Elastic properties of the aorta and factors affecting aortic stiffness in patients with

Objectives: In this study, we evaluated aortic stiffnessand echocardiographic and laboratory factors affectingaortic stiffness in patients with metabolic syndrome(MetS).Materials and methods: Forty-six patients (25 male,mean age 47.3±6.5 years) with the diagnosis of MetS accordingto the Adult Treatment Panel III Final Report criteriawere included. Forty-four age and gender matchedhealthy subjects (18 male, mean age 46.0±6.1 years)were recruited as the control group. Aortic strain, distensibilityand stiffness index were calculated by M-modeechocardiography and diastolic parameters were measured.Results: Left ventricular mass index (LVMI), decelerationtime (DT), isovolumic relaxation time (IVRT) wereincreased and mitral E/A ratio was decreased in patientswith MetS compared to controls. In the MetS patients,aortic distensibility was significantly decreased (10.4±3.5cm2.dyn-1.10-6 vs. 12.7±3.4 cm2.dyn-1.10-6, p=0.002),and ASI was significantly increased (6.5±2.0 vs. 3.2±0.8,p<0.001). ASI was positively correlated with triglycerides,fasting glucose, uric acid, hsCRP, LVMI, DT, IVRT andsystolic blood pressure level, and was negatively correlatedwith HDL-cholesterol and mitral E/A ratio. In regressionanalysis, hsCRP (p=0.05) and systolic blood pressurelevel (p<0.001) were independent predictors of ASI.Conclusions: ASI is increased in patients with MetS. Inthese patients; decrease in aortic elasticity properties wasassociated with left ventricular diastolic dysfunction. Highsystolic pressure and hsCRP levels were found to be independentpredictors of ASI.Key words: Metabolic syndrome, Echocardiography,elastic properties of aorta, hsCR

Thrombotic, fibrinolytic and proliferative activities of pulmonary vascular bed in secondary pulmonary hypertension

Amaç: Bu çalışma, sekonder pulmoner hipertansiyonda (SPH) sıklıkla izlenen in situ tromboz gelişimine ve vasküler yeniden biçimlenmeye pulmoner vasküler yatağın lokal katkısını araştırmak için planlanmıştır. Yöntemler: Kliniğimizde kalp kateterizasyonu yapılan 71 SPH hastası (38 kadın, 33 erkek; yaş ortalaması 40.36 1.05 yıl) çalışmaya dahil edilmiştir. Her hastanın pulmoner arter (PA) ve sol ventrikülünden (LV) alınan kan örneklerinde plazminojen aktivator inhibitör-1 (PAI-1), trombosit kökenli büyüme faktörü (PDGF), damar endoteli büyüme faktörü (VEGF), D-Dimer, von-Willebrand faktörü (vWF), protein-C, antitrombin-III, fibrinojen ve plazminojen düzeyleri bakılarak karşılaştırılmıştır. Ayrıca her parametrenin ortalama PA basıncı (MPAP) ile korelasyonu araştırılmıştır. Bulgular: Ortalama VEGF düzeyi LV’de PA’e göre daha yüksektir (p0.001); ancak, her iki değer de normal sınırlardadır. Ortalama PDGF ve D-dimer düzeyi LV'de PA'den daha yüksektir (p0.001 ve p0.001) ve her iki değer normalin üstündedir. Ortalama vWF düzeyi LV ve PA arasında benzerdir, ancak her iki değer normalin hafif üstündedir. Ortalama PAI-1 düzeyi PA'de LV 'e göre daha yüksektir (p0.012); ancak, her iki değer de normal sınırlardadır. Antitrombin-III, protein-C, plazminojen ve fibrinojen düzeyleri açısından PA ve LV arasında fark yoktur ve fibrinojen hariç diğer parametrelerin ortalama değerleri normal sınırlardadır. Fibrinojen düzeyi her iki boşlukta da hafif yüksektir. Gerek PA, gerekse LV'deki D-dimer düzeyi ile MPAP arasında anlamlı pozitif korelasyon mevcuttur. Sonuç: Sekonder pulmoner hipertansiyonda pulmoner dolaşımda lokal olarak artmış protrombotik, hipofibrinolitik ve proliferatif aktiviteler mevcuttur ve bu durum pulmoner hipertansiyonun şiddeti ile ilişkilidir.Objective: To determine whether pulmonary vascular bed contributes to the development of in situ thrombosis and vascular remodelling in secondary pulmonary hypertension (SPH) via changes in its local secretory activities. Methods: Seventy-one patients with the diagnosis of secondary pulmonary hypertension (38 females, mean age 40.36± 1.05 years) were included in the study. Selective right and left heart catheterization was performed to each patient for diagnostic purposes. Blood samples obtained from left ventricle (LV) and pulmonary artery (PA) of each patient were analyzed for levels of plasminogen activator inhibitor-1 (PAI-1), platelet derived growth factor (PDGF), vascular endothelial growth factor (VEGF), D-dimer, von Willebrand factor (vWF), protein-C, antithrombin-III, fibrinogen, and plasminogen. Results were compared between LV and PA. Correlation analysis between each parameter and mean pulmonary artery pressure (MPAP) was performed. Results: Although mean level of VEGF in LV and PA were found to be in normal range, it was significantly higher in LV than in PA (p<0.001). Mean PDGF and D-dimer levels, which remained in normal range were also higher in LV (p<0.001 and p<0.001, respectively) than in PA;.vWF showed similar degree of elevation in both LV and PA. Only one parameter, PAI-1, was found to be significantly higher in PA than in LV (p0.012). Antithrombin-III, protein C, plasminogen, and fibrinogen levels showed no significant differences between two chambers. They also remained in normal range, except for fibrinogen which was slightly elevated in both LV and PA. Correlation analysis revealed strong positive correlation between D-dimer level in both LV and PA and MPAP (r0.775, p<0.001 and r0.649, p<0.001, respectively). Conclusion: In SPH, pulmonary vascular bed shows increased thrombotic, hypofibrinolytic, and proliferative activities which are partially related to the severity of illness

The association of estimated whole blood viscosity with hemodynamic parameters and prognosis in patients with heart failure

Aim: We aimed to investigate the association of estimated whole blood viscosity (WBV) with hemodynamic parameters and prognosis in patients with heart failure with reduced ejection fraction. Materials & methods: Total of 542 patients were included and followed-up for median 13 months. Results: The WBV parameters had negative relationship with right atrium pressure and positive correlation with cardiac index. The WBV parameters were found to be independent predictors of composite end point (CEP) and all-cause mortality. Every one cP increases of WBV(h) and WBV(l) were associated with 17 and 1% reductions of CEP. In Kaplan-Meier analysis, patients with low WBV quartiles were found to have significantly more CEP. Conclusion: Being an easily accessible and costless prognosticator, WBV seems to be a novel marker for determining prognosis and an emerging tool to individualize heart failure with reduced ejection fraction management