Assessment of 25-hydroxyvitamin D levels in patients with resistant hypertension

Objective: To investigate the possible correlation between serum 25-hydroxyvitamin D levels and resistant hypertension [RH]

Subjects and Methods: Patients who had undergone ambulatory blood pressure measurements [ABPM] during outpatient controls were enrolled. Fifty subjects with RH, 50 with controlled hypertension [CHT] and 50 normotensive subjects [NT] were included in the study. RH was defined as 'suboptimal blood pressure control despite using 3 antihypertensive agents including a diuretic or need for 4 or more drugs to control blood pressure'. The 25-hydroxyvitamin D and parathormone levels were compared between the groups. Pearson's correlation coefficient test was applied to assess the correlation between 25-hydroxyvitamin D levels and office blood pressure [BP] and ABPM. Logistic regression analysis was used to determine the independent correlates of RH

Results: The 25-hydroxyvitamin D level was significantly lower in the RH group [17.02 +/- 5.4 ng/ml] compared to the CHT [24.9 +/- 4.8 ng/ml] and NT groups [28.0 +/- 5.7 ng/ml, p < 0.001]. In univariate correlation analysis, 25-hydroxyvitamin D levels had a significant negative correlation with office systolic BP [r = -0.329, p < 0.001], office diastolic BP [r = -0.395, p < 0.001], systolic ambulatory BP [r = -0.844, p = 0.004], and diastolic ambulatory BP [r = -0.567, p = 0.005]. ROC analysis revealed that 25-hydroxyvitamin D levels <21.50 ng/ml predicted the presence of RH with a sensitivity of 78% and a specificity of 79% [AUC = 0.89, 95% CI 0.83-0.94]. In the multivariate logistic regression analysis, 25-hydroxyvitamin D level was independently correlated with the presence of RH [beta 0.660, 95% CI 0.572-0.760, p < 0.001]

Conclusion: There was an independent correlation between lower 25-hydroxyvitamin D levels and presence of RH

Metabolic syndrome is associated with atrial electrical and mechanical dysfunction

In this study, we aimed to investigate the left atrial [LA] electrical and mechanical functions in patients with metabolic syndrome [MetS]. Subjects and The study population consisted of 87 patients with MetS and 67 controls. Intra-atrial and interatrial electromechanical delays [EDs] were measured with tissue Doppler imaging. P-wave dispersion [Pd] was calculated from the 12-lead electrocardiograms. LA volumes were measured echocardiographically by the biplane area-length method. Intra-atrial and interatrial EDs and Pd were significantly higher in patients with MetS [10.3 +/- 6.3, 21.0 +/- 11.5 and 41.7 +/- 10.8] than in controls [7.4 +/- 5.5, 12.3 +/- 10.4 and 29.2 +/- 7.4; p = 0.003, p < 0.001 and p < 0.001, respectively]. The LA preatrial contraction volume and active emptying volumes were higher in this population, but the LA passive emptying fraction was lower. In the multivariate linear regression analysis, the presence of MetS, LA active emptying volume and left ventricular early diastolic [E] wave velocity/late diastolic [A] wave velocity [E/A] ratios were independent correlates of interatrial ED [p = 0.002, p = 0.001 and p = 0.025, respectively]. This study showed that intra-atrial and interatrial EDs and Pd were prolonged and LA mechanical functions were impaired in patients with MetS

case of anomalous origin of circumflex artery from right sinus of valsalva recognized by three-dimensional transesophageal echocardiography and coronary computed tomography angiography

Anomalous origin of the circumflex coronary artery from the right sinus of Valsalva is the most common coronary anomaly. It is thought to be of no clinical relevance unless cardiac surgery is performed. We report a 53-year-old patient with aberrant circumflex coronary artery origin from the right aortic sinus of Valsalva which was first suspected from transthoracic 2D and transesophageal 3D echocardiographic views and confirmed by coronary CT angiography. The patient did not receive further diagnostic or therapeutic options. Therefore, we recommended medical therapy with optimal treatment of his cardiovascular risk factors together with regular clinical follow up