Epicardial Fat Thickness is Associated with Abnormal Left Ventricle Geometry in Newly Diagnosed Hypertension.

BACKGROUND: Epicardial adipose tissue is an emerging cardio metabolic risk factor. Although an association between epicardial fat thickness (EFT) and left ventricle (LV) hypertrophy in hypertensive patients is known, the relationship between abnormal LV geometric patterns and EFT has yet to be investigated. The aim of the present study was to investigate the relationship between EFT and abnormal LV geometric patterns in hypertensive patients. METHODS: Measurements were obtained from 343 patients with untreated essential hypertension (mean age 51.6 ± 5.5 years) and 52 healthy control subjects (mean age 51.8 ± 4.5 years). Four different geometric patterns (NG; normal geometry, CR; concentric remodeling, EH; eccentric hypertrophy, and CH; concentric hypertrophy) were determined according to LV mass index (LVMI) and relative wall thickness (RWt). EFT was measured using transthoracic echocardiography. High sensitive C-reactive protein (hs-CRP) and other biochemical markers were measured in all participants. RESULTS: The highest EFT and hs-CRP values were determined in the CH group (EFT = 8.9 ± 2.1 mm) compared with the controls (EFT = 5.7 ± 1.5 mm), followed by the NG (EFT = 5.9 ± 1.6 mm), CR (EFT = 5.9 ± 1.3 mm) and EH groups (EFT = 6.5 ± 1.6 mm) (all p < 0.05). In addition, the EFT values of the EH group were higher than the control, NG and CR groups (all p < 0.05). Multivariate linear regression analysis showed that EFT was independently associated with LV geometry (ß = 0.161, p = 0.032), total cholesterol level (ß = -0.129, p = 0.003), triglyceride level (ß = 0.266, p < 0.001), hs-CRP level (ß = 0.349, p < 0.001), and creatinine level (ß = 0.108, p = 0.010). CONCLUSIONS: EFT is independently associated with abnormal LV geometry, LV hypertrophy, creatinine level, and low grade chronic inflammation.

Morning blood pressure surge and arterial stiffness in newly diagnosed hypertensive patients.

OBJECTIVE: We aimed to investigate the relationship between the morning blood pressure (BP) surge and arterial stiffness in patients with newly diagnosed hypertension. SUBJECTS AND METHODS: Three hundred and twenty four (mean age 51.7 ± 11.4 years) patients who had newly diagnosed hypertension with 24 h ambulatory BP monitoring were enrolled. Parameters of arterial stiffness, pulse wave velocity and augmentation index (Aix) were measured by applanation tonometry and aortic distensibility was calculated by echocardiography. RESULTS: Compared with the other groups, pulse wave velocity, day-night systolic BP (SBP) difference (p < 0.001, for all) and hs-CRP (p = 0.005) were higher in morning BP surge high group. Aortic distensibility values were significantly lower in morning BP surge high group compared to the other groups (p < 0.05, for all). Morning BP surge was found to be independently associated with pulse wave velocity (ß = 0.286, p < 0.001), aortic distensibility (ß= -0.384, p < 0.001) and day-night SBP difference (ß = 0.229, p < 0.001) in multivariate linear regression analysis. CONCLUSIONS: We found independent relationship between morning BP surge and arterial stiffness which is a surrogate endpoint for cardiovascular diseases. The inverse relationship between morning BP surge and aortic distensibility and direct relation found in our study is new to the literature.

Epicardial fat thickness is associated with aortic intima-media thickness in patients without clinical manifestation of atherosclerotic cardiovascular disease.

BACKGROUND: Although the relationship between epicardial fat thickness (EFTh) and coronary atherosclerosis is well established, this relation in the early periods of atherosclerosis has not been fully demonstrated. On the other hand, thoracic aortic intima-media thickness (IMT) rather than carotid IMT was reported as an earlier marker of preclinical atherosclerosis. OBJECTIVE: We aimed to assess the relationship between thoracic aortic IMT and EFTh in patients undergoing transesophageal echocardiography (TEE) examination for different indications. METHODS: We included 104 patients (mean age 38±11.4 years), who underwent TEE for various indications. The patients were divided into two groups according to the median thoracic aortic IMT values (IMT normal group<10 mm and IMT abnormal group≥10 mm). EFTh was obtained using two-dimensional transthoracic echocardiography on the right ventricular free wall during systole and diastole. RESULTS: The highest EFTh values (3.3±0.96 mm vs. 4.51±0.66 mm, P<.001) were observed in the abnormal aortic IMT group. Multivariate linear regression analysis showed that aortic IMT was independently correlate with EFTh (ß=0.423, P<.001). Moreover, EFTh was found to be associated with history of transient ischemic attack (r=.403, P<.001) and abnormal IMT (r=.643, P<.001) in bivariate analysis. CONCLUSION: Epicardial fat thickness is independently related to the extent of subclinical thoracic aortic atherosclerosis. Increase in EFTh may be crucial marker for initial atherosclerosis.

Plasma apelin-12 levels may predict in-hospital major adverse cardiac events in ST-elevation myocardial infarction and the relationship between apelin-12 and the neutrophil/lymphocyte ratio in patients undergoing primary coronary intervention.

OBJECTIVE: We aimed to investigate the compliance of plasma apelin-12 levels to show angiographic properties and hospital MACE in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). MATERIAL AND METHODS: The association of apelin-12 levels with the N/L ratio on admission was assessed in 170 consecutive patients with primary STEMI undergoing primary PCI. All patient SYNTAX scores and thrombolysis in myocardial infarction (TIMI) flow grades were also assessed. Patients were divided into two groups according to their TIMI flow grade. Patients with a TIMI 0-2 flow and TIMI 3 flow with grade 0/1 myocardial blush grade (MBG) score were defined as the no-reflow group and patients with TIMI grade 3 flow with ⩾2 MBG were considered as the normal flow group. RESULTS: Baseline apelin-12 levels were significantly lower in the no-reflow group than in the normal flow group (3.3±1.81 vs 6.2±1.74, p<0.001). In-hospital events, including death, myocardial infarction (MI) and re-infarction were significantly higher in patients in the no-reflow group than normal flow group (23% vs 7%, p<0.001). Apelin-12 level was negative correlated with the N/L ratio (r= -0.352, p<0.001), Hs-Crp (r=-0.272, p=0.01) and SYNTAX score (r= -0.246, p=0.029). In the multivariate regression analysis, apelin-12, presence of no-reflow and the SYNTAX score were independent predictors of in-hospital MACE (odds ratio [OR] 1.41, 95% confidence interval (CI) [1.27 to 1.67], p=0.001 for apelin-12, OR 1.085, [0.981 to 1.203], p<0.001 for no-reflow and OR 0.201, 95% CI [0.05 to 0.47], p= 0.004 for SYNTAX score). CONCLUSION: We have shown that lower apelin-12 level on admission is associated with higher SYNTAX scores and no-reflow phenomenon and may be used as a prognostic marker for hospital MACE in patients with STEMI.

The Role of Thiol/Disulphide Homeostasis in Anthracycline Associated Cardiac Toxicity.

The aim of the present study was to evaluate whether the baseline thiol/disulfide state can predict the occurrence of anthracycline induced cardiac toxicity. A total of 186 cancer patients receiving anthracycline (doxorubicin)-based chemotherapy were enrolled. All patients underwent 2-dimensional (2D) speckle tracking echocardiography (STE) to determine their left ventricular ejection fraction (LVEF) and blood samples for measuring thiol forms were obtained before treatment and 4 weeks after completion of the chemotherapy. The mean dose of doxorubicin exposure was 255 ± 39.2 mg/m2. Baseline native thiol was found to be lower whereas baseline disulfide and the disulfide/total thiol ratio were found to be higher in patients who had a decrease in LVEF after anthracycline therapy. Also, the amount of decrease in LVEF was well correlated with the delta value of the thiol forms. Logistic regression analysis revealed that changes in BNP and global longitudinal strain (GLS), baseline level of native thiol, disulfide, and the disulfide/total thiol ratio were strong predictors for a decrease in LVEF.The thiol/disulfide pathway may be a factor for predicting chemotherapy-induced cardiac toxicity as one of the oxidative stress mechanisms.

The prognostic importance of thiol/disulfide homeostasis in patients with acute pulmonary thromboembolism.

OBJECTIVE: The aim of this study was to evaluate the role of thiol/disulfide homeostasis in acute pulmonary embolism (APE) and investigate its compliance to show hospital mortality of patients with APE. MATERIAL AND METHODS: A total of 173 participants including 113 patients with APE, and 60 healthy individuals were included in the study. APE group was categorized into two subgroups according to Pulmonary Embolism Severity Index (PESI) clinic risk score (PESI low group [n=71, class 1-3] and PESI high group [n=42, class 4-5]). RESULTS: Mean level of native thiol was lower and disulfide level and disulfide/total thiol ratio were higher in APE group than control group. In APE group, 14 patients died during hospitalization. Native thiol and disulfide level, presence of shock, heart rate, oxygen saturation, right ventricular dysfunction, N-terminal pro-brain natriuretic peptide, and creatinine levels were found to have prognostic significance in univariate analysis. On multilvariable logistic regression analysis, native thiol and disulfide level (odds ratio [OR], 1.16(0.87-1.36); P=.010 and OR, 1.49; P=.015, respectively), presence of shock (OR, 1.04; P=.012) and N-terminal pro-brain natriuretic peptide (OR, 1.67; P=.002) were strong predictors for APE-related hospital mortality after the adjustment of other potential confounders. CONCLUSION: We have shown that thiol/disulfide homeostasis can be altered during APE and associated with worse hemodynamic parameters, and may be used as a prognostic marker for hospital mortality.

High morning blood pressure surge is associated with oxidative stress and paraoxonase 1 activity in newly diagnosed hypertensive patients.

BACKGROUND: Both oxidative stress and morning surge (MS) of blood pressure (BP) were found to be closely related with cardiovascular and cerebrovascular diseases. We investigated the association between MS of BP and oxidative stress in newly diagnosed hypertensive patients. METHODS: We prospectively included 237 newly diagnosed hypertensive patients in the present study (mean age: 51.6 ± 11.7 years). The patients were classified according to the extent of the sleep-through surge as follows: the top decile of sleep-through surge (>47.2 mmHg, n = 27; EMShigh group), versus all others (n = 210, EMSlow group). Total antioxidant capacity (TAC) and total oxidant status (TOS) levels were determined by using an automated measurement method. The oxidative stress index (OSI) was calculated as the ratio of TOS to TAC. Serum paraoxonase 1 (PON-1) activity was measured spectrophotometrically. RESULTS: Patients in EMShigh group were found to have higher hs-CRP, TOS, and OSI values and lower TAC and PON-1 values (p < 0.01, for all). MS of BP was associated with hs-CRP, PON-1, TOS, TAC, and OSI levels in bivariate analysis. Multivariate linear regression analysis showed that MS of BP was significantly associated with PON-1(ß = -0.206, p < 0.001), OSI (ß = 0.602, p < 0.001) and hs-CRP (ß = 0.210, p < 0.001). CONCLUSION: Present study shows that OSI is increased and antioxidant PON-1 activity is decreased in patients with enhanced MS of BP. There is a close association between high MS of BP and oxidative stress markers in newly diagnosed hypertensive patients.

Scorpion envenomation-induced acute thrombotic inferior myocardial infarction.

The occurrence of a serious cardiac emergency following scorpion envenomation has rarely been reported and, when so, mostly presented as non-ST segment elevation myocardial infarction, cardiogenic shock, or myocarditis. Possible mechanisms include imbalance in blood pressure and coronary vasospasm caused by the combination of sympathetic excitation, scorpion venom-induced release of catecholamines, and the direct effect of the toxin on the myocardium. We report a case of a 55-year-old man who presented with acute inferior wall myocardial infarction (MI) within 2 h of being stung by a scorpion. Coronary angiogram revealed total thrombotic occlusion of the left circumflex artery, which was treated successfully with glycoprotein IIb/IIIa inhibitor, thrombus aspiration, antivenom serum, and supportive therapy. Therefore, life-threatening MI can complicate the clinical course during some types of scorpion envenomation and should be managed as an acute coronary syndrome.

A Novel-Modified Provisional Bifurcation Stenting Technique: Jailed Semi-Inflated Balloon Technique.

OBJECTIVE: We proposed a new technique for the treatment of coronary bifurcation lesions, called jailed semi-inflated balloon technique (JSBT). BACKGROUND: Currently, provisional approach is recommended to treat most of coronary bifurcation lesions. However, it is associated with the risk of side branch (SB) occlusion after main vessel (MV) stenting due to plaque or carina shift into the SB. The SB occlusion may cause peri-procedural myonecrosis or hemodynamic compromise. Therefore, strategies are needed to reduce the SB occlusion during provisional approach. METHODS: Between September 2014 and April 2015, we selected 137 patients (104 male, 33 female; mean age 63.6 ± 11.7 years) with 148 distinct coronary bifurcation lesions underwent percutaneous coronary intervention using JSBT. All patients were followed with hospital visits or telephone contact up to 1 month. RESULTS: The majority of the patients had acute coronary syndrome (64.2%) and Medina 1.1.1. bifurcation lesions (62.8%). The lesion localization was distal left main (LM) coronary artery in 28 patients. After the MV stenting, thrombolysis in myocardial infarction (TIMI) 3 flow was established in 100% of both MV and SB. There was no SB occlusion in any patient. There was no major adverse cardiac event during in-hospital stay and 1 month follow-up. CONCLUSIONS: The JSBT technique can be successfully performed in both LM and non-LM bifurcation lesion. This technique provides high rate of procedural success, excellent SB protection during MV stenting and excellent immediate clinical outcome.

Coronary collateral development and arterial stiffness in patients with chronic coronary total occlusions.

OBJECTIVE: Coronary collateral circulation (CCC) mainly develops through arteriogenesis in response to shear forces. Increased arterial stiffness (AS) causes decreased coronary perfusion, which may reduce shear stress, arteriogenesis, and thus collateral formation. The aim of this study was to assess the relationship between CCC and AS in patients with chronic coronary total occlusion (CTO). DESIGN: We prospectively enrolled 163 patients with CTO. Patients were divided into two groups according to their Rentrop scores: (a) poorly developed (PD) CCC group (Rentrop 0-1) and (b) well-developed (WD) CCC group (Rentrop 2-3). AS measurements were carried out using a Mobil-O-Graph arteriography system. RESULTS: Fasting glucose, creatinine, uric acid, neutrophil count, and neutrophil-to-lymphocyte ratio were found to be higher in patients with PD-CCC. Moreover, patients with PD-CCC had significantly higher augmentation index (AIx) and pulse wave velocity (PWV) compared with WD-CCC group (27.3 ± 8.9 vs. 18.7 ± 7.4, p < 0.001 and 11.7 ± 2.6 vs. 8.5 ± 1.4, p < 0.001, respectively). In multivariate logistic regression analysis, PWV, AIx, and serum uric acid were found to be independently associated with the development of CCC. CONCLUSION: AS parameters, such as AIx and PWV, as well as serum uric acid are independently associated with the development of CCC in stable coronary artery disease with CTO.

Gamma glutamyl transferase activity is independently associated with oxidative stress rather than SYNTAX score.

BACKGROUND: Gamma glutamyl transferase (GGT) is involved in the pathophysiologic process of coronary atherosclerosis. GGT activity plays a role in the catabolism of glutathione which is known as one of the major antioxidants. However, there is a lack of research on direct examination of relevance between serum GGT activity with systemic oxidative stress. OBJECTIVES: We aimed to investigate the relationship between GGT activity with systemic oxidative stress markers and the extent and complexity of coronary artery disease (CAD) assessed with SYNTAX score in stable CAD. METHODS: Measurements were obtained from 359 patients with stable CAD (Mean age = 57.7 ± 10.1 years). The patients were divided into two groups according to the median GGT level (GGT < median group < 22 and GGT > median group ≥ 22). Angiography was performed and SYNTAX score was calculated in all patients. Oxidative stress markers (total oxidant status [TOS], total antioxidant capacity [TAC] and oxidative stress index [OSI]) were measured in all patients. RESULTS: While SYNTAX score and oxidative stress markers such as TOS and OSI have been increased, TAC was decreased in GGT > median group compared with GGT < median group (p < 0.05, for all). GGT activity was independently associated with diabetes (ß = 0.106, p = 0.015) and OSI (ß = 0.556, p < 0.001) in multiple linear regression analysis. However, the independent association between GGT activity and SYNTAX score was not found in present study (ß = 0.063, p = 0.238). CONCLUSION: In stable CAD, increased GGT activity within the normal range is associated with increased oxidative stress rather than increased extent and complexity of CAD.

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

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

Serum 25-Hydroxyvitamin D Level and Aortic Intima-Media Thickness in Patients Without Clinical Manifestation of Atherosclerotic Cardiovascular Disease.

OBJECTIVES: Existing evidence suggests that impaired vitamin D metabolism contribute to the development of atherosclerosis. Aortic intima-media thickness (IMT) is an earlier marker than carotid IMT of preclinical atherosclerosis. However, there is a lack of researches on direct investigation of relevance between serum 25-hydroxyvitamin D (25(OH)D) and thoracic aortic IMT. In this study, we aimed to assess the relationship between thoracic aortic IMT and 25(OH)D. METHODS: We studied 117 patients (mean age: 45.5 ± 8.4 years) who underwent transesophageal echocardiography (TEE) for various indications. Serum 25(OH)D was measured using a direct competitive chemiluminescent immunoassay. The patients were divided into three groups according to the their serum 25(OH)D levels (VitDdeficiency , VitDinsufficient and VitDnormal groups). TEE was performed in all subjects. High sensitive C-reactive protein (hsCRP) and other biochemical markers were measured using an automated chemistry analyzer. RESULTS: Only 24.8% (29 patients) of patients had normal levels of 25(OH)D. The highest aortic IMT values were observed in VitDdeficiency group compared with VitDinsufficient and VitDnormal groups (P < 0.05, for all). Also aortic IMT values of VitDinsufficient group were higher than VitDnormal group (P < 0.05). 25(OH)D was independently associated with hs-CRP (ß = -0.442, P < 0.001) and aortic IMT (ß = -0.499, P < 0.001). CONCLUSIONS: The lower 25(OH)D level was independently associated with higher aortic IMT values. Therefore, hypovitaminosis D may have a role on pathogenesis of subclinical thoracic atherosclerosis.

Coronary flow velocity reserve in patients with ascending aorta aneurysm.

BACKGROUND: Ascending aorta aneurysms (AAA) are one of the leading causes of morbidity and mortality. Impairment in coronary flow may contribute to cardiovascular consequences in AAA patients. Coronary flow velocity reserve (CFVR) has been considered an important diagnostic index of the functional capacity of coronary arteries noninvasively. The aim of this study was to evaluate, by noninvasive CVFR, whether patients with AAA demonstrate significant coronary microvascular dysfunction in the absence of coronary artery disease (CAD). METHODS: We prospectively included 44 patients with thoracic AAA in the absence of concomitant CAD (30 men, 14 women; mean age 57.5 ± 8.4 years). A total of 36 patients without aortic dilatation (mean age 55.2 ± 9.9 years) were selected as the control group. Coronary flow velocities in the distal left anterior descending (LAD) artery were measured using transthoracic echocardiography. CFVR was calculated as the hyperemic to resting coronary diastolic peak velocities ratio. RESULTS: Compared with controls, patients with AAA had higher baseline LAD peak diastolic coronary flow velocities (28.3 ± 5.8 vs. 25.2 ± 4.5 cm/sec, P = 0.01), lower hyperemic LAD flow velocities (54.0 ± 10.3 vs. 57.2 ± 12.7 cm/sec, P = 0.220), and consequently lower CFVR (1.9 ± 0.3 vs. 2.3 ± 0.5, P < 0.001). Multivariate linear regression analysis showed that CFVR was independently associated only with aortic systolic diameter (AoSD) (ß = -0.679, P = <0.001). CONCLUSIONS: Our study demonstrates that noninvasive CFVR is significantly reduced in patients with AAA and AoSD is the most important determinant of impaired CFVR.

The association between aortic distensibility and coronary flow reserve in newly diagnosed diabetic patients.

INTRODUCTION: Aortic distensibility (AD) is an important parameter affecting coronary hemodynamics. Coronary flow velocity reserve (CFVR) is a reliable marker of coronary endothelial function in diabetic patients. The aim of this study was to investigate the association between AD and CFVR in newly diagnosed diabetic patients. METHOD: We studied 77 patients with newly diagnosed diabetes mellitus (DM) and 30 age- and sex-matched healthy control subjects. CFVR was calculated as the hyperemic to resting coronary diastolic velocities ratio by using transthoracic echocardiography. Pulse pressure (PP) and AD were calculated. RESULTS: Fasting blood glucose, HbA1c and PP were significantly higher in patients with diabetes (P < 0.001, P < 0.001 and P = 0.009, respectively). Other clinical and demographical characteristics, laboratory findings and echocardiographic findings were similar in both groups (P > 0.05, for all). The measurement of CFVR and AD in patients with diabetes were significantly lower compared with the controls (P < 0.001 and P = 0.001, respectively). CFVR was significantly negatively correlated with age, body mass index, HbA1c, systolic blood pressure, and PP, while significantly positively correlated with AD (P < 0.05, for all). Multivariate regression analysis showed that only AD (ß = 0.485, P < 0.0001) and HbA1c (ß = -0.362, P < 0.0001) were independently associated with CFVR. The cutoff value of AD obtained by the receiver operator characteristic (ROC) curve analysis was 2.44 for the prediction of impaired CFVR. CONCLUSION: Aortic distensibility and HbA1c were independently associated with CFVR. The decrease in AD may be used as a marker of impaired coronary microcirculation in asymptomatic diabetic patients.

Association between high-sensitivity troponin T, left ventricular hypertrophy, and myocardial performance index.

BACKGROUND: The prognostic importance of high-sensitivity cardiac troponin T (hs-cTnT) has recently been reported in patients with heart failure. The myocardial performance index (MPI), which combines parameters of both systolic and diastolic ventricular function, provides a better marker of left ventricular dysfunction in hypertensive patients with preserved left ventricular ejection fraction (LVEF). AIM: We aimed to investigate the relationship between hs-cTnT and tissue Doppler-derived MPI in newly diagnosed hypertensive patients with preserved LVEF. METHODS: We studied 306 patients with newly diagnosed hypertension. The patients were divided into two groups according to their median MPI values: MPIlo and MPIhigh groups. The MPI was calculated from the pulsed-wave Doppler recordings. Left ventricular mass index (LVMI) was determined according to the Devereux formula. hs-cTnT, uric acid, and high-sensitivity C-reactive protein (hs-CRP) levels were measured in all patients. RESULTS: Hs-cTnT, hs-CRP, and uric acid levels were higher in the MPIhigh group compared with the MPIlow group (p < 0.05, for all). The LVMI values in the MPIhigh group were higher than in the MPIlow group (p < 0.05). MPI was independently associated with age, uric acid, hs-cTnT, and LVMI in multivariate analysis. Multivariate logistic regression analysis showed that MPI and LVMI were independent predictors of high hs-cTnT level in newly diagnosed hypertensive patients with preserved LVEF. CONCLUSION: Hs-cTnT was independently associated with LV dysfunction and LV hypertrophy assessed with MPI in newly diagnosed hypertensive patients.

Epicardial fat thickness as associated with left ventricular myocardial performance in patients with newly diagnosed hypertension.

OBJECTIVE: Epicardial fat thickness (EFth) is associated with both left ventricular hypertrophy (LVH) and diastolic dysfunction. However, the effect of EFth on myocardial performance is not known. The aim of this study was to investigate the relationship between EFth and tissue Doppler myocardial performance index (TD-MPI), which incorporates both systolic and diastolic left ventricular (LV) function, in newly diagnosed hypertension (HT) patients. METHODS: A total of 314 consecutive, newly diagnosed HT patients were prospectively included (mean age: 51.9±1.7 years). EFth was measured perpendicularly on the free wall of the right ventricle at the end of the systole in 2 echocardiographic views (parasternal short and long axis). Myocardial performance index (MPI) was calculated using tissue Doppler (TD) echocardiography. Patients were divided into 2 groups according to median TD-MPI levels (TD-MPIlow and TD-MPIhigh). RESULTS: EFth values of the TD-MPIhigh group were higher than those of the TD-MPIlow group (p<0.05). Patients in the TD-MPIhigh group also had higher age, body mass index, systolic blood pressure (SBP), diastolic blood pressure (DBP), left ventricular mass index (LVMI), E/A ratio, and aortic distensibility, compared with the TD-MPIlow group (p<0.05 for all). Multivariate linear regression analysis showed that TD-MPI was independently associated with age (ß=0.089, p=0.012), LVMI (ß=0.090, p=0.05), E/A (ß=-0.118, p=0.005), and EFth (ß=0.432, p<0.001). CONCLUSION: TD-MPI was independently associated with EFth in patients with newly diagnosed HT. EFth may be used as a predictor of impaired LV global functions in patients with normal left ventricular ejection fraction (LVEF) and newly diagnosed HT.

Left ventricle geometry affects coronary flow reserve in diabetic patients.

OBJECTIVES: The aim of this study was to investigate the association between coronary flow reserve (CFR) and left ventricle (LV) geometric patterns in patients with newly-diagnosed diabetes mellitus (DM). STUDY DESIGN: We studied 116 patients with newly-diagnosed DM and 31 healthy control subjects. Echocardiographic examination was performed on all subjects. Four different geometric patterns were identified in diabetic patients, according to LV mass index (LVMI) and relative wall thickness (RWT) [NG: Normal geometry; CR: Concentric remodeling; EH: Eccentric hypertrophy; CH: Concentric hypertrophy]. CFR was calculated as the hyperemic to resting coronary diastolic peak velocities ratio. RESULTS: Compared with controls, CFR was decreased in diabetic patients (p<0.05). The lowest CFR values were observed in the CH group compared with control and other groups (p<0.05, for all). Also, CFR values of the CR and EH groups were lower than NG and the control group (p<0.05, for all). CFR was associated with LV geometry (r=-0.449, p=0.001), LVMI (r=-0.401, p<0.001), RWT (r=-0.247, p=0.008), HbA1c (r=-0.576, p<0.001) and mitral valve E/A ratio (r=0.239, p=0.01) in bivariate analysis. CFR was independently associated with LV geometry (ß=-0.449, p<0.001), LVMI (ß=-0.192, p=0.016), and HbA1c (ß=-0.576, p<0.001) in multivariate analysis. CONCLUSION: CFR was impaired in newly-diagnosed DM. The degree of this deformation increases from normal geometry towards to concentric hypertrophy. This condition suggests that myocardial structural remodeling due to diabetes might be effective on CFR.

Mean platelet volume is independently associated with renal dysfunction in stable coronary artery disease.

It has been suggested that athero-thrombotic risk progressively increases as the glomerular filtration rate (GFR) declines. Mean platelet volume (MPV) is the most commonly used measure of platelet size, and higher MPV value is independent risk factor for athero-thrombotic disease such as myocardial infarction. We aimed to evaluate the association between estimated GFR and MPV in patients with stable coronary artery disease showing normal to mildly impaired renal function. A total of 471 patients (288 males and 183 females; mean age: 62.5+9.5 years) with angiographically proven CAD were included. The patients were divided into two groups according to the estimated GFR value (GFRlow group: GFR <60 ml/minute per 1.73 m(2) and GFRhigh group: GFR ≥ 60, ml/min per 1.73 m(2)). Estimated GFR was calculated according to the Cockcroft-Gault formula. MPV, high-sensitive C-reactive protein (hsCRP) and other biochemical markers were measured in all patients. Prevalent of CAD was determined by the SYNTAX score. Patients with GFRlow group were of older age, had higher incidence of female gender, current smoker, diabetes, hypertension and hyperlipidemia, lower values of total cholesterol, LDL cholesterol, hemoglobin and platelet count and higher values of BMI, SYNTAX score, hs-CRP and MPV compared with patients with GFRhigh group. Multivariate linear regression analysis showed that the MPV was independently related with diabetes (ß=0.189, p<0.001), eGFR (ß=-0.267, p<0.001), hs-CRP level (ß=0.158, p<0.001) and platelet count (ß=-0.116, p=0.002). In conclusion, MPV is independently associated with GFR as well as hsCRP, platelet count and diabetes. These findings may explain, in part, the increase in athero-thrombotic risk with slightly impaired renal function.

High-sensitivity cardiac troponin T levels in newly diagnosed hypertensive patients with different left ventricle geometry.

BACKGROUND: The high-sensitivity cardiac troponin T (hs-cTnT) assay provides important prognostic information on cardiovascular diseases. Although hs-cTnT is associated with left ventricle (LV) hypertrophy (LVH), it has not been investigated in different LV geometric patterns incorporating normal LV structure and concentric remodeling in addition to LVH. OBJECTIVES: We aimed to investigate the possible association between hs-cTnT and LV geometric patterns in newly diagnosed hypertensive patients. METHODS: We studied 306 patients with newly diagnosed hypertension (HT; mean age 51.7 ± 5.6 years) and 44 healthy control subjects (mean age 51.3 ± 4.7 years). Echocardiographic examination was performed in all subjects. Four different geometric patterns were determined in hypertensive patients according to LV mass index (LVMI) and relative wall thickness (RWth). hs-cTnT and other biochemical markers were measured in all participants. RESULTS: The highest hs-cTnT values were observed in the concentric hypertrophy group compared with the control, normal geometry, concentric remodeling and eccentric hypertrophy groups (p < 0.05, for all). Also, hs-cTnT values of the eccentric hypertrophy group were higher than the control, normal geometry and concentric remodeling groups (p < 0.05, for all). Multivariate regression analysis showed that hs-cTnT was independently associated with LV geometry (ß = 0.326, p = 0.001) as well as LVMI (ß = 0.228, p = 0.010) and creatinine level ß = 0.132, p = 0.012). CONCLUSION: hs-cTnT level is related not only to LVH but also to LV geometry in hypertensive patients. hs-cTnT levels may mediate poorer LV geometric patterns in hypertensive patients.