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.

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.

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.

Impaired kidney function is associated with SYNTAX score in patients with stable coronary artery disease.

OBJECTIVES: The strong relationship between severe renal dysfunction and coronary artery disease (CAD) is well-known. However, the association between kidney function with SYNTAX Score (SS) has not been investigated in patients with stable CAD with normal to mildly impaired renal function. We aimed to investigate the association between kidney function with SS. STUDY DESIGN: In this study, 411 stable CAD patients in whom coronary angiography (CAG) was performed were prospectively included (247 male, 164 female; mean age 58.6 ± 12.4 years). Glomerular filtration rate was estimated (eGFR) by a modification of diet in renal disease (MDRD) formula. Two different groups were determined according to median eGFR values (GFRlow group <90, and GRFhigh group ≥ 90). CAG was performed based on clinical indications. SS was determined in all patients. RESULTS: Patients in GFRlow group were older, and have a history of hypertension (HT) and diabetes mellitus and high body mass index. SS values of GFRlow group were higher than GFRhigh group (p<0.001 for all). Multivariate regression analysis showed that eGFR was independently associated with diabetes (ß, -0.206, p<0.001), HT (ß, -0.093, p=0.026) and SS (ß, -0.445, p<0.001). CONCLUSION: eGFR is independently associated with extent and complexity of CAD as well as diabetes and HT. Importantly, these results may explain, in part, the increase in cardiovascular risk in with slightly impaired renal function.

Myocardial performance index and aortic distensibility in patients with different left ventricle geometry in newly diagnosed essential hypertension.

BACKGROUND: Abnormal left ventricular (LV) geometric patterns, particularly concentric LV hypertrophy, are associated with a greater risk of hypertensive complications. The aim of this study was to investigate the association between LV myocardial performance index (LVMPI) and aortic distensibility (AD) with different LV geometric patterns in patients with newly diagnosed hypertension (HT). METHODS: We studied 181 patients with newly diagnosed HT (mean age 51.7 ± 5.4 years) and 39 healthy control subjects (mean age 51.2 ± 5.1 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 (RWT). AD was calculated from the echocardiographically derived ascending aorta diameters and haemodynamic pressure measurements. LVMPI was calculated from the tissue Doppler-derived ejection time, isovolumic contraction and relaxation times. RESULTS: The highest LVMPI and the lowest AD values were observed in concentric hypertrophy group compared with control, normal geometry, concentric remodelling and eccentric hypertrophy groups (p < 0.05, for all). LVMPI was associated with LVMI (r = 0.497, p < 0.001), RWT (r = 0.270, p < 0.001), AD (r = -0.316, p < 0.001) and E deceleration time (r = 0.171, p = 0.02) in bivariate analysis. In multiple linear regression analysis, LVMPI was independently related to LVMI (ß = 0.381, p < 0.001) and AD (ß = -0.263, p = 0.001). CONCLUSIONS: The LVMPI was highest and AD was lowest in patients with concentric hypertrophy. The LVMPI was independently associated with LVMI and AD in hypertensive patients.

Aortic distensibility and aortic intima-media thickness in patients without clinical manifestation of atherosclerotic cardiovascular disease.

BACKGROUND: There is growing evidence that aortic distensibility (AD) is a subclinical marker of early atherosclerosis. Aortic intima-media thickness (IMT) was an earlier marker than carotid IMT of preclinical atherosclerosis. In this study, we aimed to assess the relationship between thoracic aortic IMT and AD. METHODS: We studied 192 patients (mean age: 45.5 ± 8.4 years) who underwent transesophageal echocardiography (TEE) for various indications. Four different grades were determined according to IMT of thoracic aorta (Grade 1 < 1 mm; 1 mm ≤ Grade 2 < 3 mm; 3 mm ≤ Grade 3 < 5 mm; 5 mm ≤ Grade 4). AD was calculated from the echocardiographically derived ascending aorta diameters and hemodynamic pressure measurements in all patients. High sensitive C-reactive protein (hsCRP) and other biochemical markers were measured using an automated chemistry analyzer. RESULTS: TEE evaluation characterized thoracic aortic intimal morphology as grade 1 in 71 patients (37%), grade 2 in 57 patients (29.7%), grade 3 in 34 patients (17.7%), and grade 4 in 30 (15.6%) patients. The lowest AD level was observed in grade 4 group compared with grade 1 and grade 2 groups (P < 0.001, P = 0.009, respectively). AD level of grade 3 group was lower than grade 1 and grade 2 group (P < 0.001, P = 0.021, respectively). In multiple linear regression analysis, AD was independently associated with age (ß = -0.138, P = 0.029), hsCRP (ß = -0.209, P = 0.001), and aortic IMT (ß = -0.432, P < 0.001). CONCLUSION: AD is independently associated with age, thoracic aortic IMT, and hsCRP. Impaired elasticity index of the aorta might be an independent predictor for the severity of thoracic atherosclerosis.

Relationship between myocardial performance index and severity of coronary artery disease assessed with SYNTAX score in stable coronary artery disease.

BACKGROUND: The aim of the study was to investigate the relationship between severity of coronary artery disease (CAD) assessed with SYNTAX score (SS) and myocardial performance index (MPI) in stable CAD. METHODS: The study participants consisted of 106 consecutive patients (mean age: 57.6 ± 9.5 years) with angiographically proven obstructive stable CAD and 30 patients with nonobstructive CAD (control group) (mean age: 58.0 ± 7.6 years). The MPI was calculated by using pulsed-wave Doppler before coronary angiography. Coronary angiography was performed in all patients. The SS was prospectively calculated in 106 obstructive CAD patients. Patients were partitioned into 3 groups based on SS. Frequencies of risk factors, biochemical and hematological data were recorded in all patients. RESULTS: The SS tertiles were defined as SS(low) ≤ 8 (n = 35), SS(mid) ≤ 17 (n = 36), and SS(high) > 17 (n = 35). The patients with SS(high) group (mean MPI; 0,48 ± 0.06) based on SS had significantly higher MPI values compared with the SS(mid) (mean MPI; 0,44 ± 0.05), SS(low) (mean MPI; 0.43 ± 0.06), and control (mean MPI; 0.41 ± 0.05) groups (P < 0.05 for all). The MPI levels of control group were also lower than compared with SS(mid) group (P = 0.006). The MPI value was significantly correlated with SS (r = 0.564, P < 0.001), diabetes (r = 0.355, P < 0.001), hypertension (r = 0.326, P < 0.001), and ejection fraction (EF) (r = -0.224, P = 0.018) in bivariate analysis. Multivariate regression analysis showed that MPI was independently associated with SS (ß = 0.486, P < 0.001) and diabetes (ß = 0.205, P = 0.028). CONCLUSION: Although the normal EF, MPI value was impaired in proportion to the severity of CAD in patients with stable CAD.

Coronary flow reserve and myocardial performance index in newly diagnosed diabetic patients.

BACKGROUND: Patients with diabetes mellitus (DM) are at high risk of left ventricular (LV) dysfunction. A reduction of coronary flow reserve (CFR) has been demonstrated in diabetic patients without coronary artery stenosis. In this study, we investigated the association between LV myocardial diastolic and systolic functions and the CFR in newly diagnosed diabetic patients in the absence of coronary artery disease. METHOD: We studied 88 patients (mean age 49 ± 10 years) with newly diagnosed DM and 40 healthy control subjects (mean age 50 ± 9 years). All subjects underwent transthoracic echocardiography. The myocardial performance index (MPI) was determined by using pulsed-wave Doppler. The CFR was calculated as the hyperemic to resting coronary diastolic peak velocities ratio. RESULTS: Patients with diabetes had significantly longer mitral E-wave deceleration time and higher MPI value than control group (P = 0.023 and P < 0.001, respectively). The mean CFR was lower in diabetic patients compared with controls (P = 0.001). The MPI was significantly correlated with CFR (r = -0.371, P < 0.001), LV ejection fraction (r = -0.274, P = 0.018) E/A ratio (r = -0.244, P = 0.024), and glycosylated hemoglobin (HbA1c) (r = 0.476, P < 0.001). Multivariate regression analysis showed that MPI was independently associated with CFR (ß = -0.292, P < 0.0001) and HbA1c level (ß = 0.372, P < 0.0001). CONCLUSIONS: The MPI was independently associated with CFR in newly diagnosed diabetic patients. The decrease in CFR may cause LV systolic and diastolic dysfunction in asymptomatic diabetic patients.

Evaluation of left ventricle function by strain imaging in patients with familial Mediterranean fever.

AIM: Familial Mediterranean Fever (FMF) is a hereditary inflammatory disease characterized by recurrent fever and serositis. We aimed to evaluate cardiac involvement in FMF patients by using strain and strain rate echocardiographic imaging method in this study. MATERIALS AND METHODS: Echocardiographic evaluation was performed in 23 FMF patients and 22 healthy controls. FMF diagnosis was based on Tell-Hashomer diagnostic criteria. Conventional echocardiography, tissue Doppler echocardiography and longitudinal two-dimensional (2D) strain and strain rate imaging were performed in patient and control groups. RESULTS: There were no significant differences between patient and control groups in terms of 2D, M-mode, conventional Doppler and tissue Doppler velocities. Left ventricle strain value was significantly lower in five out of eight segments in FMF patients than controls and left ventricle strain rate value was significantly lower in three out of eight segments in FMF patients than controls. Mean left ventricle strain value was significantly lower in FMF patients than controls (-21.1 ± 2.2% vs. -23.8 ± 2.2%; P < 0.001). No significant difference was noted between FMF patients and controls in mean left ventricle strain rate value (-1.61 ± 0.23 vs. -1.58 ± 0.21; P = 0.48). CONCLUSION: We have shown that although conventional echocardiography and tissue Doppler velocity data were similar, strain, strain rate values were significantly lower in FMF patients than controls. We know that strain and strain rate imaging method might be useful for evaluating subclinical cardiac involvement in case of normal conventional and tissue Doppler velocity data in patients with FMF.

Modified flower petal technique in the treatment of Medina type 0,0,1 or 0,1,0 lesions.

AIMS: The optimal strategy for patients with isolated ostial bifurcation lesions has not yet been determined. We propose the modified flower petal technique for the treatment of Medina type 0,0,1 or 0,1,0 coronary bifurcation lesions. METHODS AND RESULTS: We selected 64 patients who had Medina type 0,0,1 or 0,1,0 coronary bifurcation lesions. Percutaneous coronary intervention (PCI) was performed with the modified flower petal technique in all patients. After PCI, all patients were followed up to nine months after the intervention. Quantitative coronary angiography (QCA) analyses were performed for both the main and the side branch at baseline, after the stent implantation and at nine-month follow-up. Twenty patients (31.2%) had ostial left anterior descending artery lesions, nine patients (14.1%) had ostial circumflex artery lesions and the other patients had isolated ostial non-left main bifurcation lesions. The procedural success rate was 100%. There was no death, myocardial infarction, subacute or late stent thrombosis at nine-month follow-up. In one patient, in-stent restenosis requiring reintervention was noted. CONCLUSIONS: The modified flower petal technique has excellent acute results and midterm clinical outcomes in the management of Medina type 0,0,1 or 0,1,0 coronary bifurcation lesions.

Coronary flow velocity reserve in donor artery and myocardial performance index after successful recanalization of chronic total coronary occlusions.

BACKGROUND: Percutaneous recanalization of chronic total coronary occlusion (CTO) tends to show a positive effect on left ventricular remodeling and ejection fraction (LVEF). Coronary flow velocity reserve (CFVR) is an important diagnostic index of the functional capacity of coronary arteries. The aim of this study was to evaluate, by non-invasive CFVR, whether the blood flow of donor artery reverts to normal after CTO percutaneous coronary intervention (PCI). Also, we assessed the effects of CTO recanalization on global cardiac functions by using myocardial performance index (MPI). METHODS: We evaluated 25 patients (mean age, 57.5 ± 14.1 years) who underwent CTO-PCI of the right coronary artery, whose collaterals were provided by the left anterior descending (LAD) artery. The coronary flow velocities in the distal LAD were measured using transthoracic echocardiography (TTE) before, 24 hours after, and within 3 months of PCI. Both two-dimensional and tissue Doppler (tD) echocardiography were used to calculate MPI. RESULTS: CFVR at month 3 was significantly increased compared to the basal and early CFVR (1.8 ± 0.3 vs. 2.3 ± 0.3 [P<.001] and 1.8 ± 0.2 vs. 2.3 ± 0.3 [P<.001], respectively). MPI at month 3 was significantly decreased compared to the basal and early MPI (0.61 ± 0.09 vs. 0.53 ± 0.07 [P<.001] and 0.60 ± 0.08 vs. 0.53 ± 0.07 [P<.001], respectively). Also, tD-MPI within 3 months was significantly decreased (0.58 ± 0.9 vs. 0.53 ± 0.8 [P=.01] and 0.57 ± 0.07 vs. 0.53 ± 0.8 [P<.001], respectively, for tD-MPI septal and 0.59 ± 0.08 vs. 0.51 ± 0.07 [P<.001] and 0.58 ± 0.08 vs. 0.51 ± 0.07 [P<.001], respectively, for tD-MPI lateral). CONCLUSION: Successful recanalization of CTO results in increased CFVR-indicated blood flow in the donor artery and MPI-indicated global cardiac functions.

Evaluation of left ventricle functions by tissue Doppler, strain, and strain rate echocardiography in patients with primary hyperparathyroidism.

Cardiovascular morbidity and mortality are increased in patients with primary hyperparathyroidism (PHPT). We aimed to evaluate left ventricle systolic and diastolic functions with tissue Doppler imaging (TDI) and strain and strain rate echocardiography in patients with PHPT. Thirty-one patients with PHPT and 29 healthy controls were evaluated with conventional and pulse Doppler echocardiography, TDI and strain and strain rate echocardiography. Myocardial performance index (MPI) was calculated. Strain and peak systolic strain rate in mid and basal segments of lateral, anterior, inferior, and septal walls of left ventricle were determined. TDI showed similar late diastolic myocardial peak velocity in two groups. Peak systolic mitral annular velocity, early diastolic myocardial peak velocity, and ratio of early to late diastolic myocardial peak velocity were lower in PHPT patients (p = 0.01, p < 0.001 and p < 0.001, respectively). MPI calculated by TDI was 0.53 ± 0.15 in PHPT group and 0.44 ± 0.09 in control group (p = 0.013). Strain values were lower in mid and basal segments of septum, lateral and anterior walls, and basal segment of inferior wall in PHPT patients. Mean systolic strain was -20.88 ± 2.30 and -24.25 ± 2.13 in PHPT patients and control group, respectively (p < 0.001). Mean strain rate was lower in PHPT patients compared to control group (-1.38 ± 0.19 vs -1.57 ± 0.25) (p = 0.002). Patients with PHPT, but no cardiac symptoms or documented cardiovascular disease, have subclinical systolic and diastolic myocardial dysfunction. Evaluation of these patients with TDI and S and Sr echocardiography in addition to conventional echocardiography might be valuable to detect subclinical cardiac involvement.

Serum bilirubin level and aortic intima-media thickness in patients without clinical manifestation of atherosclerotic cardiovascular disease.

We investigated the association between serum bilirubin level and thoracic aortic intima-media thickness (IMT). The study population consisted of 417 patients without coronary artery disease, who underwent transesophageal echocardiography examination for various indications. The highest aortic IMT values were observed in the bilirubinlow group compared with the bilirubinhigh group (P < .001). Serum bilirubin level was associated with high-density lipoprotein cholesterol level (r = .162, P = .001), high-sensitivity C-reactive protein (hsCRP; r = -.265, P < .001), and aortic IMT (r = -.551, P < .001) in bivariate analysis. Multivariate linear regression analysis showed that serum bilirubin level was independently and negatively associated with hsCRP (ß = -.095, P = .028) and aortic IMT (ß = -.513, P < .001). Serum bilirubin level may be an independent predictor of the extent of subclinical aortic atherosclerosis assessed by thoracic aortic IMT.

Automated functional imaging in atrioventricular delay time optimisation in patients with dual chamber pacemakers.

BACKGROUND: Optimisation of atrioventricular (AV) delay time has positive effects on left ventricular (LV) functions in patients with a DDD pacemaker. However, the method used for optimisation is still debated. AIM: To evaluate the effect of different AV delay times on various LV systolic performances by using automated functional imaging (AFI) in patients with a DDD pacemaker and preserved LV systolic function. METHODS: The study population consisted of 40 patients with a DDD pacemaker implanted for third degree AV block and preserved LV systolic function (19 men; mean age 64.3 ± 10.9 years). During each pacing period, blood samples were taken for the measurement of B-type natriuretic peptide (BNP) levels, and telemetric and echocardiographic evaluations were performed to all patients. Also peak systolic global longitudinal strain (PSGLS) was calculated using the AFI method. RESULTS: No significant differences except for LV outflow tract-velocity time integral (LVOT-VTI) were observed in pulse wave Doppler parameters with different AV delay times. PSGLS were better at 150 and 200 ms AV delay times compared to 100 ms (p < 0.001 for 100-150 ms and 100-200 ms). Similarly, LVOT-VTI values were significantly higher at 150 and 200 ms AV delay times compared to 100 ms (for 100-150 ms, p = 0.017 and for 100-200 ms, p = 0.013). Also there was a significant reduction in BNP levels at 150 ms and 200 ms compared to 100 ms AV delay time (for 100-150 ms, p = 0.001, and for 100-200 ms, p < 0.001). CONCLUSIONS: In patients with an implanted DDD pacemaker and preserved LV systolic function, increasing AV delay time has beneficial effects on LV systolic performance in the acute phase, as shown by the AFI method in our study.

Predictors of failure of final kissing-balloon inflation after mini-crush stenting in non-left main bifurcation lesions: importance of the main-vessel angle.

BACKGROUND: The majority of bifurcation lesions are treated with crush stenting. However, the success of crush stenting depends on final kissing-balloon inflation (FKBI), which is potentially difficult. Although mini-crush stenting has a higher rate of successful FKBI, it still cannot be achieved in some patients. The aim of this study was to investigate the factors that contribute to failure of FKBI in mini-crush stenting. METHODS AND RESULTS: We included 173 consecutive patients who were treated with mini-crush stenting. The patients were divided into FKBI and non-FKBI groups. The bifurcation angles were measured: (1) proximal bifurcation angle (angle A, between proximal main vessel and side branch); (2) distal bifurcation angle (angle B, between distal main branch and side branch); and (3) the main-vessel angle (angle C, between proximal main vessel and distal main branch). FKBI could be performed in 153 patients. Angle C and calcification were significantly lower and angle A and mean stent diameter in the main vessel were significantly higher in the FKBI group. Multivariate logistic regression analysis showed that only Angle C was an independent predictor of FKBI failure. CONCLUSIONS: Main-vessel angle was the only independent predictor of FKBI failure in mini-crush stenting.

Uric acid and high sensitive C-reactive protein are associated with subclinical thoracic aortic atherosclerosis.

BACKGROUND AND PURPOSE: The detection of atherosclerotic lesions in the aorta by transesophageal echocardiography (TEE) is a marker of diffuse atherosclerotic disease. Hyperuricemia is a well-recognized risk factor for cardiovascular diseases. However, no data are available concerning the relationship between serum uric acid (UA) and subclinical thoracic aortic atherosclerosis. We aimed to investigate the association between thoracic aortic atherosclerosis and serum UA level. METHODS: We studied 181 patients (mean age 46.3 ± 8 years) who underwent TEE for various indications. Four different grades were determined according to intima-media thickness (IMT) of thoracic aorta. UA and other biochemical markers were measured with an automated chemistry analyzer. RESULTS: TEE evaluation characterized thoracic aortic intimal morphology as Grade 1 in 69 patients, Grade 2 in 52 patients, Grade 3 in 31 patients, and Grade 4 in 29 patients. The highest UA level was observed in patients with Grade 4 IMT when compared with Grade 1 and 2 IMT groups (p<0.001 and p=0.014, respectively). UA levels in patients with Grade 3 and Grade 2 IMT were also higher than patients with Grade 1 IMT group (p<0.001, for all). In multiple linear regression analysis, IMT was independently associated with UA level (ß=0.350, p<0.001), age (ß=0.219, p=0.001), total cholesterol (ß=-0.212, p=0.031), low-density lipoprotein cholesterol (ß=0.350, p=0.001), and high sensitivity C-reactive protein (hsCRP) levels (ß=0.148, p=0.014). CONCLUSION: Uric acid and hsCRP levels are independently and positively associated with subclinical thoracic atherosclerosis.

Serum 25-hydroxyvitamin D is associated with both arterial and ventricular stiffness in healthy subjects.

BACKGROUND: Vitamin D regulates the renin-angiotensin system, suppresses proliferation of vascular smooth muscle and improves endothelial cell dependent vasodilatation. These mechanisms may play a role on pathogenesis of arterial and left ventricular stiffness. OBJECTIVES: We aimed to investigate the association between serum 25-hydroxyvitamin D with arterial and left ventricular stiffness in healthy subjects. METHODS: We studied 125 healthy subjects without known cardiovascular risk factors or overt heart disease (mean age: 60.2 ± 11.9 years). Serum 25-hydroxyvitamin D was measured using a direct competitive chemiluminescent immunoassay. The subjects were divided into two groups according to the serum vitamin D level; vitamin D sufficient (≥ 20 ng/ml, n = 56) and vitamin D deficient (<20 ng/ml, n = 69). Indexes of LV stiffness such as E/A and E/E' were measured. Pulse wave velocity (PWV), which reflects arterial stiffness, was calculated using the single-point method via the Mobil-O-Graph(®) ARC solver algorithm. RESULTS: Systolic blood pressure, level of serum calcium, PWV and E/E' values were higher and E/A values were lower in vitamin D deficient group compared with vitamin D sufficient group. Multiple linear regression analysis showed that vitamin D level was independently associated with E/E' (ß = -0.364, p<0.001), serum calcium (r = -0.136, p = 0.014), PWV (ß = -0.203, p = 0.003), E/A (ß = 0.209, p = 0.001) and systolic blood pressure (ß = -0.293, p<0.001). CONCLUSION: 25-Hydroxyvitamin D levels are associated with increased ventricular and arterial stiffness as well as systolic blood pressure in healthy subjects.

Association of mean platelet volume and pre- and postinterventional flow with infarct-related artery in ST-segment elevation myocardial infarction.

Platelets play a role in the pathogenesis of ST-segment elevation myocardial infarction (STEMI). We assessed the relationship between mean platelet volume (MPV) on admission and pre- and postinterventional flow with the infarct-related artery (IRA) in patients with STEMI. We prospectively included 840 patients with STEMI who underwent primary percutaneous coronary intervention (PCI). The patients were divided into 3 groups according to MPV tertiles. Pre- and post-PCI Thrombolysis In Myocardial Infarction (TIMI) flow grade was determined. Initial TIMI flow grade 3 was accepted as patent IRA. After the primary PCI, normal flow was defined as post-PCI TIMI flow 3. When the MPV was increased, the incidence of pre-PCI patent IRA (P = .004) and post-PCI normal TIMI flow (P < .001) was significantly decreased. Multivariate analysis showed that MPV was independently associated with post-PCI TIMI flow grade.

Serum 25-hydroxyvitamin D level is associated with aortic distensibility and left ventricle hypertrophy in newly diagnosed type 2 diabetes mellitus.

We aimed to evaluate the association between serum vitamin D status and elastic properties of aorta in patients with diabetes mellitus (DM). We studied 136 patients with newly diagnosed DM (mean age: 62.9 ± 10.6 years). Serum 25-hydroxyvitamin D was measured using a direct competitive chemiluminescent immunoassay. Aortic distensibility was calculated from the echocardiographically derived ascending aorta diameters and haemodynamic pressure measurements. Left ventricle mass index (LVMI) was determined according to the Devereux formula. Multiple linear regression analysis showed that vitamin D level is independently associated with LVMI (ß = -0.259, p = 0.001), aortic distensibility (ß = 0.369, p < 0.001), high-sensitive C-reactive protein (hs-CRP) (ß = -0.220, p = 0.002) and body mass index (ß = -0.167, p = 0.015) in patients with DM. In diabetic patients, serum 25-hydroxyvitamin D level is independently associated with aortic distensibility. Vitamin D may play a role on pathogenesis of impaired elastic properties of aorta in type 2 DM.

Serum 25-hydroxyvitamin D level is associated with arterial stiffness, left ventricle hypertrophy, and inflammation in newly diagnosed hypertension.

OBJECTIVES: Vitamin D may modulate vascular inflammation, vascular smooth muscle cell proliferation, the renin-angiotensin system, and cardiomyocyte proliferation, myocardial fibrosis, and proliferation. These mechanisms may play a role on arterial stiffness and left ventricle hypertrophy (LVH) in hypertensive patients. We aimed to evaluate the association between serum vitamin D with arterial stiffness and LVH in patients with hypertension. METHODS: We studied 133 patients with newly diagnosed hypertension [mean (SD) age, 62.9 (10.6) years]. Pulse wave velocity (PWV), which reflects arterial stiffness, was calculated using the single-point method via the Mobil-O-Graph ARCsolver algorithm. Left ventricular mass index (LVMI) was determined according to Deverux formula. The patients were divided into the following 2 groups according to serum vitamin D level: vitamin Dlow group with less than 20 ng/mL and vitamin Dhigh group with greater than or equal to 20 ng/mL. RESULTS: The highest PWV, high-sensitivity C reactive protein, and LVMI values were observed in vitamin Dlow group compared with vitamin Dhigh group. Multiple linear regression analysis showed that vitamin D level was independently associated with LVMI (ß = -0.235, P = 0.002) and PWV (ß = -0.432, P < 0.001). Adjustment for age, sex, parathyroid hormone level, body surface area, and mean blood pressure did not modify these associations. Vitamin D level was also independently associated with high-sensitivity C reactive protein (ß = -0.143, P = 0.047). However, adjustment for parathyroid hormone level or body surface area and mean blood pressure attenuate this association. CONCLUSIONS: Serum 25-hyroxyvitamin D is independently related with arterial stiffness, LVH, and inflammation. Vitamin D may play a role on pathogenesis of arterial stiffness and LVH in patient with newly diagnosed hypertension.