Body mass index is a predictor of presence of fragmented QRS complexes on electrocardiography independent of underlying cardiovascular status.

BACKGROUND: Fragmented QRS (fQRS) as a sign of myocardial fibrosis indicates adverse outcomes in various cardiovascular diseases. However, there are no clear data regarding relationship between obesity and fQRS. We aimed to investigate whether high body mass index (BMI) predicts fQRS on electrocardiography (ECG) independent of underlying cardiovascular status. METHODS: A total of 1530 patients were included into the study. Patients were divided into three groups according to BMI (normal, overweight and obese). Groups were compared regarding frequency of fQRS on ECG and we investigated the correlation between BMI and fQRS. RESULTS: Among study population, 841 patients had normal BMI, 402 patients were overweight, and 287 patients were obese. Obese patients had significantly higher frequency of fQRS on ECG compared to non-obese patients (p < 0,001). Furthermore, multivariate logistic regression analysis revealed that BMI is an independent predictor of presence of fQRS on ECG (OR:1,220, 95% CI: 1,177-1,266, p < 0.0001). CONCLUSION: BMI predicts fQRS independent of underlying cardiovascular status. Similar to cardiovascular diseases, BMI should be taken into consideration when using fQRS as a prognostic marker.

CD133+ cells are associated with ADIPOCYTOKINES and endothelial dysfunction in hemodialysis patients.

BACKGROUND: Hemodialysis (HD) patients have increased risk of cardiovascular disease (CVD). Impaired stem cell health and adipocytokine metabolism may play important roles in the complex pathophysiological mechanisms of CVD in this patient population. We aimed to investigate the relationships between CD133+ cell counts, adipocytokines and parameters of endothelial dysfunction and atherosclerosis in HD patients. METHODS: In 58 chronic HD patients (male/female:28/30, mean age:58 ± 14 years), serum levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), leptin, adiponectin and resistin were measured by ELISA. Left ventricular mass index (LVMI), carotid intima-media thickness (CIMT), flow-mediated dilatation (FMD) of the brachial artery were measured. CD133+ cells were counted by flow cytometry (BD FACSCalibur-BD Bioscience,CA). RESULTS: CD133+ cell counts were inversely associated with FMD (r = -0.39, p = 0.007) and positively correlated with serum resistin (r = 0.45, p < 0.001) and serum TNF-α (r = 0.31, p = 0.02). Serum leptin levels were higher in high CD133 group compared to low CD133 group [32.37(12.74-72.29) vs 15.50(5.38-37.12)ng/mL, p = 0.03]. Serum leptin levels were correlated with TNF-α(r = 0.35, p = 0.009). Serum adiponectin levels were negatively correlated with serum leptin (r = -0.28, p = 0.03). Serum resistin levels were associated with TNF-α (r = 0.54, p < 0.001) and leptin (r = 0.29, p = 0.03). Serum IL-6 levels were significantly associated with LVMI (r = 0.31, p = 0.03). Serum IL-6 levels were significantly higher in patients with carotid plaque compared to patients without plaque [12.75(9.91-28.68) vs 8.27(5.97-14.04) pg/mL, p = 0.02]. In multiple linear regression analysis to determine the factors predicting LogFMD; dialysis vintage, LVMI and LogCD133+ cell counts were included as independent variables(R = 0.57, adjusted R-square = 0.27, p = 0.001). CD133+ cell count and LVMI were found to significantly predict FMD (p = 0.03 and p = 0.04 respectively). CONCLUSION: CD133+ cells were associated with inflammation and endothelial dysfunction in HD patients. Serum leptin, resistin and TNF-α levels were positively related to CD133+ cell count. Impaired regulation of undifferentiated stem cells and adipocytokines might contribute to endothelial dysfunction in HD patients.

Decrease of Urotensin II activity can impact on the volume status in predialysis chronic kidney disease.

Urotensin II (U-II) was thought to be one of the mediators of primary renal sodium retention due to effects on renal sodium excretion. For this purpose, the relationship between U-II and overhydration was investigated. A total of 107 patients were enrolled in the study. According to body compositor monitor analysis, fluid overload up to 1.1 L, was considered normohydration. Patients were divided according to hydration status; overhydrate (n = 42) and normohydrate (n = 65) were studied in both groups. Pulse waveform velocity propagation for arterial stiffness and blood pressure analysis and echocardiographic left ventricular and left atrial indices were performed with known fluid overload-related parameters. U-II levels were measured by using Human ELISA kit. In overhydrated group, U-II levels were significantly lower. All parameters (blood pressure, arterial stiffness parameters, echocardiographic data, age, gender, diabetes, U-II, hemoglobin) correlated with overhydration, were determined by linear regression model (method = enter), when considered together, U-II was found to be an independent predictor from other conventional overhydration-related parameters. Male sex, left ventricular mass index, left atrial volume index, hemoglobin value were found to be independent predictors for overhydration. Considering the association of low U-II levels with adverse cardiovascular events and its role in sodium retention, we think that low U-II levels can be accepted as a potential therapeutic target in patients with hypervolemic cardio-renal syndrome.

Two-year results of carotid artery stenting.

OBJECTIVES: The effectiveness of carotid artery stenting (CAS) for primary and secondary prevention of ischemic stroke has been demonstrated. The aim of our study was the clinical and radiological evaluation of the reliability of the CAS procedure over a two-year follow-up period. STUDY DESIGN: This study included 120 patients (mean age, 68 (48-86) years) admitted to our hospital between December 2010 and March 2013 for whom CAS was decided in the neurology, cardiovascular surgery and cardiology council. Symptomatic cases with more than 50% stenosis by angiography and asymptomatic patients with stenosis of more than 70% were included in the study. 80% of the asymptomatic patients were those detected during the screening before the coronary bypass surgery. RESULTS: The success rate of the procedure was found as 97.5%. No mortality or myocardial infarction was observed in any of the patients in whom CAS was applied successfully. In 1 symptomatic patient (0.8%), ischemic cerebrovascular event with sequelae was observed 24 hours after the procedure. In total, transient ischemic attack was observed in 2 patients (1.7%) 6 and 11 months after the procedure. Asymptomatic restenosis was detected in 3 patients (2.5% of the total, with 2 in the asymptomatic and 1 in the symptomatic group). Symptomatic restenosis was not observed. None of the patients experienced hyperperfusion syndrome. CONCLUSION: We believe the CAS procedure can be performed safely in symptomatic and asymptomatic patients with low complication and high success rates.

Decrease in endothelial progenitor cells associated with inflammation, but not with endothelial dysfunction in chronic hemodialysis patients.

INTRODUCTION: Endothelial progenitor cells (EPC), bone marrow derived cells, are considered to have a pivotal role in maintaining the integrity and repair of the endothelium. Endothelial dysfunction, atherosclerosis and inflammation are implicated for increased CV mortality in uremia. In this study, we aimed to investigate the possible association of EPC with inflammation, endothelial dysfunction and atherosclerosis in chronic hemodialysis (HD) patients. PATIENTS AND METHODS: 67 HD patients (male/female: 30/37, mean age: 58 ± 15 years) and 22 healthy controls (male/female: 13/9; mean age: 48 ± 8 years) were included. EPC were cultivated in the fibronectin-covered culture dishes and counted. Also EPC markers were studied by flow cytometry using anti-CD34, anti-CD133 and anti-vascular endothelial growth factor receptor 2 (VEGFR-2) antibodies. Serum levels of IL-6, TNF-α, intercellular cell adhesion molecule (ICAM), vascular cell adhesion molecule (VCAM) and asymmetric dimethyl-arginine (ADMA) were measured by ELISA method. Endothelial function was investigated by measuring flow-mediated dilatation (FMD) of the brachial artery. Carotid intima-media thickness (CIMT) and ratio (CIMR) were also examined. RESULTS: EPC number was decreased in HD patients when compared to controls (63.7 ± 8.9 vs. 101.5 ± 19.6/ high power field, p < 0.001). Also CD34+ cell count was significantly lower in the HD group (2.26 ± 3.52 vs. 6.03 ± 4.73%, p < 0.0001). EPC number was significantly inversely correlated with serum TNF-α levels in HD patients(r: -0.453, p < 0.001) and also in the control group (r = -0.509, p = 0.044). There was an inverse association between VEGFR-2+/CD34+cell count and serum IL-6 levels (r: -0.364, p = 0.006) in HD patients. However, EPC count was not related to FMD and CIMT/CIMR. In HD patients, there was a positive correlation between serum IL-6 levels with CIMT (r = 0.358, p = 0.01) and CIMR was positively correlated with serum ICAM (r = 0.430, p = 0.002). CONCLUSION: EPC number was decreased in uremia and was associated with inflammation. TNF-α might have specific inhibitory actions on EPC in both HD patients and healthy controls. No relationship was present between EPC and endothelial dysfunction/atherosclerosis.

[Acute massive pulmonary embolism in a patient using clavis panax]. / Clavis panax kullanan bir hastada gelisen akut yaygin pulmoner emboli.

In recent years, the use of herbal combinations, plant extracts or food supplements has increased in our country and all over the world. However, there is not enough data to determine the effective doses of these substances in the composition of herbal preparations, or their effects on metabolism and drug interactions. With the widespread use of herbal combinations, life-threatening side effects and clinical manifestations that arise from them have been reported. Herein we present a case with acute massive pulmonary embolism while using an herbal combination in the context of Tribulus terrestris, Avena sativa and Panax ginseng. A 41-year-old man was admitted to the emergency department with the complaint of sudden onset of dyspnea and syncope. As a result of investigations (blood gases, echocardiography, ventilation-perfusion scintigraphy) he was diagnosed with an acute massive pulmonary embolism. The patient's use of panax did not pose as a risk factor for the pulmonary embolism. He was given thrombolytic therapy and shortness of breath improved. At the pre-discharge the patient was informed of the risks associated with the herbal combination, especially panax. Coumadin was started and he was discharged for the INR checks to come.

Reduction of uric acid levels with allopurinol treatment improves endothelial function in patients with chronic kidney disease.

BACKGROUND: Endothelial dysfunction (ED) is a key event in the development of atherosclerotic cardiovascular disease (CVD) in patients with chronic kidney disease (CKD). Association of hyperuricemia with CVD has been previously reported in the nonuremic population. In this prospective study, we aimed to evaluate the effects of treatment of hyperuricemia with allopurinol on ED and changes in the serum reactive oxygen species in patients with CKD. METHODS: In this study, 19 (13 male) hyperuricemic (UA > 7 mg/dl) nondiabetic CKD patients without any comorbidity, aged < 60 years with creatinine clearance (CrCl) between 20 and 60 ml/min were evaluated. Endothelial functions were assessed by ischemia-induced forearm vasodilatation method (EDD). Oxidative stress was evaluated by measuring the serum oxidized LDL (ox-LDL), advanced oxidation protein products (AOPP) and nitrotyrosine (NT) levels. After measuring all these tests at baseline, allopurinol therapy was commenced for 8 weeks. After 8 weeks of allopurinol treatment, all measurements were repeated. Then, allopurinol treatment was ceased and same measurements were also repeated 8 weeks after ceasing of the treatment. RESULTS: Serum creatinine, total cholesterol, albumin, hs-CRP, CrCl and proteinuria levels of the patients were similar among three study periods. After allopurinol therapy, the mean serum UA and NT levels significantly reduced as compared to baseline. At the 8th week after cessation of allopurinol treatment, serum UA levels were significantly increased. After allopurinol therapy, EDD value increased from 5.42 ± 8.3% at baseline to 11.37 ± 9% (p < 0.001). At the 8th week after ceasing allopurinol treatment, EDD returned to baseline values (5.96 ± 8%, p < 0.001). CONCLUSION: Treatment of hyperuricemia with allopurinol improve ED in patients with CKD. However, mechanism responsible for this beneficial effect seems to be apart from antioxidant effects of allopurinol.

High concentrations of asymmetric dimethylarginine are associated with ST-segment resolution failure after reperfusion for acute myocardial infarction.

BACKGROUND: Increased concentrations of asymmetric dimethylarginine (ADMA) have been detected in patients with cardiovascular risk factors. In addition, high baseline plasma concentrations of ADMA have been shown to be an independent predictor of adverse outcomes in various disorders. This study aimed to evaluate the impact of admission ADMA concentrations on microvascular flow after primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). METHODS: Blood samples from 39 patients with STEMI were collected at admission to measure the concentrations of ADMA and other cardiovascular risk factors including inflammatory markers and the lipid profile. Primary PCI was performed in patients with STEMI. The maximum ST-segment elevation in standard 12-leads electrocardiogram (ECG) before and 24 h after PCI was measured, and patients were stratified as complete or incomplete ST-segment resolution (STR). RESULTS: Twenty-five patients had complete (≥ 70%) and 14 incomplete (<70%) STR. In patients with incomplete STR, ADMA concentrations were significantly higher than that seen in others (0.447 ± 0.215 µmol/L vs. 0.310 ± 0.134, p=0.019), and was independently associated with STR. CONCLUSIONS: Admission concentrations of ADMA appeared to be useful for early risk stratification in reperfusion therapy for acute myocardial infarction.

Intraaortic balloon occlusion during refractory cardiac arrest. A case report.

Despite recent advances in its management, the outcome from cardiac arrest is often poor despite appropriate cardiopulmonary resuscitation (CPR). The coronary perfusion pressure (CPP) achieved during CPR is associated with successful return of spontaneous circulation (ROSC). Continuous balloon occlusion of the descending aorta is an experimental method that can occlude the 'unnecessary' part of the circulation, thus diverting generated pressure and blood flow to the heart and brain. We present a case report with a patient unresponsive to standard CPR in which constant intraaortic balloon occlusion achieved ROSC and successful survival.

OPERATOR DEPENDENCY OF THE RADIATION EXPOSURE IN CARDIAC INTERVENTIONS: FEASIBILITY OF ULTRA LOW DOSE LEVELS.

INTRODUCTION: Mean radiation exposure in invasive cardiology varies greatly between different centres and interventionists. The International Commission on Radiological Protection and the EURATOM Council stipulate that, despite reference values, 'All medical exposure for radiodiagnostic purposes shall be kept as low as reasonably achievable' (ALARA). The purpose of this study is to establish the effects of the routine application of ALARA principles and to determine operator and procedure impact on radiation exposure in interventional cardiology. MATERIALS AND METHODS: A total of 240 consecutive cardiac interventional procedures were analysed. Five operators performed the procedures, two of whom were working in accordance with ALARA principles (Group 1 operators) with the remaining three working in a standard manner (Group 2 operators). Radiation exposure levels of these two groups were compared. RESULTS: Total fluoroscopy time and the number of radiographic runs were similar between groups. However, dose area product and cumulative dose were significantly lower in Group 1 when compared with Group 2. Radiation levels of Group 1 were far below even the reference levels in the literature, thus representing an ultra-low-dose radiation exposure in interventional cardiology. CONCLUSION: By use of simple radiation reducing techniques, ultra-low-dose radiation exposure is feasible in interventional cardiology. Achievability of such levels depends greatly on operator awareness, desire, knowledge and experience of radiation protection.

Directly ventricular septal defect closure without using arteriovenous wire loop: Our adult case series using transarterial retrograde approach.

OBJECTIVE: The standard transcatheter ventricular septal defects (VSD) closure procedure is established with arteriovenous (AV) loop and is called as antegrade approach. The directly retrograde transarterial VSD closure without using AV loop might be better option as shortens the procedure time and decreases radiation exposure. METHODS: Our series consist of twelve sequential adult cases with congenital VSDs (seven with perimembranous, four with muscular, one with postoperative residuel VSD). The mean age was 26.9 (Range 18-58), the mean height was 168.75 cm (Range 155-185cm), and the mean body mass index was 23.4 (Range 17.3-28.4). Maximum and minimum defect sizes were 10 and 5 mm and the mean defect size was 6.24 mm. The procedure was performed with left heart catheterization and advancing the delivery sheath over the stiff exchange wire then VSD occlusion from left side. RESULTS: The defects were successfully closed with this technique in eleven patients. In sixth patient, the defect could not be cannulated by the delivery sheath, as the tip of the sheath did not reach the defect and VSD was closed with same sheath by standard transvenous approach using AV loop. We didn't encounter any complication releated to semilunar or atrioventricular valves. Atrioventricular conduction system was not affected by the procedure in any patients. The median procedure and fluoroscopy times were 66 and 16.5 minutes respectively. CONCLUSION: Transarterial retrograde VSD closure without using AV loop simplifies the procedure, decreases the radiation exposure, and shortens the procedure time. The only limitation in adult patients is delivery sheath length.

Phenotype distribution of the paraoxonase gene in patients with cardiac disease.

INTRODUCTION: Paraoxonase (PON1) is an enigmatic enzyme with multiple enzymatic properties including arylesterase and lactonase activities besides its ability to hydrolyze the toxic metabolite of parathion, paraoxon. The aim of this study was to determine the phenotype distribution of PON1 in patients with cardiac disease who were classified in coronary artery bypass grafting (CABG), heart valve disease (HVD), heart failure (HF) and ST elevation myocardial infarction (STEMI) groups and healthy subjects as a control group. MATERIAL AND METHODS: A total of 300 people (100 cardiac surgery (70 CABG and 30 HVD), 70 HF, 30 STEMI patients and 100 healthy controls) were admitted to this study. Individual variations in PON1 were determined using the dual substrate (paraoxon and phenylacetate) method. RESULTS: The following phenotype distributions were found in the cardiac disease and control groups: cardiac disease group (n = 200): 48.5% (QQ), 42.5% (QR), 9% (RR) and control group (n = 100): 58% (QQ), 39% (QR), 3% (RR). RR (high activity) phenotypic distribution was more common in the cardiac disease group than in controls (p = 0.04). In particular, the frequency of the RR phenotype was two- to three-fold higher in the STEMI and HF patients compared to the controls as well as CABG and HVD groups. CONCLUSIONS: We found a higher percentage of RR phenotype in STEMI and HF patients compared to a large control group as well as compared to two other groups of cardiac disease patients.

ß-2 microglobulin level is negatively associated with global left ventricular longitudinal peak systolic strain and left atrial volume index in patients with chronic kidney disease not on dialysis.

OBJECTIVE: There are many factors related to high left atrial volume index (LAVI) and global left ventricular longitudinal peak systolic strain (GLS-%) decline in chronic kidney disease. The purpose of our study is to investigate the relation between the ß-2 microglobulin (ß-2µ ) and GLS-% and LAVI in patients with chronic kidney disease not yet on dialysis. METHODS: Our study was a non-randomized, controlled, prospective study. We included 87 consecutive patients with eGFR levels below 60 ml/min/m2 not on dialysis and 82 normal healthy individuals with complaints of atypical chest pain and negative stress tests as control group in our study. Patients with hospitalization related to dialysis or heart failure attacks within 3 months, active malignancy, malnutrition, pregnancy, and uncontrolled hypertension were excluded. Brachial pulse wave velocity (PWV), augmentation index, augmentation pressure and central hemodynamics, and PWV analysis were performed in order to assess the arterial stiffness and blood pressure. According to the distribution of data, Spearman and Pearson correlations and multiple linear regression were used to determine significant and independent factor associated with high LAVI and low GLS-%. RESULTS: There were significant correlations between ß-2µ with LAVI (r=0.313, p=0.004) and with GLS-% (r=-0.222, p=0.04). In multiple linear regression, the relationship between ß-2µ with GLS-% [ß=-0.037, 95% CI (-0.062, -0.013), p=0.004] and LAVI [ß=4.522, 95% CI (2.806, 6.238), p<0.001] was independent of age, PWV, central and peripheral blood pressures, parathormone, CalciumXPhospor, Hgb levels, and eGFR. CONCLUSION: Increasing ß-2µ levels were found to be associated with increased LAVI and decreased GLS-%. Additional experimental studies are needed to clarify these relationships.

Association of overhydration and cardiac dysfunction in patients have chronic kidney disease but not yet dialysis.

BACKGROUND/AIM: Fluid overload and cardiac dysfunction is well established in hemodialysis patients. But in predialysis chronic kidney disease, the association of fluid overload and cardiac dysfunction is relatively unknown. In this study, we aimed to investigate the relationship between fluid overload and cardiac dysfunction in predialysis chronic kidney disease patients. METHOD: We enrolled 107 consecutive patients in our study. Fluid overload was assessed via body composition monitor. Patients were dichotomized according to the fluid overload status. The patients with FO < 1.1L were determined as normovolemic and those with FO ≥ 1.1L as hypervolemic according to the previously reported physiologic model. Left atrial volume index (LAVI), left ventricular end-diastolic-end-systolic index (LVEDVI, LVESVI), E/e', LVMI and global longitudinal left ventricular left ventricular strain (GLS-%) were evaluated in each patient as markers of cardiac dysfunction. Arterial stiffness was also assessed by Mobil-O-Graph(®) 24h pulse wave analysis monitor and pWV values were recorded. RESULTS: Fifty-five patients were normovolemic and 52 patients were hypervolemic. LAVI, LVMI, LDEDVI, LVEDSVI, E/e' were increased in hypervolemic patients. Also in hypervolemic patients pulse wave velocity was increased and GLS was decreased. Multivariate analysis showed that FO was independently associated with GLS which is the most specific echo-parameter for left ventricular dysfunction. CONCLUSION: FO was independently associated with cardiac dysfunction in patients with chronic kidney disease not ongoing dialysis. Effective treatment of hypervolemia may be important in these patients to avoid further cardiac damage.

Thrombolytic therapy delay is independent predictor of mortality in acute pulmonary embolism at emergency service.

Acute pulmonary embolism (PE) carries a high risk of morbidity and mortality. Delays in diagnosis or therapy may result in sudden, fatal deterioration; therefore, rapid diagnosis and an appropriate therapeutic approach are needed. We aimed to investigate the effect of delaying thrombolytic administration on the mortality rate in a suspected PE. We retrospectively analyzed 49 consecutive patients who were aged 18 years or older and received thrombolysis for a high-risk PE without a major contraindication. All patients were classified according to the time of onset of the thrombolytic therapy. Patients experiencing cardiopulmonary arrest were analyzed from the time of admission to thrombolytic administration with 10-minute cutoff values. Data were analyzed by a regression analysis and a receiver operating characteristic (ROC) analysis for significant and independent associated risk factors and in-hospital mortality. Mortality was seen in 17 of the 49 cases. Thirteen of these had received thrombolytic therapy 1 hour after their emergency department (ED) admission. Among all cases, the mortality rate was 35%. The ROC analysis indicated that a > 97-second delayed thrombolytic administration time was associated with mortality with 53% sensitivity and 91% specificity (area under the curve, 0.803; 95% confidence interval, 0.668-0.938). In the logistic regression, a 5-minute delay in thrombolytic therapy (beta = 1.342; 95% confidence interval, 1.818-2.231; p = 0.001) was associated with in-hospital mortality in the multivariable model. No major bleeding complications were seen in PE survivors. We conclude that early onset thrombolytic therapy in the ED for high-risk and hemodynamically worsening patients appears safe and life-saving.

No association between vitamin D levels and inflammation markers in patients with acute coronary syndrome.

PURPOSE: A modern concept regards acute coronary syndrome (ACS) as an auto-inflammatory disorder. The purpose of the present study is to assess the plasma levels of inflammation related to biomarkers and cytokines in ACS patients and to correlate the values with 25-hydroxy vitamin D3 (calcidiol). There are no previously published reports concerning serum concentrations of inflammatory markers in patients with hypovitaminosis D in ACS. PATIENTS AND METHODS: Eighty-eight consecutive patients with ACS [n=47 ST elevation myocardial infarction (STEMI), n=41 unstable angina pectoris (USAP)] were enrolled within 12h after symptoms. The blood samples were collected on admission in order to evaluate calcidiol, serum amyloid A (SAA), interleukin (IL)-6, interleukin (IL)-10, tumor necrosis factor-alpha (TNFα) and high sensitivity C-reactive protein (hsCRP). RESULTS: Calcidiol, TNFα and SAA levels were significantly lower (p=0.01, p<0.01 and p<0.01 respectively), whereas hsCRP levels were significantly higher (p<0.01) in STEMI group as compared to USAP group. In the STEMI group, there were negative correlations between SAA and hsCRP (r=-0.347; p=0.01) and SAA and IL-6 (r=-0.356; p=0.01). There was a positive correlation between IL-6 and hsCRP (r=0.529; p<0.01). In the USAP group, it was found that there were a strong negative correlation between SAA and hsCRP (r=-0.75; p<0.01) and a positive correlation between IL-6 and TNF-α (r=0.54; p<0.01). CONCLUSION: This study demonstrates that calcidiol levels are not associated with the inflammation markers in patients with acute phase ACS.

Cardiovascular-renal changes after kidney donation: one-year follow-up study.

BACKGROUND: Long-term consequences of kidney donation are not well known. Most of the studies published were focused on renal risk. In this prospective study, we investigated the changes in cardiovascular function after kidney donation. METHODS: Thirty-eight living kidney donors were included. In addition to 24-hr ambulatory blood pressure monitoring, serum interleukin-6, vascular cell adhesion molecule (VCAM), and asymmetric dimethylarginine levels were measured. Endothelial function was examined by measuring ischemia-induced flow-mediated dilation (FMD) of the brachial artery. All studies were repeated at 3 months and 12 months after kidney donation. RESULTS: The mean serum interleukin-6 levels, both at 3 months and 12 months, were significantly increased as compared to the baseline (P = 0.007 and P < 0.001, respectively). The mean serum asymmetric dimethyl-arginine (P < 0.001) and VCAM levels (P < 0.001) at 12 months were significantly increased as compared to baseline. FMD values at 1 year (9.3% ± 7.1%) were significantly decreased as compared to 3 months (13.0% ± 6.0%, P = 0.001) and baseline (13.9% ± 6.3%, P = 0.002). In multivariate analysis, serum uric acid (P = 0.001), estimated glomerular filtration rate (P = 0.027), and VCAM (P = 0.014) levels were the independent predictors of FMD 12 months after kidney donation. CONCLUSION: Our findings suggest that kidney donation might increase the cardiovascular risk in kidney donors.

Cardiotrophin-1: A new predictor of atrial fibrillation relapses after successful cardioversion.

We aimed to investigate whether or not cardiotrophin-1 (CT-1) can be used as a predictor of sinus rhythm constancy in patients with atrial fibrillation (AF) converted to sinus rhythm. Thirty two patients with AF (48-78 years), without any structural heart disease were enrolled for the study. The control group consisted of 32, age and gender matched healthy persons. Measurements of CT-1 were made after transthoracic and transesophageal echocardiography prior to cardioversion (CV). Relapses of AF were investigated by monthly electrocardiograms (ECGs) and ambulatory ECGs at 1st, 3rd, and 6th month. At the end of 6th month, measurements of CT-1 were repeated. At the beginning patients with AF had increased CT-1 levels when compared to controls (0.94 ± 0.32 pg/mL vs. 0.30 ± 0.12 pg/mL, [p < 0.001]). At the end of follow-up of the 32 patients, 17 (53%) had AF relapse. Age, initial duration of AF, left ventricle diameters, ejection fraction, left atrium appendix flow rates were similar among patients with and without AF relapse. However, basal left atrium diameter (4.24 ± 0.14 cm vs. 4.04 ± 0.22 cm, p = 0.005), pulmonary artery pressure (32.82 ± 5 vs. 28.60 ± 6.23 mmHg, p = 0.004) and CT-1 values (1.08 ± 0.37 vs. 0.82 ± 0.16 pg/mL, p = 0.02) were significantly increased in patients with AF relapse. Furthermore, patients with relapsed AF had higher CT-1 levels at 6th month when compared to those in sinus rhythm (1.00 ± 0.40 vs. 0.71 ± 0.23 pg/mL). We conclude that post-CV, AF relapses are more frequent among patients with increased baseline CT-1 levels, and CT-1 may be a potential predictor of AF relapse.

Impact of anxiety level on circadian rhythm of blood pressure in hypertensive patients.

INTRODUCTION: Considering the high prevalence rates and growing incidences of hypertension (HT) and anxiety disorders in the modern world, a full understanding of anxiety's relationship to HT is crucial. In this study we aimed to investigate the effects of anxiety level on circadian rhythm of blood pressure (BP) in hypertensive patients. MATERIAL AND METHOD: This cross-sectional study included 160 previously diagnosed essential hypertensive patients (80 female, 80 male, mean age: 55.3±15.1 years). All participants underwent 24 h ambulatory blood pressure monitoring (ABPM) and filled State-Trait Anxiety Inventory (STAI) (trait) Questionnaire. The study population was divided into 2 groups according to their STAI scores; an anxiety group (n=97; STAI ≥45) and a control group (n=63; STAI<44). Clinical characteristics, laboratory findings and ABPM measurements were compared between the groups. RESULTS: There was no significant difference between the groups for ABPM parameters except morning blood pressure surge (MBPS). Anxiety group had a significantly higher MBPS compared to control group (14.4±17.0 vs 9.1±11.9 mmHg, P:0.03). Multivariate analysis showed that duration of HT and STAI score were the only independent predictors of MBPS. CONCLUSION: Patients' anxiety level is associated with MBPS which is an independent risk factor for cardiovascular complications. Assessment and control of anxiety seems to be worthy in effective treatment of hypertension.