Umit Guray

The Anatolian Journal of Cardiology - Peer-reviewed cardiology journal publishing original research, reviews, case reports. Impact Factor 1.5. The Anatolian Journal of Cardiology - Leading international cardiology journal with Impact Factor 1.5. Publishing original research, reviews, and case reports in cardiovascular medicine. Indexed in PubMed, Scopus, and Web of Science.

Purpose Long-term administration of glucocorticoids (GCs) increases myocardial oxidative stress. 4-Hydroxynonenal (4-HNE) protein adducts, a marker of oxidative damage, have been associated with several cardiovascular diseases, including atherosclerosis, cardiac hypertrophy, cardiomyopathy, and ischemia–reperfusion injury. Exercise training has been shown to have a protective effect on the heart by lowering the level of oxidative stress in cardiomyocytes. Therefore, we aimed to investigate the effect of long-term dexamethasone treatment and exercise training on myocardial 4-HNE levels. Methods Twenty-four female Wistar albino rats were assigned to sedentary control-saline treated (C, n = 8), sedentary-dexamethasone treated (D, n = 8), and exercise training-dexamethasone treated (DE, n = 8) groups. Daily dexamethasone was injected for 28 days at a 1 mg kg⁻¹ dose, while C animals were injected with the same volume of saline subcutaneously. DE animals underwent an exercise training protocol of 60 min/day, 5 days a week, at 25 m/min⁻¹ (0% grade) for 28 days. Left ventricular 4-HNE, Hsp72 levels, and pHsp25/Hsp25 ratio were determined by Western blot. Results The administration of dexamethasone led to a significant elevation in 4-HNE levels in the myocardium of adult rats (p < 0.05; D vs. C). The concurrent implementation of exercise training impeded this increase (p > 0.05; DE vs. C). Exercise training induced a threefold increase in myocardial Hsp72 expression (p < 0.001; DE vs. C and D) and attenuated the dexamethasone-induced increase in Hsp25 phosphorylation (p < 0.05; C vs. D) (p < 0.001; DE vs. D). Conclusion Our results indicate that long-term administration of dexamethasone is associated with an increase in cardiac 4-HNE levels, which is hindered by the addition of exercise training.

Glucocorticoids are among the most prescribed drugs globally due to their potent anti‐inflammatory and immunosuppressive properties. Although they have positive effects on the treatment of various disease states; long‐term administration is associated with high blood pressure, insulin resistance, and susceptibility to type 2 diabetes. The heart attempts to cope with increased blood pressure and a decrease in glucose utilization by developing pathological cardiac remodeling. However, in this process, cardiac fibrosis formation and deterioration in heart structure and functions occur. Galectin‐3, a member of the β‐galactoside binding lectins, is consistently associated with inflammation and fibrosis in the pathogenesis of various disease states including insulin resistance and heart failure. Galectin‐3 expression is markedly increased in activated macrophages and a subset of activated fibroblasts and vascular cells. Also, failing and remodeling myocardium show increased Gal‐3 expression and elevated Gal‐3 levels are related to heart failure severity and prognosis. Furthermore, Gal‐3‐related pathways are recently suggested as therapeutic targets both pharmacologically and genetically to increase insulin sensitivity in vivo. The objective of this review is to provide a summary of our current understanding of the role of glucocorticoid‐associated insulin resistance, which is important for some cardiac events, and the potential role of galectin in this pathophysiological process.

Aim:We aimed to investigate the association between whole blood viscosity (WBV) and nondipping pattern in patients with essential hypertension.Materials & methods:A total of consecutive 530 patients who had been evaluated by ambulatory blood pressure monitoring were included. WBV was estimated by using hematocrit and plasma total protein levels for both WBV in low shear rate (0.5 s(-1)) and WBV in high shear rate (208 s(-1)) according to the de Simone's formula.Results:In the multivariate analysis, low shear rate and high shear rate of WBV were associated independently with nondipping pattern in patients with essential hypertension.Conclusion:As a simple, inexpensive and noninvasive tool, WBV seems to be a significant predictor of nondipping hypertension.

Koroner arter anevrizmaları (CAA), bazı akut ve kronik komplikasyonlarla ilişkili nadir klinik tablolardır. Genellikle tesadüfen tespit edilir. Anevrizma içindeki durağanlık tromboz ve dolayısıyla akut koroner sendroma neden olabilir. Bu yazıda, kardiyak arrest nedeniyle acil servise getirilen ve elektrokardiyografisi (EKG) akut anterior miyokard infarktüsü ile uyumlu olan 37 yaşındaki bir kadın hastanın koroner anjiyografisinde gözlenen LMCA dev anevrizması sunulmaktadır.Koroner arter anevrizmaları (CAA), bazı akut ve kronik komplikasyonlarla ilişkili nadir klinik tablolardır. Genellikle tesadüfen tespit edilir. Anevrizma içindeki durağanlık tromboz ve dolayısıyla akut koroner sendroma neden olabilir. Bu yazıda, kardiyak arrest nedeniyle acil servise getirilen ve elektrokardiyografisi (EKG) akut anterior miyokard infarktüsü ile uyumlu olan 37 yaşındaki bir kadın hastanın koroner anjiyografisinde gözlenen LMCA dev anevrizması sunulmaktadır.

Junctional tachycardias(JT) are rare supraventricular tachyarrhythmias observed mainly in infants and children. JT is rare in adult patients, and it is associated with poor outcomes. In general, these supraventricular tachycardias respond insufficiently to pharmacological treatment. In this report, we present the case of a 72-year-old patient with incessant tachyarrhythmia in whom cryoablation of the para-Hisian ectopic focus was successfully performed.

The predisposition to atrial fibrillation (AF) in mitral stenosis (MS) has been demonstrated with several electrocardiographic (increased P-wave dispersion) and echocardiographic parameters (atrial electromechanical delay). Despite the improvement in P-wave dispersion after percutaneous mitral balloon valvuloplasty (PMBV), the changes in echocardiographic parameters related to AF risk are unknown. In this study we aimed to investigate the acute effect of PMBV on atrial electromechanical delay (EMD) assessed by tissue Doppler echocardiography in addition to electrocardiographic parameters. This single-center study consisted of 30 patients with moderate or severe MS (23 females and seven males, aged 36.5 ± 8.5 years, with a mean MVA of 1.1 ± 0.2 cm²) who underwent successful PMBV without complication at our clinic and 20 healthy volunteers from hospital staff as a control group (16 females and four males, aged 35.4 ± 6 years). We compared the two groups in regard to clinical, electrocardiographic and echocardiographic features. The patients with MS were also evaluated after PMBV within 72 h of the procedure. The P-wave dispersion was calculated from12-lead ECG. Interatrial and intra-atrial EMDs were measured by tissue Doppler echocardiography. These ECG and echocardiographic parameters after PMBV were compared with previous values. The maximum P-wave duration (138 ± 15 vs. 101 ± 6 ms, p < 0.01), PWD (58 ± 18 vs 23 ± 4, p < 0.01), the interatrial (55 ± 16 vs 36 ± 11 ms, p < 0.01) and left-sided intra-atrial EMD (40 ± 11 vs 24 ± 12 ms, p < 0.01) were higher in patients with MS than in healthy subjects. The left atrial (LA) diameter, LA volume and LA volume index had positive association with the interatrial (r = 0.5, p < 0.01; r = 0.5, p < 0.01 and r = 0.5, p < 0.01, respectively) and left-sided intra-atrial EMD (r = 0.5, p < 0.01; r = 0.4, p < 0.01; r = 0.4, p < 0.01 respectively). After PMBV, the interatrial (55 ± 16 vs. 40 ± 11 ms, p < 0.01) and left-sided intra-atrial EMD (40 ± 11 vs 31 ± 10, p < 0.01) showed significant improvement compared to previous values. There was also a statistically significant difference in maximum P-wave duration and PWD between pre-and post-PMBV (138 ± 15 vs 130 ± 14, p < 0.01, and 58 ± 18 vs 49 ± 16, p < 0.01, respectively). Our study shows that PMBV has a favorable effect on the electrocardiographic and echocardiographic parameters related with AF risk in patients with MS. Die Prädisposition zum Vorhofflimmern (VF) bei Mitralstenose (MS) ist an verschiedenen elektrokardiographischen (vermehrte P-Wellen-Dispersion) und echokardiographischen Parametern [atriale elektromechanische Verzögerung („electromechanical delay“, EMD)] nachgewiesen worden. Trotz der Besserung der P-Wellen-Dispersion (PWD) nach perkutaner Mitralklappen-Ballondilatation („percutaneous mitral balloon valvuloplasty“, PMBV) sind die Veränderungen echokardiographischer Parameter, die in Bezug zum VF-Risiko stehen, nicht bekannt. In der vorliegenden Studie war es Ziel, die akute Wirkung der PMBV auf die atriale EMD zu untersuchen, welche durch Gewebedopplerechokardiographie und elektrokardiographische Parameter bestimmt wurde. An der Einzelzenterstudie nahmen 30 Patienten mit mittelgradiger oder schwerer MS teil [23 Frauen, 7 Männer, Alter: 36,5±8,5 Jahre, mittlere Mitralklappenöffnungsfläche („mitral valve area“, MVA): 1,1±0,2 cm²], bei denen eine PMBV erfolgreich komplikationslos in unserer Klinik durchgeführt wurde, sowie 20 gesunde Probanden des Krankenhauspersonals als Kontrollgruppe (16 Frauen, 4 Männer, Alter: 35,4±6 Jahre). Wir verglichen die beiden Gruppen im Hinblick auf klinische, elektrokardiographische und echokardiographische Merkmale. Innerhalb von 72 h nach der PMBV wurden die Patienten mit MS nachuntersucht. Die PWD wurde anhand des 12-Kanal-EKG berechnet. Gewebedopplerchokardiographisch erfolgte die Messung der interatrialen und intraatrialen EMD. Diese EKG- und echokardiographischen Parameter nach PMBV wurden mit den vorherigen Werten verglichen. Maximale P-Wellen-Dauer (138 ± 15 vs. 101 ± 6 ms, p < 0,01), PWD (58 ± 18 vs. 23 ± 4, p < 0,01), interatriale (55 ± 16 vs. 36 ± 11 ms, p < 0,01) und linksseitige intraatriale EMD (40 ± 11 vs. 24 ± 12 ms, p < 0,01) waren bei den Patienten mit MS höher als bei den Gesunden. Der linksatriale (LA-)Durchmesser, das LA-Volumen und der LA-Volumenindex waren positiv mit der interatrialen (r = 0,5, p < 0,01; r = 0,5, p < 0,01 bzw. r = 0,5, p < 0,01) und linksseitigen intraatrialen EMD (r = 0,5, p < 0,01; r = 0,4, p < 0,01 bzw. r = 0,4, p < 0,01) assoziiert. Nach PMBV wiesen interatriale (55 ± 16 vs. 40 ± 11 ms, p < 0,01) und linksseitige intraartriale EMD (40 ± 11 vs. 31 ± 10, p < 0,01) eine signifikante Verbesserung im Vergleich zu vorher auf. Außerdem war der Unterschied bei maximaler P-Wellen-Dauer und PWD vor und nach PMBV statistisch signifikant (138 ± 15 vs. 130 ± 14, p < 0,01 bzw. 58 ± 18 vs. 49 ± 16, p < 0,01). Die vorliegende Studie zeigt, dass eine PMBV sich günstig auf EKG- und echokardiographische Parameter auswirkt, die in Bezug zum VF-Risiko bei Patienten mit MS stehen.

Water intoxication, defined as excessive water ingestion within a short period of time, may cause severe neurologic and cardiac symptoms. This condition is commonly seen in psychiatric patients, however the ingestion of excessive water is an infrequent method for attempting suicide. In this case report we present a 51-year-old woman with ventricular fibrillation due to electrolyte imbalance caused by excessive water ingestion during a suicide attempt. The patient was admitted to our emergency clinic with altered consciousness and agitation. She was hypertensive and neurological examination revealed no lateralizing signs. Ventricular arrhythmias, cardiopulmonary arrest and tonic-clonic seizure were observed during hospitalization. Blood chemistry showed hyponatremia and hypokalemia relevant to the patient’s history of ingestion of 12 liters of water in 4 hours time. After electrolyte disturbances were corrected, ventricular arrhythmias and seizure did not recur. The patient was referred for psychiatric evaluation and was discharged with antidepressive medication. Although water intoxication is well described in psychiatric disorders such as schizophrenia, it has not been previously reported in depressive patients with suicidal thought. Awareness of the clinical presentation of this rare situation may prevent potentially fatal complications