The Relationship between Resistant Hypertension and Advanced Glycation End-Product Levels Measured Using the Skin Autofluorescence Method: A Case-Control Study.

Resistant hypertension is hypertension that cannot be controlled despite the use of three antihypertensive drugs, one of which is a diuretic. Resistant hypertension often coexists with advanced age, obesity, smoking, and diabetes. Advanced glycation end products (AGEs) are substances that are generated as a result of the glycation of proteins, lipids, and nucleic acids due to conditions such as hyperlipidemia, oxidative stress, and hyperglycemia. There are studies showing the relationships between AGE levels and aortic stiffness, hypertension, and microvascular and macrovascular complications in diabetes. In our study, we examined the relationship between resistant hypertension and AGE levels. Our study was planned as a case-control study, and 88 patients with resistant hypertension were included in the focus group, while 88 patients with controlled hypertension were included in the control group. The AGE levels of the patients were measured using the skin autofluorescence method. AGE levels were found to be significantly higher in patients with resistant hypertension than those recorded in the control group. A significant increase in AGE levels was also observed in patients with resistant hypertension and without diabetes compared with the control group. The levels of AGEs, which can be measured cheaply, noninvasively, and quickly with the skin autofluorescence method, may provide benefits in identifying these patients with resistant hypertension.

The Role of Advanced Glycation End-Product Levels Measured by Skin Autofluorescence in the Development of Mitral Annular Calcification.

As a person ages, mitral annular calcification develops in the mitral annulus with increasing frequency. Lipid deposition, inflammation, and aging-related degeneration have been cited as potential causes of this pathophysiology, though there is currently no conclusive evidence to support this. AGEs accumulate in tissues due to the glycation of proteins and lipids, increasing the release of proinflammatory cytokines secondary to oxidative stress through the AGE receptor. The AGE levels increase in diabetic microvascular complications and degenerative aortic valve disease. Our study was planned prospectively as a case-control study involving 94 MAC-positive patients and 94 MAC-negative patients. The demographics, echocardiographic data and AGE levels of the patients were measured and recorded using the skin autofluorescence method. AGE levels were significantly higher in the MAC-positive patient group (3.2 vs. 2.7; p < 0.001). The AGE levels were observed as an independent predictor of MAC development in a regression analysis (OR: 8.05, 95% CI: 3.74-17.33, p < 0.001). In a ROC-curve analysis, the AUC was 0.79 (95% CI: 0.72-0.85). At a cut-off value of 2.7, 79.7% sensitivity and 69.1% specificity were observed. AGE levels can be used to cheaply, easily and non-invasively identify patients at risk of developing MAC.

Short-Term Prognostic Value of the Culprit-SYNTAX Score in Patients with Acute Myocardial Infarction.

BACKGROUND: The SYNergy between Percutaneous Coronary Intervention with TAXus and Cardiac Surgery (SYNTAX) score is a scoring system that helps to decide on surgery or percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (MI), and studies are showing the prognostic value of this scoring system in both AMI and coronary artery disease patients undergoing PCI. In acute coronary syndrome (ACS) patients, the infarct-related artery and the complexity of the lesions are also important in terms of mortality and morbidity. Our study aimed to determine the prognostic value of the culprit vessel's SYNTAX score (cul-SS) in patients presenting with MI. METHODS: In our study, 1284 patients presenting with MI were analyzed retrospectively. The SYNTAX scores and cul-SS of the patients were calculated. In-hospital and 30-day deaths and major complications were accepted as primary outcomes. The SYNTAX scores and cul-SS were compared in terms of predicting primary outcomes. CONCLUSIONS: Major complications were observed in 36 (2.8%) patients, death in 42 (3.3%) patients, and stent thrombosis in 24 (1.9%) patients. The area under the curves for SYNTAX and cul-SS for predicting primary outcomes is 0.64 and 0.68 (p = 0.026), respectively. Cul-SS was as successful as the SYNTAX score in predicting stent thrombosis and was superior in predicting short-term death and major complications.

The effect of being married on heart rate variability, an indicator of autonomic dysfunction: A retrospective study.

Heart rate variability (HRV) is a noninvasive assessment that reflects the autonomic functions of the heart and is known to be impaired in many diseases. In our study, we aimed to investigate the relationship between HRV and being married. The study included 104 patients, between the aged 20 to 40 years were included in the study. The patients were divided into 2 groups as 53 healthy married (group 1) and 51 healthy unmarried (group 2). 24-hour rhythm Holter recordings were performed on all married and unmarried patients. Group 1 had a mean age of 32 ± 5 years and 47.2% men, and group 2 had a mean age of 30 ± 5 years and 54.9% men. Standard deviation of normal to normal (SDNN) was 150 ± 40 versus 128 ± 30 ( P = .003), SDNN index was 66 ± 20 versus 56 ± 12 ( P = .004), the square root of the mean of the squares of the differences of the adjacent root mean square of successive differences (RMSSD) was 37 ± 10 versus 30 ± 10 ( P < .001), percentage of successive R-R intervals that differ by more than 50 milliseconds (PNN50) was 13.5 ± 7 versus 8.5 ± 7 ( P = .001), HF was 450 ± 270 versus 225 ± 130 ( P < .001) found to be significantly less in the group 2. LF/HF ratio was 1.68 ± 0.65 versus 3.31 ± 1.56 ( P < .001) found to be significantly higher in the group 2. In our study, it is possible to say that the sympathetic system effect on the heart was more dominant and the HRV was lower in the unmarried group.

Interventional therapy of acute coronary syndromes in very old patient population and results of 2 years follow-up.

BACKGROUND: Research on cardiovascular treatment options and prognosis in very old age groups of patients is warranted. In our study, we evaluated and followed up on clinical conditions on admission and comorbidities of patients older than 80 years who were admitted to our hospital with acute myocardial infarction and shared our findings. RESULTS: A total of 144 patients were included in the study, with a mean age of 84.56 ± 5.01 years. No complications resulting in death or requiring surgery were observed in the patients. All-cause mortality was found to be related to heart failure, chronic pulmonary disease shock, and C-reactive protein levels. Cardiovascular mortality was correlated to heart failure, shock on admission, and C-reactive protein levels. No significant difference in mortality was observed between Non-ST elevated myocardial infarction and ST-elevation myocardial infarction. CONCLUSIONS: Percutaneous coronary intervention is a safe treatment option with low complication and mortality rates in very old patients with acute coronary syndromes.

Comparison of SYNTAX and Gensini Scores in the Decision of Surgery or Percutaneous Revascularization in Patients With Multivessel Coronary Artery Disease.

INTRODUCTION:  Many scoring systems have been developed to determine the extent of coronary artery disease (CAD) in patients with multi-vessel disease. The most widely used of these are Synergy between percutaneous coronary intervention with Taxus and cardiac surgery (SYNTAX) and Gensini scoring. Gensini scoring system can successfully show coronary plaque burden. In our study, we aimed to test the predictive power of SYNTAX and Gensini scores for surgical or percutaneous intervention decisions made by the cardiac team in patients with three-vessel disease. METHODS: A total of 476 patients without ST-elevation myocardial infarction with the three-vessel disease were included in the study. SYNTAX and Gensini scores of the patients were calculated from their coronary angiographies. Receiver operating characteristic curve (ROC-curve) analysis was performed using both scores. RESULTS:  Both the SYNTAX score and Gensini score were able to predict heart team decisions (AUC: 0.759, 0.680; p<0.001). Diabetes and smoking were more common in patients who were decided to have surgery (p<0.001). CONCLUSION:  In the light of our study results, the decisions to be made with the SYNTAX score will be closer to the decisions of the heart team than the Gensini score.

Neutrophil to lymphocyte ratio is associated with proximal/middle segment of the LAD lesions in patients with ST segment elevation infarction.

INTRODUCTION: Neutrophil to lymphocyte ratio (NLR) was revaled to have a close relation with atherosclerotic cardiovascular disease. The relationship between NLR and culprit plaque localization has never been studied. AIM OF THE STUDY: To evaluate the association between NLR and unstable plaque localization of left anterior descending artery (LAD) in anterior miyocardial infarction patients. MATERIAL AND METHODS: Patients admitted to our hospital with acute anterior STEMI were included. Fifhy-eight patients who have single-vessel disease at LAD and their hematological parameters were analyzed retrospectively. Proximal segment of LAD lesions were groupped as Group I and mid segment of the LAD lesion groupped as Group II. The groups were compared according to their NLR and other parameters. RESULTS: Between group I (n = 41, mean age 52.5 ±12.7) and group II (n = 17, mean ages 52.0 ±10.8); NLR, were significantly higher in group I compared to the group II (6.9 ±5.6 vs. 3.3 ±2.0, p = 0.01). In group I, left ventricular ejection fraction (LVEF) was significantly lower (p = 0.02). In correlation analyzes, NLR was positively correlated with CK MB (r = 0.32, p = 0.01) and negatively correlated with LVEF (r = -0.28, p = 0.03). CONCLUSIONS: The present study demonstrated that anterior myocardial infarction patients with high NLR had a greater possibility having proximal culprit lesion on the LAD. Therefore NLR can be used as a useful tool to culprit plaque localization in patients with acute miyocardial infarction patients.

Infective endocarditis: a tertiary referral centre experience from Turkey.

INTRODUCTION: We aimed to define the current characteristics of infective endocarditis (IE) in a part of Turkey. METHODS: All patients who were hospitalized in our hospital with a diagnosis of IE between 2009 and 2014 were included in the study. Data were collected from archives records of all patients. Modified Duke criteria were used for diagnosis. RESULTS: There were 85 IE cases during the study period. The mean age of patients was 52 years. Fourty eight of patients were males. Native valves involved in 47%, prostetic valves involved in 40% and pacemaker or ICD lead IE in 13% of patients. Mitral valve was the most common site of vegetationb (38%). The most common valvular pathology was mitral regurgitation. The most common predisposing factor was prosthetic valve disease (40%). Positive culture rate was 68%. Staphylococci were the most frequent causative microorganisms isolated (27%) followed by Streptococcus spp. (11%). In-hospital mortality rate was 36%. CONCLUSION: In Turkey, IE occurs in relatively young patients. In high developed part of Turkey, prosthetic and dejenerative valve disease is taking the place of rheumatic valve disease as a predisposing factor. Surgery is an important factor for preventing mortality.

High tenascin-C levels cause inadequate myocardial blush grade in patients with acute myocardial infarction.

AIM: Coronary artery disease (CAD) and its serious clinical form, ST segment elevated myocardial infarction (STEMI) has been the leader within the death causes around the world and in our country. In STEMI, the main objective is providing the myocardial reperfusion. In our study, it was aimed to investigate the predictive value of tenascin-C level for the degree of myocardial reperfusion in patients with STEMI. METHODS: In our study, 58 patients admitted to our hospital with acute anterior STEMI were included. All the patients had underwent primary percutaneous intervention for the single-vessel disease at left anterior descending coronary artery. After admission to coronary care unit tenascin-C levels were measured. Subjects were classified according to their myocardial blush grades (MBG); MBG 0, MBG 1 and MBG 2 were groupped as Group I, MBG 3 was groupped as Group II. The groups were compared according to their tenascin-C levels and other parameters. RESULTS: Between group I (n = 31, mean age 55 ± 12.5) and group II (n = 27, mean ages 49.3 ± 11.1); tenascin-C, troponin I and CK-MB levels were significantly higher in group I compared to the group-II (P < 0.001; P < 0.001 and P < 0.05; respectively). In group I, left ventricular ejection fraction (LVEF) was significantly lower (P < 0.001), left ventricular end-diastolic volume and left ventricular end-systolic volume were significantly higher (P = 0.03) as compared to group II. In group I, ST-segment resolution at ECG was worse (P = 0.003). In correlation analyzes, tenascin-C was significantly positively correlated with troponin-I (r = 0.596; P < 0.001) and CRP (r = 0.615, P < 0.001). Tenascin-C was significantly negatively correlated with MBG, LVEF and ST-segment resolution (r = -0.626, P < 0.001, r = -0.411, P = 0.002 and r = -0.631; P < 0.001, respectively). CONCLUSION: Based on our study, it can be estimated that in patients with high tenascin-C levels myocardial reperfusion was inadequate, even underwent successfull PCI. In this context, increased tenascin-C may help predict not only left ventricular remodelling and prognosis but also the effectiveness of primary PCI.

Mean platelet volume levels in the presence of angiographically documented peripheral artery disease.

AIM: Increased mean platelet volume (MPV) have been shown to be associated with peripheral artery disease (PAD). However in these studies, noninvasive methods for the diagnosis of PAD was used. In the literature, there is no studies examining the values of MPV in the angiographically documented PAD. We aimed to evaluate the relationship between angiographically documented PAD and MPV levels in the peripheral blood samples. METHODS: In this study, retrospective analysis of 1386 patients was performed who underwent peripheral angiography at the cardiology service of the our hospital, between 2006 and 2012 for a suspected diagnosis of lower extremity peripheral arterial disease. Patients with a stenosis percent of 50% or above in the peripheral angiography were considered as having peripheral arterial disease. MPV values are affected by many factor. Only 84 patients who complied with the inclusion criteria were detected. The study patients were divided into 2 groups according to the results of peripheral angiography. 56 patients diagnosed with PAD based on the specified criteria were grouped into Group I (mean age 59 ± 10 years) while 28 patients without peripheral arterial disease were grouped into Group II (mean age 60 ± 11 years). Blood tests and angiographic images were analyzed from patients' data. RESULTS: Both groups were similar in terms of basic parameters of anemia including hemoglobin, hematocrit and red cell distribution width levels. There were no significant differences between MPV levels in both groups (8.08 ± 0.91 vs 8.28 ± 1.16, P > 0.05). Mean corpuscular volume and mean corpuscular hemoglobin levels, on the other hand, were significantly higher in Group I (P < 0.05). CONCLUSIONS: In our study, we did not found any significant changes in the MPV levels of angiographically documented PAD diseases. The use of MPV level as a risk factor for peripheral arterial disease is impractical due to the fact that MPV is affected by a lot of factors and there are several technical factors. Because of this, in the real life, we are not recommend to use MPV values as an indicator for peripheral artery disease.

Red blood cell distribution width is associated with myocardial injury in non-ST-elevation acute coronary syndrome.

OBJECTIVES: The red blood cell distribution width has been associated with an increased risk of cardiovascular events. In the present study, we assessed the relationship between red cell distribution width values and cardiac troponin I levels in patients admitted with non-ST-elevation acute coronary syndrome. METHODS: We analyzed blood parameters in 251 adult patients who were consecutively admitted to the intensive coronary care unit with non-ST-elevation acute coronary syndrome over a 1-year period. For all patients, a baseline blood sample was collected for routine hematological testing. Cardiac troponin I was measured at baseline and after 6 h. The patients were diagnosed with non-ST-elevation myocardial infarction or unstable angina based on the elevation of cardiac troponin I levels. RESULTS: The red cell distribution width was higher in the group with non-ST-elevation myocardial infarction compared with the patient group with unstable angina (14.6±1.0 vs 13.06±1.7, respectively; p = 0.006). Coronary thrombus was detected more frequently in the group of patients with non-ST-elevation myocardial infarction than in the patients with unstable angina (72% vs 51%, respectively; p = 0.007). Using receiver operating characteristic curve analysis for the prediction of non-ST-elevation myocardial infarction based on the red cell distribution width, the area under the curve was 0.649 (95% confidence interval: 0.546-0.753; p = 0.006), suggesting a modest model for the prediction of non-ST-elevation myocardial infarction using the red cell distribution width. At a cut-off value of 14%, the sensitivity and specificity of the red cell distribution width were 73% and 59%, respectively. Additionally, the red cell distribution width was positively correlated with cardiac troponin I (r = 0.19; p = 0.006). CONCLUSION: A greater baseline red cell distribution width value was associated with myocardial injury and elevated cardiac troponin I levels in non-ST-elevation acute coronary syndrome. Therefore, the red cell distribution width could be considered for risk stratification of acute coronary syndrome patients admitted to emergency departments.

Red blood cell distribution width is associated with myocardial injury in non-ST-elevation acute coronary syndrome

OBJECTIVES: The red blood cell distribution width has been associated with an increased risk of cardiovascular events. In the present study, we assessed the relationship between red cell distribution width values and cardiac troponin I levels in patients admitted with non-ST-elevation acute coronary syndrome. METHODS: We analyzed blood parameters in 251 adult patients who were consecutively admitted to the intensive coronary care unit with non-ST-elevation acute coronary syndrome over a 1-year period. For all patients, a baseline blood sample was collected for routine hematological testing. Cardiac troponin I was measured at baseline and after 6 h. The patients were diagnosed with non-ST-elevation myocardial infarction or unstable angina based on the elevation of cardiac troponin I levels. RESULTS: The red cell distribution width was higher in the group with non-ST-elevation myocardial infarction compared with the patient group with unstable angina (14.6±1.0 vs 13.06±1.7, respectively; p = 0.006). Coronary thrombus was detected more frequently in the group of patients with non-ST-elevation myocardial infarction than in the patients with unstable angina (72% vs 51%, respectively; p = 0.007). Using receiver operating characteristic curve analysis for the prediction of non-ST-elevation myocardial infarction based on the red cell distribution width, the area under the curve was 0.649 (95% confidence interval: 0.546-0.753; p = 0.006), suggesting a modest model for the prediction of non-ST-elevation myocardial infarction using the red cell distribution width. At a cut-off value of 14%, the sensitivity and specificity of the red cell distribution width were 73% and 59%, respectively. Additionally, the red cell distribution width was positively correlated with cardiac troponin I (r = 0.19; p = 0.006). CONCLUSION: A greater baseline red cell distribution width value was associated with ...

Could elevated platelet-lymphocyte ratio predict left ventricular systolic dysfunction in patients with non-ST elevated acute coronary syndrome?

OBJECTIVE: The prognostic value of a high platelet-lymphocyte ratio (PLR) has been reported in patients with non-ST elevated myocardial infarction (NSTEMI) and different oncologic disorders. We aimed to evaluate the predictive value of the PLR for left ventricular systolic dysfunction (LVSD) in patients with non-ST elevated acute coronary syndrome (NST-ACS). METHODS: A total of 220 patients with NST-ACS were included in the study. The study population was divided into tertiles based on admission PLR values. High (n=73) and low PLR (n=147) groups were defined as patients having values in the third tertile (>135.6) and lower 2 tertiles (≤ 135.6), respectively. Left ventricular dysfunction was defined as ejection fraction ≤ 40%, and related variables were evaluated by backward conditional binary logistic regression analysis. RESULTS: The patients in the high PLR group were older (p<0.001) and had a higher rate of previous myocardial infarction and NSTEMI (p=0.046, p=0.013, respectively). There were significantly more coronary arteries narrowed (p=0.001) and lower left ventricular ejection fraction (p<0.001) in the high PLR group. Baseline platelet levels were significantly higher (p<0.001) and triglyceride and lymphocyte levels were significantly lower (p=0.009 and p<0.001, respectively) in the high PLR group. PLR >135.6 was found to be an independent predictor of systolic dysfunction in the multivariate analyses (ß: 0.306, 95% confidence interval: 0.151-0.619; p=0.001). CONCLUSION: A high PLR is a strong and independent predictor for LVSD in patients with NST-ACS.

White Blood Cell Subtypes and Neutrophil-Lymphocyte Ratio in Prediction of Coronary Thrombus Formation in Non-ST-Segment Elevated Acute Coronary Syndrome.

Leukocytes are reported as crucial not only for plaque activation but also in thrombus formation in acute coronary syndromes (ACSs). Among the markers of inflammation, in coronary artery disease neutrophil-lymphocyte ratio (NLR) has been reported to have the greatest predictive power of poor outcomes. Our aim was to evaluate the association of NLR with coronary thrombus in patients with non-ST-segment elevated ACSs (NST-ACSs). A total of 251 patients were hospitalized with a diagnosis of NST-ACS including non-ST-segment elevated myocardial infarction and unstable angina pectoris. Coronary angiographies were performed. In 167 patients, coronary thrombus was detected. Between the patient groups with and without coronary thrombus, neutrophil count, platelet count, and NLR are significantly increased, and lymphocyte count is significantly decreased in the group with coronary thrombus as compared to patient group without coronary thrombus. Leukocyte count and NLR may give an indication about the presence of coronary thrombus. In NST-ACS, blood parameters may give valuable information about the status of the coronary arteries.

Assessment of the relationship between red cell distribution width and fragmented QRS in patients with non-ST elevated acute coronary syndrome.

BACKGROUND: Red cell distribution width (RDW) and fragmented QRS (fQRS) complexes have also been reported to be pre-dictors of cardiac events and all-cause mortality in coronary artery disease (CAD). We aimed to investigate the association of serum red cell distribution width (RDW) levels and fQRS in patients with non-ST elevated acute coronary syndrome (NST-ACS). MATERIAL AND METHODS: We retrospectively evaluated a total of 251 patients (191 men and 60 women) with NST-ACS. The NST-ACS consisted of unstable angina (UA) and non-ST elevated myocardial infarction (NSTEMI). The fQRS pattern was defined as the presence of an additional R' or crochetage wave, notching in the nadir of the S wave or fragmentation of the RS or QS complexes in 2 contiguous leads corresponding to a major coronary artery territory. The relationships between the RDW and fQRS were assessed. RESULTS: The patients in the fQRS group were older, left ventricular ejection fraction (LVEF) levels were significantly lower, and baseline RDW and troponin levels were significantly higher than in the group without fQRS. There were positive correlations between age, number of coronary arteries narrowed, and RDW, and negative correlations between triglyceride, LVEF, and RDW in study patients. There were positive correlations between number of fQRS leads, age, and RDW, and negative correlations between triglyceride, LVEF, and RDW in NSTEMI patients. CONCLUSIONS: Our results indicate that an elevated RDW values is associated with fQRS in NST-ACS. Elevated RDW values and fQRS together may be useful for identifying NSTEMI patients in NST-ACS.

Disturbed Left Atrial Function is Associated with Paroxysmal Atrial Fibrillation in Hypertension.

BACKGROUND: Hypertension is the most prevalent and modifiable risk factor for atrial fibrillation. The pressure overload in the left atrium induces pathophysiological changes leading to alterations in contractile function and electrical properties. OBJECTIVE: In this study our aim was to assess left atrial function in hypertensive patients to determine the association between left atrial function with paroxysmal atrial fibrillation (PAF). METHOD: We studied 57 hypertensive patients (age: 53 ± 4 years; left ventricular ejection fraction: 76 ± 6.7%), including 30 consecutive patients with PAF and 30 age-matched control subjects. Left atrial (LA) volumes were measured using the modified Simpson's biplane method. Three types of LA volume were determined: maximal LA(LAVmax), preatrial contraction LA(LAVpreA) and minimal LA volume(LAVmin). LA emptying functions were calculated. LA total emptying volume = LAVmax-LAVmin and the LA total EF = (LAVmax-LAVmin )/LAVmax, LA passive emptying volume = LAVmax- LAVpreA and the LA passive EF = (LAVmax-LAVpreA)/LAVmax, LA active emptying volume = LAVpreA-LAVmin and LA active EF = (LAVpreA-LAVmin )/LAVpreA. RESULTS: The hypertensive period is longer in hypertensive group with PAF. LAVmax significantly increased in hypertensive group with PAF when compared to hypertensive group without PAF (p=0.010). LAAEF was significantly decreased in hypertensive group with PAF as compared to hypertensive group without PAF (p=0.020). A' was decreased in the hypertensive group with PAF when compared to those without PAF (p = 0.044). CONCLUSION: Increased LA volume and impaired LA active emptying function was associated with PAF in untreated hypertensive patients. Longer hypertensive period is associated with PAF.

Função Atrial Esquerda Prejudicada Associada com a Fibrilação Atrial Paroxística na Hipertensão / Disturbed Left Atrial Function is Associated with Paroxysmal Atrial Fibrillation in Hypertension

Fundamento: A hipertensão arterial é o fator de risco mais prevalente e modificável para a fibrilação atrial. A sobrecarga de pressão no átrio esquerdo induz alterações fisiopatológicas que ocasionam alterações na função contrátil e nas propriedades elétricas. Objetivo: Nesse estudo, o objetivo foi avaliar a função do átrio esquerdo em pacientes hipertensos para determinar a associação entre a função atrial esquerda e a fibrilação atrial paroxística (FAP). Método: Foram estudados 57 pacientes hipertensos (idade: 53 ± 4 anos, fração de ejeção do ventrículo esquerdo: 76 ± 6,7%), incluindo 30 pacientes consecutivos com FAP e 30 indivíduos de controle pareados por idade. Os volumes do átrio esquerdo (AE) foram medidos através do método biplano de Simpson modificado. Foram determinados três tipos de volume do AE: volume máximo do AE (AEVmax), contração atrial prematura do AE (AEVpreA) e volume mínimo do AE (AEVmin). Foram calculadas as funções de esvaziamento do AE. Volume total de esvaziamento do AE = AEVmax - AEVmin e a FEtotal do AE = (AEVmax - AEVmin)/AEVmax, volume de esvaziamento passivo do AE = AEVmax-AEVpreA, e a FE do AE = (AEVmax - AEVpreA)/AEVmax, o volume de esvaziamento ativo do AE = AEVpreA- AEVmin e a FE ativa do AE = (AEVpreA - AEVmin)/AEVpreA. Resultados: O período hipertenso é maior no grupo de hipertensos com FAP. O AEVmax aumentou significativamente no grupo de hipertensos com FAP quando comparado ao grupo de hipertensos sem FAP (p = 0,010). A FEAE diminuiu significativamente no grupo de hipertensos com FAP em comparação com o grupo de hipertensos sem FAP (p = 0,020). A' diminuiu no grupo de hipertensos com FAP quando comparado com hipertensos sem FAP (p = 0,044). ...

Background: Hypertension is the most prevalent and modifiable risk factor for atrial fibrillation. The pressure overload in the left atrium induces pathophysiological changes leading to alterations in contractile function and electrical properties. Objective: In this study our aim was to assess left atrial function in hypertensive patients to determine the association between left atrial function with paroxysmal atrial fibrillation (PAF). Method: We studied 57 hypertensive patients (age: 53±4 years; left ventricular ejection fraction: 76±6.7%), including 30 consecutive patients with PAF and 30 age-matched control subjects. Left atrial (LA) volumes were measured using the modified Simpson's biplane method. Three types of LA volume were determined: maximal LA(LAVmax), preatrial contraction LA(LAVpreA) and minimal LA volume(LAVmin). LA emptying functions were calculated. LA total emptying volume = LAVmax−LAVmin and the LA total EF = (LAVmax-LAVmin )/LAVmax, LA passive emptying volume = LAVmax− LAVpreA and the LA passive EF = (LAVmax-LAVpreA)/LAVmax, LA active emptying volume = LAVpreA−LAVmin and LA active EF = (LAVpreA-LAVmin )/LAVpreA. Results: The hypertensive period is longer in hypertensive group with PAF. LAVmax significantly increased in hypertensive group with PAF when compared to hypertensive group without PAF (p=0.010). LAAEF was significantly decreased in hypertensive group with PAF as compared to hypertensive group without PAF (p=0.020). A' was decreased in the hypertensive group with PAF when compared to those without PAF (p = 0.044). Conclusion: Increased LA volume and impaired LA active emptying function was associated with PAF in untreated hypertensive patients. Longer hypertensive period is associated with PAF. .

[Relationship between presence of fragmented QRS on 12-lead electrocardiogram on admission and long-term mortality in patients with non-ST elevated myocardial infarction]. / ST yükselmesiz miyokart enfarktüslü hastalarda basvurudaki 12-derivasyonlu elektrokardiyografide fragmente QRS varligi ile uzun dönem mortalite arasindaki iliski.

OBJECTIVES: Fragmented QRS (fQRS) as a predictor of cardiac events in coronary artery disease has previously been reported. In this study, we hypothesized that presence of fQRS on a 12-lead electrocardiogram (ECG) on admission would be predictive of adverse outcomes in non-ST elevated myocardial infarction (NSTEMI). STUDY DESIGN: A total of 149 NSTEMI patients (112 male, 37 female) were retrospectively analyzed. The fQRS pattern was defined as the presence of an additional R', notching in the nadir of the S wave, fragmentation of the RS or QS complexes in 2 contiguous leads corresponding to a major coronary artery territory. The relationship between presence of fQRS on admission on a 12-lead ECG, and primary end points [cardiovascular death (CVD)] and secondary end points (re-infarction, repeat target vessel revascularization [percutaneous/surgical]) were assessed. The median follow-up time was 18 (13-24) months. RESULTS: Other than age, there were no significant differences in baseline characteristics and laboratory findings for patients in the fQRS and non-fQRS groups. The patients in the fQRS group were older [64 years vs 59 years, p=0.048]. CVD and re-infarction were significantly higher in the fQRS group in the median 18-month follow-up (26.1% vs 8.7%, p=0.005; 23.9% vs 10.7%, p=0.035, respectively). By a multivariate regression analysis in all 149 patients, age ≥65 years and the presence of fQRS in a 12-lead ECG on admission were found to be powerful independent predictors of cardiovascular mortality (HR: 4.91, 95% CI: 1.60-15.03, p=0.005; HR: 2.77, 95% CI: 1.02-7.50, p=0.044, respectively). CONCLUSION: Presence of fQRS on a 12-lead ECG on admission is associated with increased long-term mortality in patients with NSTEMI.

Left atrial appendage function in prediction of paroxysmal atrial fibrilation in patients with untreated hypertension.

Abstract The onset of AF results in a significant increase in mortality rates and morbidity in hypertensive patients and this rhythm disorder exposes patients to a significantly increased risk of cerebral or peripheral embolisms. Tissue Doppler imaging was found to be useful in early detection of myocardial dysfunction in several diseases. It was shown that tissue Doppler analysis of the walls of the left atrial appendage (LAA) can give accurate information about the function of the LAA in hypertensive patients. In this study, we aimed to investigate and identify the specific predictive parameters for the onset of AF in patients with hypertension with tissue Doppler imaging of LAA. We studied age and sex matched 57 untreated hypertensive patients with paroxysmal atrial fibrillation (PAF) and 27 untreated hypertensive subjects without PAF. With transthoracic echocardiography, diastolic mitral A-velocity and LA maximal volume index which reflects reservoir function of left atrium was measured, with transesophageal echocardiography, LAA emptying velocity (LAA-PW D2) and tissue Doppler contracting velocity of LAA (LAA-TDI-D2) were measured. LA maximal volume index of the groups (22.28 ± 3.59 mL/m(2) in Group 1 versus 20.37 ± 3.97 mL/m(2) in Group 2, p = 0.07) and diastolic mitral A-velocity [0.93 (0.59-1.84) m/s in patients with PAF versus 0.90 (0.62-1.76) m/s in patients without PAF, p = 0.26] was not significantly different between study groups, during TEE, LAA-PW D2 (0.31 ± 0.04 m/s in Group 1 versus 0.33 ± 0.03 m/s in Group 2, p = 0.034) and LAA-TDI-D2 (0.18 ± 0.04 m/s in Group 1 versus 0.21 ± 0.05 m/s in Group 2, p = 0.014) were significantly decreased in Group 1. In this study, we found that in hypertensive PAF patients despite normal global LA functions, LAA contracting function was deteriorated. Tissue Doppler analysis of LAA is clinically usefull approach to detect the risk of developing PAF in hypertensives.

Left atrial mechanical functions in patients with the metabolic syndrome.

OBJECTIVE: Metabolic syndrome (MS) is a cluster of risk factors leading to cardiometabolic diseases.The aim of the present study was to investigate the effect of MS on left atrial function, which is an important determinant of left ventricular filling. METHODS: Left atrial (LA) volumes were measured echocardiographically in 32 MS patients and 32 age- and sex-matched controls. LA volumes were determined at the time of mitral valve opening (maximal, Vmax), at the onset of atrial systole (p wave on the electrocardiogram, Vp) and at the mitral valve closure (minimal, Vmin) according to the biplane area-length method in apical 4-chamber and 2-chamber view. All volumes were corrected to the body surface area, and following left atrial emptying functions were calculated. LA passive emptying volume =Vmax- Vp LA passive emptying fraction = LA passive emptying volume/Vmax . Conduit volume= LV stroke volume - (Vmax- Vmin), LA active emptying volume =Vp- Vm,, LA active emptying fraction= LA active emptying volume/Vp, LA total emptying volume = (Vmax -Vmin), LA total emptying fraction = LA total emptying volume/Vmax. RESUITS: LA maximal volume and LA presystolic volume were significantly higher in MS patients than in controls (P <0.001). But LA minimum volume was significantly lower in MS patients than in controls (P <0.001). Although LA passive emptying volume (P <0.03), LA passive emptying fraction (P <0.001) and conduit volume (P <0.001) were found to be significantly lower in MS patients than in controls, LA active emptying volume (P <0.001) and LA active emptying fraction (P< 0.001) were significantly greater in MS patients than in controls. Conclusion In our study, metabolic syndrome was associated with increased left atrial volume, decreased left atrial passive emptying function and increased pump function. Increased left atrial pump function represents a compensatory mechanism in patients with MS.Thus, these results underline the importance of maintaining a sinus rhythm in these patients.