Echocardiographic epicardial fat thickness measurement: A new screening test for subclinic atherosclerosis in patients with inflammatory bowel diseases.

OBJECTIVE: Inflammatory bowel diseases (IBD) consist of a number of chronic inflammatory diseases. Inflammatory process is known to be involved in all stages of atherosclerosis. Early atherosclerosis is reflected by increased levels of carotid artery intima media thickness (c-IMT) and high-sensitivity C-reactive protein (hs-CRP). Epicardial fat thickness (EFT) strongly influences both the formation and progression of atherosclerosis. Recent studies have demonstrated a relationship between c-IMT and hs-CRP levels and the risk of atherosclerosis in patients with IBD. However, no study has yet compared EFT between patients with IBD and the general healthy population. Hence, this study was designed to further evaluate whether patients with IBD have higher EFT values with increased c-IMT and hs-CRP levels compared to those in the healthy population. METHODS: A total of 110 patients with IBD and 105 healthy volunteers were enrolled into this study. EFT was evaluated by transthoracic echocardiography. c-IMT levels were measured using an ultrasound scanner with a linear probe. The plasma levels of hs-CRP were measured using a highly sensitive sandwich ELISA technique. RESULTS: The hs-CRP and c-IMT levels of patients with IBD were significantly higher than those of the control group. The EFT values of patients with IBD were significantly higher than those of the control group (0.54±0.13 vs. 0.49±0.09, p=0.002). CONCLUSION: Echocardiographic EFT measurements of patients with IBD were significantly higher than those of the normal population, which may be associated with an increased subclinical atherosclerosis risk in these patients.

Retrobulbar blood flow and carotid intima-media thickness alteration may relate to subclinic atherosclerosis in patients with chronic inflammatory diseases.

OBJECTIVE: AA amyloidosis occurs in the setting of longstanding inflammation. An increased incidence of coronary artery disease (CAD) was noted in patients with chronic inflammatory disease (CID). Retrobulbar blood flow predicts future macrovascular events including CAD. Increase in carotid artery intima-media thickness is regarded as a marker for early atherosclerosis. The relationship between chronic inflammation and atherosclerosis is well known; however, the connection between amyloidosis-advanced CIDs and retrobulbar microvascular function and carotid intima-media thickness (CIMT) is unidentified. We aimed to investigate whether retrobulbar microcirculation and CIMT were impaired or not in amyloidosis-advanced CID patients compared to normal subjects. METHODS: Fourteen patients with renal AA amyloidosis and a group of healthy volunteers were included in the study. Measurement of CIMT and retrobulbar blood flow velocities was performed with ultrasound scanner and color Doppler ultrasonography. RESULTS: The CIMT of patients with renal amyloidosis was significantly thicker than that of the normal population (p < 0.001). The resistivity index of the ophthalmic artery (OA) of patients with renal amyloidosis was significantly higher than the study group (p < 0.001). CONCLUSION: This study demonstrates that accelerated atherosclerosis which can be shown by increased OA resistivity index and CIMT are found in amyloidal-related CID patients.

Cardiac changes with subclinical hypothyroidism in obese women.

OBJECTIVES: Obesity has been linked to a spectrum of minor cardiovascular changes. The aim of this study was to determine the effect of obesity on cardiac functions and its relations with subclinical hypothyroidism in healthy women. STUDY DESIGN: Eighty-eight consecutive "healthy" females (mean age: 31.2±6.6 years) were included in the study. Thyroid function tests and echocardiography studies were performed in all patients. Height, weight, and waist and hip circumference were also measured. A body mass index (BMI) above 30 kg/m2 was considered obese. RESULTS: Left ventricular mass (LVM) was higher in obese subjects (p<0.001). Doppler-derived indices of LV diastolic filling showed clear abnormalities of myocardial relaxation in obese subjects with higher E/e' (p=0.001) and larger left atrial volume (LAV) (p<0.001). LV myocardial performance index was also significantly higher in obese subjects (p=0.033). Thyroid-stimulating hormone (TSH) levels were significantly higher in obese subjects (p=0.011) and were positively correlated with BMI, waist circumference, LAV, and LVM. The prevalence of abnormal systolic and diastolic functions showed stepwise increases with higher TSH levels in obese subjects. Multiple regression analysis was used to evaluate the association of E/e' with anthromorphometric and biochemical parameters, and waist circumference was found to be the strongest independent variable correlated with the E/e' ratio. CONCLUSION: Cardiac structural and functional deteriorations may be related with subclinical hypothyroidism in obese subjects.

[The value of serum homocysteine in predicting one-year survival in patients with severe systolic heart failure]. / Serum homosistein düzeyinin ileri sistolik kalp yetersizligi olan hastalarda bir yillik sagkalimi öngörmedeki degeri.

OBJECTIVES: Heart failure (HF) is a major public health problem responsible for high morbidity and mortality rates. Thus, the importance of survival predictors in directing the treatment of HF is gradually increasing. In some recently published studies, plasma homocysteine has been presented as a newly recognized risk factor for development of HF. In the present study, we investigated the value of serum homocysteine levels in predicting the survival of patients with HF. STUDY DESIGN: Seventy HF patients (44 males, 26 females; mean age 60±12; range 28 to 83 years) with left ventricle ejection fractions <35% were included in our study. Clinical, echocardiographic, and biochemical parameters were measured at baseline, and all patients were followed. Cardiac death was established as the end point of the study. RESULTS: At the end of the 12 month follow-up period, 14 patients (20%) had died. Serum homocysteine levels were significantly higher in the deceased patients compared to the patients who survived (20.8±5.8 vs. 16.9±5.1 µmol/l, p=0.029). A serum homocysteine level of >17.45 µmol/l predicted death at the end of the first year with 71.4% specificity and 67.9% sensitivity (ROC area under curve: 0.855, CI 95% 0.792-0.965, p<0.001). Multivariate Cox regression analysis showed that the serum homocysteine level was the only parameter predicting survival. CONCLUSION: Serum homocysteine level may be an important predictor of mid-term mortality in patients with HF.