Usefulness of neutrophil-to-lymphocyte ratio for predicting acute pericarditis outcomes.

BACKGROUND: In daily practice, C-reactive protein (CRP) may be used to predict recurrence and treatment response in patients with acute pericarditis; however, the predictive role of CRP might be insufficient for clinical prediction in some patients. In this study, we aimed to investigate the relationship between neutrophil-to-lymphocyte ratio (NLR) and the composite endpoint of pericarditis recurrence and/or tamponade within 1 year in patients with acute pericarditis. METHODS: A total of 104 patients diagnosed with acute idiopathic pericarditis (mean age 42.8 ± 15.2 years, 55.8% male) were included in the study. Physical examination findings of these patients, electrocardiography, echocardiography, chest X-ray and laboratory findings were evaluated and analysed. During the 1-year follow-up, the composite of cardiac tamponade and/or pericarditis recurrence was investigated as the primary endpoint of the study. RESULTS: Compared to the group without the composite outcome, the group with the composite outcome had significantly higher rates of moderate and severe pericardial effusion (p < 0.01) and higher white blood cell (WBC) count (p:0.001), platelet count (p = 0.003), NLR (2.14 (1.49-3.02) vs 6.60 (5.50-8.68); p < 0.001) and high-sensitivity C-reactive protein (hs-CRP) (8.01 (5.1-24.5 vs 69.5 (40.8-128); p:0.001). Higher hs-CRP (p < 0.001), WBC (p:0.001), NLR (p < 0.001) and platelets (p:0.02) were associated with pericarditis recurrence. NLR and hs-CRP were independently associated with the composite endpoint (p < 0.001 and p < 0.001, respectively). CONCLUSION: NLR and hs-CRP were found to be independent predictors for the composite endpoint of tamponade and/or recurrence in acute pericarditis patients during the 1-year follow-up. Similar to hs-CRP, NLR may also be used for risk assessment in patients with idiopathic pericarditis.

A novel predictor of radial spasm: arterial stiffness.

OBJECTIVE: In this study, we aimed to assess the relationship between radial artery spasm (RAS) and arterial stiffness (AS) measured by the oscillometric method. MATERIALS AND METHODS: A total of 123 consecutive patients scheduled for elective coronary angiography in a single default radial center were enrolled for the study. AS [namely, augmentation pressure; augmentation index (AIx); and pulse wave velocity] was assessed using a validated oscillometric device (Mobil-O-Graph NG 24 h PWA). Central arterial pressures were also recorded. In the cath lab, the number of puncture attempts, total procedural time (TPT), and largest catheter size were noted. If greater than two catheters were required to complete imaging, it was additionally specified. RAS was considered to exist if two or more of predefined clinical features were present. RESULTS: RAS was observed in 20 (16.3%) patients. Patients were divided into two distinct groups in terms of the occurence of RAS. In the RAS(+) group, the proportion of hypertensive individuals was significantly higher, whereas there were fewer smokers. With respect to operational data, TPT (24.3±9.8 vs. 29.3±9.1 mins; P=0.038) and procedures carried out with more than one puncture attempts were significantly higher in the RAS(+) group. Among all oscillometric parameters, augmentation pressure, AIx, and PR were found to be higher in the RAS(+) group. According to multivariate analysis, TPT (P=0.029) and AIx (odds ratio: 1.044, 95% confidence interval=0.977-1.117; P=0.009) were found to be independent predictors of RAS. CONCLUSION: Along with conventional risk factors, AS assessment, as a practical, noninvasive method, may help to predict RAS in angiographic procedures.

Effect of cardiac resynchronization therapy on mitral valve geometry: a novel aspect as "reversed mitral remodeling".

Amelioration of the valvular geometry is a possible mechanism for mitral regurgitation (MR) improvement in patients receiving cardiac resynchronization therapy (CRT). We aimed to establish the precise definition, incidence, and predictors of reversed mitral remodeling (RMR), as well as the association with MR improvement and short-term CRT outcome. Ninety-five CRT recipients were retrospectively evaluated for the end-point of "MR response" defined as the absolute reduction in regurgitant volume (RegV) at 6 months. To identify RMR, changes in mitral deformation indices were tested for correlation with MR response and further analyzed for functional and echocardiographic CRT outcomes. Overall, MR response was observed in 50 patients (53%). Among the echocardiographic indices, the change in tenting area (TA) had the highest correlation with the change in RegV (r = 0.653, p < 0.001). The mean TA significantly decreased in MR responders (4.15 ± 1.05 to 3.67 ± 1.01 cm2 at 6 months, p < 0.001) and increased in non-responders (3.68 ± 1.04 to 3.98 ± 0.97 cm2, p = 0.014). The absolute TA reduction was used to identify patients with RMR (47%) which was found to be associated with higher rates of functional improvement (p = 0.03) and volumetric CRT response (p = 0.036) compared to those without RMR. Non-ischemic etiology and the presence of LBBB independently predicted RMR at multivariate analysis. In conclusion, reduction in TA is a reliable index of RMR, which relates to MR response, and functional and echocardiographic improvement with CRT. LBBB and non-ischemic etiology are independent predictors of RMR.

The relationship between the S-wave in lead 1 and recurrence of RVOT PVC ablation.

BACKGROUND: Radiofrequency catheter ablation (CA) is a common non-pharmacological treatment option for ventricular premature contractions (PVCs) originating from right ventricular outflow tract (RVOT). In this study, we aimed to investigate the relationship between recurrence after CA for RVOT-PVC and S-wave in lead 1 that was shown to be associated with RVOT depolarization. METHODOLOGY: A total of 104 patients who were referred to our clinic for CA for idiopathic RVOT-PVC between 2012 and 2015years were enrolled. All ECG parameters were measured before and after the ablation procedure. RESULTS: Ablation was successful in 100 patients (96,1%). These patients with successful ablation were followed for a mean duration of 1078days. 13 patients (13%) had recurrence. Univariate logistic regression analysis revealed age (odds ratio: 1.916, p:0,012), presence of post-procedural S1 (odds ratio:1.040 p:0,028), post-procedural S1 area (oddsratio:1.023 p:0,041), ΔS1 area (odds ratio:1.242 p:0,004) as predictors for recurrence. Multivariate logistic regression analysis detected age (odds ratio:1.053 p:0,032) and ΔS1 area (odds ratio:0.701 p:0,009) as predictors for recurrence. CONCLUSION: Radiofrequency CA for RVOT-PVC can be performed with high procedural success and low complication rates. Age and ΔS1 area might be helpful for prediction of recurrence after CA.

Pocket haematoma after cardiac electronic device implantation in patients receiving antiplatelet and anticoagulant treatment: a single-centre experience.

Objective In modern cardiology practice, implantation of cardiac electronic devices in patients taking anticoagulant or antiplatelet therapy is a common clinical scenario. Bleeding complications are of particular concern in this patient population and pocket haematoma is one of the most frequent complications. We sought to determine the relationship between periprocedural antiplatelet/anticoagulant therapy and pocket haematoma formation in patients undergoing cardiac implantable electronic device (CIED) implantation. Methods We conducted a retrospective study including 232 consecutive patients undergoing CIED implantation in the department of cardiology of the Medipol University Hospital. Patients were divided into six groups: clopidogrel group (n = 12), acetylsalicylic acid (ASA) group (n = 73), ASA + clopidogrel group (n = 29), warfarin group (n = 34), warfarin + ASA group (n = 21) and no antiplatelet-anticoagulant therapy group as the control group (n = 63). CIED implantations were stratified under four subtitles including implantable cardioverter/defibrillator (ICD), cardiac resynchronization therapy (CRT), permanent pacemaker and the last group as either device upgrade or generator replacement. Results The mean age of the patients was 63 ± 14 years and 140 patients were male (60.3%). A pocket haematoma was documented in 6 of 232 patients (2.6%). None of the patients with pocket haematoma needed pocket exploration or blood transfusion. The type of the device did not have a significant effect on pocket haematoma incidence (P = 0.250). Univariate logistic regression showed that platelet level and ASA plus clopidogrel use were significantly associated with haematoma frequency after CIED implantations, respectively (OR: 0.977, CI 95% [0.958-0.996]; OR: 16.080, CI 95% [2.801-92.306]). Multivariate analysis revealed that dual antiplatelet treatment (ß = 3.016, P = 0.002, OR: 2.410, 95% CI [3.042-136.943]) and baseline platelet level (ß = -0.027, p:0.025, OR: 0.974, 95% CI [0.951-0.997]) were independent risk factors for pocket haematoma formation. Conclusion Dual antiplatelet therapy and low platelet levels significantly increased the risk of pocket haematoma formation in patients undergoing CIED implantations.

Assessment of 25-OH vitamin D levels and abnormal blood pressure response in female patients with cardiac syndrome X.

OBJECTIVE: Vitamin D deficiency is associated with coronary artery disease, hypertension, heart failure, endothelial dysfunction, and metabolic syndrome. The pathophysiology of cardiac syndrome X (CSX) involves many pathways that are influenced by vitamin D levels. This study aimed to investigate the relationship between vitamin D deficiency and abnormal blood pressure response to exercise in patients with CSX. METHODS: This was a cross-sectional and observational study. Fifty females with normal epicardial coronary arteries who presented with typical symptoms of rest or effort angina and 41 healthy age-matched female controls, were included. Patients with cardiomyopathy, severe valvular disease, congenital heart disease, and left ventricular hypertrophy were excluded. All patients underwent stress electrocardiography examination and 25-hydroxy (OH) vitamin D level measurements. RESULTS: Levels of 25-OH vitamin D were significantly lower in CSX patients (9.8±7.3 ng/mL vs. 18.1±7.9 ng/mL; p<0.001). Systolic blood pressure (SBP) (188±15 mm Hg vs. 179±17 mm Hg; p=0.013) and diastolic blood pressure (DBP) (98±9 mm Hg vs. 88±9 mm Hg; p<0.001) during peak exercise were higher in CSX patients. Levels of 25-OH vitamin D were negatively correlated with peak SBP (r=-0.310, p=0.004) and peak DBP (r=-0.535, p<0.001) during exercise. To discard the multicollinearity problem, two different models were used for multivariate analyses. In the first model, metabolic equivalents (METs) (p=0.003) and 25-OH vitamin D levels (p=0.001) were independent predictors. METs (p=0.007), 25-OH vitamin D levels (p=0.008), and peak DBP were determined as independent predictors in the second multivariate model. CONCLUSION: In patients with CSX, 25-OH vitamin D levels were lower than those in controls; moreover, 25-OH vitamin D deficiency was also associated with higher levels of peak DBP during exercise.

Predicting Ventricular Arrhythmias in Cardiac Resynchronization Therapy: The Impact of Persistent Electrical Dyssynchrony.

BACKGROUND: Although response to cardiac resynchronization therapy (CRT) has been conventionally assessed with left ventricular volume reduction, ventricular arrhythmias (ventricular tachycardia/ventricular fibrillation [VT/VF]) are of critical importance associated with unfavorable outcomes even in the "superresponders" to therapy. We evaluated the predictors of VT/VF and the association of residual dyssynchrony during follow-up. METHODS: Ninety-five patients receiving CRT were followed-up for 9 ± 3 months. Post-CRT dyssynchrony was defined as a prolonged QRS duration (QRSd) for persistent electrical dyssynchrony (ED), and a Yu index ≥ 33 ms for persistent mechanical dyssynchrony. The first VT/VF episode, including nonsustained VT detected on device interrogation and/or appropriate antitachycardia pacing or shock for VT/VF, were the end points of the study. RESULTS: Forty-five patients who reached the study end points had significantly lower mean ΔQRS (baseline QRSd - post-CRT QRSd) values than those without VT/VF (-20.8 ± 28.9 ms vs -6.6 ± 30.7 ms, P = 0.022). Both the baseline and post-CRT QRSds, along with the Yu index values, were not different in two groups. Patients with VT/VF were statistically more likely to have persistent ED (38% vs 9%, P = 0.021). Kaplan-Meier curves showed that a negative ΔQRS was associated with a higher incidence of VT/VF during follow-up (P = 0.016). A multivariate Cox model revealed that QRS prolongation was an independent predictor of VT/VF after CRT (P = 0.029). CONCLUSIONS: A negative ΔQRS, also called persistent ED, is associated with VT/VF. Narrowest possible QRSd might be a reliable goal of both implantation and optimization of devices to reduce arrhythmic events after CRT.

Native Electrocardiographic QRS Duration after Cardiac Resynchronization Therapy: The Impact on Clinical Outcomes and Prognosis.

BACKGROUND: We investigated whether reversed electrical remodeling (RER), defined as narrowing of the native electrocardiographic QRS duration after cardiac resynchronization therapy (CRT), might predict prognosis and improvement in echocardiographic outcomes. METHODS AND RESULTS: A total of 110 CRT recipients were retrospectively analyzed for the end points of death and hospitalization during 18 ± 3 months. Native QRS durations were recorded at baseline and 6 months after CRT (when pacing was switched off to obtain an electrocardiogram) to determine RER. CRT response and mitral regurgitation (MR) improvement were defined as ≥15% reduction in left ventricular end-systolic volume and absolute reduction in regurgitant volume (RegV) at 6 months, respectively. Overall, 48 patients (44%) had RER, which was associated with functional improvement (77% vs 34%; P < .001) and CRT response (81% vs 52%; P < .001) compared with those without RER. The change in the intrinsic QRS duration correlated with the reduction in RegV (r = 0.51; P < .001) and in tenting area (r = 0.34; P < .001). RER was a predictor of MR improvement (P = .023), survival (P = .043), and event-free survival (P = .028) according to multivariate analyses. CONCLUSIONS: Narrowing of the intrinsic QRS duration is associated with functional and echocardiographic CRT response, reduction in MR, and favorable prognosis after CRT.

Effect of QRS Narrowing After Cardiac Resynchronization Therapy on Functional Mitral Regurgitation in Patients With Systolic Heart Failure.

The determinants of improvement in functional mitral regurgitation (FMR) after cardiac resynchronization therapy (CRT) remain unclear. We evaluated the predictors of FMR improvement and hypothesized that CRT-induced change in QRS duration (ΔQRS) might have an impact on FMR response after CRT. One hundred ten CRT recipients were enrolled. CRT response (≥ 15 reduction in left ventricular end-systolic volume) and FMR response (absolute reduction in FMR volume) were assessed with echocardiography before and 6 months after CRT. The study end points included all-cause death or hospitalization assessed in 12 ± 3 months (range 1 to 18). A total of 71 patients (65%) responded to CRT at 6 months. FMR response was observed in 49 (69%) of the CRT responders and 8 (20%) of the CRT nonresponders (p <0.001). Although the baseline QRS durations were similar, the paced QRS durations were shorter (p = 0.012) and the ΔQRS values were greater (p = 0.003) in FMR responders compared with FMR nonresponders. There was a linear correlation between ΔQRS and change in regurgitant volume (r = 0.49, p <0.001). At multivariate analysis, baseline tenting area (p = 0.012) and ΔQRS (p = 0.028) independently predicted FMR response. A ΔQRS ≥ 20 ms was related to CRT response, FMR improvement, and lower rates of death or hospitalization during follow-up (p values <0.05). In conclusion, QRS narrowing after CRT independently predicts FMR response. A ΔQRS ≥ 20 ms after CRT is associated with a favorable outcome in all clinical end points.

QRS prolongation after cardiac resynchronization therapy is a predictor of persistent mechanical dyssynchrony.

PURPOSE: Prolonged QRS duration is the main selection criterion for cardiac resynchronization therapy (CRT) which ameliorates left ventricular mechanical dyssynchrony (MD). However, consequences of post-CRT QRS prolongation and residual MD have been poorly evaluated. We aimed to define the predictors of persistent MD and hypothesized that CRT-induced QRS change (ΔQRS) might have an impact on residual MD after CRT. METHODS: A total of 80 patients receiving CRT were included in the study. ΔQRS was calculated as the difference between the baseline and paced QRS intervals. Residual MD was assessed early after device implantation with a longitudinal dyssynchrony index (Yu index). Significant MD was defined as a Yu index ≥ 33 msec. Two groups were created based on residual MD and compared according to clinical, electrocardiographic and echocardiographic features. RESULTS: Patients with persistent MD had longer paced QRS durations (182.5 ± 16.2 vs. 165.4 ± 22.5 msec, p = 0.03) and were less likely to have left ventricular (LV) leads located in the posterolateral vein (53 % vs. 85 %, p = 0.002). The linear correlation between the ΔQRS and the Yu index values was modest (Spearman's rho = -0.341, p = 0.002); additionally, a prolonged QRS was strongly associated with MD after CRT (p = 0.00008). Both LV lead localization and CRT-induced QRS prolongation emerged as the significant predictors of persistent MD. A biventricularly paced QRS more than 10 msec longer than the pre-paced QRS width was predictive of persistent MD after CRT (sensitivity = 80 %, specificity = 62 %). CONCLUSIONS: ΔQRS was found to be associated with residual MD after CRT. Ten milliseconds of QRS prolongation predicted persistent MD after CRT.

Impact of Intracoronary Adenosine on Myonecrosis in Patients with Unstable Angina Pectoris Undergoing Percutaneous Coronary Intervention.

BACKGROUND: In this study, we aimed to investigate the impact of prophylactic intracoronary adenosine administered during percutaneous coronary intervention (PCI) due to unstable angina pectoris on myonecrosis by measuring post-procedural levels of cardiac troponin I (cTnI) and creatine kinase-myocardial band (CK-MB). METHODS: A total of 122 patients with unstable angina undergoing PCI were included in this single-center, double-blind, randomized study. The patients were randomly allocated to adenosine and placebo groups. In the adenosine group, a single-dose of intracoronary adenosine (100 µg for the right coronary artery and 150 µg for the left coronary artery) was administered. Primary endpoint was post-PCI myonecrosis, which was defined as abnormal levels of periprocedural cTnI. Secondary endpoints were defined as elevated cTnI levels [5 × upper limit of normal (ULN)], abnormal CK-MB levels, angiographic coronary flow measured by Thrombolysis In Myocardial Infarction (TIMI) frame count (TFC), the cumulative incidence of in-hospital death and in-hospital urgent target vessel revascularization (TVR). RESULTS: Clinical and angiographic characteristics of both adenosine (61 patients, 61 ± 9 years) and placebo (61 patients, 59 ± 10 years) groups were similar (p > 0.05 for all). Post-procedural abnormal cTnI levels in the adenosine group were significantly lower than the placebo group (32 % vs. 55 %, p: 0.011). cTnI >5 × ULN (21 % vs. 31 %, p: 0.217) and abnormal CK-MB levels (11 % vs. 19 %, p: 0.263) were similar in both groups. Post-procedural TFCs in the adenosine group were significantly lower than the placebo group (24 ± 4 vs. 27 ± 5, p: 0.004). In-hospital events including death and urgent TVR were not observed in either group. CONCLUSION: Intracoronary administration of single-dose adenosine in patients with unstable angina undergoing PCI is associated with decreased periprocedural myonecrosis and improved coronary blood flow.

Effect of Pulmonary Vein Anatomy and Pulmonary Vein Diameters on Outcome of Cryoballoon Catheter Ablation for Atrial Fibrillation.

BACKGROUND: In this study, we aimed to determine pulmonary vein (PV) variation patterns in patients undergoing cryoballoon ablation for atrial fibrillation (AF) and their impacts on procedural success and recurrence and also to identify predictors for recurrence. METHODS: We enrolled 54 patients with AF and having symptoms despite medical therapy. Prior to the procedure, PV variation and left atrium (LA) size were evaluated in all patients by computed tomography scan. Ablation procedure was performed with single balloon and predictors for AF recurrence were determined. RESULTS: The study population consisted of 54 patients (male: 50 [27%], mean age: 53 ± 12) with AF. Paroxysmal AF and persistent AF were detected in 55.6% (30) and 44.4% (24) of the patients, respectively. Mean procedural and fluoroscopy times were 73 ± 19 minutes and 16 ± 4 minutes, respectively. The number of the patients with PV variation of right pulmonary vein (RPV) with >2 ostia and accessory PV was 27.8% (15) and 18.5% (10). During the follow-up, 20.4% (11) of patients had AF recurrence. Patients with recurrence had greater transverse LA size (62 ± 6 mm vs 57 ± 5 mm, P: 0014), longitudinal LA size (65 ± 5 mm vs 61 ± 6 mm, P: 0025), LA volume (78 ± 17 mL vs 65 ± 14 mL, P: 0011), fluoroscopy time (20.4 ± 4.6 minutes vs 15.7 ± 3.5 minutes, P: 0001), RPV with >2 ostia (72.7% vs 27.3%, P: 0001), right upper pulmonary vein (RUPV) diameter (21.6 ± 2.8 cm vs 15.8 ± 2.1 cm; P < 0001), and persistent AF (33.3% vs 66.7%, P: 0046). In multivariate analysis, RUPV diameter (ß: 1006; P: 0010; odds ratio [OR]: 2736; 95% confidence interval [CI]: [1267-5906]) and fluoroscopy time (ß: 0327; P: 0050; OR: 1386; 95% CI: [1000-1921]) were determined as independent predictors for AF recurrence. CONCLUSIONS: Transverse and longitudinal LA size, LA volume, fluoroscopy time, presence of persistent AF, RUPV size, and the number of RPV ostia are associated with AF recurrence following cryoballoon-based ablation. RUPV size and fluoroscopy time are predictors for recurrence.

Evaluation of adult versus pediatric transesophageal echocardiography probe efficiency for guiding septal puncture during atrial fibrillation ablation.

PURPOSE: Transesophageal echocardiography (TEE) has a pivotal role in invasive cardiology practice in terms of guiding a variety of procedures. It is challenging to perform TEE examination with sedated patients due to difficulties in cooperation and positioning the patient properly, therefore the risk of complications is escalated. We aimed to assess the impact of pediatric TEE probe utilization on procedural success and complication rates; in comparison with conventional adult TEE probe. METHODS: Fifty-eight patients undergoing atrial fibrillation (AF) ablation with TEE guidance were enrolled and patients were grouped based on probe size: Group 1 (n = 35) included patients undergoing the procedure with adult TEE probe guidance and Group 2 (n = 23) included patients with pediatric TEE probe guidance. Procedural success, postprocedural odynophagia and periprocedural intra-oral bleeding frequency, number of intubation attempts, TEE imaging time, and midazolam doses for both groups were compared. RESULTS: Odynophagia frequency was significantly higher in Group 1 (25.7% [n = 9] vs. 0%, P = 0.008) besides oral mucosal bleeding was also higher in Group 1, although the difference did not reach statistical significance (5.7% [n = 2] vs. 0%, P = 0.513). Number of repeated attempts was lower in Group 2 (median, 1; range [3-1] vs. 1, [1-1], P = 0.038). Image resolutions and septal puncture success rates were similar for both groups. Total imaging time with TEE was significantly shorter in Group 2 (6.4 ± 1.8 min vs. 3.6 ± 0.9 min, P < 0.001). Midazolam dose was lower in Group 2 (7.0 ± 1.7 vs. 6.2 ± 1.7, P = 0.065). CONCLUSION: Using TEE probes with smaller size for guiding invasive percutaneous procedures performed in cardiac catheterization laboratory decreased TEE-associated complication rates and enhanced patient comfort without any negative effect on procedural success.

Plasma factor XI and XII activity in patients with slow coronary flow.

The exact pathophysiology of slow coronary flow (SCF) phenomenon, characterized by delayed opacification of coronary arteries during coronary angiography, is still unknown, although endothelial dysfunction, inflammation, vasomotor disorders and atherosclerosis are shown. The present study was conducted to investigate whether there is a coagulation pathway abnormality in patients with SCF measuring plasma factor XI and XII activity. The study included 55 patients with angiographically proven SCF (group I) and 40 individuals with normal coronary flow (NCF, group II). Baseline demographic properties were similar in both groups. Echocardiographic parameters were also similar in patients with SCF and NCF. Factor XI activity was significantly higher in group I when compared with group II. Factor XII activity was also significantly higher in group I when compared with group II (108.9 ±â€Š19 vs. 98.8 ±â€Š20, P = 0.018 and 131.2 ±â€Š17 vs. 119.1 ±â€Š16, P = 0.001, respectively). We conclude that SCF phenomenon appears to be associated with enhanced procoagulant state, which may support the role of inflammation and atherosclerosis in the pathogenesis of this phenomenon.

Serum uric acid and carotid artery intima media thickness in patients with masked hypertension.

BACKGROUND: Serum uric acid is related to hypertension and cardiovascular diseases. Masked hypertension is associated with an increase in cardiovascular risk. The aim of our study was to evaluate the serum uric acid level and its relationship with carotid intima-media thickness (IMT) in patients with masked hypertension. SUBJECTS AND METHODS: A total of 114 untreated masked hypertension patients (62 men, 52 women; mean age 44.6 +/- 7.9 years) and 38 controls (20 men, 18 women; mean age 44.8 +/- 7 years) were included in the study. All patients underwent 24-hour ambulatory blood pressure. Serum uric acid and carotid IMT were measured. RESULTS: Serum uric acid was significantly higher in masked hypertension patients when compared to the control group (5.14 +/- 1.42 mg/dl, 4.84 +/- 1.45 mg/ dl, P = 0.01). Masked hypertension patients had significantly higher carotid IMT than control subjects (0.58 +/- 0.09, 0.52 +/- 0.09, P < 0.001). The masked hypertension group was also divided into two groups according to the median value of the serum uric acid levels (median value: 5 mg/dl). Carotid IMT was significantly higher in patients with a higher uric acid when compared to those with a lower uric acid (P < 0.001). We also found that the serum uric acid level was a good predictor of increased carotid IMT at the receiver-operating characteristic curve.The area under the curve was 66% (95% confidence interval, 0.56-0.77), and the serum uric acid level was significantly predictive of a high carotid IMT (P = 0.001). CONCLUSIONS: Our data suggest that the uric acid levels were significantly higher in the masked hypertension group and elevated uric acid levels were associated with increased carotid IMT, indicating that elevated serum uric acid levels might contribute to the increase in cardiovascular risk in masked hypertension.

Increased platelet activation and inflammatory response in patients with masked hypertension.

Masked hypertension is associated with an increase in cardiovascular risk. Mean platelet volume (MPV), a determinant of platelet function, is a new risk factor for atherothrombosis. High-sensitive C-reactive protein (CRP) is an exquisitely sensitive systemic marker of inflammatory response. We designed this study to evaluate MPV and CRP in masked hypertensive patients and to compare those with essential hypertensive and healthy normotensive individuals. Forty-two untreated masked hypertensive patients, 53 untreated essential hypertensive patients and age-sex matched 37 normotensive healthy individuals were included in the study. Blood samples were collected and haematological parameters were measured. Plasma CRP level was measured by immunonephelometery method. The MPV was significantly higher in masked hypertensive (8.8 ±â€Š1.6 fl) and essential hypertensive patients (9.1 ±â€Š1.7 fl) than those of normotensive control individuals (7.8 ±â€Š0.8 fl) (P = 0.01 and P = 0.003, respectively), whereas there was no significant difference between the masked hypertensive and essential hypertensive individuals (P > 0.05). CRP levels were also significantly higher in masked hypertensive patients than in normotensives individuals (3.31 ±â€Š1.70, 1.98 ±â€Š1.56 mg/l, P < 0.001, respectively). There was a significant positive correlation between MPV and CRP levels (P < 0.001, r = 0.850) in masked hypertensive patients. Patients with masked hypertension have higher MPV and CRP values than controls. Increased MPV and CRP levels may be the possible mechanisms behind the increased cardiovascular risk in masked hypertensive patients.

Impaired cerebral circulation in patients with slow coronary flow.

Slow coronary flow (SCF) is characterized by delayed opacification of coronary arteries during coronary angiography and is associated with myocardial perfusion abnormalities, ischemia or myocardial infarction. We hypothesized that SCF could be a part of systemic circulatory abnormalities. Therefore, the present study was conducted to investigate whether cerebral blood flow velocity is altered in patients with SCF. The study included 16 patients suffering from chest pain with angiographically proven SCF and 16 subjects suffering from atypical chest pain with angiographically normal coronary flow. All study subjects were selected among those who undergone routine cardiac catheterization. SCF was defined based on thrombolysis in myocardial infarction frame count that reflects coronary artery flow. Thrombolysis in myocardial infarction frame count was significantly higher in patients with SCF than those with normal coronary flow. The average peak systolic, end diastolic and mean flow velocities of the middle cerebral artery were measured and recorded in both groups by transcranial Doppler ultrasonography. Baseline demographic properties were similar in both groups. Echocardiographic parameters were also similar in patients with SCF and those with normal coronary flow. In contrast, both right and left middle cerebral artery peak systolic, end diastolic and mean flow velocities were significantly lower in patients with SCF than those with normal coronary flow. We conclude that cerebral blood flow velocity is significantly lower in patients with SCF. SCF phenomenon may reflect a part of impaired systemic circulation.

Do mobile phones pose a potential risk to autonomic modulation of the heart?

BACKGROUND: It has long been speculated that mobile phones may interact with the cardiac devices and thereby cardiovascular system may be a potential target for the electromagnetic fields emitted by the mobile phones. Therefore, the present study was designed to test possible effects of radiofrequency waves emitted by digital mobile phones on cardiac autonomic modulation by short-time heart rate variability (HRV) analysis. METHODS AND RESULTS: A total of 20 healthy young subjects were included to the study. All participants were rested in supine position at least for 15 minutes on a comfortable bed, and then time and frequency domain HRV parameters were recorded at baseline in supine position for 5 minutes. After completion of baseline records, by using a mobile GSM (Global System for Mobile Communication) phone, HRV parameters were recorded at turned off mode, at turned on mode, and at calling mode over 5 minutes periods for each stage. CONCLUSION: Neither time nor frequency domain HRV parameters altered significantly during off mode compare to their baseline values. Also, neither time nor frequency domain HRV parameters altered significantly during turned on and calling mode compared to their baseline values. Short-time exposure to electromagnetic fields emitted by mobile phone does not affect cardiac autonomic modulation in healthy subjects.