Mehmet Fatih Karakas

Background. Ventricular dyssynchrony is an co-determinant of progression and exacerbation of heart failure (HF). The co-existence of ventricular dyssynchrony with hypertension (HT) and HF were shown, however there is no data regarding the effect of circadian rhythm of blood pressure (BP) on ventricular synchrony. Therefore, we aimed to study the left ventricular synchrony in dipper and non-dipper normotensive and hypertensive participants. Methods. Participants (n = 142) were categorized into four groups as “Normotensive-Dipper” (NT-D) (n = 40), “Normotensive-Non-dipper” (NT-ND) (n = 30), “Hypertensive-Dipper” (HT-D) (n = 38) and “Hypertensive-Non-dipper” (HT-ND) (n = 34). Left ventricular dyssynchrony was investigated by color-coded tissue Doppler imaging. Results. Non-dippers had higher 24-h and night-time BP both in normotensives and hypertensives. The incidence of ventricular dyssynchrony (a Ts-SD-12 > 34.4 ms) was higher in the hypertensive group (47.2% vs 24.3%, p = 0.005). The frequency of ventricular dyssynchrony was higher in the HT-ND group than the HT-D group (58.8% vs 36.8%, p = 0.05); however, the frequency of ventricular dyssynchrony was similar among the normotensives (26.7% vs 22.5%, p = 0.45). Ts-SD-12 and Ts-12 were higher in NT-ND group than the NT-D group. Conclusions. Non-dipping BP pattern was associated with impaired left ventricular contraction synchrony in both normotensive and hypertensive participants, which may be related with short- and long-term effects of HT on myocardium.

Background: Atherosclerosis is a complex inflammatory process in which inflammatory markers are involved. Although pentraxin 3 (PTX-3), a newly identified inflammatory marker, was associated with adverse outcomes in stable angina pectoris, no association between PTX-3 and the complexity of coronary artery disease (CAD) has been reported. Thus, the aim of the present study was to assess the association between the level of PTX-3 and the complexity and severity of CAD assessed with SYNTAX and Gensini scores in patients with stable angina pectoris. Methods: The study population consisted of 2 groups: 161 patients with anginal symptoms and evidence of ischemia who underwent coronary angiography and 50 age- and sex- matched control subjects without evidence of ischemia were included. Patients were grouped into 3 groups according to the complexity and severity of coronary lesions assessed by the SYNTAX score (30 patients with a SYNTAX score of 0 were excluded). Serum PTX-3 and high-sensitivity C-reactive protein (hs-CRP) levels were measured. Results: The PTX-3 levels demonstrated an increase from low to high SYNTAX groups ( r = 0.72, P < 0.001). Whereas the low SYNTAX group had statistically significantly higher PTX-3 levels when compared with the control group (0.50 ± 0.01 vs 0.24 ± 0.01 ng/mL, P < 0.001), the hs-CRP levels were not different (0.81 ± 0.42 vs 0.86 ± 0.53 mg/dL, P = 0.96). However, the intermediate SYNTAX group had higher hs-CRP levels compared with the low SYNTAX group (1.3 ± 0.66 vs 0.86 ± 0.53 mg/dL, P = 0.002). Serum PTX-3 levels and hs-CRP levels were correlated with the SYNTAX scores and Gensini scores (for SYNTAX: r = 0.87 [ P < 0.001] and r = 0.36 [ P = 0.01]; for Gensini: r = 0.75 [ P < 0.001] and r = 0.27 [ P = 0.002], respectively), and according to the results of univariate and multivariate analyses, for “intermediate and high” SYNTAX scores, age, diabetes mellitus, low-density lipoprotein cholesterol, hs-CRP, and PTX-3 were found to be independent predictors, whereas for the presence of “high” SYNTAX score only PTX-3 was found to be an independent predictor. The receiver operating characteristic curve analysis further revealed that the PTX-3 level was a strong indicator of high SYNTAX score with an area under the curve of 0.91 (95% confidence interval, 0.86-0.96). Conclusions: Pentraxin 3, a novel inflammatory marker, was more tightly associated with the complexity and severity of CAD than hs-CRP and was found to be an independent predictor for high SYNTAX score.

Background: Sickle cell anemia (SCA) is the most common inherited anemia. Although heart involvement in SCA is well‐established, there is no data about changes of contraction synchrony in SCA. Therefore, we aimed to study the left ventricular contraction synchrony in SCA patients with narrow QRS and normal ejection fraction (EF).Methods: Thirty‐six patients with SCA and 37 age‐ and gender‐matched control subjects were included in the study. Left ventricular dyssynchrony was investigated by color‐coded tissue Doppler imaging.Results: The SCA patients had lower hemoglobin (Hb) and higher ferritin, left ventricular end‐diastolic diameter, left ventricular end‐systolic diameter, left ventricular mass index (LVMI), and pulmonary artery pressure. Peak A velocity, Dt, and E/E′ values were higher in the SCA group however, E/A ratio and average Em were higher in the control group. LV systolic dyssynchrony parameters including Ts‐SD‐12, Ts‐12, Ts‐SD‐6, and Ts‐6 were found to be higher in SCA group when compared with controls. In addition to that, the patients with ventricular dyssynchrony (a Ts‐SD‐12 > 34.4 msec) were higher in the SCA group than the control group (55.6% vs. 8.1%, P < 0.001). In the correlation analysis, systolic dyssynchrony parameters were found to be correlated with Hb, ferritin, LVMI, E/A, Dt, Em.Conclusion: Our results revealed that in SCA patients with normal EF and narrow QRS, left ventricular systolic dyssynchrony was an early manifestation of heart involvement and might be coexisted with or preceding diastolic dysfunction.

Objectives: The aim of the present study was to assess the association between the level of pentraxin-3 (PTX-3) and the severity of metabolic syndrome (MS). Subjects and Method: One hundred and two patients with MS and 101 consecutive age- and sex-matched control subjects were included in the study. The MS patients were classified into three groups based on the number of MS criteria, i.e. group 1: patients with 3 MS criteria, group 2: patients with 4 MS criteria, and group 3: patients with 5 MS criteria. Serum PTX-3 and high-sensitivity C-reactive protein (hs-CRP) levels were measured. Results: Group 1 had higher PTX-3 levels compared to the control group (0.58 ± 0.11 ng/ml vs. 0.36 ± 0.15 ng/ml, p < 0.001). PTX-3 levels were higher in group 3 than in both group 1 (0.90 ± 0.06 ng/ml vs. 0.58 ± 0.11 ng/ml, p < 0.001) and group 2 (0.90 ± 0.06 ng/ml vs. 0.63 ± 0.12 ng/ml, p < 0.001). Group 3, however, had higher hs-CRP levels than both group 1 (1.89 ± 0.45 mg/dl vs. 1.40 ± 0.44 mg/dl, p = 0.007) and group 2 (1.89 ± 0.45 mg/dl vs. 1.47 ± 0.58 mg/dl, p = 0.01). The control group had lower hs-CRP levels than group 1 (0.81 ± 0.47 mg/dl vs. 1.40 ± 0.44 mg/dl, p < 0.001) and group 2 (0.81 ± 0.47 mg/dl vs. 1.47 ± 0.58 mg/dl, p < 0.001). Serum PTX-3 levels correlated with serum hs-CRP levels (r = 0.49, p < 0.001). Conclusions: PTX-3, a novel inflammatory marker, was found to be associated with the severity of MS.

Boron is important for many enzymes, most of which also have a role in the ischemic tolerance of the myocardium. We aimed to evaluate the influence of dietary boron intake on ischemic tolerance in a rat model. Materials and methods: Rats were divided into 3 groups according to the ischemia protocol: Sham (S) (n = 20 total), ischemia only (Isc-only) (n = 40 total), and remote ischemic preconditioning + ischemia (RIPC+Isc) (n = 40 total) groups. These 3 groups were further divided into 4 according to the amount of daily dietary boron (

High levels of mean platelet volume (MPV) have been shown to be a predictor of poor clinical outcome among survivors of myocardial infarction. We evaluated the association between admission MPV and infarct-related artery (IRA) patency in patients treated with thrombolytic therapy for acute myocardial infarction (AMI). We retrospectively evaluated 133 consecutive patients with ST-elevation AMI, who received thrombolytic therapy within 12 hours of chest pain. Sixty-five patients received streptokinase and 68 patients received recombinant tissue-type plasminogen activator, based on the discretion of the physician. Blood samples were taken before thrombolytic therapy and MPV was measured. Coronary angiography was performed within a mean of two days after thrombolytic therapy and the flow in the IRA was assessed with the TIMI flow grade and corrected TIMI frame count (CTFC). After thrombolytic therapy, TIMI 3 flow was achieved in 62 patients (46.6%), whereas 71 patients (53.4%) had insufficient TIMI flow. Patients with insufficient TIMI flow had a significantly higher mean admission MPV (9.8+/-1.5 fl vs. 8.6+/-1.4 fl; p0.05). There was a weak correlation between MPV and CTFC (p=0.01). Multivariate analysis showed MPV (OR 1.871, 95% CI 1.402-2.498; p<0.001) and the type of thrombolytic agent (OR 2.915; 95% CI 1.333-6.374; p=0.007) as independent predictors of insufficient TIMI flow. The receiver operating characteristic analysis yielded a cutoff value of 8.885 fl for MPV to predict insufficient TIMI flow, with sensitivity and specificity being 70.4% and 66.1%, respectively. Our findings show that a higher admission MPV is associated with an increased risk for insufficient TIMI flow in the IRA after thrombolytic therapy for AMI.

Penetrating atherosclerotic ulcers (PAU), aortic dissection, and intramural hematoma are the three most important diseases involving the aorta which are classified as acute aortic syndromes. Penetrating atherosclerotic aortic ulceration is characterized by ulceration of atheromatous plaque disrupting the internal elastic lamina. These aortic ulcers may penetrate through the media to cause aortic pseudoaneurysms or less often through the adventitia to cause transmural aortic rupture. We described a case of penetrating atherosclerotic ulcer of ascending aorta mimicking ST elevation myocardial infarction. To our knowledge, this is the first case reported in the literature of such a complication from PAU.