Mustafa Topuz

Background: Erectile dysfunction (ED) is a prevalent condition, with vasculogenic ED being the most common subtype, primarily related to endothelial dysfunction and cardiovascular risk factors. Low-intensity extracorporeal shock wave therapy (Li-ESWT) has emerged as a promising non-invasive treatment option. However, predictors of treatment response remain poorly defined. Aim: To identify clinical and vascular predictors of treatment success following Li-ESWT in patients with vasculogenic ED and to develop a novel, practical, and non-invasive scoring system to predict therapeutic response. Methods: This prospective study included 219 men aged 18-80 years with vasculogenic ED between January 2024 and January 2025. All patients underwent Li-ESWT (18 000 pulses over 3 weeks). Clinical and vascular parameters, including age, ED duration, body mass index, presence of cardiovascular risk factors, diabetes mellitus (DM), carotid intima-media thickness (cIMT), flow-mediated dilation rate (FMD), and prior phosphodiesterase type 5 inhibitor (PDE5i) response, were recorded. Treatment success at 6 months was defined as an increase of ≥1 point in the erection hardness score or ≥5 points in the International Index of Erectile Function-5 EF. Outcomes: The primary outcome was treatment success at 6 months after Li-ESWT. Secondary outcomes included the development and validation of a predictive scoring system. Results: Treatment success rate was 66.2% (145/219). Independent predictors of treatment success were absence of DM (odds ratio [OR] = 2.67, P = .012), ED duration <36 months (OR = 2.23, P = .026), cIMT <0.8 mm (OR = 2.04, P = .042), prior PDE5i benefit (OR = 2.47, P = .016), FMD ≥5% (OR = 2.57, P = .012), age <65 years (OR = 2.28, P = .032), and presence of cardiovascular risk factors (OR = 2.23, P = .036). A scoring system incorporating these 7 variables achieved an area under the curve of 0.819 (95% confidence interval [CI] 0.762-0.877). Using a cut-off of 4.5 points, the sensitivity was 73% and the specificity was 77% (P < .001). Clinical Implications: This scoring system may help clinicians identify patients most likely to benefit from Li-ESWT, optimize patient selection, and improve individualized treatment strategies in vasculogenic ED. Strengths & Limitations: The study is strengthened by its prospective design, relatively large sample size, and inclusion of vascular function parameters (FMD, cIMT). Limitations include the lack of external validation and the absence of penile Doppler ultrasound confirmation in all patients. Conclusion: This study identified key demographic and vascular predictors of Li-ESWT response and introduces a novel, non-invasive clinical scoring system with strong predictive accuracy. This tool may enhance treatment personalization and support clinical decision-making in the management of ED.

Aim: No-reflow phenomenon (NRP) is an undesirable result of coronary interventions, and usually occurred during the primary percutaneous coronary intervention (PPCI). On the other hand, there is gr...

Article: Epicardial adipose tissue thickness predicts non-dipper statue in newly diagnosed hypertensive patients - Gazzetta Medica Italiana - Archivio per le Scienze Mediche 2021 March;180(3):80-6 - Minerva Medica - Journals

Background: Interleukin-18 (IL-18), a pro-inflammatory cytokine, increases inflammation in the endothelium. Increased inflammation plays an important role in the development of hypertension (HT). IL-18 level is higher in hypertensives than normotensives. Objective: To investigate the relationship between IL-18 level and diurnal blood pressure (BP) variations in newly diagnosed HT patients. Methods: This prospective study included 130 subjects referred to outpatient cardiology clinic with an initial diagnosis of HT. The patients were classified as dipper HT (n = 40), non-dipper HT (n = 50), and normotensive (control, n = 40) according to 24-hour ambulatory BP monitoring. All subjects underwent blood sampling after 12 hours of fasting and transthoracic echocardiography. Results: The serum IL-18 level was significantly higher in the patient group compared with the controls (195.17 ± 93.00 mg/dl vs. 140.75 ± 71.11 mg/dl, P < 0.01) and also in the non-dipper group than in the dipper group (217.3 ± 96.90 mg/dl, 167.5 ± 80.79 mg/dl, P = 0.011). IL-18 level was positively correlated both the night-time SBP and DBP levels (r = 0.29, P = 0.02 and r = 0.34, P < 0.01, respectively). On multivariate linear regression analysis, left atrium diameter, left ventricular mass index, and serum IL-18 level were independent predictors of non-dipping pattern in newly diagnosed HT patients. Conclusion: Higher IL-18 level was particularly associated with an increase in the night-time BP levels. IL-18 can be used as a predictor for non-dipper HT in newly diagnosed HT patients.

Background: It is well known that erectile dysfunction (ED) is associated with increased risk of atrial fibrillation (AF) development. On the other hand, prolongation of the duration of atrial electromechanical delay (AEMD) is known to be a precursor for AF development. We aimed to evaluate AEMD in patients with ED patients without documented AF. Methods: Total of 68 outpatients with previously documented vascular ED and 44 participants without ED were enrolled to the current study. Sixty-eight patients with ED called as ED group and 44 participants without ED served as control group. We performed International Index of Erectile Function (IIEF-5) questionnaire for all participants to determine the disease severity of ED groups and to diagnose ED in control groups. Patients with a IIEF-5 score ≥22 were defined as having normal erectile functions. Both intra- and inter-AEMD were measured with tissue Doppler imaging. P-wave dispersion (PWD) was measured on a 12-lead electrocardiogram. Results: Basal characteristics were similar between the two groups. PWD, inter- and right intra-AEMD were significantly prolonged in patients with ED, compared to the control group (p = .02, p < .001 and p < .001, respectively). In the correlation analysis, IIEF-5 score was significantly negative correlated with systolic blood pressure, right intra- and inter-AEMD (r = –0.37, p = .02; r= −0.27, p = .02; r = –0.39, p = .001, respectively). Conclusions: According to current study results, AEMD is significantly correlated with ED severity and may be useful to stratify ED patients to the high-risk group for future development of AF as a cheap and easy method.

Ojective: The aim of this study was to evaluate the potential relationship between 25-hydroxyvitamin D-3 (25[OH]D-3), the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score, and spontaneous reperfusion (SR) in patients with ST-elevation myocardial infarction (STEMI). Methods: A total of 148 consecutive patients with acute STEMI who underwent primary percutaneous coronary intervention were retrospectively enrolled in the study. Result: In all, 36 patients with a TIMI 3 flow score (spontaneous reperfusion [SR]) before coronary intervention constituted Group 1, and 112 patients with a TIMI flow score of 0-2 served as Group 2. The SYNTAX score and the in-hospital major adverse cardiovascular event (MACE) rate were significantly higher in Group 2 (p<0.001, p=0.012, respectively). The mean 25(OH)D-3 level was significantly higher in Group 1 (p=0.003). Age, Killip class, left ventricular ejection fraction, and N-terminal pro-B-type natriuretic peptide were correlated with the SYNTAX score, and 25(OH)D-3, troponin-I, C-reactive protein, and creatinine were weakly correlated with the SYNTAX score. Multilogistic regression analysis indicated that the SYNTAX score (p<0.001), Rentrop collateral (p=0.049), and troponin-I (p=0.004) were significantly effective at predicting SR, and 25(OH)D-3 (p=0.079) and high-density lipoprotein (p=0.055) were borderline effective. Conclusion: A lower level of 25(OH)D-3 may be associated with the absence of SR, increased disease severity, and inhospital MACE rates in patients with STEMI.

Based on our findings, EAT thickness may have an effect on left ventricular diastolic functions. This independent relationship showed us the clinical importance of measuring of EAT thickness.

Objective: We aimed to investigate the compliance of plasma apelin-12 levels to show angiographic properties and hospital MACE in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Material and Methods: The association of apelin-12 levels with the N/L ratio on admission was assessed in 170 consecutive patients with primary STEMI undergoing primary PCI. All patient SYNTAX scores and thrombolysis in myocardial infarction (TIMI) flow grades were also assessed. Patients were divided into two groups according to their TIMI flow grade. Patients with a TIMI 0-2 flow and TIMI 3 flow with grade 0/1 myocardial blush grade (MBG) score were defined as the no-reflow group and patients with TIMI grade 3 flow with ⩾2 MBG were considered as the normal flow group. Results: Baseline apelin-12 levels were significantly lower in the no-reflow group than in the normal flow group (3.3±1.81 vs 6.2±1.74, p<0.001). In-hospital events, including death, myocardial infarction (MI) and re-infarction were significantly higher in patients in the no-reflow group than normal flow group (23% vs 7%, p<0.001). Apelin-12 level was negative correlated with the N/L ratio (r= -0.352, p<0.001), Hs-Crp (r=-0.272, p=0.01) and SYNTAX score (r= -0.246, p=0.029). In the multivariate regression analysis, apelin-12, presence of no-reflow and the SYNTAX score were independent predictors of in-hospital MACE (odds ratio [OR] 1.41, 95% confidence interval (CI) [1.27 to 1.67], p=0.001 for apelin-12, OR 1.085, [0.981 to 1.203], p<0.001 for no-reflow and OR 0.201, 95% CI [0.05 to 0.47], p= 0.004 for SYNTAX score). Conclusion: We have shown that lower apelin-12 level on admission is associated with higher SYNTAX scores and no-reflow phenomenon and may be used as a prognostic marker for hospital MACE in patients with STEMI.