Haldun Müderrisoğlu - Academia.edu (original) (raw)

Papers by Haldun Müderrisoğlu

Research paper thumbnail of Epicardial Adipose Tissue Thickness and Carotid Intima-Media Thickness in Hemodialysis Patients

Acta Cardiologica Sinica, 2017

BACKGROUND It is well-known that cardiovascular risk and all-cause mortality is increased in hemo... more BACKGROUND It is well-known that cardiovascular risk and all-cause mortality is increased in hemodialysis patients. Epicardial fat thickness (EFT), which reflects visceral adiposity, has been suggested as a new cardiometabolic risk factor. The purpose of this study was to investigate EFT in hemodialysis patients. METHODS A total of 144 consecutive patients (60 hemodialysis patients and 84 controls) were enrolled into the study, and patients with diabetes mellitus and cardiovascular diseases (CVD) were excluded. EFT was measured on the free wall of the right ventricle at end-diastole from the parasternal long-axis view by standard transthorasic 2D echocardiography. RESULTS The groups were similar in terms of sex distribution, age, blood pressure, heart rate and frequencies of CAD risk factors including smoking status, family history of CAD and hypertension. There were no significant differences between the hemodialysis patients and controls in 2D echocardiographic parameters, includi...

Research paper thumbnail of Assessment of epicardial adipose tissue and carotid/femoral intima media thickness in insulin resistance

Journal of cardiology, Jan 6, 2016

Metabolic syndrome is a combination of multiple cardiovascular (CV) risk factors including insuli... more Metabolic syndrome is a combination of multiple cardiovascular (CV) risk factors including insulin resistance (IR). Carotid, femoral intima media thickness (IMT), and epicardial fat thickness (EFT) are considered as novel cardiometabolic risk factors. We aimed to test the hypothesis that carotid, femoral IMT, and EFT are increased in patients with IR. We enrolled consecutively and prospectively 113 patients with IR. Then we collected data from an age- and sex-matched control group of 112 individuals without IR. Homeostasis model assessment (HOMA) index value >2.5 was accepted as IR. Patients with diabetes mellitus, CV diseases, systolic heart failure, chronic liver or renal diseases were excluded. On B-mode duplex ultrasound the mean IMT at the far wall of both left and right common carotid/femoral arteries were measured manually. EFT was measured on the free wall of the right ventricle at end-diastole from the parasternal long-axis views by standard transthoracic 2D echocardiogr...

Research paper thumbnail of The effect of raloxifene on left ventricular hypertrophy in postmenopausal women: A prospective, randomized, and controlled study

Anadolu kardiyoloji dergisi : AKD = the Anatolian journal of cardiology, Jan 3, 2014

In healthy women, there is a progressive age-related increase in myocardial mass that is not seen... more In healthy women, there is a progressive age-related increase in myocardial mass that is not seen in their male counterparts and occurs primarily in postmenopausal women. Raloxifene is a selective estrogen receptor modulator that has estrogenic actions on bone and the cardiovascular system. The aim of this study was to investigate the effect of raloxifene on myocardial hypertrophy in postmenopausal patients. A total of 22 postmenopausal osteoporotic women were included in this open-label, randomized, prospective, controlled study. Patients were randomized into two groups: 11 of the patients (group 1) were treated with raloxifene 60 mg/day, and the other 11 patients (group 2) were defined as the control group. Quantitative 2-dimensional and M-mode echocardiographic examination was performed in all patients at the beginning and repeated at the end of the 6-month follow-up period. Left ventricle mass (LVM) and left ventricle mass index (LVMI) were calculated for all patients. The mean ...

Research paper thumbnail of Decreased coronary flow reserve in obese women

Türk Kardiyoloji Derneği arşivi : Türk Kardiyoloji Derneğinin yayın organıdır, 2009

Obesity is associated with an increased rate of cardiovascular disease and risk factors. It is a ... more Obesity is associated with an increased rate of cardiovascular disease and risk factors. It is a common problem in apparently healthy women. We aimed to investigate the association between obesity and coronary flow reserve (CFR) in obese women. The study included 80 consecutive women (mean age 55.6+/-10.2 years) without diabetes mellitus and clinical coronary artery disease. Body mass index (BMI) was calculated and obesity was defined as BMI = or >30 kg/m(2). Based on BMI, the patients were grouped as normal weight (n=13; 18.5-24.9 kg/m(2)), overweight (n=32; 25-29.9 kg/m(2)), obese (n=32; = or >30-39.9 kg/m(2)), and morbid obese (n=3; = or > 40 kg/m(2)). Peak diastolic coronary flow velocities were measured in the distal left anterior descending artery by transthoracic pulsed wave Doppler echocardiography at baseline and after dipyridamole infusion and CFR was calculated as the ratio of hyperemic to baseline peak diastolic velocities. There were 35 obese women (43.8%). Cor...

Research paper thumbnail of Renal transplant improves pulmonary hypertension in patients with end stage renal disease

Multidisciplinary Respiratory Medicine, 2011

Background: Pulmonary hypertension (PH) is present in a significant proportion of patients with e... more Background: Pulmonary hypertension (PH) is present in a significant proportion of patients with end stage renal disease (ESRD) and is of prognostic importance. Data on the effect of renal transplant on PH is very limited. In this study, the aim was to examine the effect of renal transplant on systolic pulmonary artery pressure (SPAP) determined by Doppler echocardiography. Methods: Analysis was performed on the records of 500 consecutive patients who underwent renal transplant at our center between the years 1999 to 2008. The prevalence of PH in the preoperative assessment period was established. Patients were diagnosed as having PH when measured SPAP values were > 35 mm Hg. Results: Pulmonary hypertension was detected in 85 of the 500 (17%) patients under pre-transplant evaluation. At post-transplant follow up Doppler echocardiographic examination was performed on 50 of the 85 patients. After exclusion of 8 cases (1 due to massive pulmonary thromboemboli; 7 due to graft failure requiring dialysis therapy) analyses were performed on 42 patients who had undergone both pre-and post-transplant echocardiographic examination. Mean SPAP at pre-transplant evaluation was 45.9 ± 8.8 mm Hg and in 6 (14.3%) cases SPAP was above 50 mm Hg. Compared to pre-transplant values, a significant decrease was observed in mean SPAP values in an average of 53 months of postoperative follow up (41.8 ± 7.4 mm Hg vs. 45.9 ± 8.8 mm Hg, p < 0.0001). Conclusion: These findings indicate that patients with ESRD accompanied by PH may benefit from renal transplant. Further research is required for more concrete conclusions to be drawn on this subject.

Research paper thumbnail of Epicardial adipose tissue thickness and plasma homocysteine in patients with metabolic syndrome and normal coronary arteries

Diabetology & Metabolic Syndrome, 2014

Background: Increased epicardial adipose tissue thickness and plasma homocysteine levels are asso... more Background: Increased epicardial adipose tissue thickness and plasma homocysteine levels are associated with Metabolic Syndrome (MS) and coronary artery disease. The majority of patients with MS have subclinical or manifest coronary artery disease. The aim of this study was to evaluate the relationship between MS and plasma homocysteine levels and epicardial adipose tissue thickness in subjects without epicardial coronary artery disease. Methods: Patients who underwent coronary angiography due to angina or equivocal symptoms and/or abnormal stress test results and were found to have normal coronary arteries were evaluated for the presence of MS. The study group comprised 75 patients with normal coronary arteries and MS, and the control group included 75 age-gender matched subjects without coronary artery disease or MS. Results: Epicardial adipose tissue thickness (5.8 ± 1.9 mm vs. 4.3 ± 1.6 mm, p <0.001) and plasma homocysteine levels (21.6 ± 6.1 μmol/L vs. 15.1 ± 5.8 μmol/L, p <0.001) were significantly higher in the MS group. Body mass index, triglyceride level, weight, age and waist circumference were positively and HDL cholesterol level were negatively correlated with both epicardial adipose tissue thickness and plasma homocysteine level. Epicardial adipose tissue thickness had the strongest correlation with plasma homocysteine level (r = 0.584, p < 0.001). For each 1 mm increase in epicardial adipose tissue thickness, an increase of 3.51 μmol/L (95% CI: 2.24-4.79) in plasma homocysteine level was expected. Conclusions: We observed a close relationship between MS and epicardial adipose tissue thickness and plasma homocysteine levels, even in the absence of overt coronary artery disease.

Research paper thumbnail of Hyperhomocysteinemia in a young woman presenting with acute myocardial infarction: Case report

Interventional Medicine and Applied Science, 2013

Homocysteine (Hcy), a sulfur-containing amino acid that is formed by demethylation of dietary met... more Homocysteine (Hcy), a sulfur-containing amino acid that is formed by demethylation of dietary methionine to cystein. Elevated homocysteine level is known to be associated with coronary artery disease. We present a case of acute myocardial infarction in a 25-year-old woman, associated with hyperhomocysteinaemia. Her other risk factors for coronary artery disease were smoking, a moderately high LDL level, and a family history of sudden cardiac death. This case illustrates the need to include plasma homocysteine measurement in the setting of acute coronary syndromes in women with premature atherosclerosis, even in the presence of traditional risk factors for coronary artery disease.

Research paper thumbnail of Statin Therapy Helps to Control Blood Pressure Levels in Hypertensive Dyslipidemic Patients

Renal Failure, 2005

Aim. Aside from lowering lipid levels; statins improve endothelial function, decrease platelet ag... more Aim. Aside from lowering lipid levels; statins improve endothelial function, decrease platelet aggregation, reduce procoagulant blood factors, and decrease vascular tone. This study was conducted to investigate the possible effect of atorvastatin on blood pressure (BP) in a group of hypertensive and dyslipidemic patients. Methods. Thirty-six hypertensive and dyslipidemic patients with inadequately controlled lipid levels by diet were treated with atorvastatin 20 mg/day for 8 weeks and compared with 24-patient matched controls treated with diet alone. The type and dosage of antihypertensive medications were not altered during statin therapy. Blood lipid profile including total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL) and triglyceride (TG) levels were noted at inclusion and after 8 weeks. Ambulatory BP monitoring (ABPM) was carried out at study entry and at the end of week eight. Results. A total of 49 patients (32 patients in the atorvastatin group and 17 patients in the control group) completed the 3-month follow-up period of observation. The ABPM studies indicated significant reductions in total average systolic BP, total average diastolic BP, total average mean BP, day average systolic BP, day average diastolic BP, night average systolic BP, night average diastolic BP, and night average mean BP levels in the atorvastatin group, whereas these reductions were not observed in the control group. Conclusion. Our results indicate that atorvastatin therapy significantly improves BP control in hyperlipidemic hypertensive patients. However, the effects of other statins on BP, as well as, the different dosages need to be further investigated.

Research paper thumbnail of Decreased Heart Rate Recovery in Patients With Heart Failure Effect of Fluvastatin Therapy

International Heart Journal, 2005

Heart rate recovery is the difference in heart rate at peak exercise and at a specific time inter... more Heart rate recovery is the difference in heart rate at peak exercise and at a specific time interval following the onset of recovery. Attenuated heart rate recovery is an independent predictor of mortality in patients with a history of coronary artery disease. The aim of the present study was to evaluate the effect of a statin on heart rate recovery, particularly in patients with ischemic heart failure and hyperlipidemia. Twenty-nine consecutive hyperlipidemic, stable coronary artery disease patients with heart failure and 19 healthy subjects were enrolled. Heart rate recovery values at the 1st and 3rd minutes and lipid profiles of the patients were evaluated at baseline and following 3 months of treatment with fluvastatin. Compared with healthy subjects, the heart rate recovery values were significantly lower in the heart failure patients in both the 1st and 3rd minutes, respectively (31 ± 6 versus 19 ± 7, P < 0.0001; 66 ± 7 versus 47 ± 8, P < 0.0001). Heart rate recovery in the 1st and 3rd minutes increased from 19 ± 7 to 24 ± 9 and 47 ± 8 to 57 ± 11, respectively, following treatment (P < 0.001, P < 0.001). There were no significant correlations among the changes in lipid parameters or HRR in the first and third minutes in the recovery period. The results revealed an improvement in heart rate recovery in heart failure patients by fluvastatin treatment. If this association can be confirmed by other studies, it would be interesting to perform further studies into the mechanism underlying this finding.

Research paper thumbnail of Comparison of Intermittent With Continuous Simvastatin Treatment in Hypercholesterolemic Patients With End Stage Renal Failure

Japanese Heart Journal, 2004

Coronary artery disease is the most important cause of morbidity and mortality in patients with e... more Coronary artery disease is the most important cause of morbidity and mortality in patients with end-stage renal failure (RF). Hypercholesterolemia is an important risk factor for coronary heart disease. Patients with chronic renal failure (CRF) have difficulties in compliance with their care and treatment. Intermittent simvastatin treatment may help to increase compliance and can be a treatment alternative in patients with CRF at risk of coronary artery disease. We investigated the effects of simvastatin and compared intermittent with continuous simvastatin treatment in hypercholesterolamic patients with CRF. The study group included 40 of 422 CRF patients on dialysis in our clinic. The inclusion criterion was low density lipoprotein cholesterol (LDL-C) of 130 mg/dL or more. Twenty patients received simvastatin 10 mg/day (continuous group) and 20 patients received simvastatin 20 mg three times a week (only dialysis days-intermittent group) for four months. Nineteen patients served as controls and they were given a prescribed diet only. Total cholesterol (TC) and LDL-C decreased markedly in patients receiving intermittent and continuous simvastatin compared to controls. Continuous simvastatin decreased TC by 23% (P < 0.001) and LDL-C by 39% (P < 0.001). Intermittent simvastatin decreased TC by 26% (P < 0.001) and LDL-C by 40% (P < 0.001). The atherogenic index ratios in both the continuous and intermittent groups (TC/High density lipoprotein-cholesterol (HDL-C) and LDL-C/HDL-C) decreased significantly. There was no significant difference in patient compliance between the two groups. Intermittent simvastatin is as effective and reliable as continuous simvastatin treatment and can be an alternative treatment in hypercholesterolemic patients on dialysis.

Research paper thumbnail of Do young women with polycystic ovary syndrome show early evidence of preclinical coronary artery disease?

Human Reproduction, 2005

BACKGROUND: It is thought that women with polycystic ovary syndrome (PCOS) are at increased risk ... more BACKGROUND: It is thought that women with polycystic ovary syndrome (PCOS) are at increased risk of developing cardiovascular diseases. METHODS: In this study, we used transthoracic echocardiography to measure coronary flow reserve (CFR) in 28 women with PCOS and in 26 healthy women. RESULTS: The PCOS and the control groups were similar in terms of age (27.1 ؎ 4.5 versus 28.8 ؎ 4.4 years) and BMI (26.6 ؎ 5.7 versus 24.7 ؎ 4.4 kg/m 2). Fasting insulin levels and homeostasis model assessment insulin resistance index were higher in the PCOS group. LH, the LH/FSH ratio, total testosterone, free testosterone and androstenedione were higher in the PCOS group. FSH, estradiol, prolactin, progesterone, cholesterol, triglyceride and high-sensitive C-reactive protein were similar between the two groups, but homocysteine levels were higher in the PCOS group. Baseline diastolic peak flow velocity (DPFV) (25.0 ؎ 4.6 versus 23.3 ؎ 2.7 cm/s, P > 0.05), hyperaemic DPFV (71.2 ؎ 12.8 versus 73.0 ؎ 12.9 cm/s, P > 0.05) and CFR (2.8 ؎ 0.8 versus 3.2 ؎ 0.8 cm/s, P > 0.05) of the left anterior descending coronary artery were similar between the two groups. CONCLUSION: We conclude that in young women with PCOS and without cardiovascular risk factors, CFR is preserved.

Research paper thumbnail of Association between Serum Total Antioxidant Status and Coronary Microvascular Functions in Patients with SLE

Echocardiography, 2012

ABSTRACT Mortality from cardiovascular disease has been found to be increased in patients with sy... more ABSTRACT Mortality from cardiovascular disease has been found to be increased in patients with systemic lupus erythematosus (SLE). Coronary flow reserve (CFR) measurement is used both to assess epicardial coronary arteries and to examine the integrity of coronary microvascular circulation. Oxidative stress, enhancing modification of plasma lipids, is also associated with atherosclerotic events in lupus patients. Impairment of CFR and TAS has been shown to be an early manifestation of coronary atherosclerosis. Forty patients with SLE and 33 healthy volunteers were included in this study. Echocardiographic examination included left ventricular myocardial velocity measurements and coronary flow reserve (CFR) measurement. Serum total antioxidant status levels (TAS) also were measured using TAS kit. Lateral myocardial early peak velocity (Em) and lateral Em/Am ratio did not differ between the groups, but lateral myocardial atrial peak velocity (Am) was significantly higher in SLE group than the control group. Baseline coronary diastolic peak flow velocity (DPFV) of left anterior descending was similar in both the groups. However, hyperemic DPFV and CFR (2.50 ± 0.42 vs. 3.09 ± 0.45, P &lt; 0.0001) were significantly lower in the SLE group than in the control group. CFR significantly and inversely correlated with CRP and significantly correlated with TAS. Subclinical coronary microvascular dysfunction can occur in SLE patients without traditional cardiovascular risk factors, probably associated with underlying inflammation and impairment of TAS.

Research paper thumbnail of Cardiac Enzymes, Renal Failure and Renal Transplantation

Clinical Medicine & Research, 2006

Diagnostic accuracy of the currently available serum markers of cardiac injury, such as myoglobin... more Diagnostic accuracy of the currently available serum markers of cardiac injury, such as myoglobin, creatine kinase and its myocardial isoform, are altered in patients with renal failure. It is shown that cardiac troponins have decreased diagnostic sensitivity and specificity in patients receiving renal replacement therapy. Data regarding serum levels of these cardiac biomarkers, especially those of the cardiac troponins, in patients with a transplanted kidney are limited. Current data show that levels of cardiac troponin I are unaltered in patients who have undergone renal transplantation, while levels of cardiac troponin T may be elevated.We believe that cardiac troponin I should be the biomarker of choice for diagnosis of myocardial injury in these patients. However, further trials are required for conclusive results.

Research paper thumbnail of Coronary Flow Reserve Is Impaired in Subclinical Hypothyroidism

Clinical Cardiology, 2007

Objective: Although the cardiovascular system is highly sensitive to thyroid hormones, the cardio... more Objective: Although the cardiovascular system is highly sensitive to thyroid hormones, the cardiovascular effects of subtle thyroid dysfunction such as subclinical hypothyroidism (SHT) remain unclear. Therefore, we investigated coronary flow reserve (CFR) reflecting coronary microvascular function in patients with SHT. Methods: Fifty subjects with SHT and 30 control subjects with normal serum thyroid hormones and TSH levels were included in this study. Coronary diastolic peak flow velocities were measured at baseline and after dipyridamole infusion. CFR was calculated as the ratio of hyperemic to baseline diastolic peak velocity. Results: Age, gender, diastolic and systolic blood pressure, body mass index (BMI), serum lipid parameters, and thyroid hormone levels were similar between the groups. Heart rate was significantly lower in the SHT group. Left ventricular diastolic filling parameters were significantly different in the SHT group while other echocardiographic parameters were similar. CFR values were significantly lower in subjects with SHT than in the control group (2.38 ± 0.44 vs. 2.98 ± 0.47, p<0.0001). Conclusions: These findings suggest that CFR, which reflects coronary microvascular function, is impaired in patients with SHT.

Research paper thumbnail of Effects of Atorvastatin on Coronary Flow Reserve in Patients with Slow Coronary Flow

Clinical Cardiology, 2007

BackgroundStatins improve endothelial functioning in patients with coronary artery disease and hy... more BackgroundStatins improve endothelial functioning in patients with coronary artery disease and hypercholesterolemia, while substantially little is known about induced changes in myocardial microcirculation. However, although previous studies have suggested that microvascular abnormalities and endothelial dysfunction is responsible for slow coronary flow (SCF), there is no study investigating possible effects of statins on coronary microvascular function in patients with SCF.HypothesisWe prospectively investigated the effects of short‐term lipid‐lowering therapy with atorvastatin on coronary flow reserve (CFR) reflecting coronary microvascular function in patients with SCF assessed by transthoracic Doppler echocardiography (TTDE).MethodsIn an open clinical trial, CFR was studied in 20 subjects with SCF. TTDE was used to assess CFR at baseline as well as after 8 weeks of atorvastatin therapy. Coronary flow was quantified according to TIMI frame count (TFC). Coronary diastolic peak flo...

Research paper thumbnail of Effects of normal blood pressure, prehypertension and hypertension on left ventricular diastolic function and aortic elastic properties

Blood Pressure, 2007

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Trea... more The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (BP) provides guideline for the new category of BP levels as normal, prehypertension (PHT), and hypertension. Although PHT is associated with a markedly increased risk of developing hypertension within 4 years, its prognostic significance and predisposition to target-organ damage is unknown. Accordingly, we evaluated the effects of normal BP, PHT and hypertension on left ventricular (LV) diastolic function and aortic elasticity, which are sensitive indicators of target-organ damage. We evaluated LV diastolic function and aortic elastic properties of 60 subjects with PHT, 70 patients with hypertension and 50 normotensive healthy volunteers using transthoracic echocardiography. None of the subjects had any systemic disease. LV diastolic function was more significantly impaired in the hypertension group than in the PHT group compared with controls, but it was not strongly different between the PHT and control group. Aortic distensibility was significantly lower, and aortic stiffness index was significantly higher in both the hypertension and the PHT group than those in the control group. However, aortic elastic properties did not significantly differ between the PHT and hypertension groups. Furthermore, we found that the presence of the PHT was significant predictor of impaired aortic elasticity in a multivariable model that adjusted for other variables. Aortic elastic properties are significantly and LV diastolic function is slightly impaired in subjects with PHT, and impairment of aortic elasticity is as severe as that in hypertension.

Research paper thumbnail of W09.209 Increased lipoprotein(a) in metabolic syndrome: A contributing factor to premature atherosclerosis?

Atherosclerosis, 2004

Aim: Patients with metabolic syndrome (MS) have a higher risk of developing coronary m'tery disea... more Aim: Patients with metabolic syndrome (MS) have a higher risk of developing coronary m'tery disease (CAD). However, the association of novel coronary risk factors with MS is not well established. We aimed to investigate the association of lipoprotein (a) [Lp(a)], homocysteine (Hcy), m'ic acid and C-reactive protein (CRP) levels with MS. Methods and results: In our outpatient clinic, we em'olled 355 consecutive patients in the study, 186 with MS and 169 without MS according to the ATPIII criteria. The groups were homogenous with regard to age (60.2-t-9.9 vs 62.8-t-10.7 years), sex and other demographic variables (all p>0.05). MS patients had significantly higher Lp(a) (38.1-t-40.9 vs 23.1-t-23.5mg/dl; p<0.001) levels compared to controls, whereas Hcy (12.2-4-4.8 vs 12.3-t-4.9umol/L; p=0.8), uric acid (5.7-4-1.6 vs 5.3-t-l.3mg/dl; p=0.08) and CRP levels (7.1-t-5.2 vs 6.5-t-5.3mg/L; p=0.072) were similar. Despite similar incidences of coronary angiographic examination in both groups the prevalence of CAD was significantly higher in the MS group (20.0% vs 10.3%, p<0.05). As expected, the prevalences of hypertension (85.4% vs 55.6%, p<0.001), diabetes mellitus (36.7% vs 8.0%, p<0.001) and dislipidemia (78.3% vs 62.6%, p<0.05) were higher in the MS group, whereas groups were comparable with respect to smoking (28.4% vs 24.8%, p=0.4) and family history of CAD (46.1% vs 40.8 %, p=0.3). Conclusion: Lp(a) levels are significantly higher in patients with MS, which might contribute to the premature atherosclerosis seen in these patients.

Research paper thumbnail of Higher serum gamma-glutamyltransferase levels are independently associated with impaired coronary microvascular function in patients with dilated cardiomyopathy

Atherosclerosis, 2008

Background: Patients with idiopathic dilated cardiomyopathy (IDC) have impaired coronary flow res... more Background: Patients with idiopathic dilated cardiomyopathy (IDC) have impaired coronary flow reserve (CFR) and reduced CFR has been reported to be a poor prognostic indicator and independent predictor of subsequent cardiac events in patients with IDC. Serum gammaglutamyltransferase (GGT) level is an independent risk factor for cardiovascular disease. Therefore, we aimed to determine whether serum GGT level is associated with CFR impairment in patients with IDC. Methods: We examined 32 patients with IDC. The patients were divided into two groups based on serum GGT levels. Results: There were no significant differences between the lower and higher GGT groups regarding clinical data, baseline hemodynamics, medications and biochemical data except GGT and hsCRP levels. Subjects with higher GGT had significantly impaired CFR as compared to those with lower GGT (1.86 ± 0.28 vs. 2.27 ± 0.38, P = 0.002). After adjusting for potential confounders, including age, sex, body mass index, blood pressure, lipids and glucose, we found that serum GGT levels were independently associated with CFR impairment (β =−0.48, P = 0.001). We also found that GGT level was a good predictor of low CFR at the receiver-operating characteristic curve. Area under the curve was 81% (95% CI: 0.66-0.95), and GGT level was significantly predictive of low CFR (P = 0.003). Conclusion: These results showed that there was an independent association between serum GGT level and CFR in patients with IDC.

Research paper thumbnail of High Serum Bilirubin Concentrations Preserve Coronary Flow Reserve and Coronary Microvascular Functions

Arteriosclerosis, Thrombosis, and Vascular Biology, 2005

Background— Elevated serum bilirubin concentrations protect against atherosclerotic diseases; how... more Background— Elevated serum bilirubin concentrations protect against atherosclerotic diseases; however, it is not clear whether higher serum bilirubin concentrations in physiological ranges work in favor of the cardiovascular system in younger persons with no cardiovascular risk factors. Accordingly, we investigated the effects of high, intermediate, and low serum bilirubin concentrations on coronary flow reserve (CFR). Methods and Results— Fifty-two healthy subjects with hyperbilirubinemia (total bilirubin 1.43±0.33 mg/dL; mean age 35.9±7.3), 55 subjects with intermediate bilirubin level (total bilirubin: 0.69±0.11 mg/dL; mean age: 36.4±6.8), and 53 healthy subjects with hypobilirubinemia (total bilirubin 0.37±0.08 mg/dL; mean age, 37.6±6.6) were studied. Transthoracic second harmonic Doppler echocardiography examination was performed using an Acuson Sequoia C256 Echocardiography System. Coronary diastolic peak flow velocities were measured at baseline and after dipyridamole infusio...

Research paper thumbnail of Association Between Serum Gamma-Glutamyltransferase Activity and Carotid Intima-Media Thickness

Angiology, 2011

Serum gamma-glutamyltransferase (GGT) activity is a marker of oxidative stress and activity is as... more Serum gamma-glutamyltransferase (GGT) activity is a marker of oxidative stress and activity is associated with cardiovascular disease. Carotid intima-media thickness (IMT) is a noninvasive predictor of atherosclerosis. We investigated the association between serum GGT activity and carotid IMT. Fifty-five persons who had normal liver function tests were consecutively enrolled. Carotid IMT was evaluated in the right and left common carotid arteries. The averaged values of carotid IMT and serum GGT activity were compared. Serum GGT activity correlated with carotid IMT (r = .396, P = .003). Serum GGT activities were increased in patients with carotid intimal hyperplasia compared with those without intimal hyperplasia (20.3 ± 11.2 vs 34.3 ± 16.1 U/L; P = .001). Serum GGT activity is associated with carotid IMT. This finding supports the concept that elevated serum GGT activity is a marker of atherosclerosis.

Research paper thumbnail of Epicardial Adipose Tissue Thickness and Carotid Intima-Media Thickness in Hemodialysis Patients

Acta Cardiologica Sinica, 2017

BACKGROUND It is well-known that cardiovascular risk and all-cause mortality is increased in hemo... more BACKGROUND It is well-known that cardiovascular risk and all-cause mortality is increased in hemodialysis patients. Epicardial fat thickness (EFT), which reflects visceral adiposity, has been suggested as a new cardiometabolic risk factor. The purpose of this study was to investigate EFT in hemodialysis patients. METHODS A total of 144 consecutive patients (60 hemodialysis patients and 84 controls) were enrolled into the study, and patients with diabetes mellitus and cardiovascular diseases (CVD) were excluded. EFT was measured on the free wall of the right ventricle at end-diastole from the parasternal long-axis view by standard transthorasic 2D echocardiography. RESULTS The groups were similar in terms of sex distribution, age, blood pressure, heart rate and frequencies of CAD risk factors including smoking status, family history of CAD and hypertension. There were no significant differences between the hemodialysis patients and controls in 2D echocardiographic parameters, includi...

Research paper thumbnail of Assessment of epicardial adipose tissue and carotid/femoral intima media thickness in insulin resistance

Journal of cardiology, Jan 6, 2016

Metabolic syndrome is a combination of multiple cardiovascular (CV) risk factors including insuli... more Metabolic syndrome is a combination of multiple cardiovascular (CV) risk factors including insulin resistance (IR). Carotid, femoral intima media thickness (IMT), and epicardial fat thickness (EFT) are considered as novel cardiometabolic risk factors. We aimed to test the hypothesis that carotid, femoral IMT, and EFT are increased in patients with IR. We enrolled consecutively and prospectively 113 patients with IR. Then we collected data from an age- and sex-matched control group of 112 individuals without IR. Homeostasis model assessment (HOMA) index value >2.5 was accepted as IR. Patients with diabetes mellitus, CV diseases, systolic heart failure, chronic liver or renal diseases were excluded. On B-mode duplex ultrasound the mean IMT at the far wall of both left and right common carotid/femoral arteries were measured manually. EFT was measured on the free wall of the right ventricle at end-diastole from the parasternal long-axis views by standard transthoracic 2D echocardiogr...

Research paper thumbnail of The effect of raloxifene on left ventricular hypertrophy in postmenopausal women: A prospective, randomized, and controlled study

Anadolu kardiyoloji dergisi : AKD = the Anatolian journal of cardiology, Jan 3, 2014

In healthy women, there is a progressive age-related increase in myocardial mass that is not seen... more In healthy women, there is a progressive age-related increase in myocardial mass that is not seen in their male counterparts and occurs primarily in postmenopausal women. Raloxifene is a selective estrogen receptor modulator that has estrogenic actions on bone and the cardiovascular system. The aim of this study was to investigate the effect of raloxifene on myocardial hypertrophy in postmenopausal patients. A total of 22 postmenopausal osteoporotic women were included in this open-label, randomized, prospective, controlled study. Patients were randomized into two groups: 11 of the patients (group 1) were treated with raloxifene 60 mg/day, and the other 11 patients (group 2) were defined as the control group. Quantitative 2-dimensional and M-mode echocardiographic examination was performed in all patients at the beginning and repeated at the end of the 6-month follow-up period. Left ventricle mass (LVM) and left ventricle mass index (LVMI) were calculated for all patients. The mean ...

Research paper thumbnail of Decreased coronary flow reserve in obese women

Türk Kardiyoloji Derneği arşivi : Türk Kardiyoloji Derneğinin yayın organıdır, 2009

Obesity is associated with an increased rate of cardiovascular disease and risk factors. It is a ... more Obesity is associated with an increased rate of cardiovascular disease and risk factors. It is a common problem in apparently healthy women. We aimed to investigate the association between obesity and coronary flow reserve (CFR) in obese women. The study included 80 consecutive women (mean age 55.6+/-10.2 years) without diabetes mellitus and clinical coronary artery disease. Body mass index (BMI) was calculated and obesity was defined as BMI = or >30 kg/m(2). Based on BMI, the patients were grouped as normal weight (n=13; 18.5-24.9 kg/m(2)), overweight (n=32; 25-29.9 kg/m(2)), obese (n=32; = or >30-39.9 kg/m(2)), and morbid obese (n=3; = or > 40 kg/m(2)). Peak diastolic coronary flow velocities were measured in the distal left anterior descending artery by transthoracic pulsed wave Doppler echocardiography at baseline and after dipyridamole infusion and CFR was calculated as the ratio of hyperemic to baseline peak diastolic velocities. There were 35 obese women (43.8%). Cor...

Research paper thumbnail of Renal transplant improves pulmonary hypertension in patients with end stage renal disease

Multidisciplinary Respiratory Medicine, 2011

Background: Pulmonary hypertension (PH) is present in a significant proportion of patients with e... more Background: Pulmonary hypertension (PH) is present in a significant proportion of patients with end stage renal disease (ESRD) and is of prognostic importance. Data on the effect of renal transplant on PH is very limited. In this study, the aim was to examine the effect of renal transplant on systolic pulmonary artery pressure (SPAP) determined by Doppler echocardiography. Methods: Analysis was performed on the records of 500 consecutive patients who underwent renal transplant at our center between the years 1999 to 2008. The prevalence of PH in the preoperative assessment period was established. Patients were diagnosed as having PH when measured SPAP values were > 35 mm Hg. Results: Pulmonary hypertension was detected in 85 of the 500 (17%) patients under pre-transplant evaluation. At post-transplant follow up Doppler echocardiographic examination was performed on 50 of the 85 patients. After exclusion of 8 cases (1 due to massive pulmonary thromboemboli; 7 due to graft failure requiring dialysis therapy) analyses were performed on 42 patients who had undergone both pre-and post-transplant echocardiographic examination. Mean SPAP at pre-transplant evaluation was 45.9 ± 8.8 mm Hg and in 6 (14.3%) cases SPAP was above 50 mm Hg. Compared to pre-transplant values, a significant decrease was observed in mean SPAP values in an average of 53 months of postoperative follow up (41.8 ± 7.4 mm Hg vs. 45.9 ± 8.8 mm Hg, p < 0.0001). Conclusion: These findings indicate that patients with ESRD accompanied by PH may benefit from renal transplant. Further research is required for more concrete conclusions to be drawn on this subject.

Research paper thumbnail of Epicardial adipose tissue thickness and plasma homocysteine in patients with metabolic syndrome and normal coronary arteries

Diabetology & Metabolic Syndrome, 2014

Background: Increased epicardial adipose tissue thickness and plasma homocysteine levels are asso... more Background: Increased epicardial adipose tissue thickness and plasma homocysteine levels are associated with Metabolic Syndrome (MS) and coronary artery disease. The majority of patients with MS have subclinical or manifest coronary artery disease. The aim of this study was to evaluate the relationship between MS and plasma homocysteine levels and epicardial adipose tissue thickness in subjects without epicardial coronary artery disease. Methods: Patients who underwent coronary angiography due to angina or equivocal symptoms and/or abnormal stress test results and were found to have normal coronary arteries were evaluated for the presence of MS. The study group comprised 75 patients with normal coronary arteries and MS, and the control group included 75 age-gender matched subjects without coronary artery disease or MS. Results: Epicardial adipose tissue thickness (5.8 ± 1.9 mm vs. 4.3 ± 1.6 mm, p <0.001) and plasma homocysteine levels (21.6 ± 6.1 μmol/L vs. 15.1 ± 5.8 μmol/L, p <0.001) were significantly higher in the MS group. Body mass index, triglyceride level, weight, age and waist circumference were positively and HDL cholesterol level were negatively correlated with both epicardial adipose tissue thickness and plasma homocysteine level. Epicardial adipose tissue thickness had the strongest correlation with plasma homocysteine level (r = 0.584, p < 0.001). For each 1 mm increase in epicardial adipose tissue thickness, an increase of 3.51 μmol/L (95% CI: 2.24-4.79) in plasma homocysteine level was expected. Conclusions: We observed a close relationship between MS and epicardial adipose tissue thickness and plasma homocysteine levels, even in the absence of overt coronary artery disease.

Research paper thumbnail of Hyperhomocysteinemia in a young woman presenting with acute myocardial infarction: Case report

Interventional Medicine and Applied Science, 2013

Homocysteine (Hcy), a sulfur-containing amino acid that is formed by demethylation of dietary met... more Homocysteine (Hcy), a sulfur-containing amino acid that is formed by demethylation of dietary methionine to cystein. Elevated homocysteine level is known to be associated with coronary artery disease. We present a case of acute myocardial infarction in a 25-year-old woman, associated with hyperhomocysteinaemia. Her other risk factors for coronary artery disease were smoking, a moderately high LDL level, and a family history of sudden cardiac death. This case illustrates the need to include plasma homocysteine measurement in the setting of acute coronary syndromes in women with premature atherosclerosis, even in the presence of traditional risk factors for coronary artery disease.

Research paper thumbnail of Statin Therapy Helps to Control Blood Pressure Levels in Hypertensive Dyslipidemic Patients

Renal Failure, 2005

Aim. Aside from lowering lipid levels; statins improve endothelial function, decrease platelet ag... more Aim. Aside from lowering lipid levels; statins improve endothelial function, decrease platelet aggregation, reduce procoagulant blood factors, and decrease vascular tone. This study was conducted to investigate the possible effect of atorvastatin on blood pressure (BP) in a group of hypertensive and dyslipidemic patients. Methods. Thirty-six hypertensive and dyslipidemic patients with inadequately controlled lipid levels by diet were treated with atorvastatin 20 mg/day for 8 weeks and compared with 24-patient matched controls treated with diet alone. The type and dosage of antihypertensive medications were not altered during statin therapy. Blood lipid profile including total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL) and triglyceride (TG) levels were noted at inclusion and after 8 weeks. Ambulatory BP monitoring (ABPM) was carried out at study entry and at the end of week eight. Results. A total of 49 patients (32 patients in the atorvastatin group and 17 patients in the control group) completed the 3-month follow-up period of observation. The ABPM studies indicated significant reductions in total average systolic BP, total average diastolic BP, total average mean BP, day average systolic BP, day average diastolic BP, night average systolic BP, night average diastolic BP, and night average mean BP levels in the atorvastatin group, whereas these reductions were not observed in the control group. Conclusion. Our results indicate that atorvastatin therapy significantly improves BP control in hyperlipidemic hypertensive patients. However, the effects of other statins on BP, as well as, the different dosages need to be further investigated.

Research paper thumbnail of Decreased Heart Rate Recovery in Patients With Heart Failure Effect of Fluvastatin Therapy

International Heart Journal, 2005

Heart rate recovery is the difference in heart rate at peak exercise and at a specific time inter... more Heart rate recovery is the difference in heart rate at peak exercise and at a specific time interval following the onset of recovery. Attenuated heart rate recovery is an independent predictor of mortality in patients with a history of coronary artery disease. The aim of the present study was to evaluate the effect of a statin on heart rate recovery, particularly in patients with ischemic heart failure and hyperlipidemia. Twenty-nine consecutive hyperlipidemic, stable coronary artery disease patients with heart failure and 19 healthy subjects were enrolled. Heart rate recovery values at the 1st and 3rd minutes and lipid profiles of the patients were evaluated at baseline and following 3 months of treatment with fluvastatin. Compared with healthy subjects, the heart rate recovery values were significantly lower in the heart failure patients in both the 1st and 3rd minutes, respectively (31 ± 6 versus 19 ± 7, P < 0.0001; 66 ± 7 versus 47 ± 8, P < 0.0001). Heart rate recovery in the 1st and 3rd minutes increased from 19 ± 7 to 24 ± 9 and 47 ± 8 to 57 ± 11, respectively, following treatment (P < 0.001, P < 0.001). There were no significant correlations among the changes in lipid parameters or HRR in the first and third minutes in the recovery period. The results revealed an improvement in heart rate recovery in heart failure patients by fluvastatin treatment. If this association can be confirmed by other studies, it would be interesting to perform further studies into the mechanism underlying this finding.

Research paper thumbnail of Comparison of Intermittent With Continuous Simvastatin Treatment in Hypercholesterolemic Patients With End Stage Renal Failure

Japanese Heart Journal, 2004

Coronary artery disease is the most important cause of morbidity and mortality in patients with e... more Coronary artery disease is the most important cause of morbidity and mortality in patients with end-stage renal failure (RF). Hypercholesterolemia is an important risk factor for coronary heart disease. Patients with chronic renal failure (CRF) have difficulties in compliance with their care and treatment. Intermittent simvastatin treatment may help to increase compliance and can be a treatment alternative in patients with CRF at risk of coronary artery disease. We investigated the effects of simvastatin and compared intermittent with continuous simvastatin treatment in hypercholesterolamic patients with CRF. The study group included 40 of 422 CRF patients on dialysis in our clinic. The inclusion criterion was low density lipoprotein cholesterol (LDL-C) of 130 mg/dL or more. Twenty patients received simvastatin 10 mg/day (continuous group) and 20 patients received simvastatin 20 mg three times a week (only dialysis days-intermittent group) for four months. Nineteen patients served as controls and they were given a prescribed diet only. Total cholesterol (TC) and LDL-C decreased markedly in patients receiving intermittent and continuous simvastatin compared to controls. Continuous simvastatin decreased TC by 23% (P < 0.001) and LDL-C by 39% (P < 0.001). Intermittent simvastatin decreased TC by 26% (P < 0.001) and LDL-C by 40% (P < 0.001). The atherogenic index ratios in both the continuous and intermittent groups (TC/High density lipoprotein-cholesterol (HDL-C) and LDL-C/HDL-C) decreased significantly. There was no significant difference in patient compliance between the two groups. Intermittent simvastatin is as effective and reliable as continuous simvastatin treatment and can be an alternative treatment in hypercholesterolemic patients on dialysis.

Research paper thumbnail of Do young women with polycystic ovary syndrome show early evidence of preclinical coronary artery disease?

Human Reproduction, 2005

BACKGROUND: It is thought that women with polycystic ovary syndrome (PCOS) are at increased risk ... more BACKGROUND: It is thought that women with polycystic ovary syndrome (PCOS) are at increased risk of developing cardiovascular diseases. METHODS: In this study, we used transthoracic echocardiography to measure coronary flow reserve (CFR) in 28 women with PCOS and in 26 healthy women. RESULTS: The PCOS and the control groups were similar in terms of age (27.1 ؎ 4.5 versus 28.8 ؎ 4.4 years) and BMI (26.6 ؎ 5.7 versus 24.7 ؎ 4.4 kg/m 2). Fasting insulin levels and homeostasis model assessment insulin resistance index were higher in the PCOS group. LH, the LH/FSH ratio, total testosterone, free testosterone and androstenedione were higher in the PCOS group. FSH, estradiol, prolactin, progesterone, cholesterol, triglyceride and high-sensitive C-reactive protein were similar between the two groups, but homocysteine levels were higher in the PCOS group. Baseline diastolic peak flow velocity (DPFV) (25.0 ؎ 4.6 versus 23.3 ؎ 2.7 cm/s, P > 0.05), hyperaemic DPFV (71.2 ؎ 12.8 versus 73.0 ؎ 12.9 cm/s, P > 0.05) and CFR (2.8 ؎ 0.8 versus 3.2 ؎ 0.8 cm/s, P > 0.05) of the left anterior descending coronary artery were similar between the two groups. CONCLUSION: We conclude that in young women with PCOS and without cardiovascular risk factors, CFR is preserved.

Research paper thumbnail of Association between Serum Total Antioxidant Status and Coronary Microvascular Functions in Patients with SLE

Echocardiography, 2012

ABSTRACT Mortality from cardiovascular disease has been found to be increased in patients with sy... more ABSTRACT Mortality from cardiovascular disease has been found to be increased in patients with systemic lupus erythematosus (SLE). Coronary flow reserve (CFR) measurement is used both to assess epicardial coronary arteries and to examine the integrity of coronary microvascular circulation. Oxidative stress, enhancing modification of plasma lipids, is also associated with atherosclerotic events in lupus patients. Impairment of CFR and TAS has been shown to be an early manifestation of coronary atherosclerosis. Forty patients with SLE and 33 healthy volunteers were included in this study. Echocardiographic examination included left ventricular myocardial velocity measurements and coronary flow reserve (CFR) measurement. Serum total antioxidant status levels (TAS) also were measured using TAS kit. Lateral myocardial early peak velocity (Em) and lateral Em/Am ratio did not differ between the groups, but lateral myocardial atrial peak velocity (Am) was significantly higher in SLE group than the control group. Baseline coronary diastolic peak flow velocity (DPFV) of left anterior descending was similar in both the groups. However, hyperemic DPFV and CFR (2.50 ± 0.42 vs. 3.09 ± 0.45, P &lt; 0.0001) were significantly lower in the SLE group than in the control group. CFR significantly and inversely correlated with CRP and significantly correlated with TAS. Subclinical coronary microvascular dysfunction can occur in SLE patients without traditional cardiovascular risk factors, probably associated with underlying inflammation and impairment of TAS.

Research paper thumbnail of Cardiac Enzymes, Renal Failure and Renal Transplantation

Clinical Medicine & Research, 2006

Diagnostic accuracy of the currently available serum markers of cardiac injury, such as myoglobin... more Diagnostic accuracy of the currently available serum markers of cardiac injury, such as myoglobin, creatine kinase and its myocardial isoform, are altered in patients with renal failure. It is shown that cardiac troponins have decreased diagnostic sensitivity and specificity in patients receiving renal replacement therapy. Data regarding serum levels of these cardiac biomarkers, especially those of the cardiac troponins, in patients with a transplanted kidney are limited. Current data show that levels of cardiac troponin I are unaltered in patients who have undergone renal transplantation, while levels of cardiac troponin T may be elevated.We believe that cardiac troponin I should be the biomarker of choice for diagnosis of myocardial injury in these patients. However, further trials are required for conclusive results.

Research paper thumbnail of Coronary Flow Reserve Is Impaired in Subclinical Hypothyroidism

Clinical Cardiology, 2007

Objective: Although the cardiovascular system is highly sensitive to thyroid hormones, the cardio... more Objective: Although the cardiovascular system is highly sensitive to thyroid hormones, the cardiovascular effects of subtle thyroid dysfunction such as subclinical hypothyroidism (SHT) remain unclear. Therefore, we investigated coronary flow reserve (CFR) reflecting coronary microvascular function in patients with SHT. Methods: Fifty subjects with SHT and 30 control subjects with normal serum thyroid hormones and TSH levels were included in this study. Coronary diastolic peak flow velocities were measured at baseline and after dipyridamole infusion. CFR was calculated as the ratio of hyperemic to baseline diastolic peak velocity. Results: Age, gender, diastolic and systolic blood pressure, body mass index (BMI), serum lipid parameters, and thyroid hormone levels were similar between the groups. Heart rate was significantly lower in the SHT group. Left ventricular diastolic filling parameters were significantly different in the SHT group while other echocardiographic parameters were similar. CFR values were significantly lower in subjects with SHT than in the control group (2.38 ± 0.44 vs. 2.98 ± 0.47, p<0.0001). Conclusions: These findings suggest that CFR, which reflects coronary microvascular function, is impaired in patients with SHT.

Research paper thumbnail of Effects of Atorvastatin on Coronary Flow Reserve in Patients with Slow Coronary Flow

Clinical Cardiology, 2007

BackgroundStatins improve endothelial functioning in patients with coronary artery disease and hy... more BackgroundStatins improve endothelial functioning in patients with coronary artery disease and hypercholesterolemia, while substantially little is known about induced changes in myocardial microcirculation. However, although previous studies have suggested that microvascular abnormalities and endothelial dysfunction is responsible for slow coronary flow (SCF), there is no study investigating possible effects of statins on coronary microvascular function in patients with SCF.HypothesisWe prospectively investigated the effects of short‐term lipid‐lowering therapy with atorvastatin on coronary flow reserve (CFR) reflecting coronary microvascular function in patients with SCF assessed by transthoracic Doppler echocardiography (TTDE).MethodsIn an open clinical trial, CFR was studied in 20 subjects with SCF. TTDE was used to assess CFR at baseline as well as after 8 weeks of atorvastatin therapy. Coronary flow was quantified according to TIMI frame count (TFC). Coronary diastolic peak flo...

Research paper thumbnail of Effects of normal blood pressure, prehypertension and hypertension on left ventricular diastolic function and aortic elastic properties

Blood Pressure, 2007

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Trea... more The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (BP) provides guideline for the new category of BP levels as normal, prehypertension (PHT), and hypertension. Although PHT is associated with a markedly increased risk of developing hypertension within 4 years, its prognostic significance and predisposition to target-organ damage is unknown. Accordingly, we evaluated the effects of normal BP, PHT and hypertension on left ventricular (LV) diastolic function and aortic elasticity, which are sensitive indicators of target-organ damage. We evaluated LV diastolic function and aortic elastic properties of 60 subjects with PHT, 70 patients with hypertension and 50 normotensive healthy volunteers using transthoracic echocardiography. None of the subjects had any systemic disease. LV diastolic function was more significantly impaired in the hypertension group than in the PHT group compared with controls, but it was not strongly different between the PHT and control group. Aortic distensibility was significantly lower, and aortic stiffness index was significantly higher in both the hypertension and the PHT group than those in the control group. However, aortic elastic properties did not significantly differ between the PHT and hypertension groups. Furthermore, we found that the presence of the PHT was significant predictor of impaired aortic elasticity in a multivariable model that adjusted for other variables. Aortic elastic properties are significantly and LV diastolic function is slightly impaired in subjects with PHT, and impairment of aortic elasticity is as severe as that in hypertension.

Research paper thumbnail of W09.209 Increased lipoprotein(a) in metabolic syndrome: A contributing factor to premature atherosclerosis?

Atherosclerosis, 2004

Aim: Patients with metabolic syndrome (MS) have a higher risk of developing coronary m'tery disea... more Aim: Patients with metabolic syndrome (MS) have a higher risk of developing coronary m'tery disease (CAD). However, the association of novel coronary risk factors with MS is not well established. We aimed to investigate the association of lipoprotein (a) [Lp(a)], homocysteine (Hcy), m'ic acid and C-reactive protein (CRP) levels with MS. Methods and results: In our outpatient clinic, we em'olled 355 consecutive patients in the study, 186 with MS and 169 without MS according to the ATPIII criteria. The groups were homogenous with regard to age (60.2-t-9.9 vs 62.8-t-10.7 years), sex and other demographic variables (all p>0.05). MS patients had significantly higher Lp(a) (38.1-t-40.9 vs 23.1-t-23.5mg/dl; p<0.001) levels compared to controls, whereas Hcy (12.2-4-4.8 vs 12.3-t-4.9umol/L; p=0.8), uric acid (5.7-4-1.6 vs 5.3-t-l.3mg/dl; p=0.08) and CRP levels (7.1-t-5.2 vs 6.5-t-5.3mg/L; p=0.072) were similar. Despite similar incidences of coronary angiographic examination in both groups the prevalence of CAD was significantly higher in the MS group (20.0% vs 10.3%, p<0.05). As expected, the prevalences of hypertension (85.4% vs 55.6%, p<0.001), diabetes mellitus (36.7% vs 8.0%, p<0.001) and dislipidemia (78.3% vs 62.6%, p<0.05) were higher in the MS group, whereas groups were comparable with respect to smoking (28.4% vs 24.8%, p=0.4) and family history of CAD (46.1% vs 40.8 %, p=0.3). Conclusion: Lp(a) levels are significantly higher in patients with MS, which might contribute to the premature atherosclerosis seen in these patients.

Research paper thumbnail of Higher serum gamma-glutamyltransferase levels are independently associated with impaired coronary microvascular function in patients with dilated cardiomyopathy

Atherosclerosis, 2008

Background: Patients with idiopathic dilated cardiomyopathy (IDC) have impaired coronary flow res... more Background: Patients with idiopathic dilated cardiomyopathy (IDC) have impaired coronary flow reserve (CFR) and reduced CFR has been reported to be a poor prognostic indicator and independent predictor of subsequent cardiac events in patients with IDC. Serum gammaglutamyltransferase (GGT) level is an independent risk factor for cardiovascular disease. Therefore, we aimed to determine whether serum GGT level is associated with CFR impairment in patients with IDC. Methods: We examined 32 patients with IDC. The patients were divided into two groups based on serum GGT levels. Results: There were no significant differences between the lower and higher GGT groups regarding clinical data, baseline hemodynamics, medications and biochemical data except GGT and hsCRP levels. Subjects with higher GGT had significantly impaired CFR as compared to those with lower GGT (1.86 ± 0.28 vs. 2.27 ± 0.38, P = 0.002). After adjusting for potential confounders, including age, sex, body mass index, blood pressure, lipids and glucose, we found that serum GGT levels were independently associated with CFR impairment (β =−0.48, P = 0.001). We also found that GGT level was a good predictor of low CFR at the receiver-operating characteristic curve. Area under the curve was 81% (95% CI: 0.66-0.95), and GGT level was significantly predictive of low CFR (P = 0.003). Conclusion: These results showed that there was an independent association between serum GGT level and CFR in patients with IDC.

Research paper thumbnail of High Serum Bilirubin Concentrations Preserve Coronary Flow Reserve and Coronary Microvascular Functions

Arteriosclerosis, Thrombosis, and Vascular Biology, 2005

Background— Elevated serum bilirubin concentrations protect against atherosclerotic diseases; how... more Background— Elevated serum bilirubin concentrations protect against atherosclerotic diseases; however, it is not clear whether higher serum bilirubin concentrations in physiological ranges work in favor of the cardiovascular system in younger persons with no cardiovascular risk factors. Accordingly, we investigated the effects of high, intermediate, and low serum bilirubin concentrations on coronary flow reserve (CFR). Methods and Results— Fifty-two healthy subjects with hyperbilirubinemia (total bilirubin 1.43±0.33 mg/dL; mean age 35.9±7.3), 55 subjects with intermediate bilirubin level (total bilirubin: 0.69±0.11 mg/dL; mean age: 36.4±6.8), and 53 healthy subjects with hypobilirubinemia (total bilirubin 0.37±0.08 mg/dL; mean age, 37.6±6.6) were studied. Transthoracic second harmonic Doppler echocardiography examination was performed using an Acuson Sequoia C256 Echocardiography System. Coronary diastolic peak flow velocities were measured at baseline and after dipyridamole infusio...

Research paper thumbnail of Association Between Serum Gamma-Glutamyltransferase Activity and Carotid Intima-Media Thickness

Angiology, 2011

Serum gamma-glutamyltransferase (GGT) activity is a marker of oxidative stress and activity is as... more Serum gamma-glutamyltransferase (GGT) activity is a marker of oxidative stress and activity is associated with cardiovascular disease. Carotid intima-media thickness (IMT) is a noninvasive predictor of atherosclerosis. We investigated the association between serum GGT activity and carotid IMT. Fifty-five persons who had normal liver function tests were consecutively enrolled. Carotid IMT was evaluated in the right and left common carotid arteries. The averaged values of carotid IMT and serum GGT activity were compared. Serum GGT activity correlated with carotid IMT (r = .396, P = .003). Serum GGT activities were increased in patients with carotid intimal hyperplasia compared with those without intimal hyperplasia (20.3 ± 11.2 vs 34.3 ± 16.1 U/L; P = .001). Serum GGT activity is associated with carotid IMT. This finding supports the concept that elevated serum GGT activity is a marker of atherosclerosis.