Effect of periodontal disease on oxidative stress markers in patients with atherosclerosis.

OBJECTIVES: The aim of this study was to investigate the effect of periodontal inflammation on oxidative stress in patients with atherosclerosis by considering serum and saliva total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI). MATERIALS AND METHODS: In the study, there were 4 groups, with 20 individuals in each group. These groups consisted of individuals who had periodontitis with atherosclerosis (group A-P), were periodontally healthy with atherosclerosis (group A-C), were systemically healthy with periodontitis (group P), and were systemically and periodontally healthy (group C). Clinical periodontal parameters were recorded. PISA values were calculated. Atherosclerosis severity was determined by the Gensini score. The ratio of TAS/TOS resulting in the OSI levels of the serum and saliva samples was examined biochemically. RESULTS: Group A-P serum TAS and group C saliva OSI values were lower than those of the other groups (p < 0.05). Group A-P serum TOS and OSI values were higher than those of the other groups (p < 0.05). Groups A-C and P serum TOS and OSI values were higher than those of group C (p < 0.05). In the multivariate linear regression analysis, group A-P and PISA values were independently associated with serum TOS and OSI values (p < 0.05). Group A-P, group P, and PISA values were independently associated with saliva OSI values (p < 0.05). CONCLUSIONS: Periodontitis and atherosclerosis may have systemic oxidative stress-increasing effects. The coexistence of periodontitis and atherosclerosis increases oxidative stress beyond that seen in either condition alone. Periodontitis can be associated with increased systemic TOS and OSI values in patients with atherosclerosis. STATEMENT OF CLINICAL RELEVANCE: Oxidative status is affected more severely when periodontitis and atherosclerosis coexist rather than when either exists alone. Periodontitis can cause increasing effect on serum TOS and OSI and decreasing effect on TAS in patients with atherosclerosis. The increase in oxidative stress markers with the presence of periodontal disease in patients with atherosclerosis emphasizes that controlling periodontal diseases, a treatable disease, may contribute to the prognosis of atherosclerosis.

Impact of Chronic Rheumatic Valve Diseases on Large Vessels.

BACKGROUND AND AIM OF STUDY: Rheumatic valvular heart disease, which remains a common health problem in developing countries, has numerous consequences on the heart chambers and circulation. The study aim was to investigate the effects of chronic rheumatic valve disease on the diameters of the descending aorta (DA) and inferior vena cava (IVC). METHODS: A total of 88 patients with echocardiographically documented rheumatic valvular heart disease and 112 healthy controls were enrolled into the study. All patients underwent detailed echocardiographic examinations, while their height and body weight were recorded and adjusted to their body surface area. RESULTS: The most common involvement was mitral valve disease, followed by aortic valve disease and tricuspid valve disease. The mean diameter of the DA (indexed to BSA) was 1.79 ± 0.49 cm for patients and 1.53 ± 0.41 for controls (p <0.001). The mean diameter of the IVC (indexed to BSA) was 1.69 ± 0.73 for patients and 1.38 ± 0.35 cm for controls (p <0.001). There was a significant positive correlation between mitral valve mean gradient and IVC diameter (p = 0.01, r = 0.18). There were also strong associations between the mitral valve area and the diameters of the DA (p = 0.001, r = -0.239) and IVC (p <0.001, r = -0.246). CONCLUSION: Rheumatic valve disease, especially mitral stenosis, was closely related to remodeling of the great vessels.

Renal functions in obstructive sleep apnea patients.

PURPOSE: The aim of this study is to investigate possible factors influencing glomerular filtration rate (GFR) in obstructive sleep apnea (OSA). METHODS: Data of OSA patients admitted to Gaziantep University sleep clinic from January 2005 to January 2010 were retrospectively evaluated. GFR is calculated with the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Patients younger than 18 years old were excluded. RESULTS: The mean age of OSA (n = 634) and control group (n = 62) were 51.13 ± 11.61 and 50.69 ± 13.88 years, respectively (p = 0.81). The mean estimated GFR (eGFR) was 90.73 ± 19.59 ml/min/1.73 m(2) in OSA patients and 94.14 ± 18.81 ml/min/1.73 m(2) in control subjects (p = 0.19). GFR was 84.25 ± 20.87 ml/min/1.73 m(2) in patients with left ventricular hypertrophy (LVH) while it was 93.94 ± 18.44 ml/min/1.73 m(2) in patients without LVH (p = 0.00). GFR of male subjects was 92.1 ± 19.23 in OSA and 95.84 ± 20.08 ml/min/1.73 m(2) in controls (p = 0.33). GFR of female and male patients in the OSA were 87.45 ± 20.10 and 92.91 ± 18.02 ml/min/1.73 m(2), respectively (p = 0.13). Serum creatinine was higher in OSA patients compared to controls (p = 0.01). GFR was 92.30 ± 19.27 in male and 88.33 ± 19.84 ml/min/1.73 m(2) in female subjects (p = 0.01). GFR was 84.86 ± 19.95 in hypertensive patients while it was 95.11 ± 18.20 ml/min/1.73 m(2) in normotensive subjects (p = 0.00). GFR was 89.30 ± 19.96 in patients with metabolic syndrome (MetS) and it was 93.46 ± 18.68 ml/min/1.73 m(2) in patients without MetS (p = 0.00). CONCLUSIONS: GFR values were lower in sleep apneic patients with MetS as well as in patients with hypertension and LVH.

An update on cardiovascular effects of obstructive sleep apnoea syndrome.

Obstructive sleep apnoea syndrome is an important health problem which may cause or worsen systemic diseases. Chronic intermittent hypoxia during repetitive airflow cessations may cause endothelial dysfunction. Sleep apnoea is also shown to be associated with hypercoagulability which may be due to decreased nitric oxide levels and impaired vasodilatation. Endothelial dysfunction, increased systemic inflammation, sympathetic nervous system activation, increased oxidative stress and dysglycaemia may all contribute to cardiovascular processes such as hypertension, arrhythmia, stroke, heart failure and coronary artery disease in patients with obstructive sleep apnoea. Treatment approaches in patients with obstructive sleep apnoea mainly focus on maintaining upper airway patency either with positive airway pressure devices or upper airway appliances. Strategies involving positive airway pressure therapy are associated with decreased morbidity and mortality. Obstructive sleep apnoea should be suspected as an underlying mechanism in patients with cardiovascular disease and warrants appropriate treatment.

Relationship between Neurocardiogenic Syncope and Ventricular Repolarization.

BACKGROUND: We aimed to analyze ventricular repolarization in neurocardiogenic syncope (NCS) patients by using T-peak-T-end interval, T-peak-T-end/QT ratio, T-peak-T-end/QTc ratio and corrected QT interval (QTc), QT dispersion (QTd), QT index (QTI) and corrected QT interval index (QTcI) comparing with the corrected JT dispersion (JTcd), and corrected JT (JTc) and the corrected JT interval index (JTcI), by inspecting ventricular activation until termination of repolarization. These parameters are used as an index of potential ventricular arrhythmogenesis. METHODS: We have studied patients with head-up tilt table test (HUTT) (+) (33 patients; mean age: 28 ± 11 years) and HUTT (-) as control group (33 patients; mean age: 30 ± 11 years). In all patients, T-peak-T-end interval, T-peak-T-end/QT ratio, T-peak-T-end/QTc ratio, QT, QTd, QTI, QTc, QTcI, JTd, JTc, and JTcI were measured on electrocardiogram. RESULTS: The following parameters were statistically significant between groups: QTd (22.72 ± 17.54 msn; 11.21 ± 13.40 msn; P = 0.004), QTc (424.27 ± 33.75 msn; 403.66 ± 38.08 msn; P = 0.023), QTcI (114.09 ± 14, 29%; 106.71 ± 15.33%, P = 0.047), and QTI (100.72 ± 7.19%; 97.14 ± 7.13%, P = 0.046). Furthermore, T-peak-T-end interval was significantly prolonged in the study group (93.78 ± 20.27 msn; 81.21 ± 11.66 msn; P = 0.003). T-peak-T-end/QT ratio was significantly higher in the study group (0.24 ± 0.04 msn; 0.22 ± 0.04 msn; P = 0.030). T-peak-T-end/QTc ratio was significantly higher in the study group (0.22 ± 0.04 msn; 0.20 ± 0.03 msn; P = 0.015). The JTc and JTd were also significantly higher in the study group ([103.00 ± 9, 72%; 95.44 ± 10.26%, P = 0.003], [27.57 ± 16.01 msn; 10.45 ± 16.08 msn; P < 0.001], respectively). CONCLUSIONS: Electrocardiographic ventricular repolarization parameters including T-peak-T-end interval, T-peak-T-end/QT ratio, T-peak-T-end/QTc ratio, QTc, QTd, QTI, QTcI, JTc, JTd, and JTI are prolonged in NCS.

An epidemiological study to evaluate the use of vitamin K antagonists and new oral anticoagulants among non-valvular atrial fibrillation patients in Turkey- AFTER-2 study design.

OBJECTIVES: Atrial fibrillation (AF) is one of the most common causes of preventable ischemic stroke and is related to increased cardiovascular morbidity and mortality. There is a lack of data in Turkey on the use of new oral anticoagulants (NOACs), and time in therapeutic INR range (TTR) in vitamin K antagonist users and AF management modality. In this multi-center trial, we aimed to analyze, follow and evaluate the epidemiological data in non-valvular AF patients. STUDY DESIGN: Four thousand one hundred consecutive adult patients from 42 centers with at least one AF attack identified on electrocardiography will be included in the study. Patients with rheumatic mitral valve stenosis and prosthetic valve disease will be excluded from the study. At the end of one year, the patients will be evaluated in terms of major cardiac end points (death, transient ischemic attack, stroke, systemic thromboembolism, major bleeding and hospitalization). RESULTS: First results are expected in June 2015. Data about major cardiovascular end-points will be available in January 2016. CONCLUSION: The rates and kind of oral anticoagulant use, TTR in vitamin K antagonist users and main management modality applied in non-valvular AF patients will be determined by AFTER-2 study. In addition, the rate of major adverse events (MACEs) and the independent predictors of these MACEs will be detected (AFTER-2 Study ClinicalTrials.gov number, NCT02354456.).

Atrial electromechanical conduction delay in patients with neurocardiogenic syncope.

AIM: We aimed to investigate the presence of atrial electromechanical conduction delay in patients with neurocardiogenic syncope, which was diagnosed with head-up tilt table test (HUTT). MATERIALS AND METHODS: A total of 29 patients (mean age: 30.6 ± 15.9 years) with vasovagal syncope, as diagnosed by HUTT, and 23 healthy control subjects (mean age: 34.7 ± 16.3 years) with a negative HUTT were enrolled to the study. Atrial electromechanical conduction delay was defined as the time elapsed from the beginning of the P wave in the electrogardiogram to the beginning of the Am wave in tissue Doppler. RESULTS: There was no statistically significant difference between the groups in terms of interatrial conduction delay, whereas the difference was significant with regard to the right intraatrial electromechanical conduction delay (P < 0.01) and the left intraatrial electromechanical conduction delay (P < 0.0001). There was a negative correlation between the left intraatrial electromechanical conduction delay and the right intraatrial electromechanical conduction delay (r = -0.486, P = 0.001), whereas a positive correlation was present with the interatrial electromechanical conduction delay (r = 0.507, P = 0.001). CONCLUSION: In this study, the tissue Doppler method revealed that there is left and right intraatrial electromechanical conduction delay in patients with vasovagal syncope. The impact and role of atrial conduction delay as a pathophysiological determinant should be confirmed in further studies.

Giant pulmonary artery aneurysm: 12 years of follow-up. case report and review of the literature.

Pulmonary artery aneurysm (PAA) is defined as pulmonary artery diameter of greater than 4 cm. PAA is not frequently encountered in clinical practice. There is a rare report in giant low-pressure PAA in terms of long-term follow-up. Herein, we sought to report a case of idiopathic PAA that was followed for 12 years in view of its learning points and to review the current literature for PAA. Herein we observed learning points according to long-term follow-up of PAA case as follows. PAA progressed dramatically after reaching a diameter greater than 6 cm and resulted in 7.87 cm in 2 years according to our case observation. Pericardial effusion may develop after a dramatic increase of PAA diameter. The reason for pericardial effusion is not always dissection or rupture; the presence of pericardial effusion possibly stemmed from the impairment of lymphatic drainage because of pressure effect on lymphatic circulation. Progressive increase of dilatation may lead to cough, as in our case.

Cardiac metastasis of a low-grade myofibroblastic sarcoma.

We aim to present a rare case of low-grade myofibroblastic sarcoma arising in the inguinal region accompanied by cardiac metastasis. A 36-year-old male patient suffering from recurrent inguinal swelling was operated on and the initial histopathological evaluation mistakenly diagnosed the condition as benign. During follow-up, a recurrence of mass was detected in the same region and a pathological examination revealed a low-grade myofibroblastic sarcoma. Cardiac metastasis was diagnosed shortly before rapid disease progression and death. The learning points relevant to this case are as follows: (1) Echocardiographic screening in patients with noncardiac myofibroblastic sarcomas may be helpful in the detection of silent metastasis. (2) Low-grade myofibroblastic sarcomas in the inguinal region may be misdiagnosed as benign after enucleation. Thus, rigorous histopathological examination of myofibroblastic sarcomas is crucial. (3) According to our knowledge, this is the first report of a low-grade myofibroblastic sarcoma to have a potential for cardiac metastasis with potentially fatal course.

Effects of lying position on P-wave dispersion in patients with heart failure.

OBJECTIVE: It was the aim of this study to investigate the effects of the right lateral decubitus, left lateral decubitus and supine lying position on P-wave dispersion (PWD) in patients with heart failure (HF). SUBJECTS AND METHODS: Seventeen patients with HF whose ejection fraction was <35% were included in the study. Right lateral decubitus, left lateral decubitus and supine electrocardiogram (ECG) recordings were obtained. The recordings for each of the three positions were taken after the patients had maintained each position for 30 min to ensure a stabilized hemodynamic position. For the baseline recording, in supine position, there was no 30-min waiting period before the ECG. RESULTS: After the right lateral decubitus position, there was a statistically significant reduction in the longest P-wave duration (100.0 ± 14.5 and 84.7 ± 16.2 ms; p = 0.001) and a significant decrease in PWD (41.7 ± 8.0 and 24.1 ± 7.1 ms; p < 0.0001). After the left lateral decubitus position, there was no significant change between the baseline PWD values (41.7 ± 8.0 and 40.2 ± 9.7 ms; p = 0.606). After the supine position, there was no significant change between the baseline PWD values (41.7 ± 8.0 and 39.7 ± 9.4 ms; p = 0.427). CONCLUSION: Our study revealed that patients' PWDs and maximum P-wave durations were lower in the right lateral decubitus lying position than in other positions. The clinical implication of this study needs to be further explored.

Influence of recurrent electroconvulsive therapy on cardiac function.

OBJECTIVE: To investigate the effects of recurrent electroconvulsive therapy (ECT) on cardiac function as assessed by echocardiography. SUBJECTS AND METHODS: Twenty-three patients (11 males and 12 females) with different psychiatric disorders who were apparently free of any cardiovascular disorders and underwent ECT were enrolled in the study. Echocardiographic findings including diastolic mitral inflow and tissue Doppler features were recorded at baseline and at the end of the 7th and last ECT in all patients. RESULTS: The mean age of the patients was 37.95 ± 13.28 years (range 19-71). There was no significant difference in mitral E wave velocities and tissue Doppler E' velocities between the baseline and after the 1st ECT (p = 0.161 and p = 0.083, respectively). The results were similar after the last ECT session (p = 0.463 and p = 0.310, respectively). However, there was a significant increase in transmitral A wave velocity after the 1st and 7th ECT session compared to the values at baseline (p = 0.008 and p = 0.017, respectively). CONCLUSION: The mitral diastolic inflow A wave velocity increased 20 min after ECT, and this increase persisted after recurrent ECT sessions. This finding could be considered as an indicator of acutely increased sympathetic tone.

Impact of scorpion stings on electrocardiographic changes and relationship with body oxidant and antioxidant status.

OBJECTIVE: To investigate electrocardiogram changes due to scorpion stings and association between oxidative stress index, body oxidant/antioxidant system and the electrocardiogram changes. METHODS: The study was conducted at the Faculty of Medicine, Gaziantep University, Turkey, between May 2009 and October 2010. It comprised 44 patients admitted to the emergency department for scorpion sting, and a control group of matched age and gender of 20 persons. Electrocardiograms were taken promptly in the most painful phases of the patients. Cardiac parametres were measured. Erythrocyte packages were prepared to detect toxin/antioxidant levels. SPSS 18 was used for statistical analysis. RESULTS: Of the 44 patients, 22 (50%) were male. Overall average age of the patients was 45.22 +/- 17.99 years. None of the patients required intensive care and none of them had limb losses. Cardiac parametres of the patients in electrocardiogram were higher (p < 0.05). Difference between those with changed electrocardiogram and unchanged electrocardiogram in terms of the values of total antioxidant status, total oxidant status, and oxidative stress index, were not statistically significant (p > 0.05). CONCLUSION: Scorpion stings associated with electrocardiogram changes. The mechanism of this relationship is not related with the status of body oxidative stress index and body oxidant and antioxidant capacity. Some parametres warrant further study in terms of potential serious arrhythmias in scorpionism.

Impact of rheumatic mitral stenosis on aortic elastic properties.

BACKGROUND AND AIM OF THE STUDY: Although mitral stenosis has profound effects on the circulation and hemodynamics, few data exist regarding its impact on aortic elastic properties. The study aim was to determine the association between mitral stenosis and aortic elastic properties by using strain and distensibility as a surrogate. METHODS: Sixty-six patients with echocardiographic documentation of rheumatic mitral stenosis, and 25 age- and gender-matched healthy control subjects were enrolled in the study. Aortic elasticity parameters including strain and distensibility were measured by means of echocardiography. RESULTS: The mean age of the patient and control groups were 41.8 +/- 12.0 and 38.9 +/- 5.0 years, respectively (p = 0.12). There was a significant impairment in distensibility and strain in the patient group compared to controls (0.276 +/- 0.167 versus 0.491 +/- 0.260 cm2 x dyn(-1), p = 0.001; 6.54 +/- 3.18% versus 9.19 +/- 4.78%, p = 0.015). There was a strong correlation between distensibility and left atrial diameter (p < 0.001; r = -0.39), left atrial volume index (p < 0.001; r = -0.56), mitral valve area (p < 0.001; r = 0.40), and mean transmitral gradient (p = 0.022; r = -0.18). Strain was also associated with left atrial diameter (p = 0.002; r = -0.32), left atrial volume index (p < 0.001; r = -0.41), mitral valve area (p = 0.002; r = 0.31), and mean transmitral gradient (p = 0.035; r = -0.18). CONCLUSION: Mitral stenosis was shown to be associated with impaired aortic elasticity, but further studies are required to clarify the clinical significance of this finding.

Comparison of metabolic syndrome with growing epidemic syndrome Z in terms of risk factors and gender differences.

PURPOSE: The aim of this study is to compare metabolic syndrome with syndrome Z growing epidemic in terms of risk factors, demographic variables, and gender differences in our large cohort at southeastern area in Turkey. METHODS: Data of patients admitted to sleep clinic in University of Gaziantep from January 2006 to January 2011 were retrospectively evaluated. ATP III and JNC 7 were used for defining metabolic syndrome and hypertension. RESULTS: Data of 761 patients were evaluated. Hypertension, diabetes mellitus, coronary artery disease, pulmonary hypertension, and left ventricular hypertrophy were more common in patients with syndrome Z than in patients without metabolic syndrome. Age, waist/neck circumferences, BMI, triglyceride, glucose, and Epworth sleepiness scale score were detected higher, whereas the minimum oxygen saturation during sleep was lower in patients with syndrome Z. Metabolic syndrome was more common in sleep apneic subjects than in controls (58 versus 30 %). Female sleep apneics showed higher rate of metabolic syndrome than those of males (74 versus 52 %). Hypertension, diabetes mellitus, coronary artery disease, and left ventricular hypertrophy were detected higher in males with syndrome Z than in males without metabolic syndrome. Snoring and excessive daytime sleepiness were detected higher in females with syndrome Z than in females without metabolic syndrome. Systemic/pulmonary hypertension, diabetes mellitus, and left ventricular hypertrophy were more common in females with syndrome Z than in females without metabolic syndrome. Complaints of headache and systemic/pulmonary hypertension were more common among females than males with syndrome Z. Female syndrome Z patients had lower minimum oxygen saturation than male patients with syndrome Z. CONCLUSIONS: Metabolic syndrome in sleep apneic patients is more prevalent than in controls. All metabolic syndrome parameters were significantly different among obstructive sleep apneic patients with respect to gender with more severe coronary risk factors in males.

Contribution of giant aneurysm of a membranous ventricular septal defect to right ventricular outflow tract obstruction.

Perimembranous defects are the most common types of ventricular septal defects (VSDs). In many cases, an aneurysm accompanies this defect. The aneurysm can have advantageous consequences on defect hemodynamics. However, it also has numerous complications that are frequently encountered in clinical practice. In this case, we describe a patient with a membranous VSD with giant aneurysm formation contributing to subpulmonic severe obstruction.

Isolated ruptured inter-atrial septal cystic echinococcosis during pregnancy.

Herein, we present a case of asymptomatic isolated cardiac cystic echinococcosis localized entirely to the inter-atrial septum in a pregnant woman. The patient underwent successful surgery. Cardiac cystic echinococcosis is rarely seen in pregnancy. A high index of suspicion is necessary for the diagnosis of a cardiac cyst hydatid. The treatment of cardiac cyst hydatid is surgical and should not be delayed during pregnancy. Early surgery might prevent septic embolization and cardiac life-threatening complications and save the lives of both mother and baby as in the present case.

Rapid recovery from acute myocarditis under levosimendan treatment: report of two cases.

WHAT IS KNOWN AND OBJECTIVES: Acute viral myocarditis (AVM) is an inflammatory heart disease that may lead to acute heart failure caused by cardiomyocyte loss. AVM may result in fatal outcome due to hemodynamic compromise. There is no specific treatment for AVM. Treatment is generally same as the treatment of conventional heart failure. Levosimendan is a new molecule with inotropic and vasodilator effect and is widely used for acute decompensated heart failure. DETAILS OF THE CASES: Case 1: A 48-years-old, previously healthy male patient admitted to our clinic with complaints of acute onset of rest dyspnea and orthopnea, started the day before. Cardiac chambers were enlarged on echocardiography with global hypokinesia and ejection fraction (EF) was 25%. The patient was diagnosed as AVM complicated with decompensated heart failure. Continuous infusion of 0·2 µg/kg/min levosimendan for 24 h with treatment of conventional heart failure. Echocardiographic follow-up revealed a rapid improvement in left ventricular EF (50%) after 24 h. Case 2: A 33-years-old male patient admitted to our clinic with new onset shortness of breath and palpitation complaints. Echocardiography revealed enlarged left heart cavities with global hypocinesia (EF was 25%). The patient was diagnosed as AVM complicated with decompensated heart failure. Continuous infusion of 0·2 µg/kg/min levosimendan for 24 h with treatment of conventional heart failure. Echocardiography revealed dramatic improvement of left ventricular systolic function (EF = 55%) 24 h later. WHAT IS NEW AND CONCLUSION: To our knowledge, there is no report or study on levosimendan therapy for AVM in humans to date. Herein, we share two cases that revealed dramatic improvement in the myocardial function with levosimendan usage during the early phase of AVM.

Circadian variation of blood pressure is impaired in normotensive pregnant women with gestational diabetes mellitus.

Data about circadian blood pressure (BP) in normotensive patients with gestational diabetes mellitus (GDM) are lacking. Thus, we sought to compare dipper and nondipper circadian variation of BP profile between normotensive women complicated with GDM and normal pregnant women. Forty-two women with GDM and 33 normal uncomplicated pregnant women who met the entry criteria for the study were enrolled in the study. Twenty-four-hour noninvasive ambulatory blood pressure monitoring and echocardiography to measure the left ventricle mass index and diastolic parameters were performed. Nocturnal blood pressure dipping was calculated as follows: (awake BP - sleep BP) × 100/awake BP. Patients with a nocturnal reduction in average daytime systolic BP and diastolic BP of less than 10% were classified as nondippers. Left ventricle mass index was higher in normotensive pregnant women with GDM group than in normal pregnant subjects (101.98 ± 24 g/m(2) vs. 90.67 ± 15 g/m(2), P < .018). Significant nocturnal systolic and diastolic nondippings were observed in GDM groups compared with normal subjects. From diastolic variables, the mitral E velocity and isovolumetric relaxation time were compatible with diastolic dysfunction relaxation abnormalities (P = .003 and P = .015, respectively) in nondipper group. From all confounding factors, only E velocity (P = .002) and diagnosis of GDM (P < .001) were predictive of nondipper circadian variation. This study shows that (i) circadian BP is impaired in normotensive pregnant subjects with GDM, (ii) the left ventricle mass index is higher in pregnant subjects with GDM than in normal pregnant subjects who despite a 24-hour BP are within normal limits, and (iii) in nocturnal nondipper group, the tendency to having diastolic relaxation abnormalities is noted.

Subclinical cardiovascular target organ damage manifestations of ankylosing spondylitis in young adult patients.

AIM: Although it is known that ankylosing spondylitis (AS) is associated with cardiovascular complications, the extent of these complications has not been clearly demonstrated in young adult patients. We have therefore investigated myocardial diastolic functions, carotid intima-media thickness (CIMT), and aortic elastic properties of young adult patients diagnosed with AS. METHOD: Sixty-six AS patients and 21 age/gender-matched healthy subjects were enrolled in the study. Spectral and tissue Doppler echocardiography, CIMT, aortic strain and distensibility, and serum B-type natriuretic peptide values were compared with disease activity indexes of AS, including the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and the role of other variables, such as anti-tumor necrosis factor-alpha (anti-TNF-α) treatment, lipid parameters, erythrocyte sedimentation rate, and C-reactive protein. RESULTS: Both mitral early diastolic flow speed (mE) and late diastolic flow speed (mA) scores were lower among patients than among the control subjects (p = 0.015 and p = 0.035, respectively). The Em ratio of the patients was remarkably lower than that of the control subjects (p = 0.044). BASDAI scores of >4 were used to identify patients with more active disease. The mA and mE/mA ratios were significantly different between patients with a BASDAI score of >4 and those with a BASDAI score of <4 (p = 0.026 and p = 0.021, respectively). While aortic elasticity were not significantly different between the groups, AS patients treated with anti-TNF-α had significantly improved aortic strain and distensibility values (p = 0.022 and p = 0.014, respectively) compared to those treated with non-steroidal anti-inflammatory drugs (NSAIDs). CONCLUSION: Myocardial diastolic functions were significantly deteriorated in the AS patients, and disease activity and myocardial diastolic functions were associated. An interesting finding was that patients receiving anti-TNF-α had better aortic elasticity than those treated with NSAIDs.

[Comparison of controlled pressure belt -allowing mobility to sandbags after percutaneous coronary intervention: pilot study]. / Perkütan koroner girisim sonrasi -mobiliteye izin veren- kontrollü baski kemerinin kum torbasiyla karsilastirilmasi: Pilot çalisma.

OBJECTIVES: We aimed to investigate the efficacy and safety of a belt mechanism (anjiobelt), which we developed recently and patented, which allows mobility after coronary operations and the application of adjustable pressure to the femoral artery. STUDY DESIGN: Between October 2012 and April 2013, 189 consecutive patients undergoing percutaneous coronary intervention electively or due to acute coronary syndrome were enrolled. There were 96 patients in the sandbag group and 93 patients in anjiobelt group. Manual compression was applied to the femoral artery until reaching primary homeostasis. Then, a 4-5 kilogram sandbag or anjiobelt was placed. Mobilization was allowed in case of need in the anjiobelt group. Twenty-four hours after the procedure, superficial bruising in the femoral region, hematoma, pseudo-aneurysm, and arteriovenous fistula, as femoral artery complications, were noted using Doppler ultrasound. RESULTS: Hematoma occurred more frequently in the sandbag group. Hematoma of <1 cm developed in 52 patients with sandbag and in 25 patients with anjiobelt (p<0.0001), while hematoma of 1-5 cm developed in 5 patients with sandbag and in 3 patients with anjiobelt (p<0.0001). Femoral artery pseudoaneurysm was seen in 4 patients (2 with anjiobelt, 2 with sandbag; p=0.975). CONCLUSION: Anjiobelt significantly reduces the incidence of hematoma in comparison to conventional sandbag in patients undergoing percutaneous coronary intervention. Other complications of the femoral region in terms of efficiency and safety appear to be similar to those observed with sandbag. The main problems occurring in these patients due to absolute immobilization have been eliminated with the anjiobelt.