The Effect of Smoking on Endothelial Dysfunction in Autosomal Dominant Polycystic Kidney Disease Patients with Preserved Renal Function.

BACKGROUND: In autosomal dominant polycystic kidney disease (ADPKD), endothelial dysfunction (ED) is common and occurs much earlier than kidney function impairment. The impact of smoking on ED in ADPKD patients has not been previously studied. The aim of this study was to investigate the potential contribution of smoking habits to ED and subclinical atherosclerosis in these patients. METHODS: This case-control study included 54 ADPKD patients with preserved renal function and 45 healthy control subjects. ED was assessed using ischemia-induced forearm flow-mediated dilatation (FMD). Carotid intima-media thickness (CIMT) was measured from 10 mm proximal to the right common carotid artery. Clinical demographic characteristics and laboratory data were recorded for the patients and control group. Regression analysis was used to determine independent associations of ED and CIMT. RESULTS: FMD was significantly lower in the ADPKD patients (19.5 ± 5.63 vs. 16.56 ± 6.41, p = .018). Compared with nonsmoker ADPKD patients, smoker patients had significantly lower FMD values (18.19 ± 6.52 vs. 13.79 ± 5.27, p = .013). In multiple regression analysis, age (ß = -0.294, 95% CI: -0.392: -1.96, p = .001) for FMD and smoking (ß = 1.328, 95% CI: 0.251, 2.404, p = .017) for CIMT were independent predictors. CONCLUSIONS: Patients with ADPKD had more impaired endothelial function and subclinical atherosclerosis compared with control subjects. Smoking may increase the risk of subclinical atherosclerosis in ADPKD patients.

Morning blood pressure surge in early autosomal dominant polycystic kidney disease and its relation with left ventricular hypertrophy.

INTRODUCTION: The activation of the sympathetic nervous system, which usually leads to a swift surge in blood pressure in the morning hours (MBPS) may be the cause of left ventricular hypertrophy (LVH) and endothelial dysfunction (ED) in early autosomal dominant polycystic kidney disease (ADPKD) patients. We studied the association between MBPS and LVH in ADPKD patients with preserved renal functions. METHODS: Patients with ADPKD with preserved renal functions were enrolled. Prewaking MBPS was calculated using ambulatory blood pressure monitoring. The patients were categorized as MBPS (≥median) and non-MBPS (

The association between cardiac valvular calcification and fetuin-A levels in kidney transplant recipients.

OBJECTIVES: Low fetuin-A levels in hemodialysis patients can be associated with development of vascular and valvular calcifications. The mechanisms underlying vascular and valvular calcifications are multifactorial. There are a few studies showing the relationship between low fetuin-A levels and valvular calcification after kidney transplantation. We aimed to evaluate the association between serum fetuin-A levels and valvular calcification in kidney transplant recipients. METHODS: The cardiac valvular calcification was assessed by echocardiography in 56 recipients. Patients were divided into two groups as those with (n = 11) and without (n = 45) aortic and/or mitral valve calcification. The extent of valvular calcification was visually assessed according to the standard visual score method: moderately (multiple larger spots) and heavily calcified (extensive thickening and calcification) of all cusps. Serum fetuin-A levels were measured. RESULTS: The demographic features of both groups were comparable. There was no significant difference between regular physical exercise (63.6% vs. 55.6%), obesity (18.2% vs. 17.8%), abdominal obesity (54.5% vs. 46.7%), smoking (0% vs. 13.3%), hypertension (63.6% vs. 68.9%), left ventricular hypertrophy (45.5% vs. 33.3%) and diabetes mellitus (9.1% vs. 20%) ratios in groups with or without valvular calcification, respectively (p > 0.05). Fetuin-A levels of both groups did not differ. Fetuin-A levels positively correlated with serum creatinine (r 0.326, p = 0.014), and negatively correlated with estimated glomerular filtration rate (r - 0.297, p = 0.026). CONCLUSIONS: We could not find a relationship between serum fetuin-A levels and valvular calcification in kidney recipients. In this population, further studies are needed to assess the role of serum fetuin-A in valvular calcification.

Serum paraoxonase activity in patients with ischaemic and nonischaemic dilated cardiomyopathy.

BACKGROUND: This study examined whether the serum PON1 activity is different in patients with ischaemic dilated cardiomyopathy (IDCM) and nonischaemic dilated cardiomyopathy (NDCM) and the relation between the serum PON1 activity and serum pro-BNP levels. METHODS AND RESULTS: In this study, we enrolled 60 patients with left ventricular systolic failure (New York Heart Association [NYHA] class III-IV) and a left ventricular ejection fraction (EF) < 40% as determined by echocardiography and 30 healthy subjects. The patients with systolic heart failure were divided into two groups: patients with IDCM and patients with NDCM. Blood samples were obtained to measure the serum PON1 activity and the serum pro-BNP levels. The median serum PON1 activities were lower among the patients with IDCM or with NDCM compared with the control subjects (p < .001, p = .043, respectively). Compared with the control subjects, the patients with IDCM or with NDCM had higher serum pro-BNP levels (p < .001, p < .001, respectively). The serum PON1 activity was negatively correlated with the serum pro-BNP levels in patients with IDCM (r = -0.548, p < .001). The area under the ROC curve of the serum PON1 activity was 0.798. Using a serum PON1 activity of 201.3 U/L as a cut-off value, the sensitivity was 86.84% and specificity was 66.67% for the diagnosis of IDCM. CONCLUSIONS: In this study, the serum PON1 activity was significantly reduced in the patients with IDCM or with NDCM compared with the control subjects. The serum PON1 activity of the patients with IDCM was negatively correlated with the serum pro-BNP levels.

Catheter-directed ultrasound-accelerated thrombolysis may be life-saving in patients with massive pulmonary embolism after failed systemic thrombolysis.

The treatment options for high risk acute pulmonary embolism (PE) patients with failed systemic thrombolytic treatment (STT) is limited. The clinical use of catheter directed thrombolysis with the EkoSonic Endovascular System (EKOS) in this population has not been evaluated before. Catheter directed thrombolysis is an effective treatment modality for high risk PE patients with failed STT. Thirteen consecutive patients with failed STT were included in the study. EKOS catheters were placed and tissue plasminogen activator (t-PA) in combination with unfractionated heparin were given. Clinical and echocardiographic properties of the patients were collected before EKOS, at the end of EKOS and during the follow-up visit 6 months after discharge. The duration of EKOS treatment was 21.8 ± 3.8 h and the total dose of tPA was 31.2 ± 15.3 mg. One patient who presented with cardiac arrest died and the clinical status of the remaining subjects improved significantly. Any hemorrhagic complication was not observed. EKOS resulted in significant improvement of right ventricular functions and decrease of systolic pulmonary artery pressure. During a follow-up period of 6 months none of the patients died or suffered recurrent PE. In addition, echocardiographic parameters or right ventricular function significantly got better compared to in-hospital measurements. EKOS is an effective treatment modality for high risk PE patients with failed STT and can be applied with very low hemorrhagic complications.

The relationship between serum lectin-like oxidized LDL receptor-1 levels and systolic heart failure.

OBJECTIVES: Lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) appears to be involved in atherosclerotic plaque vulnerability and rupture. In this study, we aimed to evaluate the utility of serum LOX-1 levels in the diagnosis and assessment of left ventricular systolic HF and LOX-1's relationship with serum pro-brain natriuretic peptide (NT-proBNP). DESIGN AND SETTINGS: This was a cross-sectional study of all eligible patients admitted to the department of cardiology of the University Hospital between July 2011 and April 2012. METHODS: Fifty-five patients with a diagnosis of systolic heart failure and 25 patients without systolic HF were enrolled in this study. Serum C-reactive protein, NT-proBNP, and LOX-1 were studied. RESULTS: Serum LOX-1 and NT-proBNP levels were significantly higher in the heart failure group and showed a positive correlation with NT-proBNP and negative correlations with left ventricular ejection fraction (EF). In addition, LOX-1 levels in patients with ischaemic cardiomyopathy were significantly higher, while they were similar in patients with dilated cardiomyopathy compared to control subjects. CONCLUSION: Our study demonstrates the utility of the serum LOX-1 levels in the diagnosis of left ventricular systolic heart failure. LOX-1 may have a place in the diagnosis of heart failure, in particular in patients with ischaemic cardiomyopathy.

Serum fetuin-A levels in patients with systolic heart failure.

OBJECTIVE: Inflammation and dystrophic calcification have been associated with cardiovascular disease (CVD) and chronic heart failure (CHF). The aim of the present study was to investigate the potential usefulness of fetuin-A as a biomarker in CHF. METHODS: Serum fetuin-A was measured in 66 CHF patients with left ventricular function < 50% and in 31 healthy controls at baseline. Fetuin-A was evaluated as a diagnostic marker for systolic heart failure and compared with C-reactive protein (CRP) and pro-brain natriuretic peptide (pro-BNP). RESULTS: The levels of serum fetuin-A were significantly decreased in the CHF patients compared to the control group (P < 0.01). Although there were significant correlations between fetuin-A and certain parameters in patients and controls, none of these were present consistently in either group. It was found that serum fetuin-A levels could identify patients with systolic heart failure with a high degree of sensitivity and specificity. CONCLUSIONS: Serum fetuin-A is decreased in CHF patients, indicating that anti-inflammatory activity is downregulated in CHF and that calcification may be associated with CHF.

[Management of multivalvular heart disease]. / Çoklu kalp kapak hastaliklarinda yönetim.

Multivalvular heart valve disease is not an uncommon situation. Although many studies include only patients with regurgitation or stenosis involving only one heart valve, several scenarios in which patients present with regurgitation and/or stenosis involving two or more valves exist. Data on multivalve disease are scarce because of a large number of possible combinations and also owing to difficulties of exact quantification and an overlap in surgical indications. Therefore, many fields related to multiple valve disease are not encountered in the current valvular heart disease guidelines. This article aims to explain multi valvular heart disease from etiology and background definition to surgical outcome, with special emphasis on echocardiographic assessment.

Clinical efficacy, safety, tolerability, and survival outcome of long-term inhaled iloprost treatment in the management of pulmonary arterial hypertension: Data from prospective multicenter observational OPTION study.

OBJECTIVE: To evaluate clinical efficacy, safety and tolerability of long-term inhaled iloprost treatment in the daily practice for the management of pulmonary arterial hypertension (PAH). METHODS: A total of 115 patients with PAH on inhaled iloprost treatment were included. New York Heart Association (NYHA) functional class, brain natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, and 6-minute walk distance (6MWD) were recorded at baseline and at 3rd to 24th month visits. Safety and tolerability of iloprost treatment were also evaluated during follow-up, as were the survival, clinical worsening, and the related risk factors. RESULTS: The treatment was associated with an increase in the percentage NYHA functional class II (from 0.0% at enrolment to 36.2% at 24th month visit) patients but no significant difference was noted in 6MWD values. Clinical worsening was observed in 63.5% patients, while survival rate was 69.6%. NT-proBNP levels were significantly higher in non-survivors than in survivors (p=0.042). Cox regression analysis revealed the association of female sex [odds ratio (OR)=0.318; 95% confidence interval (CI), 0.128-0.792; p=0.014] and scleroderma-related PAH (OR=0.347; 95% CI, 0.140-0.860; p=0.022) with significantly lower risk (3.14 fold and 2.88 fold, respectively) of mortality. CONCLUSION: Our findings indicate favorable efficacy, safety, and tolerability of long-term iloprost treatment in the management of PAH, whereas improved NYHA functional class was not accompanied with a significant change in 6MWD values. Patient age was a risk factor for clinical worsening, while female sex, scleroderma subtype, and lower NT-proBNP levels were associated with significantly lower mortality risk.

Impaired left ventricular systolic and diastolic functions in patients with early grade pulmonary sarcoidosis.

AIMS: Cardiac sarcoidosis is symptomatic in only 5% of patients, and it is an independent predictor of mortality and carries a very poor prognosis. In our study, we aimed to assess left ventricle (LV) systolic and diastolic functions with tissue Doppler imaging (TDI) in patients with early grade pulmonary sarcoidosis. METHODS AND RESULTS: The study population included 55 patients with Grade I-II sarcoidosis (41 females, 14 males, mean age: 47.9 ± 10.1) and 22 healthy subjects. LV lateral and septal wall early myocardial peak velocity (E(m)), late myocardial peak velocity (A(m)), E(m) to A(m) ratio, myocardial relaxation time (RT(m)), myocardial systolic wave (S(m)) velocity, isovolumic acceleration (IVA), myocardial pre-contraction time (PCT(m)), contraction time (CT(m)), and the PCT(m) to CT(m) ratio were measured. No statistically significant difference was detected between the groups according to age, gender, body mass index, systolic and diastolic blood pressure, or heart rate. LV systolic parameters, LV septal, and lateral wall IVA, were significantly lower, and the PCT(m) to CT(m) ratio (P = 0.026) was higher at the septal annulus as compared with control group. E(m), a LV diastolic parameter, was significantly lower at the septal annulus. CONCLUSION: Cardiac sarcoid involvement is not rare and is treatable. It should be identified at an early stage. TDI, especially IVA, may be a suitable tool for the early detection of subclinical LV sarcoid involvement.

Diffuse involvement of the heart and great vessels in primary cardiac lymphoma.

Primary cardiac lymphoma (PCL) is an extremely rare disorder. In this report, a 57-year-old male with diffuse large B-cell lymphoma involving the heart and great vessels is presented. Trans-thoracic echocardiography was the first modality used to establish the diagnosis. Fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) showed diffuse increased metabolic activity of the heart walls and hypermetabolic lesions occupying cardiac chambers in some areas. The patient underwent systemic chemotherapy, and after 13 days, a marked regression of the tumour mass was evident based on echocardiographic examination. After completing six R-CHOP chemotherapy treatments, PET imaging was planned to control the residual mass, but the patient was intubated due to pneumonia that developed after the sixth chemotherapy session and subsequently died due to sepsis.

Impaired aortic stiffness and pulse wave velocity in patients with branch retinal vein occlusion.

BACKGROUND: Aortic distensibility (AD) and pulse wave velocity (PWV) reflect arterial stiffness, which is linked to increased cardiovascular morbidity and mortality in different diseases such as atherosclerosis, hypertension, and diabetes mellitus, all of which are also common risk factors in patients with branch retinal vein occlusion (BRVO). In the present study, we aimed to determine whether arterial stiffness in different segments of the arterial tree is increased in patients with BRVO. METHODS: The study group consisted of 35 patients with BRVO (20 female, 15 male, mean age: 55.9+/-6.8) and the age-matched control groups consisted of 19 patients with hypertension (9 female, 10 male, mean age: 55.2+/7.6) and 17 healthy subjects (9 female, 8 male, mean age: 53.4+/-9.6). Radial artery PWV was measured using a Pulse Wave Sensor HDI system, which measures non-invasively the radial pulse-wave recording with computer analysis of the diastolic decay, and provides separate assessment of the large arterial elasticity index (LAEI) and small artery elasticity index (SAEI). Aortic strain and AD was determined echocardiographically based on the relationship between changes in aortic diameter and pressure with each cardiac pulse. Patients with diabetes mellitus or inflammatory BRVO, and control patients with any occlusive vascular eye disease, were excluded. The results of the three groups were compared. RESULTS: Compared to the subjects of the healthy control group, those with BRVO had lower LAEI (p<0.05). Both AD and aortic strain were significantly lower in the BRVO group than in both control groups (p<0.05 for both) and in the hypertensive control group than the healthy controls (p<0.05). The AD, LAEI and SAEI were positively correlated (p=0.021, r=0.307 and p=0.041, r=0.269 respectively). CONCLUSIONS: The results of this study show that the arterial stiffness indices (large arterial elasticity index and aortic distensibility) are abnormal in patients with BRVO compared to the healthy and hypertensive controls. Arterial stiffness may play a role in the onset or progression of BRVO. Further studies are needed to determine the exact role of AS in the pathogenesis of BRVO, and to reveal its value in predicting systemic morbidity and mortality in patients with BRVO.

[Impaired myocardial performance in sarcoidosis]. / Sarkoidozda bozulmus miyokard performansi.

Despite myocardial sarcoid involvement has been reported in 20-27% in autopsy series, only 5% of the patients are clinically symptomatic. This study was planned to evaluate right and left ventricular functions in patients with early stage sarcoidosis (stage I and II) without any findings of cardiac involvement with Tei index which globally shows systolic and diastolic functions of the ventricles was used. Seventy-two patients under follow-up for sarcoidosis without cardiac involvement (53 women, 19 men; mean age 49.1 ± 10.3 years) and nineteen age-matched healthy control subjects (14 women, 5 men; mean age 48.7 ± 6.5 years) were enrolled in the study. All subjects were evaluated with two-dimensional and Doppler echocardiography. Right and left ventricle Tei indices (myocardial performance index) were calculated from measured Doppler parameters. Peak velocity of the mitral A wave (A) was higher, peak velocity of the mitral E wave, E/A ratio were lower; and ejection time was shorter in patients with sarcoidosis (p< 0.05) compare to controls. Peak velocity of the tricuspid A wave was higher, E wave deceleration time was longer and E/A ratio was lower (p< 0.05) in sarcoidosis group. While left ventricular Tei index was higher in patients with sarcoidosis (p= 0.021), right ventricular Tei index was similar to healthy controls' (p>0.05). Left ventricular myocardial performance is disturbed in patients with early stage sarcoidosis. This can be related to a subclinical involvement of sarcoidosis.

Serum arylesterase activity is negatively correlated with inflammatory markers in patients with acute coronary syndromes.

OBJECTIVES: To examined whether serum paraoxonase (PON1) and arylesterase (ARE) activities are correlated with inflammatory biomarkers (procalcitonin and high sensitivity C-reactive protein (hs-CRP) in patients with acute coronary syndrome (ACS). METHODS: This cross-sectional study was conducted at the Departments of Cardiology and Biochemistry, Uludag University School of Medicine, Bursa, Turkey, from April 2007 to December 2007. Seventy-eight consecutive patients with ACS and 39 healthy controls were investigated. Acute coronary syndrome patients were divided into 3 groups according to their clinical presentation: unstable angina pectoris (UAP) (Braunwald III-B, n=25), non-ST elevation myocardial infarction (NSTEMI) (n=18), and ST-elevation myocardial infarction (STEMI) (n=35). Serum PON1/ARE activities were measured spectrophotometrically. Levels of procalcitonin and hs-CRP were measured by immunoassay. RESULTS: Paraoxonase/ARE activities were significantly lower in all patient groups compared to controls. No correlation between PON1/ARE activities and high-density-cholesterol levels was seen. Among ACS patients, serum ARE activity correlated inversely with baseline and 48-hour procalcitonin (r=-0.577, p=0.009, and r=-0.642, p=0.019) and hs-CRP levels (r=-0.614, p=0.03, and r=-0.719, p=0.044). CONCLUSION: Serum ARE activity is reduced in ACS patients and inversely correlated with inflammatory markers.

The relationship between cardiac autonomic neuropathy and Tei index in patients with type II diabetes mellitus.

OBJECTIVE: We have investigated the relationship between silent cardiac autonomic neuropathy (CAN), one of the most important causes of mortality in diabetic patients, and the Tei index, which is an indicator of global ventricular function. METHODS: Among the patients with type 2 diabetes mellitus, 15 without autonomic neuropathy (Ewing score < 1) were accepted as CAN (-) and 18 with autonomic neuropathy (Ewing score > or =1) were accepted as CAN (+).Twelve healthy individuals were included in the control group. Diastolic dysfunction and Tei index were evaluated by means of 2-D and Doppler echocardiographic examination. RESULTS: Not only Doppler mitral, but also tricuspid inflow parameters showed a significant decrease in E/A ratio, an increase in A wave amplitude and deceleration time with CAN (+) patients. Left ventricular Tei index and Ewing score were found to be positively correlated (P < 0.001, r = 0.55). Likewise to the correlation in the left ventricle, a positive correlation was also detected between right ventricular Tei index and Ewing score (P = 0.004, r = 0.43). CONCLUSIONS: We have shown that in patients with type II diabetes, CAN is related with left and right ventricular diastolic dysfunction.We also have determined that the Tei index is in correlation with CAN (Ewing score), which is a complication of diabetes.

Association between paraoxonase 1 activity and severity of coronary artery disease in patients with acute coronary syndromes.

OBJECTIVE: We sought to investigate serum paraoxonase/arylesterase activities in patients with acute coronary syndromes (ACS) and their correlations with the severity and extent of coronary artery disease (CAD). METHODS AND RESULTS: Three groups of patients were investigated: 89 patients with ACS, 54 patients with normal coronary angiograms (no-CAD group), and 27 healthy comparison subjects. ACS patients were divided into three groups according to their clinical presentation: unstable angina pectoris (UAP, Braunwald III-B, n = 31), non-ST elevation myocardial infarction (NSTEMI) (n = 27), and ST-elevation myocardial infarction (STEMI) (n = 31). Serum paraoxonase/arylesterase activities were measured spectrophotometrically. Angiographic CAD extent was expressed both by the number of vessels diseased and by the Gensini scoring system. Results showed that serum paraoxonase/ arylesterase activities and the paraoxonase/high density lipoprotein-cholesterol (HDL-C) ratio were significantly lower in the STEMI, NSTEMI, UAP groups than in no-CAD and control groups. Serum paraoxonase/arylesterase activities and paraoxonase/HDL-C ratio were reduced in patients with 2-vessel disease (VD) and 3-VD compared to the I-VD and no-CAD group (P < 0.001). In patients with ACS, the Gensini score correlated inversely with serum paraoxonase (r = -0.419, P < 0.001), arylesterase (r = -0.492, P < 0.0001), and the paraoxonase/HDL-C ratio (r = -0.377, P < 0.001). Serum arylesterase (r = 0.161, P = 0.03) and paraoxonase (r = 0.135, P = 0.002) activities were positively correlated with HDL-C levels. Serum arylesterase activity (P < 0.0001), gender (P = 0.0037), diabetes mellitus (P = 0.005) and LDL-C levels (P = 0.03) were independent predictors of CAD presence. CONCLUSIONS: Serum paraoxonase/arylesterase activities are reduced in ACS patients and inversely correlated with the severity of CAD.

Procalcitonin in patients with acute coronary syndrome: correlation with high-sensitive C-reactive protein, prognosis and severity of coronary artery disease.

OBJECTIVES: The aim of this study is to determine the relation of high-sensitive serum C-reactive protein (hsCRP) and procalcitonin with presence and severity of coronary artery disease and early prognosis in patients with acute coronary syndrome (ACS). METHODS AND RESULTS: Procalcitonin and hsCRP levels were measured at admission and after 48 hours in 50 patients (41 men, 9 women) with ACS. The patients were assigned to three groups according to their clinical diagnosis: unstable angina pectoris (UAP) (Braunwald III-B), non-ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI). Incidences of adverse cardiac events were recorded in a 3-month follow-up. Coronary angiography was performed to evaluate presence and severity of coronary artery disease. In the groups of STEMI, NSTEMI and UAP, procalcitonin (P = 0.01 3, P = 0.045 and P = 0.000 1, respectively) and hsCRP (P = 0.000 1, P = 0.01 and P = 0.00 1, respectively) levels were significantly increased. No significant correlation was found between these markers and the presence and severity of coronary artery disease. There was no correlation between procalcitonin and hsCRP levels at admission and after 48 hours and primary end points after 3 months except in the group of UAP with revascularization procedure. In the group of UAP, hsCRP levels at 48 hours were found higher in the patients with a revascularization procedure (P = 0.04). CONCLUSIONS: In conclusion, levels of hsCRP and procalcitonin are increased in patients with ACS but failed to correlate with severity of coronary disease and early prognosis.

Use of tolvaptan in patients hospitalized for worsening chronic heart failure with severe hyponatremia: The initial experience at a single-center in Turkey.

OBJECTIVE: The aim of the present study was to assess the efficacy and safety of tolvaptan for severe hyponatremia (SH) in hypervolemic heart failure (HF) patients within daily clinical practice. METHODS: We restrospectively reviewed our database on tolvaptan as an add-on treatment in hypervolemic patients admitted to our clinic due to deterioration of HF and having hyponatremia resistant to standard therapy. Severe hyponatremia was defined as serum sodium concentration ≤125 mEq/L. The database included demographic, clinical, laboratory, and echocardiographic findings on admission, and numerous outcome measures for oral tolvaptan treatment were used to assess its efficacy and safety. RESULTS: The study group consisted of 56 hypervolemic HF patients with severe hyponatremia (25 female and 31 male) with mean age of 66 years. All patients received a single dose of tolvaptan 15 mg daily for an average of 3.2 days due to severe hyponatremia. Sodium and potassium concentrations, fluid intake, and urine volume increased (p<0.0001, p=0.037, p<0.0001, and p<0.0001, respectively), whereas furosemide dosage, body weight, heart rate, systolic and diastolic blood pressure, and New York Heart Association class decreased significantly in response to tolvaptan treatment, without a rise in serum creatinine or urea concentrations (p<0.0001, p<0.0001, p=0.001, p<0.049, p<0.009 ve p=0.001, respectively). CONCLUSION: In this retrospective, single-centered study conducted in a small group of Turkish patients, short-term treatment with low-dose tolvaptan added to standard therapy of hypervolemic HF patients with severe hyponatremia was well tolerated with a low rate of major side effects and was effective in correcting severe hyponatremia.

Preliminary results from a nationwide adult cardiology perspective for pulmonary hypertension: RegiStry on clInical outcoMe and sUrvival in pulmonaRy hypertension Groups (SIMURG).

OBJECTIVE: The present study was designed to evaluate the characteristics of pulmonary hypertension (PH) and adult cardiology practice patterns for PH in our country. METHODS: We evaluated preliminary survey data of 1501 patients with PH (females, 69%; age, 44.8±5.45) from 20 adult cardiology centers (AdCCs). RESULTS: The average experience of AdCCs in diagnosing and treating patients with PH was 8.5±3.7 years. Pulmonary arterial hypertension (PAH) was the most frequent group (69%) followed by group 4 PH (19%), group 3 PH (8%), and combined pre- and post-capillary PH (4%). PAH associated with congenital heart disease (APAH-CHD) was the most frequent subgroup (47%) of PAH. Most of the patients' functional class (FC) at the time of diagnosis was III. The right heart catheterization (RHC) rate was 11.9±11.6 per month. Most frequently used vasoreactivity agent was intravenous adenosine (60%). All patients under targeted treatments were periodically for FC, six-minute walking test, and echo measures at 3-month intervals. AdCCs repeated RHC in case of clinical worsening (CW). The annual rate of hospitalization was 14.9±19.5. In-hospital use of intravenous iloprost reported from 16 AdCCs in CWs. Bosentan and ambrisentan, as monotreatment or combination treatment (CT), were noted in 845 and 28 patients, respectively, and inhaled iloprost, subcutaneous treprostinil, and intravenous epoprostenol were noted in 283, 30, and four patients, respectively. Bosentan was the first agent used for CT in all AdCCs and iloprost was the second. Routine use of antiaggregant, anticoagulant, and pneumococcal and influenza prophylaxis were restricted in only two AdCCs. CONCLUSION: Our nationwide data illustrate the current status of PH regarding clinical characteristics and practice patterns.

Contribution of 99mTc-sestamibi infusion SPECT to the characterization of fixed perfusion defects.

In patients with coronary artery disease, the distinction between scar and viable myocardium by means of myocardial perfusion imaging (MPI) sometimes can be difficult because of the equivocal meaning of fixed perfusion defects. In this study we examined whether addition of a 99mTc-sestamibi infusion study to the standard MPI could provide extra information regarding the fixed defects. Thirty-seven patients underwent standard MPI and an extra SPECT study in which 99mTc-sestamibi was given as a prolonged constant infusion. Of 324 myocardial segments available for analysis, 134 had fixed or resting perfusion abnormalities on standard MPI studies, of which 25% (33/134) in 12 patients showed partial improvement in the perfusion pattern whereas in 6% (8/134) the improvement was very significant in infusion studies. In 19 patients who were also examined with dobutamine echocardiography, 13 showed concordance between echocardiography and infusion MPI. This study suggests that infusion MPI may provide complementary information to the conventional scintigraphy with regard to interpretation of standard myocardial perfusion scans with fixed defects.