Endothelial dysfunction, subclinical atherosclerosis and LDL cholesterol are the independent predictors of left atrial functions in hypertension.

Left atrial function has an important role in determining optimal performance of the heart. Increase of left atrial dysfunction and volume are poor prognostic factors. In this study, we investigated independent determinants of left atrial function in non-diabetic patients with de novo hypertension. The study included 124 consecutive non-diabetic patients with de novo hypertension. Brachial artery flow-mediated dilatation, carotid intima-media thickness, transthoracic echocardiography, 24-h rhythm holter, and aortic stiffness measurements were recorded. In echocardiography, left atrial maximum (LAMaV) and minimum (LAMiV) volumes were calculated. Left atrium total emptying fraction (LATEF) and total emptying volume (LATEV) were divided into two groups according to the mean levels. Multivariate analysis was performed after correlation analysis for LATEV and LATEF mean levels. By logistic regression analysis, systolic blood pressure (OR 0.882, 95% CI 0.784-0.992, p = 0.036), percent of flow-mediated dilation (OR 0.747, 95% CI 0.595-0.938, p = 0.012), and presence of carotid plaque (OR 0.014, 95% CI 0.001-0.188, p = 0.001) were found as independent variables that determine LATEF. Age (OR 0.879, 95% CI 0.795-0.972, p = 0.012), smoking (OR 23.739, 95% CI 2.699-208.810, p = 0.004), left ventricular mass index (OR 1.052, 95% CI 1.012-1.094, p = 0.011), mitrale E-wave velocity (OR 1.108, 95% CI 1.031-1.191, p = 0.005) and LDL (low-density lipoprotein) cholesterol (OR 0.942, 95% CI 0.911-0.974, p = 0.001) were independent predictors of LATEV. In non-diabetic patients with de novo hypertension endothelial dysfunction, subclinical atherosclerosis and LDL cholesterol levels independently affect left atrial function.

What have we learned from Turkish familial hypercholesterolemia registries (A-HIT1 and A-HIT2)?

BACKGROUND AND AIMS: Familial hypercholesterolemia (FH) is a common genetic disease of high-level cholesterol leading to premature atherosclerosis. One of the key aspects to overcome FH burden is the generation of large-scale reliable data in terms of registries. This manuscript underlines the important results of nation-wide Turkish FH registries (A-HIT1 and A-HIT2). METHODS: A-HIT1 is a survey of homozygous FH patients undergoing low density lipoprotein (LDL) apheresis (LA). A-HIT2 is a registry of adult FH patients (homozygous and heterozygous) admitted to outpatient clinics. Both registries used clinical diagnosis of FH. RESULTS: A-HIT1 evaluated 88 patients (27 ±â€¯11 years, 41 women) in 19 centers. All patients were receiving regular LA. There was a 7.37 ±â€¯7.1-year delay between diagnosis and initiation of LA. LDL-cholesterol levels reached the target only in 5 cases. Mean frequency of apheresis sessions was 19 ±â€¯13 days. None of the centers had a standardized approach for LA. Mean frequency of apheresis sessions was every 19 ±â€¯13 (7-90) days. Only 2 centers were aware of the target LDL levels. A-HIT2 enrolled 1071 FH patients (53 ±â€¯8 years, 606 women) from 31 outpatients clinics specialized in cardiology (27), internal medicine (1), and endocrinology (3); 96.4% were heterozygous. 459 patients were on statin treatment. LDL targets were attained in 23 patients (2.1% of the whole population, 5% receiving statin) on treatment. However, 66% of statin-receiving patients were on intense doses of statins. Awareness of FH was 9.5% in the whole patient population. CONCLUSIONS: The first nationwide FH registries revealed that FH is still undertreated even in specialized centers in Turkey. Additional effective treatment regiments are urgently needed.

EVALUATION OF PARA- AND PERIRENAL FAT THICKNESS AND ITS ASSOCIATION WITH METABOLIC DISORDERS IN POLYCYSTIC OVARY SYNDROME.

OBJECTIVE: The aim of this study was to compare para- and perirenal fat (PFT) and subcutaneous abdominal fat (SFT) measurements between patients with polycystic ovary syndrome (PCOS) and control subjects and to assess the possible relation with metabolic disorders. METHODS: This study included 68 patients with PCOS and 40 age- and body mass index (BMI)-matched healthy controls. We evaluated anthropometric, hormonal, and metabolic parameters, and abdominal ultrasonography was performed to measure PFT and SFT. RESULTS: The mean PFT values were 6.1 ± 2.9 mm in patients with PCOS and 4.3 ± 2.3 mm in healthy controls (P = .002). SFT values were also higher in the patient group (9.6 ± 5 mm) compared to healthy subjects (3.5 ± 0.5 mm) (P = .017). A significant positive correlation was found between PFT and BMI (r = 0.368), waist circumference (WC) (r = 0.441), Ferriman-Gallwey (FG) score (r = 0.313), blood pressure (systolic, SBP, r = 0.213; diastolic, DBP, r = 0.215), plasma glucose (r = 0.195), homeostasis model assessment-insulin resistance (HOMA-IR, r = 0.273), SFT (r = 0.555). Conversely, negative correlations were found between PFT and estradiol (r = -0.218) and sex hormone-binding globulin (SHBG, r = -0.304). Nonobese PCOS patients (6.1 ± 3.07 mm) had higher PFT values than nonobese controls (3.47 ± 1.5 mm); however, SFT measurements did not differ (P = .086). In multiple linear regression analysis, SFT (P = .006) was a significant and independent predictor for PFT, along with WC (P = .023). In a stepwise model, SFT was the predictor of PFT (P = .001). CONCLUSION: PFT values were higher particularly in nonobese PCOS patients compared to nonobese control subjects. There was a significant interaction between PCOS and obesity on PFT.

The importance of fragmented QRS complexes in prediction of myocardial infarction and reperfusion parameters in patients undergoing primary percutaneous coronary intervention.

OBJECTIVES: The QRS complex fragmentations (fQRS) frequently seen on admission electrocardiograms (ECGs) with narrow or wide QRS complex are associated with increased morbidity and mortality. The causative relationship between fQRS and cardiac fibrosis is known, but the relation of fragmented QRS before and after primary percutaneous coronary intervention (p-PCI) with myocardial infarction and reperfusion parameters has not been studied until now. STUDY DESIGN: The study included 184 consecutive patients with ST elevation myocardial infarction (STEMI) who underwent p-PCI. Presence or absence of fQRS on pre- and post-PCI ECGs and its change following PCI were investigated. In addition, independent predictors of fQRS were also investigated. Patients with significant organic valve disease and patients having any QRS morphology with QRS duration ?120 ms as well as patients with permanent pacemakers were excluded from the study. RESULTS: Patients with fQRS on admission ECG had higher leukocyte counts (p=0.001), higher CK-MB (p=0.001) and troponin levels (p=0.005), increased pain to balloon time (p=0.004), higher Killip score (p<0.001), prolonged QRS time (p<0.001), higher Gensini score (p<0.001) and more frequent Q waves on ECG (p<0.001) in comparison to patients with non-fragmented QRS. In addition, these patients usually had an infarction of anterior territory related to a lesion in proximal LAD and wider jeopardized myocardium (p<0.001). fQRS was significantly related to infarction and myocardial reperfusion parameters before and after p-PCI. In the setting of STEMI, absence of fQRS on admission ECG predicted increased ST resolution, higher reduction in QRS duration, and better myocardial reperfusion. CONCLUSION: FQRS may be useful in identifying patients at higher cardiac risk with larger areas of ischemic jeopardized or necrotic myocardium.

Increased serum bilirubin level is related to good collateral development in patients with chronic total coronary occlusion.

OBJECTIVE: Bilirubin is a bile pigment with potent anti-oxidant properties; in previous studies it has been reported to be negatively associated with coronary artery disease (CAD). Although elevated serum bilirubin concentrations may protect against endothelial dysfunction, it is not clear whether higher serum bilirubin levels (SBLs) in physiological ranges may work in favor of good collateral development in patients with chronic total coronary occlusion (CTO). METHODS: The study population consisted of patients who underwent coronary angiography with a suspicion of CAD. Patients who had CTO in at least one major coronary artery were included. Coronary angiograms of 179 eligible patients from our database were reanalyzed and 110 of them had good collateral development and 69 had poor collateral development according to the Cohen-Rentrop method. RESULTS: Patients with good collateral development had a lower fasting plasma glucose level (FPG) (p=0.024) and higher SBLs in comparison to patients with poor collateral development (p<0.001). The number of CTO vessels (p=0.013) and left ventricular ejection fraction (EF%) were higher in good collateral group than poor collateral group (p=0.017). In multivariate analysis, FPG negatively (odds ratio [OR]: 0.981, p=0.003) and SBL (OR for per 0.1-mg/dL increase: 1.832, p<0.001) and the number of CTO vessels (OR: 5.642, p=0.007) were positively related to coronary collateral development. CONCLUSION: This study suggests that higher bilirubin levels within relatively normal ranges were related with favorable coronary collateral growth in patients with CTO. SBL may be responsible for the difference in coronary collateral vessel development among different patients with coronary artery disease. The anti-inflammatory and anti-oxidant properties of bilirubin may mediate this effect.

Relationship of the angiographic extent of peripheral arterial disease with coronary artery involvement.

OBJECTIVE: To determine the co-incidence of coronary artery disease (CAD) in patients investigated for peripheral arterial disease (PAD), and to establish the relationship between the risk factors in the two groups of patients. METHODS: The prospective study, done from January 2005 and April 2009, at the Cardiology Clinic of Rize Education and Research Hospital, Rize and John F. Kennedy Hospital, Istanbul, Turkey, had a cohort of 307 patients who had been diagnosed with peripheral artery disease either clinically or by ultrasonography for the arteries of the lower extremities and had undergone coronary angiography and peripheral angiography in the same or different sessions. The patients were evaluated in terms of age, gender and atherosclerotic risk factors. Relationship of the extent of peripheral arterial disease with coronary artery involvement was investigated. RESULTS: Of the 307 patients, 251 (81.8%) were male, and the mean age was 62.1 +/- 9.5 years. In the study population, 178 (58.0%) patients were diagnosed as hypertensive, 84 (27.4%) patients were diabetic, 18 (5.9%) patients had a family history of coronary artery disease, 111 (36.2%) were smokers, 149 (48.5%) were hypercholesterolemic, and 20 (6.5%) had cerebrovascular/carotid disease. In 92.3% of patients with peripheral arterial disease, various levels of coronary stenosis (P = 0.007) was noticed. Hypertension was a risk factor for both coronary and peripheral artery diseases (p = 0.012 and 0.027, respectively). Univariate logistic regression analysis demonstrated that the presence of peripheral artery disease was related to the coronary variety (Odds ratio [OR]: 6, 95% CI: 1.4-25.5, P = 0.016) and severe cases (diffused atherosclerotic stenosis and complete occlusion in all segments) significantly indicated the presence of some coronary pathology (OR: 8, 95% CI: 1.7-37.4, P = 0.008). This relationship maintained its significance after adjustment for age, gender, hypercholesterolaemia, smoking, hypertension, diabetes, family history, and the presence of cerebrovascular/carotid disease (p = 0.010). CONCLUSIONS: Peripheral coronary artery diseases had similar risk factors. The extent of peripheral arterial disease observed during peripheral lower extremity angiography was significantly associated with the presence and severity of coronary artery disease. Particular attention should be focused on the possibility of coronary artery disease in patients with established and extensive peripheral arterial disease. Non-invasive, as well as invasive tests, should be performed to decrease morbidity and mortality risk of such patients.

Heart fatty acid binding protein and myoglobin after reperfusion of acute myocardial infarction.

OBJECTIVE: The aim of this study was to disclose the release kinetics of heart fatty acid binding protein (HFABP) and myoglobin in acute myocardial infarction (AMI) reperfused by primary percutaneous coronary intervention (PPCI) and to determine the influence of the quality of coronary flow post PPCI on the release properties of these markers. METHODS AND RESULTS: Twenty-four patients with AMI who underwent successful PPCI and had no evidence of reocclusion within the first 120 minutes were studied. Serum myoglobin and HFABP levels at baseline and at 15, 30, 45, 60, 90 and 120 minutes after reperfusion were measured. Corrected TIMI frame count (CTFC) in the relevant vessel post PPCI was used to categorize patients in group I (CTFC > 21) and group 2 (CTFC < or = 21). Biomarker ratios at each sampling point were calculated by dividing the serum level of the biomarker at the specific sampling time by its baseline level. Baseline myoglobin and HFABP levels rose significantly at 15 minutes (153 +/- 251.5 microg/L vs. 904.3 +/- 542.6 microg/L, 10.9 +/- 8 microg/L vs. 17.8 +/- 9.1 microg/L, both P < 0.0001) after successful PPCI. Group 2 patients tended to have higher biomarker ratios at each time point as compared to group I. CONCLUSIONS: Successful PPCI for AMI results in a significant increase of both HFABP and myoglobin levels within 15 minutes of vessel opening and the quality of flow in the infarction-related artery post PCI as evaluated by CTFC does not influence the release kinetics of these biomarkers.

Effect of metoprolol on heart rate variability in symptomatic patients with mitral valve prolapse.

Metoprolol is widely used to eliminate symptoms in patients with mitral valve prolapse (MVP), a condition associated with enhanced sympathetic tone. In this study, effects of metoprolol on heart rate variability (HRV) indices were investigated in symptomatic patients with MVP. Thirty-nine symptomatic patients with MVP (26 women, mean age 26 +/- 7 years) and 16 age- and gender-matched controls were studied. After a baseline 24-hour Holter evaluation in all subjects, patients with MVP were started on metoprolol succinate therapy at a dose of 25 to 100 mg/d, and Holter analysis was repeated at the end of 3 months of metoprolol therapy. At the basal evaluation, all time-domain HRV indices with the exception of proportion of adjacent RR intervals differing by >50 ms in the 24-hour recording were significantly lower in patients with MVP than controls (SD of all normal-to-normal [NN] intervals, p = 0.013; SD of average NN intervals calculated during 5-minute periods of the entire recording, p = 0.03; triangular index, p = 0.025; and square root of mean squared differences in successive NN intervals, p = 0.026). After metoprolol treatment, all HRV indices significantly improved compared with baseline (SD of all NN intervals, p = 0.028; SD of average NN intervals calculated during 5-minute periods of the entire recording, p = 0.043; triangular index, p = 0.004; square root of the mean squared differences in successive NN intervals, p = 0.021; and proportion of adjacent RR intervals differing by >50 ms in the 24-hour recording, p = 0.014), and HRV indices after metoprolol treatment were similar to those of the control group (p >0.05). In conclusion, metoprolol significantly improved impaired HRV parameters in symptomatic patients with MVP.