The relationship between serum asymmetric dimethylarginine levels and subjective sleep quality in normotensive patients with type 2 diabetes mellitus

Background/Aims: Poor sleep quality (SQ) is associated with increased cardiovascular mortality and morbidity. Additionally, asymmetric dimethylarginine (ADMA) is an independent predictor of cardiovascular mortality and morbidity. However, no sufficient data regarding the relationship between ADMA levels and SQ have been reported. The goal of the current study was to evaluate the association between SQ and ADMA levels in normotensive patients with type 2 diabetes mellitus. Methods: The study participants consisted of 78 normotensive type 2 diabetics. The SQ of all participants was assessed using the Pittsburgh Sleep Quality Index (PSQI). Patients with a global PSQI score > 5 were defined as "poor sleepers." Factors associated with poor SQ were analyzed using a multiple regression model. Serum ADMA levels were measured using high performance liquid chromatography. Results: The median ADMA levels of the poor sleepers were increased compared with patients defined as good sleepers (5.5 [4.2 to 6.6] vs. 4.4 [2.9 to 5.4], p < 0.01, respectively). However, the L-arginine/ADMA ratio was decreased in poor sleepers (p < 0.01). Global PSQI scores were positively correlated with ADMA levels (p < 0.01) and negatively correlated with the L-arginine/ADMA ratio (p = 0.02). ADMA levels were correlated with sleep latency (p < 0.01) and sleep efficiency (p = 0.01). Logistic regression analysis showed that ADMA levels (odds ratio [OR], 1.68; 95% confidence interval [CI], 1.16 to 2.44; p = 0.01) and body mass index (OR, 1.15; 95% CI, 1.01 to 1.31; p = 0.04) were associated with poor SQ independently of glomerular filtration rate, sex, age, duration of diabetes, hemoglobin A1c, total cholesterol, and systolic blood pressure. Conclusions: Self-reported SQ was independently associated with ADMA levels in normotensive patients with diabetes mellitus

Pulmonary hypertension diagnosis and treatment

Pulmoner hipertansiyonun (PH) etyolojik olarak birçok sebebi mevcut olup, sebebi ne olursa olsun ilerleyici ve sinsi bir hastalıktır. PH’nın kendine özgü semptomlarının olmamasından dolayı tanı konulması gecikmekte ve ileri evrelerde tanı konmaktadır. PH ileri ev- relerde tedaviye daha az yanıt vermesi ve prognozunun kötü olması sebebiyle erken tanı ve tedavisi önem arz etmektedir Pulmoner hipertansiyon tanısı konulduktan sonraki basamak, hastanın kliniğinin ağırlık derecesinin belirlenmesidir. Dünya Sağlık Örgütü (DSÖ) FS I veya II hastalarda tedavi edilmediğinde 4 yıllık sağkalım %50’nin altındadır. DSÖ fonksiyonel sınıflar (FS) III veya IV hastalarda ise 2 yıllık sağkalım %60’ın altındadır. Hafif semptomatik hastalarda bile, PH tedavi edilmediğinde hızla kötüleşmektedir. Pulmoner hipertansiyon tedavisinde amaç; PH şiddetini azaltmak, fonksiyonel kapasitesini, yaşam kalitesini düzeltmek, sağ ventrikül işlevlerini iyileştirmek, oluşabilecek tromboembolik yükü azaltmak ve iyi prognoz sağlamaktır. Bu yazıda güncel kılavuzlar ışığında pulmoner hipertansiyon tanı ve tedavisi anlatılmıştır.Pulmonary hypertension has many etiological reasons and it is a progressive and insidious disease regardless of the underlying cause. The diagnosis of PH is generally delayed to advanced stages as it does not have pathagonomic symptoms and signs. The response of PH to the treatment is less and the prognosis is poor at advanced stages so early diagnosis and treatment is important. The next step after the diagnosis of PAH is to determine the severity of the disease. 4 year survival of World Health Organization (WHO) fonksional class (FC) 1 or 2 without treatment is less than 50% 2 year survival of WHO FC 3 or 4 patient is less than 60% Patients with even minor symptoms without treatment get worsen progressively. The aim of pulmonary arterial hypertension (PAH) treatment is to decrease the severity of PAH, to increase life quality, functional capacity and right ventricul functions, and to prevent possible thromboembolic events. In this paper we discussed the diagnosis and treatment of pulmonary hypertension with current guidelines

Inferior ST-segment elevation due to metastatic cardiac tumor

There are numerous causes for ST-segment elevation on ECG, the tumoral invasion of the heart being a rarer one. Because the management will differ one should always keep in mind the presence of such entity. Here we report a case of persistent ST-segment elevation due to a metastatic cardiac tumor. (C) 2022 Elsevier Inc. All rights reserved

Value of Mitral A-Wave Acceleration Time on Estimation of Left Ventricular End-Diastolic Pressure

Amaç: Bu çalışmada sol ventrikül ejeksiyon fraksiyonunun korunduğu hastalarda (ejeksiyon fraksiyonu %50), mitral A dalga yükselme zamanının, sol ventrikül diyastol sonu basıncını öngörmedeki yerinin değerlendirilmesi amaçlanmıştır.Gereç ve Yöntemler: Mayıs 2012 ile Ekim 2013 tarihleri arasında koroner anjiyografi yapılmasına karar verilen 121 hasta çalışmaya dahil edildi. Ekokardiyografi kayıtları alındıktan sonra, ölçümlerden habersiz başka bir araştırmacı tarafından sol kalp kateterizasyonu ile sol ventrikül diyastol sonu basıncı ölçüldü. Basınç değerlerine göre hastalar üç gruba ayrıldı. Sol ventrikül diyastol sonu basıncı 0 ile 10 mmHg arası olanlar grup 1, 11 ile 15 mmHg arasında olanlar grup 2, 16 mmHg ve üzeri olanlar ise grup 3'e dahil edildi. Demografi k özellikler, vital bulgular ve ekokardiyografi k parametreler gruplar arasında karşılaştırıldı.Bulgular: Çalışmamıza dahil edilen 121 hastadan 60 (%49,5) tanesi grup 1'e, 30 (%24,7) tanesi grup 2 ye, 31 (%25,6) tanesi grup 3 içerisine alındı. Gruplar arası yapılan analizde yaş, cinsiyet, vücut kitle indeksi, komorbit durumlar ve vital bulgular arasında anlamlı bir fark izlenmedi. Gruplar arasında mitral A dalga yükselme zamanında anlamlı bir fark izlenmedi. (Sırasıyla, 79,319,6 cm/sn, 83,912,5 cm/sn, 80,220,1 cm/sn p0,51).Sonuç: Tüm bu bulgulara rağmen net veriler için daha fazla hasta katılımının olduğu çalışmalara ihtiyaç olduğu açıktır.Objective: Our aim in this study was to evaluate the value of the acceleration time of the mitral A wave in predicting left ventricle end diastolic pressure of patients with preserved left ventricle ejection fraction (ejection fraction <%50).Material and Methods: 121 patients who were about to undergo coronary angiography between May 2012 and October 2013 were included in our study. After receiving the echocardiographic records, cardiac catheterization and left ventricular end-diastolic pressure measurements were done by another investigator who was unaware of the echocardiographic measurements. Patients were divided into three groups according to the pressure values. Patients whose left ventricular end diastolic pressure was between 0 and 10 mmHg were included in group 1, those whose pressure was between 11-15 mmHg were included in group 2 and those whose pressure was over 15 mmHg were included in group 3. Demographic characteristics, vital signs, and echocardiographic parameters were compared between groups.Results: 60 (49.5%) of the 121 patients were enrolled in group 1, 30 (24.7%) them were enrolled in group 2, and 31 (%25.6) were enrolled in group 3. There was no signifi cant difference between the groups regarding age, gender, body mass index, comorbid conditions and vital signs. There was no signifi cant difference between the groups according to mitral A wave acceleration time (respectively, 79.3±19.6 cm/sec, 83.9±12.5 cm/sec, 80.2±20.1 cm/sec, p0.51). Conclusion: Despite our fi ndings, studies with a larger number of participants are needed to clarify the data

The Association Among Lipoprotein-associated Phospholipase A2 Levels, Total Antioxidant Capacity and Arousal in Male Patients with OSA

<p><b>Background: </b>The mechanisms of the increased cardiac and vascular events in patients with OSA are not well understood. Arousal which is an important component of OSA was associated with increased sympathetic activation and electrocardiographic changes which prone to arrhythmias. We planned to examine the association among arousal, circulating Lp-PLA2 and total antioxidant capacity in male patients with OSA.</p><p><b>Methods:</b> Fifty male patients with newly diagnosed OSA were enrolled the study. A full-night polysomnography was performed and arousal index was obtained. Lp-PLA2 concentrations were measured in serum samples with the PLAC Test. Total antioxidant capacity in patients was determined with Antioxidant Assay Kit.</p><p><b>Results: </b>Arousal was positively correlated with LP-PLA2 levels (r=0.43, p=0.002) and was negatively correlated with total antioxidant capacity (r= -0.29, p=0.04). Elevated LP-PLA2 levels and decreased total antioxidant activities were found in the highest arousal quartile compared with the lowest and 2nd quartiles (p=0.02, p=0.05, respectively). LP-PLA2 was an independently predictor of arousal index in regression model (&#946;=0.357, p=0.002)</p><p><b>Conclusions: </b>This study demonstrated a moderate linear relationship between arousal and LP-PLA2 levels. Also, total antioxidant capacities were decreased in the higher arousal index. Based on the study result, the patients with higher arousal index may be prone to vascular events.</p

P-wave Dispersion for Predicting Paroxysmal Atrial Fibrillation in Acute Ischemic Stroke

Background: Detection of paroxysmal atrial fibrillation (PAF) in acute ischemic stroke patients poses diagnostic challenge. The aim of this study was to predict the presence of PAF by means of 12-lead ECG in patients with acute ischemic stroke. Our hypothesis was that P-wave dispersion (Pd) might be a useful marker in predicting PAF in patients with acute ischemic stroke.Methods: 12-lead resting ECGs, 24-hour Holter recordings and echocardiograms of 400 patients were analyzed retrospectively. PAF was detected in 40 patients on 24-hour Holter monitoring. Forty out of 360 age and gender matched patients without PAF were randomly chosen and assigned as the control group. Demographics, P-wave characteristics and echocardiographic findings of the patients with and without PAF were compared.Results: Maximum P-wave duration (p=0.002), Pd (p&#60;0.001) and left atrium diameter (p=0.04) were significantly higher in patients with PAF when compared to patients without PAF. However, in binary logistic regression analysis Pd was the only independent predictor of PAF. The cut-off value of Pd for the detection of PAF was 57.5 milliseconds (msc). Area under the curve was 0.80 (p&#60;0.001). On a single 12-lead ECG, a value higher than 57.5 msc predicted the presence of PAF with a sensitivity of 80% and a specificity of 73%.Conclusion: Pd on a single 12-lead ECG obtained within 24 hours of an acute ischemic stroke might help to predict PAF and reduce the risk of recurrent strokes.</p