RESULTS: PWD was significantly higher in patients with non-dippers compared with dippers (p <0.02) and controls (p <0.001). The inter-atrial conduction time was delayed in non-dippers compared with dippers (p <0.01) and controls (p <0.001). There was a positive correlation between left atrial (LA) diameter and inter-atrial conduction times (r = 0.46, p <0.001). LA diameter was also correlated with PWD (r = 0.44, p <0.001). CONCLUSION: The patients with non-dipper hypertension have higher P-wave duration, PWD and delayed inter-atrial electromechanical coupling intervals compared with those of dippers and controls. This indicates that these subjects may be more prone to atrial rhythm disturbances.

Impaired cerebral circulation in patients with slow coronary flow.

Slow coronary flow (SCF) is characterized by delayed opacification of coronary arteries during coronary angiography and is associated with myocardial perfusion abnormalities, ischemia or myocardial infarction. We hypothesized that SCF could be a part of systemic circulatory abnormalities. Therefore, the present study was conducted to investigate whether cerebral blood flow velocity is altered in patients with SCF. The study included 16 patients suffering from chest pain with angiographically proven SCF and 16 subjects suffering from atypical chest pain with angiographically normal coronary flow. All study subjects were selected among those who undergone routine cardiac catheterization. SCF was defined based on thrombolysis in myocardial infarction frame count that reflects coronary artery flow. Thrombolysis in myocardial infarction frame count was significantly higher in patients with SCF than those with normal coronary flow. The average peak systolic, end diastolic and mean flow velocities of the middle cerebral artery were measured and recorded in both groups by transcranial Doppler ultrasonography. Baseline demographic properties were similar in both groups. Echocardiographic parameters were also similar in patients with SCF and those with normal coronary flow. In contrast, both right and left middle cerebral artery peak systolic, end diastolic and mean flow velocities were significantly lower in patients with SCF than those with normal coronary flow. We conclude that cerebral blood flow velocity is significantly lower in patients with SCF. SCF phenomenon may reflect a part of impaired systemic circulation.

The relationship between echocardiographic parameters and brain natriuretic peptide levels in acute and chronic mitral regurgitation.

OBJECTIVES: Plasma brain natriuretic peptide (BNP) level increases with symptoms and severity of mitral regurgitation (MR). We aimed to determine the relationship between plasma BNP levels and echocardiographic parameters in patients with acute and chronic MR. STUDY DESIGN: The study included 55 patients (31 males, 24 females) with isolated moderate-to-severe MR. Of these, 31 patients had acute MR, and 24 patients had chronic MR. All the patients were assessed by transthoracic, transesophageal and Doppler echocardiography and plasma BNP levels were determined. RESULTS: Clinical characteristics and functional capacity were similar in the two groups. Patients with acute MR had significantly higher left ventricular (LV) ejection fraction (EF) (p=0.001), and significantly lower LV end-systolic diameter (p=0.016), end-systolic volume (p=0.027), end-diastolic diameter (p=0.011), left atrial volume (LAV) (p=0.003), and plasma BNP levels (p=0.036). Effective regurgitation orifice area was also significantly higher in patients with acute MR (p=0.038). In multiple linear regression analysis, the natural logarithm of BNP was significantly correlated with E/Ea ratio (ß=0.50, p=0.002) and LAV (ß=0.38, p=0.015) in patients with acute MR, and with systolic pulmonary artery pressure (ß=0.60, p=0.002) and EF (ß=-0.36, p=0.039) in patients with chronic MR. CONCLUSION: Although the echocardiographic degree of MR was more pronounced in patients with acute MR, serum BNP levels tended to be lower in this group. Correlation of serum BNP with E/Ea and LAV in this group may be an important finding.

The prognostic value of combined fractional flow reserve and TIMI frame count measurements in patients with stable angina pectoris and acute coronary syndrome.

BACKGROUND: The aim of this study was to evaluate the prognostic value of different fractional flow reserve (FFR) cutoff values and corrected thrombolysis in myocardial infarction frame (TIMI) count (CTFC) measurements in a series of consecutive patients with moderate coronary lesions, including patients with unstable angina, myocardial infarction, and/or positive noninvasive functional test findings. METHODS: We included 162 consecutive coronary patients in whom revascularization of a moderate coronary lesion was deferred based on a FFR value ≥0.75. Patients were divided according to the results of the intracoronary pressure and flow measurements into four groups: group A: 0.75 ≤ FFR ≤ 0.85 and CTFC > 28 (n=22), group B: 0.75 ≤ FFR ≤ 0.85 and CTFC ≤ 28 (n = 55), group C: 0.85 < FFR and CTFC > 28 (n = 19), and group D: 0.85 < FFR and CTFC ≤ 28 (n = 66). Adverse cardiac events and the presence of angina were evaluated at follow-up. RESULTS: At a mean follow-up of 18 ± 10 months, cardiac event rate in patients with 0.75 ≤ FFR ≤ 0.85 and FFR > 0.85 were 22% and 9%, respectively (P = 0.026) and also, a trend was observed toward a higher cardiac event rate in case of an abnormal CTFC (CTFC > 28) compared to a normal CTFC (24% vs 12%, P = 0.066). Furthermore, a significantly higher cardiac event rate was observed when group A was compared to group D (31.8% vs 7.6%, respectively, P = 0.004). CONCLUSION: Patients with potential microvascular dysfunction and borderline FFR values should be interpreted with caution, and management strategies should be guided not only by pressure measurement, but also by possibly supplementary clinical risk stratification and noninvasive tests.

Acute effects of moxonidine on cardiac autonomic modulation.

BACKGROUND: Moxonidine, an imidazoline I1 receptor agonist, is a centrally acting antihypertensive agent having sympatholytic effect. However, there are only limited data regarding the effects of this drug on autonomic cardiac functions. METHODS AND RESULTS: In this study we investigated the acute effects of moxonidine on cardiac autonomic modulation by heart rate variability (HRV) analysis. The effects of oral 0.4-mg moxonidine were studied on 11 healthy male volunteers in a randomized, double-blind, placebo controlled, and crossover study. After 15 minutes rest, time and frequency domain parameters of HRV were calculated from 5-minute continue electrocardiography recordings in supine position, during controlled respiration (15 breath/min) and during handgrip exercise before and 1 hour after taking placebo or moxonidine. Baseline parameters before taking placebo and moxonidine were similar (P > 0.05). Moxonidine, but not placebo, caused an increase in heart failure (HF) (119 +/- 21 vs 156 +/- 23, P = 0.029) and HFnu (39 +/- 4 vs 47 +/- 4, P = 0.033) and decrease in LFnu (61 +/- 4 vs 53 +/- 4, P = 0.033) and LF/HF ratio (1.96 +/- 0.36 vs 1.12 +/- 0.35, P = 0.010) in supine position compared with baseline parameters. However, there was no difference in other time or frequency domain parameters during controlled breathing and handgrip exercise either with moxonidine or placebo administration (P > 0.05). Single dose of moxonidine administration increases cardiovagal tone but parasympathetic and sympathetic autonomic maneuvers attenuated its short term effects on HRV in healthy male subjects.

Relationship between the tissue Doppler-derived Tei index and plasma brain natriuretic peptide levels in patients with mitral regurgitation.

BACKGROUND AND AIM OF THE STUDY: The Tei index, obtained from tissue Doppler echocardiography (TDE-Tei index), has emerged as a new parameter that incorporates both systolic and diastolic time intervals to express global ventricular performance. The study aim was to evaluate whether the TDE-Tei index also correlates with left ventricular (LV) systolic and diastolic function and plasma brain natriuretic peptide (BNP) levels and echocardiographic parameters in patients with symptoms of mitral regurgitation (MR). METHODS: Thirty-three patients (17 males, 16 females; mean age 57 +/- 17 years) with isolated organic MR underwent transthoracic echocardiography and tissue Doppler echocardiography, and were also assessed for symptoms. Plasma BNP levels were also monitored. The patients were allocated to two groups, based on a TDE-Tei index cut-off level of 0.51. RESULTS: Correlations were identified between the TDE-Tei index and LV ejection fraction (LVEF) (r = -0.54), plasma BNP level (r = 0.5), MR index (r = 0.48), MR jet area (r = 0.38), MR effective regurgitant orifice area (r = 0.37), LV end-systolic diameter (r = 0.43), E/Ea (r = 0.41) and NYHA functional class (r = 0.38). However, no correlations were identified with the left atrial area, MR vena contracta width, MR regurgitant volume, MR regurgitant fraction, systolic pulmonary artery pressure, LV end-diastolic dimensions and LV diastolic dysfunction. The mean values of the TDE-Tei index were 0.40 +/- 11, 0.44 +/- 11 and 0.53 +/- 16 in MR patients in NYHA classes I, II and III, respectively. CONCLUSION: In patients with isolated organic MR, the TDE Tei index was found to correlate well with LVEF and plasma BNP levels, and thus may be considered as a new echocardiographic parameter for the assessment of global ventricular function during patient follow up.

Increased mean platelet volume in Behçet's disease with thrombotic tendency.

The relationship between Behçet's disease (BD) and platelet aggregation has not sufficiently been investigated yet. Mean platelet volume (MPV) is a marker of platelet function, and the increase in MPV has been identified as an independent risk factor of recurrent vascular events. BD is characterized by a relapsing vasculitis of the venous as well as arterial thrombosis. However, the precise pathogenic mechanisms underlying thrombotic tendency in BD are not known. We hypothesized that there might be an association between thrombotic complication and MPV in these patients. Therefore, we investigated activation of platelets in patients with BD using a simple marker, MPV, the most accurate measure of platelet size. A total of 60 patients with BD and 40 age- and gender-matched controls were included. The BD patients were divided into subgroups based on the presence (n = 22) or absence of thrombosis (n = 38) and clinically active (n = 30) or inactive (n = 30) state. MPV was higher in patients with BD than controls (8.14 +/- 0.8 vs. 7.48 +/- 0.3 fl, p = 0.001). Among BD patients, MPV was larger in patients with thrombosis than those without thrombosis (8.45 +/- 1.0 vs. 7.96 +/- 0.7 fl, p = 0.038). However, there was no significant difference in MPV between BD patients with active and inactive states. The increase in MPV is independent of the disease activity, and the presence of thrombosis is associated with higher MPV in BD patients. Therefore, antiplatelet therapy may be useful to prevent thrombotic complications in BD patients.

Circulating stromelysin concentration is elevated in hypertensive aortic root dilatation.

Accumulating data suggest that activity of matrix metalloproteinases (MMPs) is increased in aortic dissection, and in thoracic and abdominal aneurysms. In the present study we sought to determine circulating stromelysin (MMP-3) concentration and its relationship with hypertension-induced aortic root dilatation. The study population included 42 patients with essential hypertension. The subjects were divided into two groups according to echocardiographically measured aortic diameter as those with aortic dilatation (n = 22) and without aortic root dilatation (n = 20). Plasma concentration of MMP-3 was determined by one-step sandwich enzyme immunoassay (EIA) method and compared in both groups. Baseline demographic properties were similar in both groups. Plasma stromelysin (MMP-3) level was significantly higher in patients with aortic dilatation than those without aortic dilatation (5.2 +/- 2.3 vs 3.3 +/- 1.9 ng/ml; P = 0.007). In conclusion, we found that circulating stromelysin (MMP-3) concentration was elevated in hypertension-induced aortic root dilatation.

P wave duration changes and dispersion. A risk factor or autonomic dysfunction in stroke?

OBJECTIVE: To investigate the P wave duration and P wave dispersion in stroke patients, and to compare those with healthy subjects. METHODS: We measured maximum and minimum P wave durations, and dispersion on the 12-lead surface ECG in 67 consecutive patients with first ever-acute ischemic stroke and 58 controls at the neurology wards of the Medical School, Duzce, Turkey, between May 2005 and October 2006. The subjects were not included if there were a history of atrial fibrillation, cardiac problem, and using drugs related to cardiovascular diseases or psychiatric problems. RESULTS: P wave durations and dispersion were similar in stroke patients and controls. The correlation analysis revealed a positive relation between age and Pmin duration (p=0.03). The mean Pmin values were 63.85+/-22.55 for male and 76.43+/-26.84 for female patients, and this difference was statistically significant (p=0.04). The correlations between P wave durations, and the presence of risk factors, the stroke outcome scales, and death of patient within 6 months were not statistically significant. CONCLUSION: Although there were some previous reports on ECG changes including P waves in acute stroke, we found that P wave durations and dispersion were similar in acute stroke patients and controls. This may be related to the patient selection criteria of this study, as we did not include patients with any previous cardiac abnormality. We concluded that the autonomic nervous system dysfunctions causing cardiac abnormalities in stroke need more investigation.

Predictive value of noninvasively determined endothelial dysfunction for long-term cardiovascular events and restenosis in patients undergoing coronary stent implantation: a prospective study.

BACKGROUND: Endothelial dysfunction plays a key role in atherosclerosis and predicts future cardiovascular events in individuals with or without coronary artery disease and improves with risk reduction therapy. We sought to determine the predictive value of endothelial dysfunction for long-term cardiovascular events and in-stent restenosis in patients undergoing percutaneous coronary intervention (PCI). METHODS: Using high-resolution ultrasound, we assessed endothelial function by using the brachial artery flow-mediated dilation (FMD) method in 135 patients with coronary artery disease before elective coronary stenting. Patients were prospectively followed up for an average of 12 months after PCI. RESULTS: Thirty patients had an event during follow-up including cardiac death (four patients), myocardial infarction (nine patients), unstable angina/non-ST elevation myocardial infarction (15 patients), and stroke (two patients) and in-stent restenosis was determined in 16 of these patients. Endothelium-dependent FMD was significantly lower in patients who had an event compared with those without an event (4.7+/-1.9 vs. 6.0+/-2.0%, P=0.007), whereas endothelium-independent vasodilation to nitroglycerin was similar in both groups. FMD was the only predictor of cardiovascular events (P=0.03). Impaired endothelial function was associated with a significantly higher incidence of cardiovascular events and in-stent restenosis by Kaplan-Meier analysis. When a cutoff point of 7.5% was used, flow-mediated dilation had a sensitivity of 93%, specificity of 37%, and negative predictive value of 95% for cardiovascular events. CONCLUSION: Impaired brachial artery FMD is associated with long-term cardiovascular events and in-stent restenosis in patients undergoing PCI. Noninvasive assessment of endothelial function may serve as a surrogate marker for the estimation of future cardiovascular event risk and long-term follow-up in these patients.