Anadolu Kardiyoloji Dergisi-The Anatolian Journal of Cardiology最新文献

Objective: Epicardial adipose tissue (EAT) secretes various inflammatory mediators and growth factor, and has endocrine and paracrine effects on myocardium and body. We planned the present study in order to evaluate the possible relationship between EAT and left ventricular mass (LVM), a potent predictor of cardiovascular mortality and morbidity, independent of age, blood pressure and the metabolic parameters in patients with hypertension (HT).

Methods: The present study was cross-sectional and observational, including consecutive 107 untreated essential hypertensive patients who underwent a complete transthoracic echocardiographic examination as well as measurements of LVM and EAT. Blood pressure, routine blood chemistry, C-reactive protein, and patient characteristics were also recorded. Univariate and then multiple linear regression analyses were used for analysis of independent variables associated with EAT.

Results: LVM significantly correlated with waist circumference, EAT, glucose, uric acid, high-density lipoprotein (HDL) cholesterol, and systolic and diastolic blood pressure. When we divided study population into two groups according to median mean blood pressure (BP) (Mean BP ≤116 vs. >116 mmHg), EAT was the only associated factor for LVM in patients below median BP (Beta: 0.518, p<0.001). Linear regression analyses revealed EAT to be independently associated with LVM (Beta: 0.419; p<0.001) and LVM index (Beta: 0.384, p<0.001) as well as high-density lipoprotein (Beta: -0.264, p=0.006).

Conclusion: EAT was related to increased LVM independent of BMI, waist circumference, weight, systolic and diastolic blood pressure and other risk parameters, in patients with HT. Determination of increased EAT by echocardiography may have an additional value as an indicator of cardiovascular risk and total visceral adipose tissue.

Objective: The aim of this study was to evaluate the association of tenascin-C (TnC) and total oxidant-antioxidant status to rheumatic or congenital heart valve diseases (HVD) in pediatric patients.

Methods: Fifty pediatric patients (25 rheumatic HVD patients and 25 congenital HVD patients) and 20 healthy age-matched control subjects, aged 3-17 years, were enrolled in this observational and cross-sectional study. Serum total antioxidant capacity (TAC), total oxidant status (TOS), oxidative stress index (OSI) and TnC levels were compared among the groups. ANOVA and Kruskal-Wallis tests were used for statistical analysis.

Results: Serum TnC level of the patients with rheumatic HVD [median 9.09 (0.94-46.30) ng/mL] was significantly higher than both congenital HVD and control groups [median 2.97 (0.66-11.80) ng/mL; p<0.01, 4.72±1.77 ng/mL; p<0.05, respectively]. However, there was no statistically significant difference between the congenital and control groups in terms of serum TnC level. The levels of serum TAC, TOS and OSI were found to be statistically similar in all groups. In addition, there were no correlations between the level of TnC, and TOS and OSI.

Conclusion: Tenascin-C can be used as a biochemical marker in the differential diagnosis of rheumatic and congenital HVD. As the oxidant and antioxidant systems were found to be in equilibrium in rheumatic and congenital HVD, oxidative stress can be thought not to have a marked role in the etiopathogenesis of rheumatic HVD during childhood.

Objective: Coronary artery disease (CAD) risk increases with the elevation of low-density lipoprotein cholesterol (LDL-C), triglyceride (TG) and low level high-density lipoprotein cholesterol (HDL-C) levels. However, the magnitude at which CAD risk increases with every lipid parameter is controversial. We developed a new index called CHOLINDEX, in order to evaluate CAD risk, and investigated its reliability.

Methods: Three hundred and seven patients (190 males and 117 females, aged between 26-80 years, mean 53.6 ± 10.2 years) who underwent diagnostic coronary angiography were included in the study. Risk factors and lipid profiles of all patients were noted. CHOLINDEX was calculated by using a formula as follows: CHOLINDEX=LDL-C-HDL-C (TG<400 mg/dL), LDL-C-HDL-C + 1/5 of TG (TG ≥ 400 mg/dL).

Results: Of the 307 patients, 180 had CAD. We found that age, male gender, hypertension, diabetes mellitus, smoking and CHOLINDEX were independent predictors of CAD. The logistic regression analysis showed that the CHOLINDEX had a much more significant relation with CAD (odds ratio=1.011, 95% CI=1.003-1.019) compared with other lipid parameters.

Conclusion: CHOLINDEX is a simple index which can be used reliably in prediction of CAD like other lipid parameters in daily clinical practice.

Objective: Mitral valve stenosis (MS) remains as an important cause of morbidity despite evolution in diagnosis and treatment. Generally, left ventricular (LV) systolic functions are well preserved in patients with MS. However, there are some studies showing impaired LV systolic functions in patients with pure MS. The purpose of this study was to evaluate subclinical LV systolic dysfunction in a cohort of isolated mild-to-moderate MS patients with normal LV ejection fraction (EF) by using tissue Doppler imaging (TDI) and velocity vector imaging (VVI) techniques.

Methods: Fifty patients with isolated mild-to-moderate MS (84% female, mean age 49.1±10.0 years) and 60 healthy subjects (76.7% female, mean age 49.1±10.5) were included in this cross-sectional observational study. Conventional echocardiography, TDI, strain (S) and strain rate (SRs) analysis were performed in all patients.

Results: Transmitral mean pressure gradient was 6.4±3.0 mmHg and mean mitral valve area was 1.45±0.36 cm² in patients with MS. Both longitudinal and circumferential S and SRs were significantly reduced in patients with MS (p<0.001). TDI-derived parameters myocardial acceleration during isovolumic contraction (IVA) and peak velocity during systolic ejection (Sa) were also significantly decreased in patients with isolated MS (p<0.001). LV ejection fraction (EF) was not correlated with deformation indices. Deformation parameters were not correlated with transmitral gradient or mitral valve area.

Conclusion: VVI-derived deformation parameters may identify subclinical systolic dysfunction in patients with isolated MS with normal EF. These findings may give way to optimal timing for mitral valve surgery.

Objective: There are many studies demonstrating deteriorated ventricle and endothelium functions in familial Mediterranean fever (FMF) patients. As FMF is an autoinflammatory disease with an ongoing inflammatory activity and inflammation plays an important role in the development and progression of atherosclerosis in some of the rheumatic diseases, we aimed to investigate the early markers of atherosclerosis in patients with FMF by the measurements of serum paraoxonase-1 (PON-1) activity, mean platelet volume (MPV) and malondialdehyde (MDA) level.

Methods: This study is a cross-sectional, observational study. Forty consecutive patients with FMF and twenty healthy volunteers were selected to form the study population. The diagnosis of FMF was based on Tel-Hashomer criteria. Serum PON-1 activity, MPV and MDA level were determined to examine their association with FMF. Student's t-test, Mann-Whitney U test, Pearson correlation analysis were used for statistical analysis.

Results: The mean PON-1 activity in FMF patients was significantly lower than in the healthy population (141.46±38.29 vs. 179.62±10.73 U/l, p<0.01). Serum MDA levels were the same between the groups (1.08±0.66 vs. 1.08±0.33 nmol/mL, p=0.99). MPV was higher in FMF patients than in the control l group (8.87±0.99 vs. 8.22±0.45 fl, p=0.04). PON, MPV and MDA levels were the same in FMF patients with acute attack and attack -free period.

Conclusion: Our results show that PON-1 activity is lower in patients with FMF. Reduced PON-1 activity and increased MPV, independent of the oxidative stress status of these patients, may lead to increased atherosclerotic propensity in FMF.

Objective: Pulmonary embolism (PE) and severe pulmonary stenosis (PS) are two distinct conditions accompanied by increased pressure load of the right ventricle (RV). Despite major advances in our understanding of the mechanisms of RV adaptation to the increased pressure, substantial gaps in our knowledge remain unsettled. One of much less known aspect of pressure overload of RV is its impact on electrocardiographic (ECG) changes. In this study, we aimed to study whether acute and chronic RV overload are accompanied by different ECG patterns.

Methods: Thirty-eight patients with PE underwent ECG monitoring were compared with 20 matched patients with PS in this observational retrospective study. ECG abnormalities suggestive of RV overload were recorded and analyzed in both groups. Logistic regression analysis was used to define the predictors of chronic RV overload.

Results: Among the ECG changes studied, premature atrial contraction (OR-12.2, 95% CI, 1.3-107, p=0.008), right axis deviation (OR-20.4, 95% CI 4.2-98, p<0.001), indeterminate axis (OR-0.11, 95% CI 0.02-0.44, p=0.001 0.11), incomplete right bundle branch block (OR-4.2, 95% CI, 1.1-15.4, p=0.02), late R in aVR (OR-8.4, 95% CI 2.1-33.2, p=0.001), qR in V1 lead (OR-8.3, 95% CI 1.2-74.8, p=0.03) were found to be the independent predictors of chronic RV pressure overload.

Conclusion: Our data indicate that the ECG changes that attributed to the acute RV pressure loading states may be more prevalent in chronic RV overload as compared with acute RV overload.