Giderek artan bilgiler depresyonun bagimsiz bir kardiyovaskuler hastalik (KVH) risk faktoru oldugunu ortaya koymaktadir. Bu calismamizda seratonin geri alim inhibitorleri (SSRI) ile tedavinin kalbin sistolik ve diyastolik fonksiyonlari ve kardiyovaskuler hastalik gelisimi icin bagimsiz ongorduruculer olan aortik sertlik ve endotel fonksiyon parametreleri uzerine etkisini arastirdik. Calismaya 16-65 yas arasi bilinen KVH oykusu olmayan ve major depresyon nedeni ile ilk defa SSRI tedavisi baslanan 41 hasta dâhil edildi. Tedavi baslangicinda ve 8 haftalik tedavi sonunda hastalarin ekokardiyografik olarak sistolik ve diyastolik fonksiyon parametreleri, miyokard performans indeksi (MPI) ve aortikgerilim (Ao strain) degerlendirildi. Otomatik analizor ile parmaktan pletismografik yontemle yapilan nabiz dalga analizi ile belirlenen nabiz ilerleme zamani (PPT), sertlik indeksi (SI) ve Refleksiyon indeksi (RI) hesaplandi. Endotel fonksiyonlari akima bagli dilatasyon yontemi ile degerlendirildi. Sekiz haftalik tedavi sonunda 19 hasta kontrole geldi (%46,3) ve nihai degerlendirmeye bu hastalarin sonuclari dâhil edildi. Analiz yapilan hastalarin tedavi oncesine gore tedavi sonunda sol ventrikul ejeksiyon fraksiyonunun (%64,83±4,54 vs %66,80±3,3, p=0,020) ve fraksiyonel kisalmasinin arttigi (%35,39±3,53 vs %37,11±2,49, p=0,013), MPI degerinin dustugu gozlendi (0,60±0,21 vs 0,45±0,15, p=0,004). Bunun disinda diyastolik fonksiyon parametreleri,aortik strain, endotel fonksiyon ve aortik sertlik parametreleri acisindan tedavi sonrasinda anlamli farklilik izlenmedi. Calismamiz yeni tani konmus depresyonlu hastalarin SSRI inhibitoru ile kisa donem tedavilerinin sol ventrikul sistolik fonksiyonlarini olumlu yonde etkileyebilecegini, diyastolik fonksiyonlarda, endotel fonksiyonlarinda ve buyuk arter sertliginde ise degisiklik yapmadigini gosterdi.

OBJECTIVE:In this prospective study, we aimed to investigate acute effect of nasal continuous positive airway pressure (CPAP) therapy on the endothelial function of patients with obstructive sleep apnea syndrome (OSA) by using brachial artery flow mediated dilatation (FMD) method.METHODS:Newly diagnosed thirty OSA patients with ages between 29 and 72 years were included in this study. FMD and high sensitivity C-reactive protein (hsCRP) values of patients obtained before and after CPAP dose titration test were compared with paired samples t test or Wilcoxon signed ranks test.RESULTS:With CPAP therapy apnea hypopnea indices were reduced (60.6±24.9/h vs. 9.6±7.9/h; p<0.001) and oxygen desaturation indices recovered (50±27/h vs. 6±7/h; p<0.001). Heart rates of patients decreased after CPAP therapy (80±10/min vs. 73±8/min; p=0.003). FMD values significantly increased after CPAP (8.55±5.82 percent vs. 12.08±7.17 percent; p=0.003). HsCRP values after CPAP were not different from baseline values.CONCLUSION:Acute improvement of the endothelial function with one night CPAP therapy suggests endothelial dysfunction in OSA patients to be result of acute pathophysiologic factors. In intermediate and severe OSA patients, CPAP therapy may be considered in acute treatment of diseases associated with endothelial dysfunction.

Background and aims : The aim of our study was to investigate the potential effect of natural aging on atrial fibrillation (AF) by means of electrocardiographic P-wave analysis and measurement of the transthoracic echocardiographic electromechanical coupling interval (EMC). Methods : The study comprised 25 healthy individuals aged =65 years (group 1) and 25 control subjects <65 years (group 2). The difference between maximum (Pmax) and minimum (Pmin) P-wave durations on 12-lead electrocardiography were defined as P-wave dispersion (PD). Intraand inter-atrial EMC were measured by tissue Doppler imaging. Results : Pmax (107.2±3.58 msec vs 100.0±3.56 msec, p<0.001) and PD (43.6±4.98 msec vs 36.5±3.56 msec, p<0.001) were significantly higher in group 1 than in group 2. Left atrial EMC [24.6 (15.20) vs 13.3 (4.50), p<0.001] and inter-atrial EMC [43.2 (16.05) vs 33.3 (4.75), p<0.001] were significantly delayed in group 1 compared with group 2. There was a significant correlation between left atrial diameter, PD, Pmax, left atrial EMC, and inter-atrial EMC. Conclusion : Aging is correlated with increased left atrial size and impaired diastolic relaxation, which may contribute to a greater risk of AF in terms of prolonged PD and atrial EMC.

HomeCirculationVol. 126, No. 2Massive Systemic Air Embolism During Aortic Root Angiography Free AccessBrief ReportPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialFree AccessBrief ReportPDF/EPUBMassive Systemic Air Embolism During Aortic Root AngiographyA Dire Complication Murat Tulmaç, MD, Vedat Şimşek, MD, Ömer Şahin, MD and Haksun Ebinç, MD Murat TulmaçMurat Tulmaç From the Department of Cardiology, Kırıkkale University Faculty of Medicine, Kırıkkale, Turkey. , Vedat ŞimşekVedat Şimşek From the Department of Cardiology, Kırıkkale University Faculty of Medicine, Kırıkkale, Turkey. , Ömer ŞahinÖmer Şahin From the Department of Cardiology, Kırıkkale University Faculty of Medicine, Kırıkkale, Turkey. and Haksun EbinçHaksun Ebinç From the Department of Cardiology, Kırıkkale University Faculty of Medicine, Kırıkkale, Turkey. Originally published10 Jul 2012https://doi.org/10.1161/CIRCULATIONAHA.112.107102Circulation. 2012;126:e17–e18Air embolism (AE) is an uncommon but potentially catastrophic complication of angiography. Although coronary AE is a well-known complication of coronary angiography, which occurs in 0.27% of cases,1 incidence and consequences of systemic massive AE are largely unknown. However, case reports are important to discuss reasons, management, and consequences of this complication.Case ReportsA 46-year-old woman with uncontrolled hypertension, thoracic aortic aneurysm, and anginal episodes at rest was referred for coronary angiography. The procedure was uneventful until the aortic root angiogram, during which 40 mL of contrast agent was intended to be injected with 14 mL/s flow and a maximum pressure of 1200 psi. On injection of contrast media into aortic root, a massive influx of air bubbles was observed (Figure and Movie I in the online-only Data Supplement). Instantly, the patient collapsed with pulseless electric activity. Meanwhile, it was realized that a large amount of air was injected into aortic root. Shortly after cardiopulmonary resuscitation, her blood pressure and pulse recovered. She became conscious, with good cooperation and orientation. However, she had a garbled speech, left hemiplegia, and partial weakness and paresthesia in right leg and arm. Under oxygen administration with mask in the 15th minute there was significant weakness in the left arm and shallow weakness in the left leg. Serial electrocardiograms revealed transient ST segment elevation of 0.05 mV in inferior derivations. Brain CT scan revealed no air bubbles, and the patient was emergently transferred to the nearest center with facility of hyperbaric oxygen chamber treatment (HBOT). At the 5th hour of the event, HBOT was started. After HBOT, left lower extremity motor and sensory functions recovered and her speech had become fluent with persisting slight paresthesia in left arm. In the next day neurological examination was completely normal. Electroencephalography and brain CT control in the third day of event were normal.Download figureDownload PowerPointFigure. Massive air influx into the aortic root.Initially troponin I showed acute elevation at 0.363 ng/mL, not accompanied by creatine kinase-MB elevation, which declined on subsequent tests. Her left ventricular wall motion was normal after HBOT. No deterioration in function of other organ systems was found. In the third year of the event, her neurological examination was still normal.This is the first case reporting accidental injection of massive air during aortic root angiography effecting both coronary and cerebral vasculature. There are hardly few reports of AE during aortography or ventriculography.1–3 Our report differs from previous cases by presenting the largest amount of air injected into aortic root during angiography (20–25 mL).Immediate treatment aims to interrupt the intervention that caused the embolic event. It was our only experience of massive AE ever, and nobody in the team was familiar with the image of massive AE. Unfortunately, AE was not noticed immediately, and therefore, with consternation, neither the catheter was pulled back nor the injection was stopped. The movie of this case (Movie I in the online-only Data Supplement) may provide an educational tool for staff in catheterization labs to recognize and interrupt the procedure when AE occurs.Massive systemic AE can have devastating clinical sequelae, including myocardial infarction, cerebral ischemia, permanent neuronal injury, and death. Operators should be prepared for the immediate recognition and emergent management of such complications. HBOT is the first-line treatment of choice for systemic AE.4,5 Catheterization laboratories should be in contact with the nearest center with an HBOT facility.DisclosuresNone.FootnotesThe online-only Data Supplement is available with this article at http://circ.ahajournals.org/lookup/suppl/doi:10.1161/CIRCULATIONAHA.112.107102/-/DC1.Correspondence to Murat Tulmaç, MD, Fabrikalar Mahallesi, Cemal Gürsel Caddesi, 35. Sokak No:1, Ersoylar Apartmanı B Blok Daire:7, 71100 Kırıkkale, Turkey. E-mail [email protected]comReferences1. Khan M, Schmidt DH, Bajwa T, Shalev Y. Coronary air embolism: incidence, severity, and suggested approaches to treatment. Cathet Cardiovasc Diagn. 1995; 36: 313– 318. CrossrefMedlineGoogle Scholar2. Krivonyak GS, Warren SG. Cerebral arterial air embolism treated by a vertical head-down maneuver. Catheter Cardiovasc Interv. 2000; 49: 185– 187. CrossrefMedlineGoogle Scholar3. Goldenberg I, Shupak A, Shoshani O, Boulos M. Left ventriculography complicated by cerebral air embolism. Cathet Cardiovasc Diagn. 1995; 35: 331– 334. CrossrefMedlineGoogle Scholar4. Muth CM, Shank ES. Gas embolism. N Engl J Med. 2000; 342: 476– 482. CrossrefMedlineGoogle Scholar5. van Hulst RA, Klein J, Lachmann B. Gas embolism: pathophysiology and treatment. Clin Physiol Funct Imaging. 2003; 23: 237– 246. CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails July 10, 2012Vol 126, Issue 2 Advertisement Article InformationMetrics © 2012 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.112.107102PMID: 22777668 Originally publishedJuly 10, 2012 PDF download Advertisement SubjectsCardiopulmonary Resuscitation and Emergency Cardiac CareCerebrovascular Disease/StrokeMyocardial InfarctionTreatment

Background. The aim of our study was to investigate the effect of white coat hypertension (WCH) to atrial conduction abnormalities by electrocardiographic P-wave analysis and echocardiographic electromechanical coupling (EMC) interval measurement. Methods. The study consisted of sex-, age-, and body mass index-matched 24 patients with WCH, 24 patients with sustained hypertension (SH), and 24 subjects with normotension (NT). The difference between the maximum (Pmax) and minimum P-wave durations on 12-lead electrocardiography was defined as P-wave dispersion (PD). Intra- and inter-atrial EMC were measured by tissue Doppler imaging. Results. Pmax and PD of subjects with WCH were significantly higher than those of normotensives and lower than those of patients with SH. Inter-atrial EMC and left atrial EMC values of WCH group were intermediate between NT and SH groups. There was a significant correlation between left atrial diameter, PD, Pmax, left ventricle mass index, left atrial EMC, and inter-atrial EMC. Conclusion. White coat hypertension is an intermediate group between SH and NT in terms of atrial electromechanical abnormalities which may be associated with the risk of atrial fibrillation.

We report a patient with retained metal coronary bulldog clips in the mediastinum during coronary artery bypass surgery which was recognized during coronary angiography following the diagnosis of unstable angina pectoris after an uncomplicated period of five years. This case suggests that conservative management of patients with postoperatively recognized retained foreign material should be kept in mind as an alternative to reoperation.

Background Impairment of endothelial function is an independent predictor of coronary events. The aim of this study was to clarify the influence of arterial access and coronary angiography on endothelial function. Methods Eighteen patients with stable angina pectoris who underwent coronary angiography were included in this study. Brachial artery flow-mediated dilatation of patients was measured before angiography, after femoral arterial sheath insertion, and after coronary angiography. Results Of 18 patients, 11 had angiographically apparent atherosclerosis. Flow-mediated dilatation after femoral arterial sheath insertion (mean ± SD, 6.62% ± 3.87%) was found to be significantly lower than either before (10.62% ± 5.18%) or after coronary angiography (11.66% ± 5.30%; P = 0.007 and P = 0.001, respectively). Basal and postangiographic flow-mediated dilatation values were similar. Flow-mediated dilatation significantly decreased after sheath insertion in the group with angiographically normal coronary arteries (14.47% ± 4.34% vs 5.98 ± 4.00%, respectively; P = 0.006), whereas the difference was not significant in patients with CAD (8.17% ± 4.16% vs 7.03% ± 3.92%, respectively). Conclusions Coronary angiography did not result in endothelial vasomotor dysfunction. Femoral arterial sheath insertion during coronary angiography was associated with a short-lived endothelial dysfunction. Larger studies are needed to interpret the effect of coronary atherosclerosis on attenuation of endothelial response against arterial wall injury.

OBJECTIVE:The aim of this study was to investigate the presence of autonomic dysfunction in patients with osteoporosis.DESIGN:This is a prospective controlled trial. Sixteen postmenopausal female patients with osteoporosis and 10 age-matched postmenopausal nonosteoporotic controls were included in the study. Participants were divided into the postmenopausal osteoporosis group and the nonosteoporotic control group according to bone mineral densities. Heart rate variability parameters and sympathetic skin responses were studied to evaluate autonomic functions.RESULTS:The latencies of sympathetic skin responses obtained from both hands were significantly increased in the patient group when compared with the control group. The sympathetic skin response amplitude of the right hands and both feet of the patient group were found to be decreased significantly when compared with that of the control group. A 24-hr high-frequency value was significantly decreased in the patient group than in control group. A 24-hr low-/high-frequency value was significantly higher in the patient group than in the control group.CONCLUSIONS:Autonomic dysfunction characterized with increased sympathetic and decreased parasympathetic activity may be present in osteoporosis, and cardiac functions in patients with osteoporosis may also be affected by accompanying autonomic dysfunction.

INTRODUCTION:Adiponectin is increased in end-stage renal disease. However, efforts to clarify the cause of that increase and its clinical effects have been inconclusive. The aim of this study was to compare serum adiponectin levels of dialysis patients against healthy individuals and evaluate the relationship among adiponectin levels, IL-6, TNF- alpha and left ventricular mass index (LVMI). METHODS:Adiponectin, IL-6 and TNF- alpha measurements and echocardiographic evaluations were performed in 36 hemodialysis, 30 continuous ambulatory peritoneal dialysis (CAPD) patients and 22 healthy volunteers. Adiponectin, IL-6 and TNF- alpha levels were measured by ELISA. RESULTS:Adiponectin was found to be higher in hemodialysis (52.78+/-18.01 ng/mL) and CAPD (52.96+/-17.53 ng/mL) groups than controls (28.36+/-13.20 ng/ mL; p=0.0003, p=0.0003, respectively). No difference was observed between the hemodialysis and CAPD groups. Adiponectin was positively correlated with IL-6 (r=0.293, p=0.02), TNF- alpha (r=0.458, p=0.0003) and LVMI (r=0.283, p=0.02). In the partial correlation analysis, by controlling for body mass index, the correlation between adiponectin and TNF- alpha (r=0.466, p=0.0003) persisted. When IL-6 was controlled with TNF- alpha, the relation between adiponectin and LVMI disappeared (r=0.145, p=0.30). In the linear regression analysis, with adiponectin as the dependent variable, and IL-6, TNF- alpha and body mass index as independent variables, a significant relationship was found between adiponectin and TNF- alpha (beta=0.488, p=0.001). CONCLUSIONS:Increased adiponectin seems to be associated with increased proinflammatory cytokines in dialysis patients, and this relationship suggests adiponectin may have a role in the development of left ventricular hypertrophy.

Objective: It is known that increased sympathetic activity and decreased parasympathetic activity are present in patients with fibromyalgia syndrome (FMS). This study aims to investigate the correlations of autonomic dysfunction and differences in autonomic circadian activity with arrhythmia prevalence in women with FMS.Methods: Fifty female patients with FMS and 30 healthy female controls were included in this cross-sectional, case-controlled study. A 12-lead electrocardiogram and 24-hour Holter monitoring were performed in all patients to evaluate arrhythmias and autonomic function tests. Heart rate variability (HRV) parameters were utilized to detect autonomic dysfunction in patients with FMS. HRV measurements were performed in total 24-hour, day time (06:00-22:59), night time (23:00-05:59) periods and during autonomic tests (stand - supine, inspiration-expiration and Valsalva tests) using 24-hour Holter monitoring recordings. Student t-test, Mann-Whitney U and Pearson Chi-square tests were used for comparisons of the data between groups. The correlation of data was tested by using Spearman correlation analysis.Results: The mean ages of the patient and control groups were 38 +/- 7.4 and 36 +/- 8.1 years, respectively. In HRV measurements, high frequency (HF) power, was significantly decreased in the patient group as compared with control group (167.4 msec(2) (107.0-312.0) vs.314.5 msec(2) (124.0-905.0), p=0.017). The low frequency/HF ratio (LF/HF) values for total 24 hours (2.22 +/- 0.18 vs. 1.22 +/- 0.12, p<0.001) and in the night time period (2.78 +/- 1.97 vs.1.15 +/- 0.77, p<0.001) were found to be significantly higher in the patient group than in control one. The ratio of LF/HFDay/LF/HFNight was markedly higher in the control group (2.67 (1.22-5.65) vs. 1.45 (0.83-2.05), p=0.004). The prevalence (p=0.028) and total number (127.1 +/- 21.4 vs. 187.3 +/- 62.3, p=0.019) of supraventricular extrasystoles in 24-hour period was higher in the patient group.Conclusion: The sympathetic activity was significantly increased and parasympathetic activity significantly decreased in FMS patients. Additionally, significant autonomic circadian activity changes were also detected in these patients. These autonomic changes might be linked to increased arrhythmia prevalence. (Anadolu Kardiyol Derg 2009, 9: 110-7)

Coronary artery fistulae are very rare congenital anomalies which constitute 0.2–0.4% of all congenital heart diseases. The right chambers of the heart are the most frequent communication site of the coronary fistulae and may cause hemodynamic impairment in the coronary circulation. The fistulae arise frequently from right coronary and left anterior descending arteries. Fistulae from left circumflex artery are very rare. We report a case in which transcatheter embolization was performed with 3-mm Guglielmi detachable coils in a young adult with a rare type of congenital fistula originating from the circumflex artery and draining into the coronary sinus.

Visfatin was recently defined as an adipocytokine; however, the pathophysiological role of visfatin is not completely understood. A few studies suggest that visfatin may be a new proinflammatory adipocytokine. The aim of the present study was to compare serum visfatin levels between hemodialysis and continuous ambulatory peritoneal dialysis (CAPD) patients and evaluate the relationship between visfatin levels to IL-6, TNF-alpha, and left ventricular hypertrophy. Serum visfatin, IL-6, and TNF-alpha levels were measured by using the ELISA method, and echocardiographic evaluations were performed in 31 hemodialysis patients, 30 CAPD patients, and 21 healthy volunteers. Serum visfatin levels were higher in the CAPD group (265.27 +/- 387.86 ng/mL) than hemodialysis (97.68 +/- 244.96 ng/mL,) and control (41.33 +/- 48.87 ng/mL) groups (p = 0.04, p = 0.01, respectively). No significant difference was observed between the hemodialysis and control groups. In univariate analysis, visfatin levels were positively correlated with IL-6 (r = 0.24, p = 0.03), TNF-alpha (r = 0.34, p = 0.002), and BMI (r = 0.26, p = 0.03) and negatively correlated with some left ventricular diastolic parameters [Em and Em/Am (r = -0.305, p = 0.01), (r = -0.251, p = 0.03), respectively]. No relationship was found between visfatin and left ventricular mass index. In the linear regression analysis, visfatin levels independently related with TNF-( (beta = 0.369, p = 0.001) and IL-6 (beta = 0.284, p = 0.015). This study has found significantly higher levels of serum visfatin in CAPD patients when compared to healthy individuals. Increased visfatin levels seem to associate with proinflammatory cytokines such as IL-6 or TNF-alpha. As for the effects of on left ventricular structure and functions, visfatin might have negative effects on left ventricular diastolic function parameters but have no effects on left ventricular mass index.

OBJECTIVES To investigate the effect of statin treatment on serum sex steroid levels, heart rate variability, erectile function, and libido in patients with hyperlipidemia.METHODS A total of 74 patients (mean age 44.7 +/- 7.1 years) with hyperlipidemia were enrolled into this study. After a cardiac examination, the serum lipid levels were measured, and the 24-hour Holter monitoring, heart rate variability, and autonomic test results were also evaluated. Erectile function was assessed using the International Index of Erectile Function (IIEF) questionnaire. Later, atorvastatin 40 mg/day was initiated in all patients and used for the subsequent 12 months. All diagnostic tests (cardiac, biochemical, and autonomic and the IIEF questionnaire) were performed again at 6 and 12 months of follow-Lip.RESULTS A statistically significant decrease was found in the serum lipid levels at 6 months (P<0.05). In contrast, the average IIEF scores (24.7 +/- 6.4 at baseline) had increased to 25.0 +/- 4.9 and 26.1 +/- 5.9 at 6 and 12 months of follow-up, respectively. Although the parasympathetic activities increased and sympathetic activities decreased with atorvastatin treatment, these changes were not statistically significant (P>0.05). In paired comparison, significant differences were found among the IIEF scores of the three periods (P = 0.013). The difference was more evident after 6 months of treatment (IIEF1vs2 = 0.475; IIEF1vs3 = 0.027; IIEF2vs3 = 0.012).CONCLUSIONS Although improvement in the lipid profile occurred early during the statin treatment, restoration of erectile function appeared later, which Could be attributed to the restoration of endothelial functions by lowered serum lipid levels.

Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of endothelial-based nitric oxide synthase. Its level is increased by end stage renal disease. However, most studies showing an increase in ADMA in dialysis patients have focused on hemodialysis. Results with peritoneal dialysis patients have been more inconclusive. Recent studies suggest that ADMA may be a new cardiovascular risk factor. The aim of the present study was to evaluate the relationship between ADMA levels, residual renal function, and left ventricular hypertrophy in peritoneal dialysis patients. Serum ADMA measurements and echocardiographic evaluations were performed in 54 peritoneal dialysis patients and 26 healthy volunteers. Residual renal function was measured in peritoneal dialysis patients by urea clearance from a urine collection. Thirty-two of the 54 peritoneal dialysis patients had residual renal function. ADMA levels of the peritoneal dialysis group were found to be significantly higher than those of healthy individuals (p = 0.03). Within the peritoneal dialysis group, ADMA levels of patients with residual renal function were significantly lower than those without residual renal function (p = 0.01), though they were still higher than the ADMA levels of the control group (p = 0.04). Serum levels of ADMA were positively correlated with left ventricular mass index (r = 0.29, p = 0.01) and negatively correlated with early mitral inflow velocity (Em) (r = -0.28, p = 0.01), Em/Late mitral inflow velocity (Am) (r = -0,32, p = 0.00), and isovolumetric relaxation time (r = -0.30, p = 0.01). In conclusion, increased ADMA levels seem to be associated with left ventricular hypertrophy in peritoneal dialysis patients, and residual renal function may lead to a reduction of serum ADMA levels.

To evaluate the relationship between the adiponectin levels and left ventricular mass index (LVMI) in uncomplicated obese subjects. Fifty-nine subjects were assigned to the obese (BMI> or =30 kg/m(2)) and 58 to the lean (BMI<30 kg/m (2) ) group. Plasma glucose, insulin, serum total cholesterol and high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol, triglycerides and adiponectin were measured. Insulin resistance was determined by the Homeostasis Assessment Model (HOMA-IR). The left ventricular functions of all subjects were determined by 2D and pulse wave Doppler echocardiography. LVMI was calculated as left ventricular mass (LVM) normalized for height in m (2.7) . The obese group displayed significantly higher LVMI and late mitral inflow velocity. Thirty-three obese subjects met the criteria for left ventricular hypertrophy (LVH) and had lower serum adiponectin levels compared with obese subjects without LVH and lean subjects (p<0.05). Adiponectin was negatively correlated with LVMI (R: -0.277, p: 0.002). Furthermore, during the partial correlation analysis where HOMA-IR was controlled, the negative correlation between adiponectin and LVMI progressed (r: -0.283, p: 0.002). The linear regression analysis showed an independent relationship between LVMI and adiponectin. (beta: -0.214, p: 0.01) Obesity is associated with LVH. This study showed direct influence of adiponectin on LVMI.

OBJECTIVEThe existence of microalbuminuria (MAU) in patients with essential hypertension is a strong indicator of microvascular damage. Although endothelial dysfunction and increased vascular permeability both have a role in the development of MAU, its ethiopathogenesis in hypertensive patients is not yet clearly understood. Vascular endothelial growth factor (VEGF) is the most important regulator of pathological or physiological angiogenesis and it additionally leads to increased vascular permeability. This study aims to assess the relationship of serum VEGF levels to MAU in non-complicated, newly-diagnosed essential hypertensive patients (EHs).METHODSThis study included 30 newly-diagnosed EHs with MAU, 46 newly-diagnosed EHs without MAU and 46 healthy controls. None of the EHs had diabetes, renal impairment or atherosclerotic diseases. Serum VEGF levels were measured using the ELISA method.RESULTSSerum levels of VEGF were significantly higher in EHs with MAU when compared with patients without MAU (225.15+/-109.34 pg/mL versus 166.78+/-114.35 pg/mL, p: 0.04) or controls (225.15+/-109.34 pg/mL versus 144.91+/-96.60 pg/mL, p: 0.007). On the other hand, no significant difference was observed between the non-MAU and control groups. In the univariate analysis, serum levels of VEGF, were positively correlated with systolic blood pressure (R: 0.253 p: 0.001), diastolic blood pressure (R: 0.162 p: 0.04), mean arterial pressure (R: 0.239 p: 0.002), creatinine clearance (R: 0.172 p: 0.04) and MAU (R: 0.338 p: 0.002). In the multiple linear regression analysis, VEGF levels were independently related to MAU (beta: 0.248, p: 0.02).CONCLUSIONVEGF levels are higher in EHs in the presence of MAU. These high values may be important in the early diagnosis of vascular damage in EHs. Additionally, VEGF may increase glomerular permeability and lead to MAU in EHs.