Development and Validation of a Scale to Measure Fear of Activity in Patients With Coronary Artery Disease (Fact-CAD).

OBJECTIVE: To develop and validate a scale to measure fear of activity in patients with coronary artery disease. DESIGN: Psychometric study. SETTING: Outpatient cardiology clinics. PARTICIPANTS: The scale was applied to patients who had myocardial infarction, coronary artery bypass grafting, or percutaneous coronary intervention within the last 12 months (N=250). INTERVENTIONS: A scale for fear of activity in patients with coronary artery disease (Fact-CAD) was created through semistructured focus group interviews with patients. Face and content validity of Fact-CAD was verified. MAIN OUTCOME MEASURES: Psychometric analysis included model fit, unidimensionality, reliability, local dependency, differential item functioning, and external construct validity. Analyses were performed using the Rasch Analysis Model. RESULTS: Fact-CAD scale was a reliable (high Person Separation Index of 0.89) and valid (unidimensional, no misfit, local independency supported, no residual correlations) measure of fear of activity. Three items showed differential item functioning according to employment status, marital status, and angina pectoris, which were not assigned as real item bias by experts and remained in the model. CONCLUSION: Fact-CAD was supported by Rasch analysis as a psychometrically valid scale to evaluate fear of activity in patients with coronary artery disease.

A Novel Marker of Impaired Aortic Elasticity in Never Treated Hypertensive Patients: Monocyte/High-Density Lipoprotein Cholesterol Ratio.

BACKGROUND: Monocyte to high density lipoprotein cholesterol ratio (MHR) is generally understood to be a candidate marker of inflammation and oxidative stress. Therefore, we aimed to assess the association between MHR and aortic elastic properties in hypertensive patients. METHODS: A total of 114 newly-diagnosed untreated patients with hypertension and 71 healthy subjects were enrolled. Aortic stiffness index, aortic strain and aortic distensibility were measured by using echocardiography. RESULTS: Patients with hypertension had a significantly higher MHR compared to the control group (p < 0.001). Also, aortic stiffness index (p < 0.001) was significantly higher and aortic distensibility (p < 0.001) was lower in the hypertensive group. There was a positive correlation of MHR with aortic stiffness index (r = 0.294, p < 0.001) and negative correlation with aortic distensibility (r = -0.281, p < 0.001). In addition, MHR and high sensitivity C-reactive protein have a positive correlation (r = 0.30, p < 0.001). Furthermore, MHR was found to be an independent predictor of aortic distensibility and aortic stiffness index. CONCLUSIONS: In patients with newly-diagnosed untreated essential hypertension, higher MHR was significantly associated with impaired aortic elastic properties.

Platelet to lymphocyte ratio as a novel indicator of inflammation is correlated with the severity of metabolic syndrome: A single center large-scale study.

Metabolic syndrome (MetS) as a cluster of several cardio-metabolic components is rapidly growing public-health problem worldwide and significantly associated with poor cardiovascular outcomes. Increased visceral adiposity activates the important pathways connecting low-grade chronic inflammation, oxidative stress and blood coagulation. Recently, platelet to lymphocyte ratio (PLR) has been evidenced as a novel indirect inflammatory marker. Therefore, for the first time, we aimed to investigate the association of PLR with both the presence and severity of MetS. In this cross-sectional study, a total of 1146 participants were enrolled (n = 539 with MetS and n = 607 without MetS). MetS was defined according to NCEP-ATP III criteria. MetS (+) group revealed significantly higher PLR and C-reactive protein (CRP) levels as compared to MetS (-) group (p < 0.05). There was a graded relationship between increasing number of MetS components and PLR (p < 0.05). Also, PLR was positively correlated with CRP level (r = 0.163, p < 0.001). In multivariate regression analysis, PLR [1.121 (1.113-1.135), p < 0.001], CRP [1.044 (1.029-1.060), p < 0.001], and age [1.030 (1.017-1.043), p < 0.001] were remained as independent predictors for the presence of MetS. In conclusion, our findings showed that increased PLR was significantly associated with both the presence and severity of MetS which was linked to systemic inflammation based on the correlation between PLR and CRP. As PLR is an easily available, simple and cheap indirect indicator of inflammation, it can be used in clinical practice as a predictor of MetS.

Evaluation of Tp-E Interval and Tp-E/QT Ratio in Patients with Aortic Stenosis.

BACKGROUND: The risk of syncope and sudden cardiac death due to ventricular arrhythmias increased in patients with aortic stenosis (AS). Recently, it was shown that Tp-e interval, Tp-e/QT, and Tp-e/QTc ratio can be novel indicators for prediction of ventricular arrhythmias and mortality. We aimed to investigate the association between AS and ventricular repolarization using Tp-e interval and Tp-e/QT ratio. METHODS: Totally, 105 patients with AS and 60 control subjects were enrolled to this study. The severity of AS was defined by transthoracic echocardiographic examination. Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios were measured from the 12-lead electrocardiogram. RESULTS: Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios were significantly increased in parallel to the severity of AS (P < 0.001, P = 0.001, and P = 0.001, respectively). Also, it was shown that Tp-e/QTc ratio had significant positive correlation with mean aortic gradient (r = 0.192, P = 0.049). In multivariate logistic regression analysis, Tp-e/QTc ratio and left ventricular mass were found to be independent predictors of severe AS (P = 0.03 and P = 0.04, respectively). CONCLUSIONS: Our study showed that Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios were increased in patients with severe AS. Tp-e/QTc ratio and left ventricular mass were found as independent predictors of severe AS.

3D echocardiographic imaging of a septal myocardial cleft in hypertrophic cardiomyopathy.

Myocardial clefts are defined as narrow, deep blood-filled invaginations within the left ventricular myocardium. They occur in hypertrophic cardiomyopathy patients with different frequency and represent a distinctive morphological expression of hypertrophic cardiomyopathy. Although two-dimensional transthoracic echocardiography is able to detect myocardial clefts in some cases, cardiovascular magnetic resonance imaging with its high spatial resolution can detect myocardial clefts not visualized with echocardiography. In this report, we represent multimodality imaging of a septal myocardial cleft in a hypertrophic cardiomyopathy patient.

Effect of Vitamin D Replacement on Atrial Electromechanical Delay in Subjects with Vitamin D Deficiency.

OBJECTIVES: Limited data are available regarding cardiac arrhythmias in vitamin D (VitD) deficiency. Therefore, we aimed to assess whether atrial electromechanical delay (AEMD) measured by tissue Doppler imaging (TDI), which is an indicator for atrial fibrillation (AF) development, is prolonged in patients with VitD deficiency as compared to the control group. The effect of vitD replacement on AEMD was also evaluated. METHODS: In this prospective study a total of 28 VitD-deficient and 56 age-, gender-, and BMI-matched VitD-sufficient healthy participants were enrolled. P-wave dispersion (PWd) was calculated on the 12-lead electrocardiogram. Both intra- and inter-AEMD were calculated by TDI. Measurements were performed at baseline in both groups and were repeated after 6-month replacement therapy in subjects with vitD deficiency. RESULTS: PWd and inter- and left intra-AEMD were significantly prolonged in patients with VitD deficiency compared to the control group (P < 0.001). While serum 25(OH)D levels were significantly and negatively correlated with left intra-AEMD (r = -0.657, P < 0.001), there was a positive correlation between serum 25(OH)D level and PWd (r = 0.523, P < 0.001). The serum 25(OH)D level was found as the independent predictor of the both left intra- and inter-AEMD in the multivariate linear regression analysis (ß:-0.552, P < 0.001 and ß:-0.555, P < 0.001, respectively). The serum 25(OH)D level was significantly increased after replacement therapy. While inter-AEMD was significantly decreased (P = 0.013), there was no change in PWD and left and right intra-AEMD (P > 0.05) following replacement therapy. CONCLUSION: PWd and left intra- and inter-AEMD are increased in patients with VitD deficiency. The serum 25(OH)D level was found as an independent predictor for AEMD in patients with VitD deficiency. Also a significant decrement was observed in inter-AEMD following vitD replacement therapy. Studies with longer follow-up are needed to investigate whether vitD-deficient patients with prolonged AEMD develop clinical arrhythmia and vitD replacement reduces the risk of atrial arrhythmias.

Impaired cardiac autonomic functions in apparently healthy subjects with vitamin D deficiency.

OBJECTIVES: Vitamin D (VitD) deficiency affects the cardiovascular system via endocrine, paracrine, and autocrine pathways. Limited data are available regarding cardiac autonomic dysfunction in VitD deficiency. The aim of this study was to assess the cardiac autonomic functions by using heart rate recovery index (HRRI) and heart rate variability (HRV) in apparently healthy subjects with VitD deficiency. METHODS: A total of 24 VitD deficient and 50 age-, gender-, and body mass index-matched VitD sufficient healthy participants who admitted to outpatient clinics at a tertiary centre were enrolled. All study participants underwent Treadmill exercise test and 24-hour Holter recording to assess cardiac autonomic functions. HRRIs were calculated by subtracting first, second, and third minute heart rates during recovery period from maximal heart rate. RESULTS: Mean HRR1 (28.0 ± 8.3 vs 42.8 ± 6.4, P < 0.001), HRR2 (41.1 ± 11.2 vs 60.8 ± 10.4, P < 0.001), and HRR3 (44.9 ± 13.3 vs 65.9 ± 9.8, P < 0.001) were significantly higher in VitD sufficient group compared to VitD deficient group. HRV parameters as, SDNN (P = 0.040), SDANN (P < 0.001), RMSSD (P < 0.001), PNN50 (P < 0.001), and HF (P < 0.001) were significantly decreased in patients with VitD deficiency; but LF (P < 0.001) and LF/HF (P = 0.003) were significantly higher in VitD deficient group. Serum 25(OH)D level was positively correlated with HRRIs (P < 0.001), PNN50, RMSSD, SDANN, and HFnu; negatively correlated with LFnu and LF/HF (P < 0.05). Also, multivariate linear regression analysis showed that serum 25(OH)D level was significantly associated with HRRIs and HRV parameters (P < 0.001). CONCLUSION: Our study results suggest that cardiac autonomic functions are impaired in patients with VitD deficiency despite the absence of overt cardiac involvement and symptoms. Further studies are needed to elucidate the prognostic significance and clinical implications of impaired autonomic functions in patients with VitD deficiency.

Three noninvasive methods in the evaluation of subclinical cardiovascular disease in patients with acromegaly: epicardial fat thickness, aortic stiffness and serum cell adhesion molecules.

CONTEXT: Several studies have reported increased risk of cardiovascular disease due to early development of endothelial dysfunction and structural vascular changes in patients with acromegaly. OBJECTIVE: The aim of this study was to evaluate subclinical cardiovascular disease with epicardial fat thickness (EFT), aortic stiffness and serum levels of cell adhesion molecules (CAMs) in patients with acromegaly. DESIGN: Cross-sectional study. PATIENTS: Twenty-seven patients with active acromegaly (AA), 13 patients with remission acromegaly (RA) and 37 age- and sex-matched healthy controls were studied. MEASUREMENTS: Epicardial fat thickness was evaluated by transthoracic echocardiography (TTE). Aortic stiffness (ß) index, aortic strain (AoS) and aortic distensibility (AoD) were calculated from the aortic diameters measured by TTE. Serum levels of CAMs such as intercellular adhesion molecule (ICAM)-1, vascular cell adhesion molecule (VCAM)-1 and E-selectin were measured. RESULTS: Epicardial fat thickness was significantly increased in patients with RA and AA as compared to controls 9·71 ± 1·54 and 10·08 ± 1·95 mm vs 5·74 ± 0·92 mm, P < 0·001, respectively). A significant positive correlation was found between the EFT and growth hormone (GH) levels (r = 0·365, P = 0·024). ß-index was similarly higher in patients with RA and AA than controls (15·68 ± 7·27 and 11·90 ± 8·24 vs 6·85 ± 2·87, P < 0·001, respectively). AoS and AoD were significantly decreased in patients with RA and AA as compared to the control group (3·81 ± 1·94 and 3·68 ± 1·99 vs 8·19 ± 4·19%, P < 0·001, respectively; and 1·21 ± 0·66 and 1·18 ± 0·63 vs 2·58 ± 1·50, 10(-6) cm(2) /dyn, P < 0·001, respectively). Serum ICAM-1 and VCAM-1 levels were significantly higher in patients as compared to the control group (P < 0·001 vs P = 0·032, respectively). There were no significant differences in EFT, AoD, AoS, ß-index and serum CAMs between two patients groups (AA vs RA, P > 0·05). There was a significant negative correlation between E-selectin and AoD (r = -0·45, P = 0·008). In multiple linear regression analysis, EFT was found to be associated with GH levels (ß-coefficient = 0·575, P = 0·008). CONCLUSION: This study suggests that EFT and risk of subclinical cardiovascular disease are increased in patients with acromegaly. Serum GH level is an independent risk factor for EFT.

Myocardial tissue perfusion predicts the evolution of fragmented QRS in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.

BACKGROUND: Fragmented QRS complex (fQRS) is associated with worse outcomes in several cardiovascular conditions. However, alterations in fQRS in patients with ST elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI) and association of fQRS with myocardial blush grade (MBG) has not been investigated until now. In this study, we aimed to investigate the association of MBG after primary PCI with evolution of fQRS. METHODS: Our study consisted of 401 consecutive patients with STEMI who underwent primary PCI. Patients were categorized into two subgroups according to persistence or new-onset of fQRS (Group 1) and absence or resolution of fQRS (Group 2) at 48 hours after primary PCI. The evolution of fQRS on pre- and post-PCI ECG and their relation with myocardial reperfusion parameters were investigated. RESULTS: Patients in group 1 showed older age, higher rate of smoking, lower HDL-cholesterol, lower LVEF, higher angina-to-door time, higher TIMI frame count, and high rate of patients with MBG <3 compared to patients with group 2 (P < 0.05). In correlation analysis, LVEF showed positive correlation with MBG (r = 0.448, P < 0.001) and negative correlation with the number of leads with fQRS (r = -0.335, P < 0.001). In multivariate regression analysis, new-onset or persistance of fQRS after primary PCI is significantly associated with MBG <3, peak CK-MB level, pre-PCI fQRS at anterior localization and smoking. CONCLUSION: Our findings showed that despite complete ST-segment resolution in all patients, fQRS is independently associated with impaired microvascular myocardial perfusion. So, fQRS, as a simple and easily available noninvasive marker, may be useful in stratification of high-risk patients with increased extent of infarcted myocardium who underwent primary PCI.

Fragmented QRS predicts the arrhythmic events in patients with heart failure undergoing ICD implantation for primary prophylaxis: more fragments more appropriate ICD shocks.

BACKGROUND: Fragmented QRS complex (fQRS) is associated with cardiovascular outcomes in various patient populations. Although there were clinical studies investigating the association of fQRS with arrhythmic events in patients with systolic heart failure, the results were conflicting regarding the association of implantable cardioverter defibrillator (ICD) shocks and fQRS. In this study, we aimed to evaluate the association between the presence and extent of fQRS with appropriate ICD shocks and/or all-cause mortality. METHODS: A total of 215 patients (age: 58.2 ± 11.6 years, 72.5 % male) with the diagnosis of left ventricular systolic heart failure in whom ICD had been implanted for primary prophylaxis were enrolled. Standard ECG evaluation revealed fQRS complex in 123 patients (57.2 %). The phenomenon of fQRS was defined as deflections at the beginning of the QRS complex, on top of the R wave, or in the nadir of the S wave similar to the definition in CAD. RESULTS: At mean 23.5 ± 12.1 months follow-up, all-cause mortality was observed in 45 (20.9 %) patients and 111 (51.6 %) patients experienced appropriate ICD shocks. Median number of ECG leads with fQRS were higher in patients with appropriate ICD shocks (3 [2-6] vs 1 [0-2], P < 0.001, respectively). The presence of fQRS (HR: 6.64, 95 % CI: 3.54-12.4, P < 0.001) and the number of leads with fQRS (HR: 1.35, 95% CI: 1.22-1.67) were found as independent predictors of appropriate ICD shocks. Additionally, there was a negative correlation between left ventricular ejection fraction and the number of leads with fQRS (r = -0.434, P < 0.001). Rates of all-cause mortality did not differ between the fQRS(+) (29 [24 % ]) and fQRS(-) (16 [17 % ]) groups (P = 0.27). CONCLUSION: Our findings suggest that the presence and extent of fQRS complex on standard 12-lead ECG predicts appropriate ICD shocks in patients with left ventricular systolic heart failure who underwent ICD implantation for primary prophylaxis.

Increased epicardial adipose tissue thickness is linked to aortic stiffness in patients with primary hypertension.

AIMS: In patients with hypertension (HT), increased aortic stiffness is related to higher cardiovascular morbidity and mortality. Recent investigations have shown that epicardial adipose tissue (EAT) is a new potential cardiometabolic risk factor. The aim of our study was to examine the relation between echocardiographically measured EAT thickness and aortic stiffness in patients with primary HT. METHODS: The study included 144 newly diagnosed and untreated essential hypertensive outpatients. Transthoracic echocardiographic EAT thickness and aortic stiffness measurements were performed for all study participants. Afterwards patients were divided in two groups according to their median EAT thickness values. The patients with EAT thickness of < 7 mm were included in group 1 and patients with EAT thickness of ≥ 7 mm were included in group 2. RESULTS: Aortic strain and distensibility parameters of group 2 were lower than in group 1. The aortic stiffness index of group 2 was found to be higher than group 1. Multivariate regression analysis revealed that EAT thickness was the only independent variable for all three parameters of aortic stiffness index, aortic strain and aortic distensibility. CONCLUSION: In patients with newly diagnosed primary HT, increased EAT thickness was significantly linked to impaired aortic elastic properties independently of other conventional adiposity measurements.

The effect of different circadian blood pressure rhythms on left ventricular systolic dyssynchrony in patients with newly diagnosed essential hypertension.

OBJECTIVES: Left ventricular (LV) synchronous contraction is impaired in patients with hypertension (HT). The deleterious effects of HT on cardiovascular system are more evident in patients with nondipper HT than dippers. In this study, we aimed to investigate the effect of nondipping HT on LV systolic synchronicity compared with dippers and controls. METHODS: One hundred patients with newly diagnosed essential HT and 50 normotensive subjects were enrolled in this study. The hypertensive patients were assigned 2 groups comprising 55 dippers and 45 nondippers. Each subject underwent a comprehensive transthoracic echocardiographic examination. The evaluation of systolic dyssynchrony was performed by tissue synchronization imaging, and the time to regional peak systolic tissue velocity (Ts) in LV was measured on the basis of 12 segmental models. The standard deviation (SD) of the 12 LV segments (Ts-SD-12) and maximal difference in Ts between any two of the 12 LV segments (Ts-12) were calculated. RESULTS: Compared with the control group, the synchronicity indexes were significantly prolonged in the hypertensive patients. Furthermore, Ts-SD-12 and Ts-12 values were found to be significantly impaired in patients with nondipper HT, compared with dippers: Ts-SD-12 (38.1 ± 18.7 vs. 31.8 ± 15.4, P ≤ 0.001); Ts-12 (123.0 ± 50.6 vs. 98.4 ± 42.3, P ≤ 0.001). Stepwise multivariate logistic regression analysis revealed a significant negative association between LV dyssynchrony indices and percentage decline in BP level from day to night. CONCLUSION: Synchronous systolic contraction of LV is found to be significantly impaired in patients with nondipping circadian pattern of HT compared with dippers and the controls.

Relation between QRS duration and atrial synchronicity in patients with systolic heart failure.

OBJECTIVES: The association of QRS duration (QRSd) with ventricular dyssynchrony is well-known in systolic heart failure (HF). However, there are no data regarding the relationship between QRSd and atrial dyssynchrony in patients with HF. We aimed to investigate the association of QRSd with intra-atrial and inter-atrial dyssynchrony in patients with systolic HF by using color tissue Doppler imaging (TDI). METHODS: The study consisted of 70 systolic HF patients and 35 healthy controls. According to QRSd, HF patients were categorized into 2 subgroups as narrow QRS (n = 35) and wide QRS (n = 35) groups. Time intervals between the onset of P-wave and the onset of A-wave on color TDI from the right atrium (P-RA), inter-atrial septum (P-IAS) and left atrium (P-LA) were measured. Atrial dyssynchrony was defined as differences between P-RA and P-IAS (RA dyssynchrony), between P-LA and P-IAS (LA dyssynchrony) and between P-RA and P-LA (inter-atrial dyssynchrony). RESULTS: In patients with either HF groups, we observed significant impairment in intra-atrial and inter-atrial synchronicity compared with the controls (P < 0.001). Moreover, LA, RA and inter-atrial synchrony were found to be significantly impaired in the wide QRS group compared to narrow QRS group. There was also a positive and strong correlation between atrial and ventricular dyssynchrony parameters. In stepwise multivariate analysis, QRSd was found to be the independent predictor of intra-atrial and inter-atrial dyssynchrony in systolic HF. CONCLUSION: Among patients with systolic HF, prolonged QRSd is associated with impaired intra-atrial and inter-atrial synchrony. Atrial and ventricular dyssynchrony parameters were well-correlated with each other.

[Relation between epicardial adipose tissue thickness and blood pressure levels in prehypertension]. / Prehipertansiyonda epikardiyal yag dokusu kalinligi ile kan basinci düzeyleri arasindaki iliski.

OBJECTIVES: Increased epicardial adipose tissue (EAT) thickness is a risk factor for cardiovascular diseases. Previous studies have demonstrated that EAT thickness is increased in patients with hypertension compared with normotensive individuals. In the current study, we aimed to evaluate whether echocardiographically measured EAT thickness differs among patients with normotension, prehypertension, hypertension, and the relation between EAT thickness and blood pressure levels in prehypertensives. STUDY DESIGN: Patients with prehypertension (n=50) and hypertension (n=50) and normotensive healthy subjects (n=50) according to the American Hypertension Guidelines (Joint National Committee 7) were enrolled in the study. All participants underwent transthoracic echocardiographic examination. EAT thickness was measured from the parasternal long-axis view at end-systole. RESULTS: Compared with normotensives, EAT thickness was significantly increased in subjects with prehypertension and hypertension (4.1±1.1 mm, 5.4±1.3 mm and 6.6±1.5 mm, respectively, p<0.001). After adjustment for confounding factors like age, gender, high-density lipoprotein, waist circumference, and body mass index, EAT thickness in the normotensive, prehypertensive and hypertensive groups was measured as 4.3±1.2 mm, 5.3±1.2 mm and 6.4±1.4 mm, respectively (p=0.001). In the prehypertensive group, multivariable linear regression analysis showed that EAT thickness was positively correlated with both systolic (r=0.305, p=0.001) and diastolic (r=0.297, p=0.001) blood pressures, independent of other risk factors. CONCLUSION: In addition to hypertensive subjects, echocardiographically measured EAT thickness is increased in prehypertensive patients when compared with normotensive subjects, independent of other factors. Additionally, increased EAT thickness is significantly correlated with systolic and diastolic blood pressure levels in patients with prehypertension.

Heart rate variability and red cell distribution width in patients with systolic left heart failure.

OBJECTIVE: Red cell distribution width (RDW) is a strong prognostic marker for systolic left heart failure regardless of the anemia status, and heart rate variability (HRV) is negatively associated with mortality and sudden cardiac death in patients with systolic left heart failure. Their relationship has not been investigated in the previous literature. DESIGN: One hundred eighty four patients who had been previously diagnosed with systolic left heart failure (with ischemic or non-ischemic etiology) were retrospectively enrolled in our study. Patients underwent 24-h electrocardiographic monitoring, and blood samples for RDW and other variables were analyzed. Study population was grouped into tertiles of RDW (Tertile 1: 13.4 ± 1.4%, Tertile 2: 14.6 ± 1.4%, and Tertile 3: 17.1 ± 1.2%). RESULTS: Most of the characteristics of patients were similar among RDW tertiles. Standard deviation of all normal RR intervals (SDNN), standard deviation of the averages of RR intervals in all 5-min segments (SDANN) and root-mean square of difference of successive RR intervals (RMSSD) values significantly differed among groups (p < 0.001). The highest RDW tertile had the lowest HRV values, and Pearson correlation analysis yielded a negative correlation between HRV parameters and RDW (for SDNN, SDANN, RMSSD; r = 0.373, 0.340, 0.362, respectively, p < 0.001 for all). In stepwise multivariate analysis HRV was independently associated with RDW. CONCLUSIONS: The HRV parameters were independently associated with RDW in patients with systolic left heart failure.

Red cell distribution width and inflammation in patients with non-dipper hypertension.

Red cell distribution width (RDW) is independently associated with morbidity and mortality in cardiovascular diseases. RDW is elevated in hypertensive patients compared with normotensives. Based on the nocturnal course, hypertension classified as dipper and non-dipper. Non-dipper hypertension is associated with higher inflammation and worse prognosis. We aimed to investigate whether RDW and high-sensitive C-reactive protein (hsCRP) are elevated in non-dipper hypertensive patients compared with dippers. The study included total 247 essential hypertensive patients. Twenty-four-hour ambulatory blood pressure monitoring (ABPM) was performed for each patient. Thereafter patients were divided into the two groups on the basis of the results of 24-h ABPM: 127 dipper hypertensives and 120 non-dipper hypertensives. Complete blood count and biochemistry were measured by standard methods and hsCRP was assessed by using BN2 model nephelometer. Non-dippers had significantly higher RDW levels than dippers [14.6 (13.8-17.0) vs 13.0 (12.5-13.4), p < 0.001, respectively]. After adjustment for hemoglobin, low-density lipoprotein-cholesterol, sex, age and hs-CRP, mean RDW values were for dipper and non-dippers 13.4 (12.4-13.2) and 14.5 (13.7-16.8), respectively (p < 0.001). RDW was negatively correlated with the percentage decline of systolic and diastolic BP from day to night (r = - 0.392, p < 0.001 and r = - 0.294, p < 0.001, respectively). Serum hsCRP levels were also significantly higher in the non-dippers (p < 0.001) and it was significantly positively correlated with RDW (r = 0.403, p < 0.001). In receiver-operating characteristic curve analysis, the optimal cut-off value of RDW to predict non-dipping pattern was > 13.8%, with 80% sensitivity and 75% specificity. RDW is significantly increased in patients with non-dipper hypertension compared with the dipper hypertension. Inflammatory activity was closely related to RDW in non-dipper hypertensives. RDW, as easy and quick measurable tool, can predict non-dipping pattern in essential hypertension.

Increased epicardial fat thickness is associated with low grade systemic inflammation in metabolic syndrome.

OBJECTIVES: Epicardial fat tissue is a type of visceral adipose tissue that functions as a metabolically active endocrine organ. Most components of metabolic syndrome (MetS), especially visceral obesity, are associated with a low-grade systemic inflammatory state. In this study, we aimed to assess the relationship between echocardiographic epicardial fat thickness (EFT), MetS, the components of MetS, and high sensitivity C-reactive protein (hs-CRP) levels in patients with MetS. STUDY DESIGN: Forty-six patients (25 males, mean age 47.3±6.5 years) with the diagnosis of MetS (according to the Adult Treatment Panel III update criteria) but without clinical coronary artery disease, and 44 age and gender matched healthy volunteers (18 males, mean age 46.0±6.1 years) were included in the study. EFT, which was measured by transthoracic echocardiography, as well as clinical and biochemical parameters were compared between the two groups. RESULTS: Waist circumference, total and LDL-cholesterol, fasting glucose, triglycerides, systolic and diastolic blood pressure levels, hs-CRP, and uric acid levels were significantly higher in patients with MetS. EFT was also significantly increased in patients with MetS (8.7±0.2 mm vs. 4.8±0.1 mm, p<0.001). Multiple regression analysis determined that MetS itself (ß=0.929, p<0.001) and hs-CRP (r=-0.181, p=0.007) are independent predictors of increased EFT. CONCLUSION: This study demonstrates that EFT is higher in patients with MetS, and that MetS and hsCRP are independent predictors of this increased EFT. Increased EFT, which is associated with low-grade systemic inflammation, may play a role in the pathogenesis of atherosclerosis in MetS patients.

[Primary percutaneous coronary intervention for acute myocardial infarction in elderly aged 75 years and over: in-hospital mortality and clinical outcome]. / Yetmis bes yas ve üstündeki akut miyokart enfarktüslü hastalarda primer perkütan girisim: Hastane içi mortalite ve klinik sonuçlari

OBJECTIVES: We aimed to determine the in-hospital mortality and clinical outcome of patients older than 75 years who were admitted to our high-volume tertiary center with ST-elevation myocardial infarction (STEMI) and treated with primary percutaneous intervention (PCI). STUDY DESIGN: Our study included patients over 75 years old who were admitted with STEMI and underwent primary PCI at our center between January 2008 and September 2011. We retrospectively collected data from our hospital records for 1165 patients with STEMI. We found 186 patients that were eligible for our study. We defined major adverse cardiovascular events (MACE) as in-hospital mortality, repeated target vessel revascularization, and reinfarction. RESULTS: The mean age of the patients was 79.7±4.4 years and the mean pain-balloon inflation time was 4.7±2.3 hours. The procedure success rate was 71.5%. In-hospital mortality and MACE occurred in 20.4% and 25.8% of patients, respectively. Twenty patients had cardiogenic shock at admission. Patients with cardiogenic shock had significantly more MACE than the rest of the study population (76.5% vs. 17.5%, p<0.0001). Independent predictors of MACE included Killip class at admission (OR 4.98, 95% CI 1.25-19.8, p=0.02), white blood cell counting (OR 1.15, 95% CI 1.0-1.3, p=0.04), development of in-hospital heart failure (OR 3.34, 95% CI 1.07-10.58, p=0.04), the presence of atrioventricular block in the hospital (OR 3.98, 95% CI 1.09-14.5, p=0.04), and the TIMI flow rate after primary PCI (OR 3.42, 95% CI 1.19-10.76, p=0.04). CONCLUSION: Our study revealed a high rate of MACE in patients older than 75 years admitted with STEMI regardless of undergoing primary PCI.

The relationship between saphenous coronary bypass graft occlusion and serum gamma-glutamyltransferase activity.

OBJECTIVES: Serum gamma-glutamyltransferase (GGT) activity has been shown to be associated with progression of atherosclerosis. We evaluated the relationship between serum GGT levels and saphenous vein bypass graft disease at least one year after coronary artery bypass graft (CABG) surgery. STUDY DESIGN: The study included 125 consecutive patients who had undergone CABG surgery with at least one saphenous vein graft (SVG) and were referred to cardiac catheterization for stable anginal symptoms or positive stress test results at least one year after CABG surgery. Laboratory parameters including serum GGT levels were measured before angiography. Occluded grafts were defined as a luminal stenosis of ≥70% or absence of distal TIMI 3 flow. Thus, SVGs were found to be patent in 53 patients (42.4%; 40 males, 13 females; mean age 65±8 years) and occluded in 72 patients (57.6%; 62 males, 10 females; mean age 64±9 years). RESULTS: The two groups were similar with regard to age, gender, hypertension, diabetes mellitus, family history of coronary artery disease, smoking, and alcohol consumption. The mean time from CABG to angiography was similar in patients with a patent and occluded SVG (6.8±4.3 vs. 8.1±3.7 years; p>0.05). Waist circumference was greater (p=0.02) and serum levels of total cholesterol (p=0.001), triglyceride (p=0.02), uric acid (p<0.001), hs-CRP (p<0.001), GGT (p<0.001) and fibrinogen (p<0.001) were significantly higher in patients with occluded veins. Serum GGT level was moderately but significantly correlated with waist circumference (r=0.2, p=0.04), uric acid (r=0.3, p=0.008), and hs-CRP (r=0.3, p=0.002). In logistic regression analysis, total cholesterol (OR=1.012, 95% CI 1.002-1.023, p=0.03), hs-CRP (OR=1.968, 95% CI 1.17-3.311, 0.01), uric acid (OR=1.57, 95% CI 1.1-2.208, p=0.01), and GGT (OR=1.047, 95% CI 1.002-1.1, p=0.04) were found to be significant predictors of SVG occlusion. CONCLUSION: Our results suggest that serum GGT activity is associated with higher occlusion rates of venous bypass grafts.