ABSTRACT
We hypothesized that patients taking warfarin require frequent hospital follow-up and they are at higher risk for complications, so the incidence of depression and anxiety is higher in patients with atrial fibrillation (AF) in the period of taking warfarin compared to the period of taking dabigatran. Fifty patients having AF without valvular diseases under treatment of warfarin in whom a transition to dabigatran was planned were consecutively enrolled in this study and followed up prospectively between July 2013 and July 2014. All patients completed Beck Depression Inventory and Hamilton Anxiety Scale (HAS) at the initiation of study and 6 months after initiation of study. Of the patients enrolled in the study, age, gender, smoking status, and comorbidities were questioned. A total of 50 patients (28 women; mean age 74.6 ± 8.7 years) treated with warfarin in whom a transition to dabigatran was planned were included. Basal mean value of BDS (15.6 ± 7.8 vs 11.5 ± 4.8, P < .001) and HAS (16.8 ± 10.4 vs 12.6 ± 8.1, P < 0.001) was significantly higher in patients when they used warfarin than when they switched to dabigatran. In categorical analysis, frequency of patients with depression (mild, moderate, and severe) was significantly higher in period of warfarin use than after dabigatran transition (n = 24, 48% vs n = 14, 28%, P = .039). Our study demonstrates that patients with nonvalvular AF under treatment of dabigatran had lower BDS and HAS scores compared to warfarin. These findings suggest that dabigatran may increase quality of life and decrease morbidity and mortality due to reduction in anxiety and depression.
Subject(s)
Anxiety/chemically induced , Atrial Fibrillation/drug therapy , Dabigatran/adverse effects , Depression/chemically induced , Warfarin/adverse effects , Aged , Aged, 80 and over , Atrial Fibrillation/complications , Dabigatran/therapeutic use , Female , Humans , Male , Prospective Studies , Quality of Life , Risk Factors , Warfarin/therapeutic useABSTRACT
BACKGROUND: Myocardial performance index (MPI) is impaired in patients with hypertension. Uric acid is biologically active and can stimulate oxidative stress, endothelial dysfunction, inflammation, and vasoconstriction. Hyperuricaemia may provide a negative contribution to impaired MPI in hypertension. AIM: The study was designed to assess the MPI in hypertensive patients with or without hyperuricaemia. METHODS: A total of 96 consecutive hypertensive patients were divided into two groups according to levels of serum uric acid (SUA); 49 normouricaemic patients (defined as SUA < 7.0 mg/dL in men and < 6.0 mg/dL in women) and 47 hyperuricaemic patients. SUA levels and other biochemistry parameters were determined by a standard analytical technique. All patients were evaluated by two-dimensional and Doppler echocardiography. RESULTS: The two groups were similar according to age, body mass index, and smoking status. Mean MPI value (0.498 ± 0.06 vs. 0.410 ± 0.05, p < 0.001) was significantly higher in the hyperuricaemic group than the normouricaemic individuals and positively correlated with the mean value of SUA levels (r = 0.51, p < 0.001). CONCLUSIONS: Our study demonstrated that high SUA levels were significantly associated with impaired MPI in hypertensive patients. SUA may suggest a valuable laboratory finding in assessing the risk of developing subclinical impaired left ventricular global function.
Subject(s)
Heart/physiopathology , Hypertension/physiopathology , Hyperuricemia/physiopathology , Aged , Echocardiography, Doppler , Female , Humans , Hypertension/complications , Hyperuricemia/complications , Male , Middle Aged , Uric Acid/bloodABSTRACT
OBJECTIVE: Acute coronary syndrom (ACS) is a common disease that causes severe morbidity and mortality. The most important aspect of ST-elevation myocardial infarction (STEMI) as a subgroup of ACS treatment is the rapid reperfusion of arteries. Successful results depend not only on the experience of the center but also on the rapidity in which reperfusion is achieved. In our study, the transfer parameters were evaluated in patients who were admitted to our hospital with STEMI. METHODS: Two hundred consecutive patients (160 males, 40 females) who underwent primary percutaneous coronary intervention (PCI) for acute STEMI between January 2011 and March 2013 were included in our study. Transfer parameters of symptom-to-reperfusion treatment, clinical characteristics, and laboratory parameters were recorded. RESULTS: Thirty-six patients were admitted to our hospital with ambulances; 70 patients were admitted to centers without PCI capability, with a mean transfer time to our hospital of 73.9±12.5 min. Median pain-to-first medical contact time was 105 min (range: 5-600 min), and average first medical contact-to-balloon time was 115.5 min (range: 20-414 min). Total pain-to-balloon time in females was significantly higher than males (246 min [range: 70-840 min], 195 min [range: 45-684 min], respectively, p=0.032). Mean pain-to-balloon time was significantly lower in patients delivered to the hospital by ambulance than in patients admitted to emergency departments independently (185 min [range: 45-439 min], 248 min [range: 65-840 min], respectively, p=0.017). CONCLUSION: In this study, our hospital door-to-balloon time was found compatible with the target specified in the European Society of Cardiology and American College of Cardiology STEMI guidelines; however, first medical contact-to-balloon time was found to be above that advised by the current guidelines.
Subject(s)
Emergency Service, Hospital/statistics & numerical data , Myocardial Infarction/epidemiology , Myocardial Infarction/therapy , Patient Transfer/statistics & numerical data , Time-to-Treatment/statistics & numerical data , Aged , Ambulances , Cohort Studies , Female , Humans , Male , Middle Aged , Percutaneous Coronary Intervention , TurkeyABSTRACT
Statins may exert pleiotropic effects in coronary artery disease (CAD), diabetes mellitus, and familial hypercholesterolemia. We evaluated the effects of statins on the neutrophil-lymphocyte ratio (NLR) and mean platelet volume (MPV) in 261 consecutive patients with hypercholesterolemia having CAD or at high cardiovascular (CV) risk and 50 healthy participants who were retrospectively included in this study. Patients were treated with 10 to 80 mg atorvastatin or 10 to 40 mg rosuvastatin for 24 weeks according to baseline levels of cholesterol, triglycerides, and CV risk. Baseline NLR and MPV were significantly higher in patients with CAD or at high risk compared to the control group (1.89 [0.37-6.78]) vs 1.44 [0.75-2.41], P < .001 and 8.8 [6.27-18.6] vs 8.45 [6-11] fL, P = .038, respectively). The NLR, MPV, and lipid parameters were also compared in the patient group after statin treatment for 24 weeks. Lipid levels decreased but the NLR and MPV did not change significantly after the statin therapy. Further studies are needed to clarify the effect of statin therapy on NLR and MPV in patients with CAD or at high CV risk.
Subject(s)
Blood Platelets/drug effects , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Hypercholesterolemia/drug therapy , Lipids/blood , Lymphocytes/drug effects , Neutrophils/drug effects , Aged , Biomarkers/blood , Female , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects , Hypercholesterolemia/blood , Hypercholesterolemia/diagnosis , Lymphocyte Count , Male , Mean Platelet Volume , Middle Aged , Retrospective Studies , Time Factors , Treatment OutcomeABSTRACT
The goal of this study was to evaluate the preejection time (PEP)-derived myocardial performance index (MPI) in hypertensive (HT) patients with sinus rhythm and its relationship to the classic Tei index. One hundred five patients were enrolled in the study (65 HT and 40 control subjects). The mean age of all patients was 50.5 ± 15 years and 60% were female. Echocardiography was performed on all patients. MPI was measured with the classic Tei method (MPI-Tei index) and the PEP-derived MPI method by using tissue Doppler echocardiography. Although the MPI-Tei index is defined as the ratio of isovolumetric contraction time (IVCT) along with isovolumetric relaxation time (IVRT) to ejection time (ET), PEP-derived MPI is defined as the ratio of PEP and IVRT to ET. We compared echocardiographic data between the HT group and the control group. MPI-Tei index and the PEP-derived MPI values were higher in the HT group compared with controls (0.52 ± 0.10 vs 0.39 ± 0.07, P < 0.001, and 0.51 ± 0.09 vs 0.39 ± 0.07). PEP-derived MPI was strongly correlated with the MPI-Tei index (r = 0.945, P < 0.001). Our study determined that the PEP-derived MPI might be used in the evaluation of left ventricular function in patients with HT, similar to the classic MPI-Tei index.
Subject(s)
Health Status Indicators , Hypertension/physiopathology , Ventricular Function, Left/physiology , Adult , Aged , Echocardiography , Electrocardiography , Female , Humans , Male , Middle Aged , Reproducibility of ResultsABSTRACT
BACKGROUND: Serum uric acid (SUA) is an independent predictor of cardiovascular events in patients with hypertension. Total atrial conduction time (TACT) is a novel echocardiographic parameter used to identify the presence of electrical and structural atrial remodeling. We hypothesized that elevated SUA levels may be associated with prolonged TACT. METHODS: A total of 50 consecutive hyperuricemic (defined as SUA>7 mg/dl for men and >6.0 mg/dl for women) patients who had hypertension were included in the study. A total of 42 normouricemic patients were also recruited consecutively as the control group. All patients were evaluated by two-dimensional echocardiography and TACT was estimated by measuring the time delay between the onset of the P-wave of ECG and peak A'-wave on the tissue Doppler imaging (TDI) of the left atrial lateral wall (PA-TDI duration). RESULTS: There were no significant differences between the two groups according to age, sex, left ventricular systolic function, left atrial diameter, and systolic and diastolic blood pressure values. PA-TDI duration was found to be significantly increased in the hyperuricemic group (112.3±14.7 vs. 92±12.7 ms; P<0.001) and positively correlated with the mean value of SUA levels (r=0.48, P<0.001). CONCLUSION: TACT increases in patients with hyperuricemia. Certainly, larger studies in different populations should further examine this potential association.
Subject(s)
Echocardiography, Doppler/methods , Heart Atria/physiopathology , Heart Conduction System/physiopathology , Hypertension/physiopathology , Hyperuricemia/physiopathology , Adult , Case-Control Studies , Electrocardiography , Female , Humans , Hypertension/blood , Male , Middle Aged , Time FactorsABSTRACT
PURPOSE: This study evaluated the response to electrical cardioversion (EC) and the effect on the myocardial performance index (MPI) in patients with persistent and long-standing persistent atrial fibrillation (AF). METHODS: We enrolled 103 patients (mean age 69.6 ± 8.9 years, 40.7% males) with a diagnosis of persistent and long-standing persistent AF. EC was applied to all patients after one g of amiodarone administration. Echocardiographic findings before EC were compared in patients with successful versus unsuccessful cardioversions and in patients with maintained sinus rhythm (SR) versus those with AF recurrence at the end of the first month. We also compared echocardiographic data before EC versus at the end of the first month in the same patients with maintained SR. RESULTS: SR was achieved in 72.8% of patients and was continued at the end of the first month in 69.3% of the patients. The MPI value of all patients was found to be 0.73 ± 0.21. The size of the left atrium was determined to be an independent predictor of the maintenance of SR at 1 month. In subgroup analyses, when we compared echocardiographic findings before EC and at the end of the first month in patients with maintained SR, the MPI (0.66 ± 0.14 vs 0.56 ± 0.09, p < 0.001) values were significantly decreased. CONCLUSIONS: Our study is the first to show impairment of the MPI, which is an indicator of systolic and diastolic function, in patients with persistent and long-standing persistent AF and improvement of the MPI after successful EC.
Subject(s)
Amiodarone/administration & dosage , Atrial Fibrillation/diagnosis , Atrial Fibrillation/therapy , Electric Countershock/methods , Stroke Volume/physiology , Aged , Analysis of Variance , Chronic Disease , Cohort Studies , Combined Modality Therapy , Echocardiography, Doppler , Electrocardiography/methods , Female , Follow-Up Studies , Heart Function Tests , Humans , Male , Middle Aged , Prospective Studies , Recovery of Function , Severity of Illness Index , Treatment OutcomeABSTRACT
OBJECTIVE: The adipocytokines visfatin and omentin have a direct effect on inflammation and endothelial injury. The expression of visfatin is closely associated with the expression of proinflammatory cytokines. Omentin has an anti-inflammatory effect and is inversely associated with coronary artery disease (CAD). The slow coronary flow phenomenon is an angiographic finding characterized by delayed distal vessel opacification in the absence of significant epicardial coronary disease. The pathophysiology of SCF has not been clearly identified, although multiple abnormalities including endothelial dysfunction, atherothrombosis and inflammation have been reported. However, the relationship between visfatin, omentin and SCF is still unknown. In this study, we aimed to investigate the relationship of these adipocytokines with SCF. METHODS: The study included slow coronary flow (n=45) and normal coronary flow (n=55) subjects, according to the corrected TIMI frame count, who underwent angiography in the catheterization laboratory of Duzce University. Statistical analyses were performed with SPSS version 12. RESULTS: Visfatin levels were significantly higher in patients with SCF than in controls (p<0.001). Plasma omentin levels were lower in the SCF group than in controls, although without statistical significance. Visfatin, gender and platelet count were significant predictors of SCF in multivariate logistic regression analysis (OR 0.748, 95% CI 0.632-0.886, p=0.01; OR 30.016, 95% CI 4.355-206.8, p=0.01; OR1.028, 95% CI 1.006-1.050, p=0.011, respectively). CONCLUSION: Adipocytokines such as visfatin and omentin may play a role in the pathogenesis of coronary slow flow.
Subject(s)
Coronary Artery Disease/blood , Coronary Artery Disease/physiopathology , Coronary Circulation , Cytokines/blood , Lectins/blood , Nicotinamide Phosphoribosyltransferase/blood , Female , GPI-Linked Proteins/blood , Humans , Male , Middle Aged , Time FactorsABSTRACT
BACKGROUND: The aim of this study was to evaluate the relationship between left ventricular (LV) myocardial performance index (MPI) and nondipper pattern in hypertensive patients. METHODS: Between June 2012 and November 2012, patients admitted to the Cardiology Department of Düzce University Faculty of Medicine and diagnosed previously with essential hypertension were included in the study. Patients were divided into two groups, nondippers and dippers, using ambulatory blood pressure measurement. All patients were evaluated by two-dimensional and Doppler echocardiography. LV MPI was calculated from tissue Doppler imaging parameters. RESULTS: There was no significant difference between the two groups in the proportion of each class of antihypertensive medications. Dippers and nondippers had similar age, BMI, lipid profiles, and smoking status. The MPI value was significantly higher in nondippers than in dippers, and was correlated negatively with the rate of systolic and diastolic blood pressure fall at night (P<0.001). CONCLUSION: Our study showed that MPI is disturbed in patients with nondipper hypertension. MPI may be used in the diagnosis and follow-up of global LV dysfunction in patients with a nondipper pattern, but further prospective studies are needed.
Subject(s)
Blood Pressure , Circadian Rhythm , Echocardiography, Doppler , Hypertension/physiopathology , Myocardium , Ventricular Function, Left , Adolescent , Adult , Female , Humans , Hypertension/diagnostic imaging , Male , Middle AgedABSTRACT
OBJECTIVE: Coronary artery disease (CAD) is the most important morbidity and mortality disease in the world. It is also one of the leading causes of death in Turkey. Omentin, a recently found adipocytokine, is reported to regulate insulin sensitivity. It has anti-inflammatory properties and is inversely associated with CAD. Omentin gene polymorphism in patients with CAD has not been studied yet. The aim of this study is to investigate the relationship between omentin Val109Asp polymorphism and CAD. METHODS: This is an observational study on genetic association. 157 consecutive patients who had undergone coronary angiography were included in the study. Seventy-five of them had CAD and the rest serves the control group. Val109Asp polymorphism was analyzed and compared. Chi-square test was used in comparison of genotype frequencies, whereas ANOVA and chi-square tests were used in comparison of clinical characteristics according to the genotypes. RESULTS: There was no significant difference between CAD patients and control subjects regarding omentin Val109Asp polymorphism. However, a 2.5 fold increase in Val/Val (homozygous mutant) genotype was detected in patients with CAD. The OR (80% Cl) for Val/Val genotype was 3.46 (1.14-10.49). CONCLUSION: Although no significant difference was detected regarding omentin Val109Asp polymorphism, Val/Val genotype frequency was found to be more in patient group than control group. In conclusion, it may be speculated that Val/Val genotype increases the tendency for CAD, but this experiment should done with larger population to clarify this issue.
Subject(s)
Coronary Artery Disease/genetics , Cytokines/genetics , Lectins/genetics , Polymorphism, Genetic , Case-Control Studies , Coronary Angiography , Coronary Artery Disease/blood , Coronary Artery Disease/diagnostic imaging , Cytokines/blood , Female , GPI-Linked Proteins/blood , GPI-Linked Proteins/genetics , Genotype , Humans , Lectins/blood , MaleABSTRACT
BACKGROUND: In-stent restenosis (ISR) is the major limitation of percutaneous coronary stenting procedure. The elements like nickel, chromate and molybdenum are known to cause contact allergy. Hypersensitivity reaction, against these metal ions, may be one of the reasons of ISR. Cobalt chromium coronary stents, which are increasingly being used in percutaneous coronary interventions, have more nickel amount than the stainless steel stents. OBJECTIVE: We aimed to investigate the association between nickel hypersensitivity reaction and ISR in patients treated with cobalt chromium coronary stents. METHODS: Epicutaneous patch tests for nickel were applied to 31 patients who had undergone elective cobalt chromium coronary stent implantation and had ISR in control angiogram. Thirty patients, without ISR, were included as the control group. Patch test results and other clinical variables were compared. RESULTS: There was no statistically significant difference of the mean age, sex, body mass index, rate of hypercholesterolemia, diabetes, hypertension and smoking between the patients with and without ISR. All other lesion characteristics were similar in the 2 groups. According to the patch test results, 7 patients had nickel contact allergy. All of these patients were in the ISR group, which was statistically significant (p<0.006). CONCLUSION: Patients treated with cobalt chromium coronary stents and had ISR were found to have significantly more nickel allergy than the control group. Nickel allergy may play role in restenosis pathophysiology.
ABSTRACT
The prevalence of myocardial involvement in influenza infection ranges from 0% to 11% depending on the diagnostic criteria used to define myocarditis. Whether such an association holds for the novel influenza A strain, pandemic-2009-H1N1, remains unknown. The clinical presentation of myocarditis varies and often mimics myocardial infarction. Although history, physical examination, laboratory data points, and electrocardiogram are helpful in distinguishing myocarditis from myocardial infarction, differential diagnosis can sometimes be difficult. Here, we present the first known report of acute myocarditis mimicking acute myocardial infarction associated with the pandemic influenza A virus (H1N1) infection.
Subject(s)
Influenza A Virus, H1N1 Subtype/isolation & purification , Influenza, Human/virology , Myocardial Infarction/diagnosis , Myocarditis/virology , Acute Disease , Adult , Antiviral Agents/therapeutic use , Coronary Angiography , Diagnosis, Differential , Electrocardiography , Female , Humans , Influenza, Human/complications , Influenza, Human/diagnosis , Influenza, Human/drug therapy , Myocarditis/diagnosis , Oseltamivir/therapeutic use , Predictive Value of Tests , Treatment OutcomeABSTRACT
BACKGROUND: Congestive heart failure (CHF) is a major public health problem that is related to substantial morbidity, impaired quality of life and diminished survival. Mean platelet volume (MPV) is an indicator of platelet activation. AIM: To investigate whether there is a difference of MPV in patients with decompensated and stable heart failure (SHF), and test the prognostic value of MPV in decompensated heart failure (DHF). METHODS: 136 consecutive patients with DHF were enrolled. 71 with SHF were also enrolled for comparison. Patients were followed up for a mean of 18±12 months. The primary endpoint was death from any cause. Clinical characteristics of patients with DHF who died during follow-up were compared with the those of the survivors. RESULTS: MPV was significantly higher in DHF group than in the SHF group. 71 patients died during the follow-up period (18±12 months). Comparison with survivors revealed that mortality was associated with age, systolic blood pressure, pulmonary artery pressure, serum creatinine, urea and MPV. MPV was determined as an independent risk factor for mortality (OR 1.553, 95% CI 1.024 to 2.354, p=0.038). Receiver operating characteristic analysis showed that MPV level on admission was a predictor of mortality (area under the curve (AUC) for in-hospital mortality was 0.716 (95% CI 0.632 to 0.789, p=0.003) and AUC for 6-month mortality was 0.815 (95% CI 0.74 to 0.877, p<0.001), respectively). CONCLUSION: MPV is increased in patients with DHF. Also, MPV on admission is an independent predictor of in-hospital mortality and 6-month mortality.
Subject(s)
Blood Platelets/pathology , Cell Size , Heart Failure/blood , Aged , Biomarkers/blood , Female , Follow-Up Studies , Heart Failure/mortality , Hospital Mortality , Humans , Logistic Models , Male , Middle Aged , PrognosisABSTRACT
The efficacy of olmesartan on fibrinolytic capacity has not been studied yet. Therefore, the aim of the present study was to investigate the efficacy of olmesartan on hemostatic/fibrinolytic status by measuring plasma level of plasminogen activator inhibitor-1 (PAI-1) and soluble thrombomodulin levels in patients with hypertension. Forty-two consecutive, newly diagnosed (25 women and 17 men with a mean age of 48 ± 8 years) patients with untreated essential hypertension were included in the study. Olmesartan medoxomil (20 mg/day) was started and the patients were followed up for 6 months. Baseline biochemical variables, thrombomodulin, and PAI-1 levels were compared with the levels of these variables measured at the end of the 6-month follow-up period. After 6 months of treatment with olmesartan medoxomil, there was a significant reduction in systolic and diastolic blood pressure (from 159.5 ± 10.9 to 134.6 ± 12.7 mmHg and from 98.0 ± 6.3 to 83.9 ± 7.0 mmHg, respectively). Mean plasma PAI-1 and thrombomodulin levels were also significantly decreased (59.73 ± 41.91 vs. 48.60 ± 33.65 ng/ml, P = 0.001 and 8.09 ± 2.29 vs. 6.92 ± 1.42 µg/l, P < 0.001, respectively). Olmesartan medoxomil decreased plasma PAI-1 and thrombomodulin levels after 6 months of therapy, indicating a favorable effect on fibrinolytic capacity in patients with essential hypertension.
Subject(s)
Angiotensin II Type 1 Receptor Blockers/therapeutic use , Antihypertensive Agents/therapeutic use , Fibrinolysis/drug effects , Hypertension/drug therapy , Imidazoles/therapeutic use , Tetrazoles/therapeutic use , Adult , Female , Humans , Male , Middle Aged , Plasminogen Activator Inhibitor 1/metabolism , Thrombomodulin/bloodABSTRACT
OBJECTIVE: Carotid intima media thickness (CIMT) is a strong predictor of future vascular events. However, data for Turkish individuals are limited and the association between cardiometabolic risk factors and CIMT has not been studied before.Therefore, we sought to investigate the CIMT and cardiometabolic risk associates in a large cohort of Turkish adults. METHODS AND RESULTS: The study was conducted on 2230 participants (1427 women, 803 men with a mean age of 49). The participants underwent a Doppler Ultrasound examination of CIMT. Mean CIMT was 0.61 +/- 0.19 mm. Age- and sex-adjusted partial correlation analysis revealed that only systolic blood pressure and smoking amount was significantly correlated with CIMT. Receiver operator characteristics (ROC) calculations showed that age had the best area under the curve (AUC = 0.84), smoking had the best sensitivity (86%) and diastolic blood pressure (> 88 mmHg) had the best specificity (74%) in predicting a person with thickened carotid intima media (> 0.8 mm). Independent predictors of thickened carotid intima media were hypertension [(odds ratio (OR) = 2.74; 95% confidence interval (CI) = 1.663-4.53; P value < or = 0.001)], systolic blood pressure [OR = 1.01; 95% CI = 1.002-1.022; P value = 0.022] and age [OR = 1.11; 95% CI = 1.079-1.136; P value < or = 0.001). CONCLUSION: Age, systolic blood pressure and smoking amount (pack/year) were the only age- and sex-adjusted associates of CIMT. Age had the best AUC in ROC analysis predicting thickened carotid artery intima media. Hypertension, systolic blood pressure and age were independent predictors of high CIMT in Turkish adults.
Subject(s)
Cardiovascular Diseases/epidemiology , Carotid Intima-Media Thickness , Age Factors , Area Under Curve , Blood Pressure , Female , Humans , Hypertension/epidemiology , Male , Middle Aged , Prognosis , ROC Curve , Risk Factors , Smoking/epidemiology , Turkey/epidemiology , Ultrasonography, DopplerABSTRACT
OBJECTIVE: Pioglitazone treatment in type 2 diabetes mellitus produced significant improvements in glycaemic control, plasma lipids, blood pressure and inflammation. The aim of this study was to investigate the effect of pioglitazone on systolic and diastolic function in diabetic patients. METHODS AND RESULTS: Forty-nine diabetic patients were included in the study. The patients had never received thiazolidinedione therapy before. Clinical and echocardiographic variables were measured. 30 mg pioglitazone were administered. The patients were followed up for six months and all the measurements were re-evaluated for comparison. Body mass index (BMI) significantly increased after treatment. Fasting glucose, HbA1c and systolic blood pressure decreased. Insulin resistance improved and the HOMA-IR index decreased after pioglitazone treatment. Mean aortic diameter, left atrial systolic and diastolic volumes significantly decreased after therapy. Among diastolic function variables mitral E wave, E/A, ejection time and pulmonary vein peak reverse flow velocity (PVA) significantly increased whereas isovolumetric relaxation time (IVRT), isovolumetric contraction time (IVCT), deceleration time, E/E' and pulmonary vein late systolic flow (PVS2) decreased after pioglitazone therapy. Among tissue Doppler variables early (E) ventricular inflow velocities measured from the tricuspid lateral annulus, the mitral septal and lateral annulus, the anterior, inferior and posterior free wall significantly increased. Late (A) ventricular inflow velocities measured from the anterior, inferior free wall and the mitral septal annulus also increased. CONCLUSION: Pioglitazone treatment in type 2 diabetes mellitus produced significant improvements in measures of glycaemic control and diastolic ventricular function.
Subject(s)
Diabetes Mellitus, Type 2/diagnostic imaging , Diabetes Mellitus, Type 2/drug therapy , Diastole/drug effects , Echocardiography, Doppler , Hypoglycemic Agents/therapeutic use , Systole/drug effects , Thiazolidinediones/therapeutic use , Ventricular Dysfunction, Left/diagnostic imaging , Ventricular Dysfunction, Left/drug therapy , Blood Flow Velocity , Blood Glucose/drug effects , Blood Pressure/drug effects , Body Mass Index , Diabetes Mellitus, Type 2/physiopathology , Female , Humans , Insulin Resistance , Male , Middle Aged , Myocardial Contraction/drug effects , Pioglitazone , Ventricular Dysfunction, Left/physiopathologyABSTRACT
OBJECTIVE: We aimed to investigate whether there was any association between the nondipping status and sleep quality in relatively young patients with an initial diagnosis of hypertension. METHODS: One hundred and thirty-three consecutive patients, diagnosed to have stage 1 hypertension by their primary physicians, were referred to our study. Patients with a history of use of any antihypertensive medication were excluded. Eligible patients underwent the Pittsburgh Sleep Quality Index (PSQI) survey, which has an established role in evaluating sleep disturbances. All patients underwent ambulatory blood pressure monitoring. RESULTS: There were 71 nondipper patients (mean age 44.3+/-5.3 years, 33 male/38 female) and 62 dipper hypertensive patients (mean age 43.3+/-6.3 years, 27 male/35 female). The PSQI scores, globally, were significantly higher in the nondippers compared with the dippers. It was noticed that all the components of the PSQI (sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbance, use of sleep medication, and daytime dysfunction) were significantly higher in the nondippers. Correlation analysis showed that systolic blood pressure fall at night was inversely and significantly related with the PSQI (r=-0.46, P<0.001). Logistic regression analysis showed that the PSQI score is an independent determinant for nondipping hypertension (HT) {odds ratio=0.842 [95% confidence interval (CI)=0.748-0.947; P=0.004]}. CONCLUSION: We showed that poor sleep quality was related with a nondipping pattern, and furthermore, it was an independent predictor of nondipping in newly diagnosed stage 1 hypertensive patients.
Subject(s)
Hypertension/physiopathology , Sleep Wake Disorders/complications , Sleep/physiology , Adult , Blood Pressure Monitoring, Ambulatory , Female , Humans , Hypertension/etiology , Male , Middle Aged , Sleep Wake Disorders/physiopathologyABSTRACT
BACKGROUND: Prolongation of the QRS complex on the surface electrocardiogram (ECG) has been shown to be predictive of cardiovascular outcomes in selected populations. A 'nondipper' blood pressure (BP) profile is currently regarded as a risk factor in its own right for cardiovascular events and target organ damage. The predictive value of ECG parameters in hypertensives with nondipper profile has not been established. METHODS: A total of 750 consecutive patients with hypertension who had been evaluated with ambulatory BP monitoring were screened for this study. One hundred and thirty-six patients who had fulfilled the inclusion and exclusion criteria were included in the final analysis. Dipper and nondipper patterns were detected and the maximum QRS duration (QRSd) measured on a 12-lead ECG was recorded. RESULTS: There were 70 nondipper and 66 dipper hypertensives. There was no significant difference between the two groups regarding the daytime systolic and diastolic mean BPs, number of medications taken, and the proportion of each class of antihypertensive medications. Other variables were similar between the two groups. QRSd was significantly higher in nondippers than dippers (P=0.006). Correlation analysis revealed that the systolic BP fall at night was inversely and significantly related with QRSd (r=-0.482, P<0.001). Regression analysis further showed that the systolic BP fall at night and age were independent correlates of QRSd. CONCLUSION: QRSd on the standard-surface 12-lead ECG was increased in patients with nondipper pattern and furthermore the systolic BP fall at night was independent correlate of QRSd in patients with hypertension.
Subject(s)
Electrocardiography , Hypertension/physiopathology , Adult , Blood Pressure Monitoring, Ambulatory , Circadian Rhythm/physiology , Female , Humans , Male , Middle Aged , SystoleABSTRACT
UNLABELLED: SUMMARY AIM: The prevalence of myocardial involvement in influenza infection ranges from 0% to 12% depending on the diagnostic criteria used to define myocarditis. Whether such an association holds for the novel influenza A strain, pandemic-2009-H1N1, remains unknown. The aim of this present study is to evaluate the cardiovascular manifestations of pandemic (H1N1) 2009 influenza A (pH1N1) by using standard echocardiography and tissue Doppler imaging (TDI). METHODS: Twenty-eight young patients who had been hospitalized for at least 24 h due to an influenza-like illness and tested positive for pH1N1 by real-time polymerase chain reaction were included in the study. All patients underwent echocardiographic studies during the first 72 h of admission. Echocardiographic studies of thirty gender and age matched control subjects were performed and the results were compared. RESULTS: Heart rate was significantly higher in patients infected with pH1N1 virus. Other clinical variables were similar between the two groups (p > 0.05). Echocardiographic variables were also similar except left ventricular end-systolic dimension, which was significantly increased in the patient group (P = 0.042). Left ventricular tissue Doppler assessment at mitral annulus showed that mean systolic velocities of pH1N1 infected patients and control group were statistically similar. However, early diastolic velocity was decreased and late diastolic velocity was increased in the patient group. Therefore early diastolic/late diastolic velocity ratio was significantly decreased in pH1N1 infected patients. Also, isovolumetric contraction time and isovolumetric relaxation time were prolonged and ejection time was significantly shortened in pH1N1 infected patients. As a result, global myocardial performance index was significantly higher in pH1N1 infected patients (p < 0.001). Right ventricular tissue Doppler assessment at tricuspid annulus showed similar results with the left ventricular measurements. CONCLUSION: The results of the study suggest an association between hospitalized pH1N1 and subclinical cardiac dysfunction as measured by tissue Doppler echocardiography.
Subject(s)
Heart/physiopathology , Influenza A Virus, H1N1 Subtype/isolation & purification , Influenza, Human/complications , Influenza, Human/pathology , Adult , Case-Control Studies , Echocardiography , Female , Humans , Influenza, Human/virology , Male , Middle AgedABSTRACT
Contrast-induced nephropathy (CIN) is associated with increased morbidity, extended hospital stay, and higher costs. We compared an atorvastatin plus N-acetylcysteine (NAC) regimen with NAC alone in patients undergoing coronary angiography. A total of 130 patients (mean age 54 +/- 10; 77 men) undergoing coronary angiography were studied. Seven CIN cases occurred in the NAC group and 2 in the atorvastatin + NAC group; this difference was not significant. Baseline mean creatinine and estimated glomerular filtration rate (eGFR) were similar between the 2 groups, whereas after the procedure there was a significant creatinine decrease and eGFR increase in the atorvastatin + NAC group. Change in creatinine (baseline creatinine-creatinine after the procedure) was also significantly higher in patients taking statin plus NAC. Atorvastatin may be effective in protecting patients undergoing coronary angiography from CIN.