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ABSTRACT: Prediabetes refers to a state where blood glucose levels are higher than normal, but not high enough to meet the diagnostic criteria for diabetes mellitus. Similar to the worldwide trend, data derived from large studies has shown an increasing trend in the prevalence of prediabetes in Turkey. According to the Centers for Disease Control and Prevention data, 79 million individuals in the United States have prediabetes. This implies a large population worldwide is at risk of developing diabetes in the near future. In addition to its strong association with the development of diabetes, prediabetes itself represents an increased risk of developing cardiovascular disease and its complications. This review will focus on definition, detection, association with cardiovascular disease and treatment of prediabetes.
Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir 09/2012; 40(5):458-65.
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Anadolu kardiyoloji dergisi: AKD = the Anatolian journal of cardiology 06/2012; 12(6):480-2. · 0.44 Impact Factor
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ABSTRACT: Inflammation plays a role both in the mechanisms leading to hypertension alone and in the mechanisms leading to atherosclerosis with hypertension. Previous studies have shown the relationship between the autonomic functions and inflammatory system activation. The aim of the study was to evaluate the relationship between inflammation and cardiac autonomic functions in hypertensive patients.
One hundred twenty one hypertensive patients (mean age 59 ± 11 years, 60 male) and 34 healthy volunteers (mean age 58 ± 11 years, 18 male) were included in the present cross-sectional observational study. The 24-hour ambulatory electrocardiogram recordings were taken using Pathfinder Software. The heart rate variability (HRV) analysis was performed using time domain parameters using the same software. Heart rate turbulence (HRT) parameters, turbulence onset and turbulence slope were calculated with HRT software. Statistical analysis was performed using unpaired t-test or Mann-Whitney U test, one-way ANOVA or Kruskal-Wallis analysis of variance, Chi-square test, and Spearman rank order correlation analysis. The association of hypertension with high sensitivity C-reactive protein (hs-CRP), HRV and HRT was analyzed after adjustment for confounding variables as age and creatinine levels.
The mean hs-CRP was higher, HRV was slightly reduced while HRT was markedly blunted in hypertensive patients in comparison with control group [SDNN; 132 ± 28 vs. 112 ± 34 msec, RMSSD; 27 (23-35) vs. 22 (16-28) msec, TO; -2.80 ± 2.15 vs. -0.96 ± 2.36%, TS; 7.56 (5.24-10.60) vs. 4.65 (2.44-7.26) msec/RR, p<0.01 for all]. All of the HRV and HRT parameters were more deteriorated in the highest tertile hs-CRP group [SDNN; 93 ± 34 msec, RMSSD; 17 (13-22) msec, TO; 0.03 ± 2.22%, TS; 2.43 (1.84-3.89) msec/RR, p<0.05 for all]. There were correlations between hs-CRP and HRV and HRT parameters (SDNN; r=-0.690, RMSSD; r=-0.277, TS; r:-0.417, TO; r=0.267, p<0.05 for all).
There is an inflammatory process in hypertensive patients and inflammation is related with unbalanced cardiac autonomic functions.
Anadolu kardiyoloji dergisi: AKD = the Anatolian journal of cardiology 03/2012; 12(3):233-40. · 0.44 Impact Factor
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ABSTRACT: Although diabetes mellitus is well known to result in systolic and diastolic left ventricular (LV) dysfunction at the subclinical level, even when it is not accompanied by hypertension and coronary artery disease, this situation has not been sufficiently investigated in prediabetes, which is the precursor of diabetes. The aims of the present study were to investigate LV systolic and diastolic function in normotensive and low-risk prediabetic and diabetic subjects for coronary disease using sensitive tissue Doppler echocardiographic parameters, to investigate early possible negative effects of glucose metabolism impairment on LV longitudinal function.
Two hundred subjects (92 with prediabetes, 48 with type 2 diabetes, and 60 age-matched healthy volunteers) were studied by conventional, tissue Doppler, and strain and strain rate echocardiography. All study subjects were normotensive, and coronary artery disease was excluded. Forty-eight patients had isolated fasting glucose impairment, and 44 patients had combined fasting glucose and glucose tolerance impairment. Longitudinal peak systolic strain and the peak systolic and diastolic strain rates of six walls in the apical four-chamber, long-axis, and two-chamber views were evaluated.
Clinical and standard echocardiographic characteristics were comparable among all groups. Mean systolic (P = .01) and diastolic (P = .02) tissue velocities, mean strain (P = .004), and mean systolic (P = .002) and diastolic (P = .001) strain rates were significantly lower in the diabetic groups than in control subjects. There were no difference between patients with isolated fasting glucose impairment and controls for tissue Doppler parameters, but mean early diastolic tissue velocity and mean strain and strain rates were statistically lower in patients with combined fasting glucose and glucose tolerance impairment compared with controls (P < .05).
LV longitudinal systolic and diastolic function was impaired in both normotensive diabetic and prediabetic patients.
Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 12/2011; 25(3):349-56. · 2.98 Impact Factor
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ABSTRACT: Obesity may start in childhood and obese children are more likely to grow up to be obese adults. Atherosclerosis is one of the most important complications of obesity. Pulse wave velocity (PWV), a noninvasive measure of arterial stiffness, is accepted to be an indicator of subclinical atherosclerosis. The aim of the study was to determine PWV in obese children.
The study included 30 obese (12 boys, 18 girls; mean age 13 ± 2 years) and 30 lean children (13 boys, 17 girls; mean age 12.5 ± 1.7 years). Weight and height were measured and obesity was defined as body mass index (BMI) of greater than the 95th percentile for age. All the subjects underwent echocardiographic evaluation and blood samples were obtained. Pulse-wave velocity was calculated using the following equation: PWV (m/sec) = height-based aortic length (cm)/(100xtransit time [sec]). The latter was measured as the difference in the time of onset of two flows at the diaphragm and the aortic valve.
Obese subjects had significantly higher blood pressure levels compared to the control group (p<0.001). The two groups were similar with respect to fasting glucose, hemoglobin, serum creatinine, and lipid levels. Among echocardiographic parameters, left ventricular end-diastolic dimension, interventricular septum thickness, posterior wall thickness, left ventricular mass index, left atrium dimension, and aortic root dimension were significantly increased in obese subjects compared to controls (p<0.01). Obese children had significantly higher PWV values than the controls (4.0 ± 0.8 vs. 3.3 ± 0.7 m/sec, p<0.001). A positive significant correlation was found between PWV and BMI (r=0.391, p=0.002).
Our findings show that aortic PWV is increased in obese children, suggesting that obesity may cause subclinical atherosclerosis even at early ages.
Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir 10/2011; 39(7):557-62.
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ABSTRACT: It has been shown that the fragmented QRS (fQRS) on electrocardiogram (ECG) signifies regional myocardial scar in patients with non-Q-wave myocardial infarction (MI). We hypothesized that presence of fQRS on ECG may be related with poorly-grown collateral coronary circulation (CCC) in patients with chronic total coronary occlusion (CTO) without prior MI.
This retrospective observational study is included 56 patients (mean age 61.73±7.96 years; 67.9% men) with CTO in one of the major coronary arteries. Collateral circulation was graded according to Rentrop's classification. The fQRS was defined as the presence of an additional R wave or notching of R or S wave or the presence of fragmentation in two contiguous ECG leads corresponding to a major coronary artery territory. Patients with pathological Q-wave or history of MI, typical bundle brunch blocks (BBB) and incomplete right BBB were excluded from study. Statistical analysis was performed using Chi-square test, Student's t-test and logistic regression analysis.
Fifteen patients had Rentrop grade 1, 15 patients had grade 2 and 26 patients had grade 3 CCC. Five (19%) of the patients who have grade 3 CCC, seven (47%) of the patients who had grade 2 CCC, ten (67%) of the patients who had grade 1 CCC had fQRS (p=0.002). Logistic regression analysis showed high predictive value of the presence of fQRS for Rentrop 1 CCC (OR=8.4, 95% CI 1.97-35.7; p=0.004).
Results of our study may implicate the presence of fQRS on electrocardiogram as a predictor of a poorly grown CCC in patients with chronic total occlusion without prior MI.
Anadolu kardiyoloji dergisi: AKD = the Anatolian journal of cardiology 06/2011; 11(4):300-4. · 0.44 Impact Factor
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ABSTRACT: There have been numerous investigations demonstrating protective effects of awell- grown coronary collateral circulation (CCC) on left ventricular systolic function. N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) is released by ventricular myocardium as a result of increased myocardial wall stress. The aim of the study was to evaluate the relationship between CCC and plasma NT-pro-BNP levels.
Study group was retrospectively selected from patients who had a coronary angiography at our center between January 2008 and December 2009. One hundred and thirty patients having at least one totally occluded main coronary artery were included in this study. Collateral circulation was graded according to Rentrop score. Grade 0 and 1 are regarded as poor, and grade 2 and 3 - good CCC. Plasma NT-pro-BNP levels were measured by electrochemiluminescence immunoassay method and left ventricular ejection fraction (LVEF) were measured by modified Simpson method. We used Chi-square, Student t and Mann-Whitney-U tests for statistical analysis.
Overall 57 patients were found to have poor CCC and 73 patients have good CCC. Plasma NT-pro-BNP levels (pg/ml)-median (minimum-maximum)- were 1319 (48-9753) in poor CCC group and 847 (16-5529) in good CCC group (p=0.004). LVEF was found to be -median (minimum-maximum)- 45% (30-55%) in poor CCC group and 50% (30-60%) in good CCC group (p=0.003). Correlation analysis demonstrated that collateral grade was negatively correlated with NT-pro-BNP levels (r=-0.252, p=0.004).
We found that plasma NT-pro-BNP levels were more elevated in patients with poor CCC than in patients with good CCC. This finding may be explained with the protective effect of good CCC on LVEF.
Anadolu kardiyoloji dergisi: AKD = the Anatolian journal of cardiology 02/2011; 11(1):29-33. · 0.44 Impact Factor
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ABSTRACT: We evaluated the relationship between coronary collateral circulation (CCC) and blood high-sensitivity C-reactive protein (hs-CRP) levels in patients with chronic stable coronary artery disease.
The study included 104 patients who underwent coronary angiography at least one month after acute coronary event and were found to have total coronary occlusion in at least one major coronary artery. Patients with the diagnosis of acute coronary syndrome within the past month, severe valve disease, systemic disease, systemic inflammatory disease, or a history of coronary surgery or percutaneous coronary intervention were excluded. Collateral circulation was graded according to the Rentrop classification. Grades 0 and 1 were defined as poor, grades 2 and 3 were defined as good CCC. Blood hs-CRP levels were measured 1 to 7 days before coronary angiography.
According to the Rentrop classification, CCC was graded as 0 in 10 patients, 1 in 26 patients, 2 in 29 patients, and 3 in 39 patients. Sixty-eight patients (65.4%) had a good CCC, and 36 patients (34.6%) had a poor CCC. The two groups were similar with respect to age, sex, risk factors, medications, localization of the occluded coronary artery, and the number of occluded arteries. However, hs-CRP levels were significantly higher in patients with a poor CCC (median 5.42 mg/dl; range 2.3-9.8 mg/dl) compared to those with a good CCC (median 3.36 mg/dl; range 2.2-9.7 mg/dl, p=0.003). Logistic regression analysis showed that hs-CRP level was a significant predictor exerting an adverse effect on collateral development (β=-320; odds ratio= 0.725; 95% confidence interval 0.587-0.894; p=0.003).
Our findings suggest that high hs-CRP level is a significant predictor of poor collateral development in patients with chronic stable coronary artery disease.
Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir 01/2011; 39(1):23-8.
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Anadolu kardiyoloji dergisi: AKD = the Anatolian journal of cardiology 11/2010; 10(6):E25. · 0.44 Impact Factor
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ABSTRACT: Traumatic intravascular hemolysis after heart valve replacement can be a serious problem. It is commonly associated with either structural deterioration or paravalvular leaks. A 63-year-old woman with a six-year history of surgery for mitral stenosis presented with complaints of weakness and dyspnea. She received treatment at other centers three times in the past six months for dyspnea and anemia requiring transfusion of red blood cells. Transthoracic echocardiography showed a normally functioning mitral mechanic prosthesis. Laboratory findings were abnormal for hemoglobin, hematocrit, white blood cell count, C-reactive protein, serum haptoglobin, and lactate dehydrogenase. Peripheral blood smear showed marked schistocytes, indicative of mechanical erythrocyte destruction. Transesophageal echocardiography demonstrated severe paravalvular leak and a large (9x13 mm) vegetation adhering to the prosthetic valve, protruding into the left atrium. Enterococcus faecalis was isolated from blood cultures. Surgery was planned because of large vegetation, repeated hemolysis, and severe paravalvular regurgitation, but the patient refused surgical treatment.
Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir 09/2010; 38(6):429-31.
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Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir 04/2010; 38(3):225.
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Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir 01/2010; 38(1):71.
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Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir 07/2009; 37(5):359.
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Anadolu kardiyoloji dergisi: AKD = the Anatolian journal of cardiology 09/2008; 8(4):E27. · 0.44 Impact Factor
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Anadolu kardiyoloji dergisi: AKD = the Anatolian journal of cardiology 10/2007; 7(3):355. · 0.44 Impact Factor
