Cardioprotective Effect of Cilostazol on Ischemia-Reperfusion Injury Model

Abstract Introduction: To clarify the potential protective role of cilostazol on rat myocardial cells with ischemia-reperfusion injury (IRI) models. Methods: The study was conducted with three groups of 10 Wistar rats (control group, rats without any coronary ischemia; sham group, rats with coronary ischemia but without cilostazol administration; and cilostazol group, rats with coronary ischemia and cilostazol administration). The level of myocardial injuries was measured by analyzing cardiac troponin T and creatine kinase MB levels in blood samples. In tissue samples, adenosine triphosphate (ATP), nitric oxide, superoxide dismutase (SOD), and malondialdehyde were used to determine the amount of tissue damage. Tissues were stained with hematoxylin-eosin method, and samples were examined under light microscope. Results: The mean level of ATP was 104.4 in the cilostazol group and 149.1 in the sham group (P=0.044). SOD level was significantly higher in the cilostazol group than in the sham group (2075.3 vs. 1783.7, P=0.043). According to histopathological examination, all samples were classified as G0 in the control group. In the sham group, one sample was categorized as G1, six samples as G2, and three samples as G3. In the cilostazol group, nine samples and one sample were categorized as G1 and G2, respectively (P=0.011). Conclusion: Cilostazol has beneficial effects on Wistar rats' myocardial cells in regard to decreasing inflammatory process, necrosis, and fibrosis. Our findings revealed that the use of cilostazol significantly decreased ATP and increased SOD levels in Wistar rats' myocardial cells after IRI.

Percutaneous Thrombectomy for the Treatment of Lower Extremity Deep Vein Thrombosis: Medium-Term Follow-up Results and Analysis of 112 Cases.

Introduction The aim of this study was to analyze percutaneous thrombectomy (PT) outcomes for the management of lower extremity deep vein thrombosis (DVT) with medium-term follow-up. Methods The study included charts of patients who underwent PT due to lower extremity DVT between August 2017 and March 2021. Patient characteristics and procedure outcomes were recorded in the electronic information system on the same day as the procedure. The procedures with complete removal of thrombus following PT without requiring additional procedure or additional thrombectomy apparatus were considered successful. Also, duration of follow-up was noted. Results In total, 112 patients were enrolled in the study. The femoropopliteal (40.2%) and iliofemoral (25.0%) veins were the most common sites with thrombus detected. The duration of PT procedure and fluoroscopy were 123.1 minutes and 21.9 minutes, respectively. Estimated blood loss was 255.1 milliliters. The hospital stay and intensive care unit stay following PT were 3.7 and 1.4 days, respectively. Major hemorrhage did not occur in any patient, but we encountered bradycardia in six (5.4%) patients, acute renal failure in one (0.9%) patient, hemoglobinuria in 11 (9.8%) patients, leg pain in 15 (13.4%) patients, and pulmonary embolism in 2 (1.8) patients, respectively. Success of the present study was 94.6% in the first month, and re-operation was required only in one patient. The mean follow-up period was 21.1 months with 90.2% venous patency rates. Conclusion The present study demonstrated that PT was an effective and reliable treatment modality with acceptable complication rates for the treatment of lower extremity DVT. Additionally, the efficacy of PT was proven by mid-term follow-up results.

Cardioprotective Effect of Cilostazol on Ischemia-Reperfusion Injury Model.

INTRODUCTION: To clarify the potential protective role of cilostazol on rat myocardial cells with ischemia-reperfusion injury (IRI) models. METHODS: The study was conducted with three groups of 10 Wistar rats (control group, rats without any coronary ischemia; sham group, rats with coronary ischemia but without cilostazol administration; and cilostazol group, rats with coronary ischemia and cilostazol administration). The level of myocardial injuries was measured by analyzing cardiac troponin T and creatine kinase MB levels in blood samples. In tissue samples, adenosine triphosphate (ATP), nitric oxide, superoxide dismutase (SOD), and malondialdehyde were used to determine the amount of tissue damage. Tissues were stained with hematoxylin-eosin method, and samples were examined under light microscope. RESULTS: The mean level of ATP was 104.4 in the cilostazol group and 149.1 in the sham group (P=0.044). SOD level was significantly higher in the cilostazol group than in the sham group (2075.3 vs. 1783.7, P=0.043). According to histopathological examination, all samples were classified as G0 in the control group. In the sham group, one sample was categorized as G1, six samples as G2, and three samples as G3. In the cilostazol group, nine samples and one sample were categorized as G1 and G2, respectively (P=0.011). CONCLUSION: Cilostazol has beneficial effects on Wistar rats' myocardial cells in regard to decreasing inflammatory process, necrosis, and fibrosis. Our findings revealed that the use of cilostazol significantly decreased ATP and increased SOD levels in Wistar rats' myocardial cells after IRI.

Learning curve for percutaneous thrombectomy in treatment of acute lower extremity deep vein thrombosis.

OBJECTIVE: We evaluated the effect of the learning curve on percutaneous thrombectomy (PT) outcomes for the treatment of lower extremity deep vein thrombosis (DVT). METHODS: The present study was conducted between October 2019 and September 2020 and included 80 patients who had undergone PT to treat lower extremity DVT of the common iliac, external iliac, common femoral, femoral, and popliteal veins. For thrombectomy, aspiration and mechanical thrombectomy procedures were performed until the thrombus had completely dissolved using the Dovi aspiration system and Mantis mechanical thrombectomy system (Invamed, Ankara, Turkey). A total of 80 patients were divided equally into four groups, with the first 20 cases in group 1, the second 20 cases in group 2, the third 20 cases in group 3, and the final 20 cases in group 4. The groups were compared for the demographic characteristics, intraoperative outcomes, complication rates, and procedure success. RESULTS: All demographic parameters were similar between the four groups. The mean operative time was 139.3 minutes for group 1, 134.8 minutes for group 2, 111.3 minutes for group 3, and 106.7 minutes for group 4. Statistical analysis revealed that the operative time was significantly shorter for groups 3 and 4 compared with that for groups 1 and 2. In addition, the fluoroscopy time was significantly decreased in groups 3 and 4 (P = .001). The complication rate was similar between the four groups (P = .899). However, success was significantly increased after the first 20 cases, and the remaining three groups had a significantly higher success rate compared with group 1 (70% for group 1, 90% for group 2, 95% for group 3, and 100% for group 4; P = .024). CONCLUSIONS: Success in the performance of PT for the treatment of acute lower extremity DVT reaches satisfactory levels after 20 cases. Additionally, operation time and fluoroscopy time are significantly decreased after 40 cases and then start plateau.

Effect of Obesity on Percutaneous Thrombectomy Outcomes in the Treatment of Lower Limb Deep Vein Thrombosis.

OBJECTIVE: To evaluate the effect of obesity on percutaneous thrombectomy (PT) results for the management of lower limb deep vein thrombosis (DVT). STUDY DESIGN: Retrospective cohort study. PLACE AND DURATION OF STUDY: Department of Cardiology, Avcilar Hospital, Istanbul, Turkey, between August 2020 and January 2021. METHODOLOGY: Patients who underwent PT for lower limb DVT were included. Patients' demographic characteristics, operative parameters, and postoperative outcomes were recorded in prospective manner. Patients were divided into two groups, as patients with body mass index (BMI) <30 kg/m2 (Group 1) and patients with BMI ≥30 kg/m2 (Group 2). The two groups were compared according to patient demographic properties, intraoperative results, and postoperative outcomes. RESULTS: Eventually, 62 patients were enrolled into the non-obese group and 30 patients had BMI ≥30 Kg/m2. Comparison of the groups demonstrated that the mean operation time and the mean fluoroscopy time were significantly higher in obese patients (121.5 min vs. 134.5, p = 0.017 and 19.8 min vs. 25.9 min, p = 0.006, respectively). In addition, the mean hospitalisation period and the mean ICU stay were significantly longer in patients with ≥30 kg/m2 (p = 0.025 and p = 0.007). Postoperative visual analog scale (VAS) score in the first hour was significantly higher in obese patients (2.4 vs. 3.0, p = 0.008). The presence of obesity did not have a significant effect on success and complication rates following PT (p = 0.368 and p = 0.646). CONCLUSION: Obesity prolonged operation time and fluoroscopy time during PT. Additionally, obesity was associated with significantly longer hospitalisation period, and ICU stay, and higher VAS score in the first hour following PT. Key Words: Complication, Deep vein thrombosis, Obesity, Percutaneous thrombectomy, Success, VAS score.

Characteristics of YouTube Videos About Peripheral Artery Disease During COVID-19 Pandemic.

INTRODUCTION: To examine English language YouTube videos that covered both COVID-19 and peripheral artery disease (PAD). METHODS: The research was planned from October 1 to 5, 2020. Two cardiologists (CB and ES) executed online searches in which the term COVID-19/coronavirus was paired with common keywords about PAD, including 'peripheral artery disease + COVID-19,' 'leg pain + coronavirus,' 'leg vascular disease + COVID-19,' 'atherosclerosis + COVID-19,' and 'claudication + coronavirus.' For each video, a record was made of the number of days on YouTube, length, number of views and comments, and the number of 'likes' and 'dislikes'. Videos were also categorized according to content as informative videos (with accurate content about the frequency of disease, symptoms, transmission, prevention techniques, and proven treatment methods), patient experience videos (with patient testimonies), or news update videos (i.e., those uploaded by professional news channels). Moreover, DISCERN and Medical Information and Content Index (MICI) were evaluated. RESULTS: Totally, 91 YouTube videos met study inclusion criteria. News update videos were the most-watched when compared with informative and patient experience videos (63,910 views vs 43,725 views vs19,778 views, p=0.032). The DISCERN score was significantly higher in the informative group: 2.8 for informative videos, 1.7 for patients' experience videos, and 1.8 for news update videos (p= 0.001). The most common theme was clinical symptoms in the informative videos (82.4%). The mean MICI score was calculated as 3.7±1.4 points for informative videos. CONCLUSION: YouTube videos about COVID-19 and PAD are widely-viewed information sources for patients. Our study has demonstrated that YouTube videos about COVID-19 and PAD generally had poor quality content.

Association of Metabolic Syndrome Components and Overactive Bladder in Women.

Background To identify associations between metabolic syndrome (MS) components and overactive bladder (OAB) in women. Methodology The present study was conducted prospectively between February 2021 and April 2021 and included the assessment of women admitted to the cardiology outpatient clinic and their female relatives. Records were made of the demographic characteristics of patients and blood tests, including cholesterol, high-density lipoproteins (HDL), low-density lipoproteins (LDL), triglyceride, and fasting glucose levels (FG). In addition, the score on the Overactive Bladder Questionnaire-8-item (OAB-V8) form was noted. The study population was divided into two groups according to OAB-V8 score. The groups were compared in terms of participant demographic properties, OAB-V8 scores, metabolic component values, and blood test results. Results In total, 200 participants with a mean age of 49.8 years were enrolled in the study. Participants with OAB had significantly higher body mass index (BMI) (30.1 kg/m2 versus 27.1 kg/m2; p = 0.001) and longer waist circumference (97.8 cm versus 89.0 cm; p = 0.001). Similarly, the mean FG and LDL levels were significantly higher in participants with OAB (p = 0.001 and p = 0.001). Lastly, mean OAB-V8 score was 20.2 for participants with OAB and 4.8 for participants without OAB. Multivariate regression analysis showed that higher BMI and longer waist circumference were significantly associated with OAB (1.228-fold; p = 0.001 and 1.058-fold; p = 0.001, respectively). Additionally, multivariate regression analysis found that higher LDL level and FG were predictive factors for OAB (1.115-fold; p = 0.003 and 1.229-fold; p = 0.001, respectively). Conclusions The present study found that higher BMI, longer waist circumference, and higher LDL and FG levels were predictive factors for OAB development in women.

Valve sparing surgery in an adult patient with dextrocardia and annuloaortic ectasia.

We report the case of a patient with situs inversus totalis, annuloaortic ectasia complicated by aortic insufficiency and mitral regurgitation which induced congestive heart failure. Both valvular lesions were repaired physiologically using aortic root sparing Yacoub 'remodeling' technique and mitral ring annuloplasty. Valve sparing techniques can be used effectively even in patients with complicated clinical scenarios (like dextrocardia and annuloaortic ectasia) to avoid the potential risks related to prosthetic valve implantation and lifelong anticoagulation therapy.

Role of cathepsin D activation in major adverse cardiovascular events and new-onset heart failure after STEMI.

AIM: Increased serum levels of the activated aspartic lysosomal endopeptidase cathepsin D (CatD) have been found in patients with acute myocardial infarction (AMI). However, to date there have been no analyses of clinical follow-up data measuring the enzyme course and its role in the development of post-MI heart failure. This study aimed to evaluate the role of serum CatD activity in the development of heart failure in patients with ST-segment elevation acute myocardial infarction (STEMI). PATIENTS AND METHODS: Eighty-eight consecutive patients (79.5 % men, mean age 57.4 ± 10.2 years) with STEMI were included in this study. Serum CatD activity was measured directly after primary percutaneous coronary intervention (PCI), before discharge, and at the 6-month follow-up. Patients were monitored for major adverse cardiovascular events (MACE), defined as hospitalization due to cardiovascular causes, recurrent nonfatal myocardial infarction, unplanned PCI, new-onset heart failure, and cardiovascular mortality. RESULTS: Serum CatD activity was significantly higher in patients with AMI after PCI and during follow-up (FU) than that in age-matched controls (16.2 ± 7.5 and 29.8 ± 8.9 vs. 8.5 ± 4.2 RFU; p < 0.001 for each time point). At the 6-month follow-up, serum CatD activity in these patients was inversely related to new-onset cardiac dysfunction compared with patients with preserved and improved LVEF after treatment (23.1 ± 3.2 vs. 28.8 ± 7.0 and 29.7 ± 5.0 RFU respectively, p < 0.01). Patients suffering from MACE during a follow-up period of 6 months had lower serum levels of activated CatD than those without any MACE (23.8 ± 4.6 vs 29.6 ± 6.9 RFU; p < 0.001). CONCLUSIONS: Serum CatD activity as a marker of healthy endogenous phagocytosis and remodeling was impaired in patients with new-onset cardiac dysfunction, and lower levels of serum CatD were associated with MACE at the 6-month post-MI follow-up.

Atrial conduction abnormalities in patients with psoriasis vulgaris.

BACKGROUND: Psoriasis vulgaris is one of the most common chronic inflammatory skin disorders. Patients with psoriasis are at risk of developing atrial fibrillation (AF). The electromechanical delay (EMD) is the time interval from the onset of the P wave on surface electrocardiography (ECG) to the beginning of the A wave. Prolonged atrial EMD is an independent risk factor for the development of AF. AIM: This study investigated the intra- and interatrial EMD in patients with psoriasis. METHODS: This study included 85 adults with psoriasis vulgaris (Group 1) and 46 age- and sex-matched healthy individuals (Group 2). ECGs were obtained from all subjects, and atrial EMD variables were calculated. Results are reported as means ± standard deviations and percentages. Continuous variables were analysed using Student's t-test. A p-value < 0.05 was considered statistically significant. RESULTS: Interatrial electromechanical delay (IA-EMD) and intra-left atrial electromechanical delay (ILA-EMD) were significantly longer in the psoriasis group compared with controls. A correlation analysis between psoriasis severity (PASI score) and the atrial conduction parameters revealed a significant positive correlation between PASI and IA-EMD (r = 0.261, p < 0.001). In addition, there was a positive correlation between high-sensitivity C-reactive protein (hsCRP) and IA-EMD (p = 0.022). CONCLUSIONS: The atrial conduction time was longer in patients with psoriasis vulgaris and it correlated with the severity of disease and hsCRP. Since the association between delayed conduction and AF is known, the measurement of intra-atrial conduction times could be a practical tool to estimate the AF risk in these patients.

Implication of plasma intermedin levels in patients who underwent first-time diagnostic coronary angiography: a single centre, cross-sectional study.

BACKGROUND: Intermedin (IMD) is involved in the prevention of atherosclerotic plaque progression, possessing cardioprotective effects from hypertrophy, fibrosis and ischemia-reperfusion injury. Elevated plasma IMD levels have been demonstrated in patients with acute coronary syndromes. No human study has examined the role of IMD in stable patients who underwent diagnostic coronary angiography with suspicion of coronary artery disease (CAD). Thus we investigated the role of IMD as a biomarker to discriminate patients with CAD and predict those with severe disease who require early and intensive therapeutic intervention before presenting with acute coronary syndrome. METHODS: Eligible two hundred and thirty-eight consecutive patients (123 males, mean age 58.4 ± 10.0 years) who underwent first-time diagnostic coronary angiography were included in this study. Plasma concentrations of IMD were measured from arterial blood samples by the enzyme-linked immunosorbent assay. Patients were divided into three groups according to the presence and degree of CAD, consisting of 48 patients with normal coronary anatomy (Group 1), 111 patients with < 50% coronary stenosis (Group 2), and 79 patients with ≥ 50% stenosis in at least one of the major coronary arteries (group 3). The severity and extent of CAD was evaluated by calculations of the vessel, Gensini, and SYNTAX scores. RESULTS: Circulating plasma IMD levels in patients with CAD were significantly higher than those in patients without CAD (157.7 ± 9.6, 134.8 ± 11.9, and 117.6 ± 7.9 pg/mL in groups 3, 2 and 1 respectively; p < 0.001). Besides, plasma IMD levels were correlated with Gensini and SYNTAX scores (rs = 0.742, and rs = 0.296, respectively; p < 0.05). The presence of ≥50% coronary artery stenosis could be predicted if a cut-off value of 147.7 pg/mL for plasma IMD was used with 88.6% sensitivity and 88.7% specificity. Moreover, a plasma IMD level of <126.6 pg/mL could discriminate a patient with normal coronary arteries from patients with angiographically proven CAD with a sensitivity and specificity of 84.7%, and 83.3% respectively. CONCLUSIONS: We demonstrated that IMD might be used as a biomarker to predict CAD and its severity in patients who underwent first time diagnostic coronary angiography.

Epicardial fat thickness in patients with psoriasis vulgaris.

OBJECTIVES: Psoriasis vulgaris is one of the most common skin disorders. Patients with psoriasis carry an excessive risk of coronary artery disease. Visceral adipose tissue around the heart affects the heart and coronaries by secreting proatherogenic mediators. It can be evaluated easily by measurement of epicardial fat thickness (EFT). The aim of this study was to investigate EFT in patients with psoriasis vulgaris. STUDY DESIGN: One hundred and fifteen adult patients (62 male; mean age 33.6±6.0 years) with psoriasis vulgaris (Group 1) and 60 age- and sex-matched healthy individuals (28 male; mean age, 32.5±8.3 years) (Group 2) were included in this study. EFT was obtained by transthoracic echocardiography. Disease-specific characteristics of the patients were recorded. Serum glucose, lipid profile and high-sensitive C-reactive protein (hs-CRP) levels were measured. RESULTS: EFT and hs-CRP were significantly higher in Group 1 than in Group 2 (5.7±1.2 vs. 4.1±1.0 mm, p<0.001 and 0.52±0.45 mg/dl vs. 0.19±0.17 mg/dl, p<0.001, respectively). The psoriasis disease activity score and hs-CRP were found to be independent predictors of EFT in patients with psoriasis vulgaris (ß=0.21, t=2.67, p=0.01 and ß=0.62, t=7.72, p=0.001, respectively). CONCLUSION: Our findings indicate that EFT was significantly higher in patients with psoriasis vulgaris compared with the controls. It was more prominent in patients with severe disease.

Is postdilatation with a noncompliant balloon necessary after coronary stent deployment during primary angioplasty?

BACKGROUND: Postdilatation (PD) with noncompliant balloon during elective percutaneous coronary intervention (PCI) is performed usually in clinical practice in order to optimize stent expansion. However, current knowledge about its use in patients undergoing primary PCI is controversial. This study aims to evaluate the angiographical and clinical results of PD in patients who underwent primary PCI with drug eluting stents (DESs). METHODS: A total of 405 consecutive patients (mean age 56.9 ± 12.3 years; 302 male) with ST elevation myocardial infarction were evaluated retrospectively. Patients received DES with or without predilatation according to physician's discretion. Eligible patients were divided into 2 groups based on PD procedure. The clinical end-points were death, target vessel revascularization (TVR) and stent thrombosis at 6 months after PCI. The angiographic end-points were postprocedural correct Thrombolysis in Myocardial Infarction (TIMI) frame count (cTFC), final TIMI flow, and myocardial blush grade (MBG). RESULTS: PD was performed in 214 patients (52.8%). Angiographical parameters such as TIMI flow, cTFC, and MBG did not differ after PD (P>0.05). During 6-month follow-up, TVR and stent thrombosis rates were lower in the PD group (6 vs. 16, P=0.03; and 3 vs. 10, P=0.04, respectively). PD and diabetes were detected as independent predictors of MACE (ß=0.52, P=0.01, and ß=-0.47, P=0.02; respectively). CONCLUSION: Our study revealed that PD does not yield adverse effects on final angiographic parameters when performed during primary PCI. Besides PD seems to decrease probability of stent thrombosis and TVR.

Ambulatory blood pressure monitoring can unmask hypertension in patients with psoriasis vulgaris.

BACKGROUND: Psoriasis vulgaris is one of the most prevalent chronic, inflammatory skin disorders. Patients with psoriasis have excess risk of essential hypertension. Masked hypertension (MH), defined as normal office blood pressure (BP) with elevated ambulatory BP (ABPM), has been drawing attention recently due to its association with increased risk of developing sustained hypertension, cardiovascular morbidity, and mortality. The aim of this study was to investigate the prevalence of MH in psoriatic patients. MATERIAL AND METHODS: On hundred and ten middle-aged, normotensive, non-obese patients with psoriasis vulgaris and 110 age- and sex-matched normotensive controls were included in the study. ABPM was performed in all participants over a 24-h period. The clinical severity of the disease was determined according to current indexes. RESULTS: The prevalence of MH among subjects with psoriasis vulgaris was 31.8% and increased compared to control subjects (p<0.01). Predictors of MH in patients with psoriasis vulgaris were detected as male sex, smoking, obesity-related anthropometric measures, and disease activity. Male sex, waist circumference, and diffuse psoriatic involvement were detected as independent predictors of MH. CONCLUSIONS: MH is prevalent in patients with psoriasis vulgaris. Assessment with ABPM and close follow-up for development of hypertension is reasonable.

Usefulness of mean platelet volume for predicting stroke risk in atrial fibrillation patients.

Early detection of atrial fibrillation patients at high risk for stroke is important. There are some studies which indicate that mean platelet volume (MPV) determines the prognosis and risk in patients with a stroke. In this study, our aim was to investigate the association between the MPV measured in stroke patients with atrial fibrillation. Consecutive patients referred to our center between January 2010 and April 2012 were included in this study. The patients with atrial fibrillation were classified into two groups according to presence or absence of a history of stroke by combining data from the medical histories after a thorough review of the medical records. MPV determination was made within 24 h following the onset of stroke. We studied 63 consecutive stroke patients with atrial fibrillation and 77 atrial fibrillation patients without stroke history. In receiver-operating characteristic (ROC) curve analysis, the value for MPV levels to detect stroke with a sensitivity of 63.5% and specificity of 64.4% was 9.4 fl. High MPV (>9.4 fl) was significantly associated with the occurrence of stroke [odds ratio (OR) 4.021, 95% confidence interval (CI) 1709-9464, P < 0.001]. Our study supports the hypothesis that a high MPV is associated with an increased risk of stroke in atrial fibrillation patients.

Electrocardiographic P-wave characteristics in patients with psoriasis vulgaris.

PURPOSE: Psoriasis vulgaris is one of the most common skin disorders. Patients with psoriasis carry an excessive risk of atrial fibrillation (AF). The differences between the maximum (Pmax) and the minimum (Pmin) P-wave duration on ECG are defined as P-wave dispersion (PWD). Prolongation of PWD is an independent risk factor for the development of AF. The aim of this the study was to investigate P-wave duration and PWD in patients with psoriasis. METHODS: Sixty-one adult patients with psoriasis vulgaris (group 1) and 58 age and sex-matched healthy individuals (group 2) were included in this study. ECG recordings were obtained, and the P-wave variables were calculated. Results were reported as mean ± standard deviation and percentages. Continuous variables were analysed using Student's t test. A value of P < 0.05 was considered statistically significant. RESULTS: Pmax and PWD were significantly higher in group 1 than in group 2 (108.8 ± 21.3 ms versus 93.3 ± 13.0 ms, P < 0.001; 67.4 ± 22.9 ms versus 45.0 ± 19.6 ms, P < 0.001, respectively). Also, Pmin was significantly lower in group 1 (41.3 ± 12.3 ms versus 48.3 ± 14.3 ms, P = 0.04). The psoriasis disease activity score and hsCRP correlated with PWD (P < 0.01). CONCLUSIONS: Atrial conduction of sinus impulses was impaired in patients with psoriasis vulgaris. It was more prominent in patients with severe disease. Physicians caring for patients with psoriasis vulgaris should screen them for AF development.

A very rare case of coexistence of ventricular noncompaction cardiomyopathy, myocardial bridging and atherosclerosis.

Noncompaction of the ventricular myocardium is a rare congenital heart disease, presumably caused by the intrauterine arrest of the myocardial compaction process at the beginning of fetal development. It could remain asymptomatic or manifest with congestive heart failure, arrhythmias, and systemic thromboemboli. Here we report a 55-year-old man who was admitted to hospital with chest pain and dyspnea, whose further evaluation revealed left ventricular noncompaction cardiomyopathy accompanying myocardial bridging and stenosis of the right coronary artery.

Non-dipping nocturnal blood pressure in psoriasis vulgaris.

BACKGROUND: Psoriasis vulgaris is one of the most prevalent chronic, inflammatory skin disorders. Patients with psoriasis carry an excess risk of hypertension and adverse cardiovascular (CV) events. Blood pressure (BP) has a circadian rhythm characterised with lower values at night. A blunted nocturnal BP decline defined as non-dipping accelerates the development of hypertension and CV diseases. The aim of this study is to evaluate circadian variation of blood pressure in normotensive middle-aged patients with psoriasis vulgaris. METHODS: Seventy adult patients with psoriasis vulgaris (group 1) and 70 age and sex-matched healthy individuals (group 2) were included in the study. Ambulatory BP monitoring was performed in all participants over a 24-h period. Non-dippers are defined as those who show a reduction in BP of less than 10 % between the average day and night systolic BP. RESULTS: Although mean 24-h BPs were similar in both groups, night-time BPs were significantly higher in psoriatic patients (115.1 ± 7.7 vs. 109.9 ± 6.0 mmHg and 72.1 ± 7.0 vs. 67.6 ± 5.5 mmHg, respectively; p < 0.05). The non-dipping pattern of BP changes was significantly more common in patients with psoriasis vulgaris compared with the control group (65.9 vs. 34.1 %, p < 0.01). Psoriasis severity and BMI are independent predictors of impaired nocturnal BP regulation. CONCLUSIONS: Patients with psoriasis vulgaris had increased nocturnal BP and heart rate. This is the first study to demonstrate a blunted nocturnal BP decrease in normotensive patients with psoriasis.