Effect of new oral anticoagulants on platelet indices in non-valvular atrial fibrillation patients.

New-generation oral anticoagulants (NOACs) are now preferred as a first-line treatment in the management of atrial fibrillation for prevention of thromboembolic complications. Mean platelet volume (MPV), one of the indicators of increased platelet activity, is also associated with an increased stroke risk in atrial fibrillation patients. The aim of this study was to evaluate changes in MPV, platelet distribution width (PDW) and plateletcrit following use of NOACs. The study included 116 patients with non-valvular atrial fibrillation without previous NOAC use. Complete blood counts, biochemical analyses and echocardiography were performed for all patients. No significant differences were observed in MPV or other platelet indices at 6 months compared to baseline. Our results indicate that MPV and other platelet indices are not affected by NOAC use in non-valvular atrial fibrillation patients.

Urinary angiotensinogen level is increased in renal transplant recipients with masked hypertension and is correlated with left ventricular mass index and albuminuria in these patients.

Activation of the local renin-angiotensin system (RAS) is an independent risk factor for the development of proteinuria and left ventricular hypertrophy (LVH) more commonly seen in masked hypertensives. It has been reported that urinary angiotensinogen (UAGT) level provides a specific index of the intrarenal RAS status. The aim of this study was to evaluate the association between UAGT and left ventricular mass index (LVMI) and urinary albumin-creatinine ratio (UACR) in renal transplant recipients (RTRs) with masked hypertension (HT). A total of 116 non-diabetic-treated hypertensive RTRs were included in this study. The patients were divided into two groups: masked hypertensives and controlled hypertensives. Forty-two (36.2%) of RTRs had masked HT. Mean UACR and LVMI levels were higher in RTRs with masked HT than in RTRs with controlled HT (P < 0.001). UAGT level was also higher in masked hypertensives compared to controlled hypertensives (P < 0.001). Multivariable regression analysis showed that UAGT was positively correlated with UACR (ß = 0.024, P = 0.001) and LVMI (ß = 0.082, P = 0.001) in masked hypertensives. Consequently, masked HT was considerably frequent (36.2%) in treated hypertensive RTRs and high UAGT levels accompanied by high albuminuria and LVMI levels were seen in these patients. Overproduction of the UAGT may play a pivotal role in the development of LVH and proteinuria in masked hypertensives.

Early repolarization pattern in the coronary slow flow phenomenon.

BACKGROUND: The coronary slow flow phenomenon (CSFP) is well-documented, and the early repolarization pattern (ERP) has recently been shown to be a risk factor for the development of malignant ventricular arrhythmias. METHODS: Those with true CSFP were included as cases and those with normal angiograms were included as controls. We assessed J-point elevation on surface electrocardiograms (ECGs) and defined ERP as notching or slurring of the terminal portion of the QRS takeoff. RESULTS: We enrolled 115 cases (33 females, 82 males; mean age, 51.9 ± 11.5 years) and 45 controls (13 females, 32 males; mean age, 50.8 ± 11.7 years). ERP was more common among cases than among controls (65% vs. 28%, p = .001). Compared with the controls, cases were more likely to have J-point elevation in the inferior leads (25% vs. 13%, p = .002), in the D1 to aVL leads (22% vs. 15%, p = .001), and in the lateral leads (17.3% vs. 0%), p = .001). Notching was also significantly more common in cases than in controls (26.0% vs. 2.2%, p = .0001). Finally, concave/ascendant ST segment (33.9% vs. 5.2%, p = .006), horizontal/non-ascendant ST segment (14.7% vs. 1.7%, p = .054), and horizontal/non-ascendant ST segment and notching (15.6% vs. 2.2%, p = .012) patterns were more common in cases than in controls. CONCLUSIONS: We report that CSFP is associated with J-wave and slurring ERPs. However, the clinical significance of these changes needs to be clarified.

Ventricular repolarization disturbances after high dose intravenous methylprednisolone Theraphy.

OBJECTIVE: There are no randomized trials evaluating the effects of pulse steroid treatment on cardiac electrophysiologic functions. The data are limited only to case series. In this study, we sought to evaluate the effects of high dose intravenous methylprednisolone therapy on indices of ventricular repolarization. METHODS: Fifty patients with various autoimmune and inflammatory disorders were enrolled to the study. Electrocardiography (ECG) was obtained 4h before and 12h after the pulse steroid treatment. All ECGs were thoroughly evaluated by an experienced electrophysiologist. Indices of ventricular repolarization including QTc, JT, Tp-Te, Tp-Te/QTc were measured and compared with before and after-treatment ECGs. RESULTS: There were 36 female and 14 male patients. Mean age was 36±13years. Heart rate was significantly reduced after the therapy (87,16±17,45bpm vs 73,86±17,45 p:0,001). QT interval (361,0±29,91 vs 388,20±42,84 p:0,001) and corrected QT interval (QTc) was significantly prolonged (401,60±19,79 vs 413,72±26,38 p:0,01) after pulse steroid therapy. Also, JT interval (273,0±28,73 vs. 299,60±45,66 p:0,001) and JT interval index (JTI%) was significantly prolonged (118,18±17,54 vs. 110,56±13,92 p:0,01). Tp-e interval was significantly prolonged after high-dose steroid treatment (74,60±13,12 vs. 83,80±13,68 p:0.001). The ratio of Tp-Te to QTc was also significantly increased after pulse steroid therapy (0,18±0,03 vs 0,20±0,03 p:0,009). CONCLUSION: Our study shows that indices of ventricular repolarization are significantly prolonged after pulse steroid treatment. These findings indicate an increased risk of arrhythmias related to high dose intravenous methylprednisolone therapy.

Evaluation of ventricular repolarization features with Tp-e, Tp-e/QTc, JTc and JTd during electroconvulsive therapy.

OBJECTIVE: The purpose of this study was to investigate the influence of electrical stimulation transmitted through the body during electroconvulsive therapy on traditional and relatively new ventricular repolarization parameters (Rate corrected QT interval (QTc), QT dispersion (QTd), rate corrected JT interval (JTc), JT dispersion (JTd), T-peak to T-end interval (Tp-e) and Tp-e/QTc ratio) under propofol anaesthesia. METHODS: Twenty-two patients (aged 18-50 years) who were each scheduled for ECT for major depression, bipolar disorder or schizophrenia enrolled to the study. Electrocardiography (ECG) recordings were obtained before anaesthesia and within 3-5 min after electrical stimulus of ECT for measurements. QTc, QTd, JTc, JTd, Tp-e and Tp-e/QTc were measured as repolarization indices. RESULTS: The study included twenty-two patients, 9(40.9%) females and 13(59.1%) males, and the mean age accounted for 33.57 ±â€¯9.95 years. The comparison of the measured parameters before and after ECT, which were not statistically different, were as follows: QTc (416.52 ±â€¯46.64 vs 430.00 ±â€¯34.00msn; p = 0.18), JTc (308.09 ± 25.09 vs 315.47 ±â€¯26.89msn; p = 0.30), QTd (22.27 ±â€¯11.51 vs 20.45 ±â€¯9.9msn; p = 0.52) and JTd (22.72 ±â€¯11.2 vs 17.72 ±â€¯10.20msn; p = 0.06). Also, no significant difference was detected at the following parameters Tp-e (80.0 ±â€¯13.45 vs 78.63 ±â€¯15.21msn; p = 0.65) and Tp-e/QTc ratio (0.19 ±â€¯0.03 vs 0.18 ±â€¯0.07; p = 0.08). On the other hand, HR showed a significant increase after ECT at 88.13 ±â€¯13.74 vs 93.0 ±â€¯15.2 bpm; p = 0.03. CONCLUSION: QTc, QTd, JTc, JTd, Tp-e interval and Tp-e/QTc ratio, which are thought to be potential repolarisation markers for ventricular arrhythmias, did not demonstrate significant change within 3-5 min of electrical stimulation during ECT.

The role of human urotensin-II in patients with hypertrophic cardiomyopathy.

OBJECTIVE: Hypertrophic cardiomyopathy (HCM) is a genetic condition with the hallmark feature of left ventricular hypertrophy. Human Urotensin-II (hUT-II) is regarded as a cardiovascular autacoid/hormone, and it has cardiac inotropic and hypertrophic properties. Aims of this study were to elucidate the clinical significance of serum hUT-II levels as a potential new biomarker in patients with HCM. METHODS: This study included 40 HCM patients (60% males and 40% females) and were compared to 30 healthy control subjects (47% males and 53% females. All patients underwent extensive clinical, laboratory, and echocardiographic. Blood samples were taken to test for serum hUT-II levels by commercial ELISA Kit. RESULTS: Serum hUT-II was significantly higher (p < 0.01) in patients with HCM (15.8 ± 2.1 pmol/L) compared with healthy controls (3.3 ± 1.7 pmol/L). With regard to HCM patient, Serum hUT-II levels were significantly higher in the female with 16.3 ± 1.9 pmol/L than the male with 15.4 ± 2.2 pmol/L (p < 0.05). Among echocardiographic parameters, hUT-II was negatively associated with ejection fraction (r = -0.160, p = 0.324). CONCLUSION: Results of the first study indicated that serum hUT-II levels were markedly elevated in patients with HCM. Serum hUT-II is a novel biomarker parameter that has clinical use in patients with the severity of LVH.

Evaluation of P-Wave Dispersion, Diastolic Function, and Atrial Electromechanical Conduction in Pediatric Patients with Subclinical Hypothyroidism.

AIM: This study aimed to evaluate ventricular diastolic dysfunction, inter- and intraatrial conduction delay, and P-wave dispersion in pediatric patients with subclinical hypothyroidism. METHODS: The study comprised a total of 30 pediatric patients with subclinical hypothyroidism (SH) (mean age 7.8 ± 3.2 years) and 30 healthy children (mean age 8.4 ± 3.6 years) as the control group. A SH diagnosis was made in the event of increased serum thyroid-stimulating hormone (TSH) and decreased serum free triiodothyronine (T3 ) and free thyroxine (T4 ) concentrations. RESULTS: Conventional Doppler imaging (TDI) showed low mitral early diastolic E-wave velocity and E/A ratio (P < 0.001) and significantly higher mitral late diastolic A-wave velocity (P = 0.001) in hypothyroidism patients. Moreover, patients with hypothyroidism had significantly lower left ventricular (LV) septal Em velocity and Em /Am ratios compared with the control group (P < 0.001), whereas Am velocity was higher in hypothyroidism patients (P = 0.018). LV lateral Em velocity and Em /Am ratio were significantly lower in patients with hypothyroidism compared with the control group (P < 0.001). With regard to atrial electromechanical conduction, atrial electromechanical delay (PA) lateral, PA septum, PA tricuspid, and each of interatrial and intraatrial conduction delay were significantly prolonged in hypothyroidism patients as compared with the control group (P < 0.001, P < 0.001, P = 0.023, P = 0.002, and P = 0.003, respectively). P-wave dispersion was significantly different in the pediatric patients with hypothyroidism (P < 0.001). CONCLUSION: This study demonstrated atrial electromechanical conduction delay, abnormal P-wave dispersion, and ventricle diastolic dysfunction in pediatric patients with hypothyroidism.

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.

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.

P-wave dispersion between transcatheter and surgical closure of secundum-type atrial septal defect in childhood.

Patients with atrial septal defect have an increased risk for atrial fibrillation. Increased P-wave dispersion predicts the development of atrial fibrillation. The aim of this study was to determine difference in P dispersion between transcatheter closure with Amplatzer septal occluder and surgical closure in childhood. A total of 68 children (the mean age was 7.2 plus or minus 3.3 years; the mean secundum atrial septal defects diameter was 17.3 plus or minus 5.4 millimetres) were evaluated in this study. Transcatheter closure was attempted in 41 children with secundum atrial septal defects, and the defect in 27 patients was closed by surgical techniques. P maximum, P minimum and P dispersion were measured by the 12-lead surface electrocardiography. P maximum, P minimum and P dispersion were found to be similar in patients with pre- and post-procedure (98.0 plus or minus 19.3 versus 95.1 plus or minus 23.0 milliseconds; 68.0 plus or minus 20.8 versus 67.6 plus or minus 24.3 milliseconds, 29.9 plus or minus 11.0 versus 27.1 plus or minus 12.1 milliseconds, respectively). There was no statistical significance in the comparison of P dispersion between the two groups. But in the surgical group, P-wave dispersion was decreased more significantly compared with baseline values (p-value equal to 0.03). In conclusion, there is no P dispersion between transcatheter closure with Amplatzer septal occluder and surgical closure of secundum atrial septal defect.

Trace elements in patients with aortic valve sclerosis.

BACKGROUND: Aortic valve sclerosis (AVSc) is defined as the thickening and calcification of aortic valve cusps, in the absence of obstruction of ventricular outflow. AVSc is linked with a clear imbalance in some trace elements. AIMS: The objective of this study was to investigate the relationship between AVSc and serum levels of iron (Fe), zinc (Zn), selenium (Se), and copper (Cu). Additionally, this research aimed to explore the clinical significance of human serum zinc, selenium, copper, and iron concentrations as a potential new biomarker for AVSc patients and to clarify the pathophysiological role in individuals at risk of developing AVSc. PATIENTS AND METHODS: The study included 40 subjects with AVSc (25% male and 75% female) who were compared with a healthy control group with the same gender ratio. AVSc was based on comprehensive echocardiographic assessments. Blood samples were taken and Zn and Cu concentrations were determined through the use of atomic absorption spectroscopy. Se was measured using an inductively coupled plasma mass spectrometry device and Fe was measured using a Beckman Coulter instrument. RESULTS: There was a significant difference in the prevalence of diabetes, blood pressure levels, and body mass index between the patients and the healthy subjects (p < 0.05). The differences between the serum Fe, Se, and Cu levels of the AVSc patients and the healthy subjects (p > 0.05) were recorded. The serum Zn of AVSc patients when compared was significantly lower compared with that of the control group (p < 0.01). CONCLUSION: Patients with AVSc had an imbalance in some of the trace elements in their blood. The patient group's valves had higher serum Cu levels and lower serum Se, Zn, and Fe concentrations compared with the healthy group's valves. In the valve patients as compared, AVSc had a high prevalence of obesity, hypertension, and diabetes.

Elabela as a novel marker: Well-correlated with WIfI amputation risk score in lower extremity arterial disease patients.

OBJECTIVE: Worldwide, over 200 million people are diagnosed with lower extremity arterial disease (LEAD). LEAD significantly increases the risk of death and amputation of the lower limb. A new classification system (WIfI) has been proposed to initially assess all patients with ischemic rest pain or wounds and also predicts 1-year amputation risk. Elabela is a bioactive peptide and a part of the apelinergic system, which has beneficial effects on body fluid homeostasis and cardiovascular health. We aimed to investigate serum Elabela levels in LEAD. METHODS: A total of 119 subjects were enrolled in this cross-sectional study, 60 of whom were in the LEAD group and 59 in the control group. All participants underwent physical examination and routine biochemical tests, including serum Elabela levels. Additionally, the LEAD group was divided into subgroups according to the Rutherford classification, ankle-brachial index (ABI) values, and WIfI risk scores. RESULTS: Serum low-density lipoprotein, Elabela, and high-sensitivity C-reactive protein (Hs-CRP) levels were statistically higher in the LEAD group (p=0.002, p<0.001, and p<0.001, respectively). In the Rutherford classification, as the stage increased, Elabela and Hs-CRP levels increased similarly (p<0.001). Elabela levels were statistically found to be positively correlated with Hs-CRP and WIfI amputation score but negatively correlated with ABI (p<0.001). CONCLUSION: Serum Elabela level, which is known to be increased in inflammatory processes, has the potential in predicting low extremity arterial obstruction and WIfI amputation risk in LEAD patients.

Assessment of subclinical left ventricular dysfunction with speckle-tracking echocardiography in hyperthyroid and euthyroid Graves' disease and its correlation with serum TIMP-1.

BACKGROUND: Graves' disease has a multitude of effects on the cardiovascular system. In the detection of subclinical left ventricular dysfunction, speckle-tracking echocardiography is more useful than conventional echocardiography. The aim of the present study was to compare the longitudinal global strain values and venous blood concentration of (tissue inhibitor of metalloproteinase-1) TIMP-1, a regulator of the extracellular matrix, among hyperthyroid patients with Graves' disease, euthyroid patients with Graves' disease and healthy control subjects. MATERIALS AND METHODS: The study enrolled 40 hyperthyroid patients with newly diagnosed Graves' disease, 40 patients with Graves' disease who were euthyroid for at least 6 months and 40 control subjects with normal thyroid function. Participants underwent conventional echocardiography and speckle-tracking echocardiography to obtain segmental and global longitudinal strain values. In addition, the serum TIMP-1 value was assessed in the venous blood samples of the participants. RESULTS: The hyperthyroid Graves' patients showed greater serum TIMP-1 levels versus the control group and the euthyroid Graves' group. Compared to the control group, the TIMP-1 level was also significantly higher in the euthyroid Graves' group. Lower GLS (global longitudinal strain) average and GLS2C, GLS3C, GLS4C values were observed in both the hyperthyroid and euthyroid Graves' patients compared to the control group. The euthyroid Graves' patients and hyperthyroid Graves' patients had similar GLS values. The serum TIMP-1 level was negatively correlated with global strain values. CONCLUSION: Graves' disease coexists with impaired segmental and global longitudinal strain and increased TIMP-1 levels. This coexistence seems to be independent of serum thyroid hormone levels.

Epidemiological, clinical and microbiological profile of infective endocarditis in a tertiary hospital in the South-East Anatolia Region.

OBJECTIVES: We aimed to evaluate epidemiological, clinical, and microbiological features of infective endocarditis (IE) in a tertiary university hospital. STUDY DESIGN: The study included 72 patients (31 women, 41 men; mean age 45+/-16 years; range 18 to 80 years) who were diagnosed as having definite IE, according to the modified Duke criteria, between 2004 and 2007. Data were reviewed on age, sex, underlying heart disease, predisposing conditions for bacteremia, echocardiographic and microbiological findings, treatment, complications, and mortality. RESULTS: Infective endocarditis developed on a native valve in 47 (65.3%), a mechanical prosthetic valve in 21 (29.2%), and a pacemaker in two cases. The location of IE could not be determined in two cases (2.8%). Rheumatic heart disease (36.1%) was the most common preexisting valvular abnormality. The mitral valve was the most commonly affected valve in both native valves (43.1%) and prosthetic valves (13.9%). The most frequent symptom was fever (n=60, 83.3%). Electrocardiography showed abnormal findings in 24 cases (33.3%). Transthoracic and/or transesophageal echocardiography showed a vegetation in 63 cases (87.5%), moderate or severe mitral regurgitation in 41 cases (56.9%), aortic regurgitation in 21 cases (29.2%), and tricuspid regurgitation in 29 cases (40.3%). Staphylococci (26.4%) and streptococci (22.2%) were the most common causative agents. Cultures were negative in 26 cases (36.1%). Twenty patients (27.8%) underwent surgical treatment. Congestive heart failure (n=23, 31.9%) and cerebrovascular accidents (n=10, 13.9%) were the major complications. In-hospital mortality occurred in 11 cases (15.3%). CONCLUSION: Our data reflect epidemiological, clinical, and microbiological profile of IE in a tertiary hospital located in the Southeastern Anatolia.

The Effect of Transcatheter Atrial Septal Defect Closure on Left Heart Function in Pediatric Patients.

OBJECTIVE: The aim of this study was to use tissue Doppler imaging to evaluate the left atrial systolic and the left ventricular (LV) diastolic function as well as the left atrial ejection force in children who underwent transcatheter closure of a secundum atrial septal defect (ASD). METHODS: Tissue Doppler measurements of the left atrial ejection force, the mitral valve, and left atrial volume were performed before the ASD closure procedure, and on the 1st day, 10th day, and 1st and 3rd months after the procedure in 56 patients and in 28 healthy controls. RESULTS: There was a significant decrease in the septal and lateral a' velocities on the first day (p<0.05). There was a statistically significant increase in the septal e'/a' parameters at the third month compared with the initial measurements. The left atrial ejection force was lower in patients with an ASD than in the healthy group (10.69±4.94 kdyn, 12.31±4.05 kdyn, respectively), but there was no significant difference (p=0.053). The left atrial ejection force was significantly greater in the patient group 3 months after the procedure, and there was no significant difference compared with the control group. CONCLUSION: Improvement in the LV diastolic and left atrial systolic functions was observed in children who underwent transcatheter closure of an ASD. There was no negative effect related to the devices used.

Aortic elastic properties of patients with neurocardiogenic syncope.

OBJECTIVE: Neurocardiogenic syncope (NCS) is a common clinical problem; however, hemodynamic mechanism is not clearly understood. Aim of the present study was to investigate aortic elastic parameters of patients with NCS provoked by head-up tilt test. MATERIAL AND METHOD: We conducted a prospective study of 40 cases referred to our institution for head-up tilt testing. Group I constituted as 22 patients who developed mixed response and were enrolled for analysis. Hemodynamic data were compared with subjects of negative head-up tilt test (Group II). Aorta-diastolic and aorta-systolic diameters, aortic strain, aortic distensibility, aortic elastic modulus, and aortic stiffness index were calculated from transthoracic echocardiographically derived diameters of thoracic aorta. RESULTS: Aortic distensibility (mean+/-SD; 2.7+/-1.2 cm2xdyn(-1)x10(-6) vs 4.0+/-1.2 cm2xdyn(-1)x10(-6), P=0.003) and aortic strain index (mean+/-SD; 7.0+/-1.8% vs 8.7+/-2.9%, P=0.042) were lower, and aortic stiffness index (mean+/-SD; 27.6+/-10.9 vs 20.9+/-6.18, P=0.035) and aortic elastic modulus (mean+/-SD; 0.94+/-0.7 cm2xdyn(-1)x10(-6) vs 0.49+/-0.1 cm2xdyn(-1)x10(-6), P=0.009) were higher in patients in Group I compared with those in Group II. There was no difference between two groups for following clinical variables: aorta-diastolic and aorta-systolic diameters, systolic and diastolic blood pressure, pulse pressure, E/A, weight, height, and body mass index. CONCLUSIONS: Findings of this study have shown that elastic properties of aorta are impaired in patients with NCS. The data suggest that increase in aortic stiffness might be one of the determinants responsible for NCS. This proposal of novel link should be confirmed in further studies.

The spectrum of rheumatic heart disease in the southeastern Anatolia endemic region: results from 1900 patients.

BACKGROUND AND AIM OF THE STUDY: Rheumatic heart disease (RHD) continues to affect mainly young adults, and accounts for a major proportion of all cardiovascular diseases in the Southeastern Anatolia region, where the disease is still endemic. The study aim was to determine the echocardiographic profile of RHD in this region, from which no recent data are available. METHODS: In this retrospective study, transthoracic echocardiographic data acquired between June 2003 and January 2008 were reviewed. Information was gathered from the database of the authors' echocardiography laboratory, which included age, gender, clinical diagnosis and echocardiographic findings. In patients with more than one echocardiographic record, only the first echocardiographic data were included in the study. RESULTS: A first admission with full echocardiographic data of RHD was found in 1,900 cases among 43,900 subjects screened (4.3%). Of the 1,900 subjects, 537 (28%) were male (mean age: 39.7 +/- 15.7 years) and 1,363 (72%) were female (mean age: 41.3 +/- 13.7 years). There was no gender difference between mixed valvular lesions. Severe mitral stenosis (MS) was identified in 144 subjects. Males were affected more severely than females, provided that adjustments were made according to valve area < or =1 cm2 or >1 cm2. A total of 594 subjects had MS with a valve area < or =1.5 cm2. Severe aortic regurgitation (AR) (grade > or =3) was more common in males than in females. The echocardiographic scores showed 525 subjects (28%) to have mild, 1083 (57%) to have moderate, and 292 (15%) to have severe AR. Among a total of 1163 patients with MS, 385 (33%) had > or =0.5 cm nodular calcification on their valves. CONCLUSION: Currently, RHD remains an alarming and unresolved health problem in the Southeastern Anatolia region. While almost 75% of affected subjects were female, males were more severely affected. In addition, subjects were relatively old, and most were affected by mixed valvular disease of an advanced stage.

Plasma urotensin II as a marker for severity of rheumatic valve disease.

In developing countries, rheumatic valve disease (RVD) is still prevalent. Management of RVD depends on symptomatology, physical examination and echocardiographic evaluation, all of which, however, might be inadequate. Reliable biomarkers to establish severity of RVD and predict complications would be highly beneficial. Urotensin II is regarded as a cardiovascular autacoid/hormone, and its role in cardiovascular diseases is emerging. We hypothesized urotensin II might have pathophysiological roles in RVD. We investigated 71 patients with RVD (mean age 40 +/- 12 years, 17 female patients) and 25 normal subjects (mean age 40 +/- 7 years, 8 female patients). We assessed their New York Heart Association (NYHA) functional class, RVD severity and pulmonary artery pressure (PAP), and measured plasma urotensin II levels. Mitral regurgitation (r = 0.226, p = 0.02), tricuspid regurgitation (r = 0.238, p = 0.02), PAP (r = 0.320, p = 0.01), and NYHA class (r = 0.213, p = 0.03) correlated positively with urotensin II levels. There was positive correlation between urotensin II levels and severity of mitral regurgitation (r = 0.248, p = 0.01) and tricuspid regurgitation (r = 0.326, p = 0.001). In linear regression analysis, only PAP was predictive of urotensin II (beta = 0.3; p = 0.02). In conclusion, this is the first study showing that plasma urotensin II is elevated in chronic RVD, associated with severe mitral and tricuspid valve regurgitation. Furthermore, urotensin II level is correlated with NYHA functional class, and the increase in PAP is predictive of plasma urotensin II.