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OP-124 PREVALENCE AND PREDICTORS OF RENAL ARTERY STENOSIS IN HYPERTENSIVE PATIENTS UNDERGOING ELECTIVE CORONARY ANGIOGRAPHY
Oral Presentations / International Journal of Cardiology 140, Supplement 1 (2010) S1–S93
Conclusions: CRT leads to reduction in BNP levels. This appears to reflect improvements in NYHA class and six minute walking distance. BNP may be a simple method for monitoring the effects of CRT.
April 17, 2010 / 08.30–10.00 Hypertension: From Pathophysiology to Therapy
OP-121 ANTIHYPERTENSIVE TREATMENT IS ASSOCIATED WITH IMPROVEMENT IN ENDOTHELIAL DYSFUNCTION AND DECREASE IN CAROTID INTIMA MEDIA THICKNESS Mehmet Ali Sendur 1 , Hikmet Yorgun 2 , Ahmet Hakan Ates 2 , Ugur Canpolat 2 , Hamza Sunman 2 , Gulay Sain Guven 1 , Kudret Aytemir 2 , Lale Tokgozoglu 2 , Hilmi Ozkutlu 2 , Ali Oto 2 1 Hacettepe University, Department of Internal Medicine, Ankara, Turkey 2 Hacettepe University, Department of Cardiology, Ankara, Turkey Objective: Hypertension increases carotid intima-media thickening (IMT) and causes endothelial dysfunction which are surrogate markers of subclinical atherosclerosis. In this study we aimed to investigate the role of antihypertensive treatment on endothelial functions and carotid IMT in patients with stage 1 essential hypertension. Methods: In this single center study, carotid IMT, endothelial functions and blood pressure were measured for 14±3 weeks period in a group of 65 patients who treated with essential hypertension and received olmesartan or nebivolol. Diabetes mellitus, chronic kidney disease, atherosclerotic vascular disease history are the main exclusion criteria. Carotid IMT was measured with B-mode cardiac ultrasound scanner (GE Vingmed Ultrasound, Horten, Norway) by 7.5 MHz transducers. Endothelial dysfunction was evaluated by flow mediated vasodilatation from brachial artery. Measurements were taken in the beginning and at the end of study for 2 times. Results: In this cohort, a decrease in systolic blood pressure/ diastolic blood pressure of 21/12 mm Hg was reached in 14±3 weeks. Carotid IMT decreased 1.5 mm and flow mediated vasodilatation was increased from 6% to 8.5%. The changes in carotid IMT and endothelial fuctions are independent of the type of antihypertensive medication (p=0.33). Conclusions: Antihypertensive treatment initiated with an angiotensin receptor blocker or a β-blocker reduced the rate of intima-media thickening and improved endothelial functions in short term follow up.
OP-122 ANTIHYPERTENSIVE TREATMENT IMPROVES HEART RATE RECOVERY INDEX IN ESSENTIAL HYPERTENSION Hikmet Yorgun 1 , Mehmet Ali Sendur 2 , Ahmet Hakan Ates 1 , Ugur Canpolat 1 , Ergun Baris Kaya 1 , Kudret Aytemir 1 , Gulay Sain Guven 2 , Giray Kabakci 1 , Hilmi Ozkutlu 1 , Ali Oto 1 1 Hacettepe University, Department of Cardiology, Ankara, Turkey 2 Hacettepe University, Department of Internal Medicine, Ankara, Turkey Objective: Hypertension is associated with a variety of cardiovascular disorders including dysrhythmias. Heart-rate recovery index can provide both an estimate of impaired parasympathetic tone and a prognosis in regard to all-cause and cardiovascular death. In this study we aimed to investigate the role of antihypertensive treatment on the indices of heart rate recovery in patients with stage 1 essential hypertension. Methods: From May to February 2009, we prospectively enrolled 41 consecutive patients with stage 1 essential hypertension in whom antihypertensive treatment was initiated with an angiotensin receptor blocker. Basal electrocardiography, echocardiography, and treadmill exercise testing were performed in all patients at the beginning and 3 months after antihypertensive treatment. The heart-rate recovery index was calculated in the usual manner, by subtracting the 1st-minute (Rec1), 2nd-minute (Rec2), and 3rd-minute (Rec3) recovery heart rates from the maximal heart rate after exercise stress testing. Results: Among 41 patients, 35.6% of them were male and mean age was 50.6±8.08. Systolic/diastolic blood pressure reduction was 18/9 mm Hg. Before antihypertensive treatment, patients with essential hypertension
S35
exhibited significantly lower heart-rate recovery numbers, compared to the control values after treatment; Rec1, 32.7±7.2 vs 34.5±7.6, P=0.15; Rec2, 45.2±10.2 vs 51.3±7.0, P=0.04; and Rec3, 49.6±12.11 vs 56.8±7.6, P=0.01. Conclusions: These results show that antihypertensive treatment improves heart rate recovery index in patients with essential hypertension; an important predictor of dysrhythmias and sudden cardiac death.
OP-123 EFFICACY OF ANTIHYPERTENSIVE TREATMENT IN STAGE I ESSENTIAL HYPERTENSION; A SINGLE CENTER STUDY Mehmet Ali Sendur 1 , Hikmet Yorgun 2 , Ahmet Hakan Ates 2 , Ugur Canpolat 2 , Hamza Sunman 2 , Gulay Sain Guven 1 , Kudret Aytemir 2 , Hilmi Ozkutlu 2 , Ali Oto 2 1 Hacettepe University, Department of Internal Medicine, Ankara, Turkey 2 Hacettepe University, Department of Cardiology, Ankara, Turkey Objective: Renin-angiotensin-aldosteron system activation is important in essential hypertension and both beta blockers and angiotensin receptor blockers are proven to be effective agents. Our aim is to evaluate the efficacy of the antihypertensive effect of nebivolol and olmesartan in stage I essential hypertension. Methods: 84 patients with essential hypertension and who were being treated with a single agent, nebivolol or olmesartan had baseline and 8±2 weeks systolic and diastolic blood pressure monitoring. Diabetes mellitus, chronic kidney disease, atherosclerotic vascular disease, morbid obesity, and proteinuria more than 300mg/day history are the main exclusion criteria. Results: Among study population, 40 patients were male and age was 52±9. Among study population, 42 patients treated with nebivolol and baseline mean of systolic and diastolic pressure was 149/94 mmHg. When compared with baseline, at the end of 8±2 weeks 73% of patients had a decrease in systolic and diastolic pressure below 140 and 90 mmHG respectively. Systolic/diastolic blood pressure decreased by 18/10 mm Hg with nebivolol. Forty two patients treated with olmesartan and baseline mean of systolic and diastolic pressure was 153/94 mmHg. When compared with baseline at the end of 8±2 weeks 77% of patients had decrease in systolic and diastolic pressure below 140 and 90 mmHG respectively. Systolic/diastolic blood pressure decreased by 24/12 mm Hg with olmesartan. Conclusions: Both angiotensin receptor blockers and β-blockers were effective in the treatment of essential hypertension.
OP-124 PREVALENCE AND PREDICTORS OF RENAL ARTERY STENOSIS IN HYPERTENSIVE PATIENTS UNDERGOING ELECTIVE CORONARY ANGIOGRAPHY Giray Kabakci, Hikmet Yorgun, Ugur Canpolat, Gorkem Fatihoglu, Ugur Karakulak, Ergun Baris Kaya, Kudret Aytemir, Lale Tokgozoglu, Hilmi Ozkutlu, Ali Oto Department of Cardiology, Hacettepe University, Ankara, Turkey Objective: Atherosclerotic process is the most common cause of renal artery disease, accounting for 90% of renal artery stenosis (RAS). Moreover, RAS has important effects on the prognosis of cardiovascular disease. RAS remains underdiagnosed because of nonspecific clinical signs, including in patients with coronary artery disease (CAD). In this study, we aimed to define its prevalence and explain potential predictors of angiographic RAS in a cohort of hypertensive patients underwent elective coronary procedures. Methods: We included 199 consecutive hypertensive patients admitted to cardiology department for evaluation of coronary artery disease and underwent catheterization laboratory for elective diagnostic or interventional coronary procedures during the period from July 2004 to November 2009. All patients underwent selective renal arteriography in the same procedure. Other causes of secondary hypertension (other than RAS) were excluded by appropriate clinical and laboratory testing. Patients were considered to have significant RAS if they had at least a 60% luminal obstruction of one or both renal arteries. Patients were classified into normal renal arteries, insignificant RAS, and significant RAS. Results: The mean age was 62±9.9 years, and 103 (53.3%) were males. 41 (20.6%) patients had previously diagnosed CAD. Mean hypertension duration was 10.49±7.4 years. 14 (7%) patients underwent percutaneous
S36
Oral Presentations / International Journal of Cardiology 140, Supplement 1 (2010) S1–S93
coronary intervention at the same procedure. Significant renal artery stenosis was found in 9 (4.5%) patients and all of them underwent renal artery stenting successfully. It correlated significantly with hypertension duration (P=0.003), history of stroke (P=0.03), history of angioplasty to coronary vessels (P=0.01), and extent of coronary disease (P=0.01). Multivariate regression analysis showed multivessel coronary artery disease as independent predictor of renal artery stenosis, with odds ratios of 8.7. Conclusions: RAS is not uncommon among hypertensive patients undergoing elective coronary angiography for known or suspected CAD. Screening for RAS by invasive renal angiography might be performed at the time of catheterization in hypertensive patients with multivessel coronary disease.
OP-125 RELATIONSHIP BETWEEN LEFT VENTRICULAR MASS AND CIRCADIAN BLOOD PRESSURE PATTERN IN ELDERLY POPULATION WITH NEWLY DIAGNOSED HYPERTENSION Ali Oto 1 , Sercan Okutucu 1 , Guliz Erdem Yazici 2 , Hakan Aksoy 1 , Sefik Gorkem Fatihoglu 1 , Ugur Nadir Karakulak 1 , Muhammet Dural 1 , Ergun Baris Kaya 1 , Kudret Aytemir 1 , Giray Kabakci 1 , Lale Tokgozoglu 1 , Hilmi Ozkutlu 1 1 Department of Cardiology, Hacettepe University, Ankara, Turkey 2 Cardiology Clinics, Kirikkale Research Hospital, Kirikkale, Turkey Objective: The prevalance of hypertension and other cardiovascular diseases increases with age. The lack of nocturnal decline in blood pressure (BP) is associated with increase in cardiovascular events. The purpose of this study was to examine the echocardiographic parameters in recently diagnosed hypertensive geriatric patients according to their circadian blood pressure. Methods: Total number of 145 geriatric patients (≥65 years) with recently diagnosed hypertension were enrolled in this study. Demographic properties like gender, smoking status; comorbid diseases including diabetes mellitus, coronary artery disease; and information about their hypertension such as the duration of hypertension, prescribed drugs were recorded. All patients underwent 24-h ambulatory BP monitorization (ABPM) and transthoracic echocardiographic examination (TTE). Patients with a decline in mean night-time blood pressure of more than 10% were accepted as dippers. Results: Patients were allocated into 2 groups according to the circadian blood pressure pattern as dippers (n=75) and non-dippers (n=70). The dipper and non-dipper groups were similar with respect to age (69.9±3.2 vs. 70.1±3.1 years), gender distribution ([male/female] 44/31 vs. 41/29), smoking status (30% vs. 28%), total cholesterol (186.5±19.0 vs. 192.0±30.6 mg/dl), LDL cholesterol (113.7±15.3 vs. 116.4±15.7 mg/dl) and HDL cholesterol levels (45.9±11.7 vs. 43.8±11.8 mg/dl) and left ventricular ejection fraction (LVEF) (65.7±3.6 vs. 64.8±3.0%). Mean left ventricular mass (156±40 vs. 142±39, p=0.034), left ventricular posterior wall end diastolic thickness (1.0±0.3 vs. 0.9±0.2, p=0.018) and interventricular septal end diastolic thickness (1.1±0.3 vs. 1.0±0.3, p=0.046) were significantly higher in non-dipper group. Conclusions: As a conclusion, blunting of the nocturnal fall in BP associates with a higher left ventricular mass in geriatric age group with recently diagnosed hypertension.
OP-126 ASSOCIATION OF SERUM FETUIN-A WITH CALCIUM CONCENTRATION IN THE MITRAL VALVE TISSUE IN PATIENTS WITH RHEUMATIC MITRAL VALVE DISEASE Kumral Cagli 1 , Nurcan Basar 1 , Kerim Cagli 2 , Ferah Armutcu 3 , Firdevs Aylak 4 , Adnan Yalcinkaya 2 , Gonul Erden 5 , Ersin Kadirogullari 2, Ozgul Malcok Gurel 1 , Selcuk Kanat 1 , Abdullah Tuncez 1 , Zehra Golbasi 1 1 Turkiye Yuksek Ihtisas Hospital, Department of Cardiology, Ankara, Turkey 2 Turkiye Yuksek Ihtisas Hospital, Department of Cardiovascular Surgery, Ankara, Turkey 3 Fatih University, Faculty of Medicine, Department of Biochemistry, Ankara, Turkey 4 Suleyman Demirel University, Faculty of Medicine, Department of Biochemistry, Isparta, Turkey 5 Ankara Numune Education and Research Hospital, Department of Biochemistry, Ankara, Turkey
Objective: Fetuin-A is an acute-phase glycoprotein that inhibits ectopic calcification. In this study we sought to assess serum fetuin-A levels in patients with rheumatic mitral valve disease (RMVD) and to evaluate the association of fetuin-A with the extent of MV calcification determined either by transesophageal echocardiography or by measurements of calcium and phosphorus concentrations in the resected valves. Methods: Twenty-one patients with RMVD (Study group, 14 female, mean age 47.9±12.4 years), who have scheduled for MV replacement surgery, and 30 age- and gender-matched healthy subjects (Control group, 17 female, mean age 43.6±11.1 years) were enrolled into the study. Baseline serum fetuin-A levels were measured by ELISA and high-sensitivity C-reactive protein (hs-CRP) levels by immunonepholometry. A Wilkins score was calculated in all patients by transesophageal echocardiography and the resected valves were analyzed for tissue concentrations of calcium and phosphorus. Results: Serum fetuin-A levels were significantly lower and hs-CRP levels were significantly higher in study group than in control group (300.4±92.5μ g/ml vs. 352.6±55.3μ g/ml, p=0.028, and 1.9±1.2 mg/dl vs. 0.3±0.2 mg/dl, p<0.0001, respectively). An inverse correlation was found between serum fetuin-A levels and hs-CRP levels (r=-0.596, p<0.0001). A significant association of either serum fetuin-A or hs-CRP was also found to be with calcium concentration in the MV tissue (r=-0.684, p=0.001, and r=0.510, p=0.018, respectively), but not with Wilkins calcium score. Conclusions: Serum fetuin-A concentration is significantly decreased in patients with rheumatic mitral valve disease and shows an inverse association with calcium concentration in the mitral valve tissue. These data support the hypothesis that fetuin-A may have a role in the pathophysiology of rheumatic valve calcification.
OP-127 LOW MOLECULAR WEIGHT HEPARINS: IS IT A SUITABLE ANTICOAGULATION OPTION IN PREGNANT WOMEN WITH MECHANICAL HEART VALVES? Sercan Okutucu, Kudret Aytemir, Banu Evranos, Hakan Aksoy, Ergun Baris Kaya, Cingiz Sabanov, Farzin Jam, Janar Akbarovna, Giray Kabakci, Lale Tokgozoglu, Hilmi Ozkutlu, Ali Oto Department of Cardiology, Hacettepe University, Ankara, Turkey Objective: There is no available definitive recommendation concerning optimal anticoagulant therapy in pregnant women with a mechanical heart valve. The purpose of the current study was to present the clinical results of low molecular weight heparin (LWMH) treatment (enoxaparin or nadroparin) with respect to pregnancy outcome and maternal complications. Methods: Baseline data recorded at the first prenatal visit include age, gestational age, New York Heart Association functional class, parity status, other medical conditions, previous cardiac events, type of mechanical valve, previous surgery or intervention, and medications. All women undergo 12lead electrocardiography and transthoracic echocardiography at the first antenatal visit. Follow-up data are obtained during each of the antenatal visits and up to 6 months postpartum. Echocardiographic variables include prosthetic valve peak and mean gradients, calculated valve areas, the size and function of the left ventricle, and right ventricular systolic pressure. Our anticoagulation protocol was as follows. When pregnancy was desired, oral anticoagulants were stopped and changed to subcutaneous nadroparin (n=3 patients) (7,500 U, twice daily) or enoxaparin (5 patients) (enoxaparin 60 mg every 12 h), until pregnancy was completed. Results: Of 8 patients (20.4±4.1 years); 4 have mitral valve replacement (MVR), 3 have aortic valve (AVR) replacement and 1 has both MVR and AVR. There was no valve thrombosis, need for valve replacement, or stroke during pregnancy or postpartum. There was no fetal loss, bleeding complication and fetal malformation. Conclusions: In conclusion, LMWH may be a suitable anticoagulation strategy in pregnant women with mechanical heart valves who are unwilling to use warfarin.
Conclusions: CRT leads to reduction in BNP levels. This appears to reflect improvements in NYHA class and six minute walking distance. BNP may be a simple method for monitoring the effects of CRT.
April 17, 2010 / 08.30–10.00 Hypertension: From Pathophysiology to Therapy
OP-121 ANTIHYPERTENSIVE TREATMENT IS ASSOCIATED WITH IMPROVEMENT IN ENDOTHELIAL DYSFUNCTION AND DECREASE IN CAROTID INTIMA MEDIA THICKNESS Mehmet Ali Sendur 1 , Hikmet Yorgun 2 , Ahmet Hakan Ates 2 , Ugur Canpolat 2 , Hamza Sunman 2 , Gulay Sain Guven 1 , Kudret Aytemir 2 , Lale Tokgozoglu 2 , Hilmi Ozkutlu 2 , Ali Oto 2 1 Hacettepe University, Department of Internal Medicine, Ankara, Turkey 2 Hacettepe University, Department of Cardiology, Ankara, Turkey Objective: Hypertension increases carotid intima-media thickening (IMT) and causes endothelial dysfunction which are surrogate markers of subclinical atherosclerosis. In this study we aimed to investigate the role of antihypertensive treatment on endothelial functions and carotid IMT in patients with stage 1 essential hypertension. Methods: In this single center study, carotid IMT, endothelial functions and blood pressure were measured for 14±3 weeks period in a group of 65 patients who treated with essential hypertension and received olmesartan or nebivolol. Diabetes mellitus, chronic kidney disease, atherosclerotic vascular disease history are the main exclusion criteria. Carotid IMT was measured with B-mode cardiac ultrasound scanner (GE Vingmed Ultrasound, Horten, Norway) by 7.5 MHz transducers. Endothelial dysfunction was evaluated by flow mediated vasodilatation from brachial artery. Measurements were taken in the beginning and at the end of study for 2 times. Results: In this cohort, a decrease in systolic blood pressure/ diastolic blood pressure of 21/12 mm Hg was reached in 14±3 weeks. Carotid IMT decreased 1.5 mm and flow mediated vasodilatation was increased from 6% to 8.5%. The changes in carotid IMT and endothelial fuctions are independent of the type of antihypertensive medication (p=0.33). Conclusions: Antihypertensive treatment initiated with an angiotensin receptor blocker or a β-blocker reduced the rate of intima-media thickening and improved endothelial functions in short term follow up.
OP-122 ANTIHYPERTENSIVE TREATMENT IMPROVES HEART RATE RECOVERY INDEX IN ESSENTIAL HYPERTENSION Hikmet Yorgun 1 , Mehmet Ali Sendur 2 , Ahmet Hakan Ates 1 , Ugur Canpolat 1 , Ergun Baris Kaya 1 , Kudret Aytemir 1 , Gulay Sain Guven 2 , Giray Kabakci 1 , Hilmi Ozkutlu 1 , Ali Oto 1 1 Hacettepe University, Department of Cardiology, Ankara, Turkey 2 Hacettepe University, Department of Internal Medicine, Ankara, Turkey Objective: Hypertension is associated with a variety of cardiovascular disorders including dysrhythmias. Heart-rate recovery index can provide both an estimate of impaired parasympathetic tone and a prognosis in regard to all-cause and cardiovascular death. In this study we aimed to investigate the role of antihypertensive treatment on the indices of heart rate recovery in patients with stage 1 essential hypertension. Methods: From May to February 2009, we prospectively enrolled 41 consecutive patients with stage 1 essential hypertension in whom antihypertensive treatment was initiated with an angiotensin receptor blocker. Basal electrocardiography, echocardiography, and treadmill exercise testing were performed in all patients at the beginning and 3 months after antihypertensive treatment. The heart-rate recovery index was calculated in the usual manner, by subtracting the 1st-minute (Rec1), 2nd-minute (Rec2), and 3rd-minute (Rec3) recovery heart rates from the maximal heart rate after exercise stress testing. Results: Among 41 patients, 35.6% of them were male and mean age was 50.6±8.08. Systolic/diastolic blood pressure reduction was 18/9 mm Hg. Before antihypertensive treatment, patients with essential hypertension
S35
exhibited significantly lower heart-rate recovery numbers, compared to the control values after treatment; Rec1, 32.7±7.2 vs 34.5±7.6, P=0.15; Rec2, 45.2±10.2 vs 51.3±7.0, P=0.04; and Rec3, 49.6±12.11 vs 56.8±7.6, P=0.01. Conclusions: These results show that antihypertensive treatment improves heart rate recovery index in patients with essential hypertension; an important predictor of dysrhythmias and sudden cardiac death.
OP-123 EFFICACY OF ANTIHYPERTENSIVE TREATMENT IN STAGE I ESSENTIAL HYPERTENSION; A SINGLE CENTER STUDY Mehmet Ali Sendur 1 , Hikmet Yorgun 2 , Ahmet Hakan Ates 2 , Ugur Canpolat 2 , Hamza Sunman 2 , Gulay Sain Guven 1 , Kudret Aytemir 2 , Hilmi Ozkutlu 2 , Ali Oto 2 1 Hacettepe University, Department of Internal Medicine, Ankara, Turkey 2 Hacettepe University, Department of Cardiology, Ankara, Turkey Objective: Renin-angiotensin-aldosteron system activation is important in essential hypertension and both beta blockers and angiotensin receptor blockers are proven to be effective agents. Our aim is to evaluate the efficacy of the antihypertensive effect of nebivolol and olmesartan in stage I essential hypertension. Methods: 84 patients with essential hypertension and who were being treated with a single agent, nebivolol or olmesartan had baseline and 8±2 weeks systolic and diastolic blood pressure monitoring. Diabetes mellitus, chronic kidney disease, atherosclerotic vascular disease, morbid obesity, and proteinuria more than 300mg/day history are the main exclusion criteria. Results: Among study population, 40 patients were male and age was 52±9. Among study population, 42 patients treated with nebivolol and baseline mean of systolic and diastolic pressure was 149/94 mmHg. When compared with baseline, at the end of 8±2 weeks 73% of patients had a decrease in systolic and diastolic pressure below 140 and 90 mmHG respectively. Systolic/diastolic blood pressure decreased by 18/10 mm Hg with nebivolol. Forty two patients treated with olmesartan and baseline mean of systolic and diastolic pressure was 153/94 mmHg. When compared with baseline at the end of 8±2 weeks 77% of patients had decrease in systolic and diastolic pressure below 140 and 90 mmHG respectively. Systolic/diastolic blood pressure decreased by 24/12 mm Hg with olmesartan. Conclusions: Both angiotensin receptor blockers and β-blockers were effective in the treatment of essential hypertension.
OP-124 PREVALENCE AND PREDICTORS OF RENAL ARTERY STENOSIS IN HYPERTENSIVE PATIENTS UNDERGOING ELECTIVE CORONARY ANGIOGRAPHY Giray Kabakci, Hikmet Yorgun, Ugur Canpolat, Gorkem Fatihoglu, Ugur Karakulak, Ergun Baris Kaya, Kudret Aytemir, Lale Tokgozoglu, Hilmi Ozkutlu, Ali Oto Department of Cardiology, Hacettepe University, Ankara, Turkey Objective: Atherosclerotic process is the most common cause of renal artery disease, accounting for 90% of renal artery stenosis (RAS). Moreover, RAS has important effects on the prognosis of cardiovascular disease. RAS remains underdiagnosed because of nonspecific clinical signs, including in patients with coronary artery disease (CAD). In this study, we aimed to define its prevalence and explain potential predictors of angiographic RAS in a cohort of hypertensive patients underwent elective coronary procedures. Methods: We included 199 consecutive hypertensive patients admitted to cardiology department for evaluation of coronary artery disease and underwent catheterization laboratory for elective diagnostic or interventional coronary procedures during the period from July 2004 to November 2009. All patients underwent selective renal arteriography in the same procedure. Other causes of secondary hypertension (other than RAS) were excluded by appropriate clinical and laboratory testing. Patients were considered to have significant RAS if they had at least a 60% luminal obstruction of one or both renal arteries. Patients were classified into normal renal arteries, insignificant RAS, and significant RAS. Results: The mean age was 62±9.9 years, and 103 (53.3%) were males. 41 (20.6%) patients had previously diagnosed CAD. Mean hypertension duration was 10.49±7.4 years. 14 (7%) patients underwent percutaneous
S36
Oral Presentations / International Journal of Cardiology 140, Supplement 1 (2010) S1–S93
coronary intervention at the same procedure. Significant renal artery stenosis was found in 9 (4.5%) patients and all of them underwent renal artery stenting successfully. It correlated significantly with hypertension duration (P=0.003), history of stroke (P=0.03), history of angioplasty to coronary vessels (P=0.01), and extent of coronary disease (P=0.01). Multivariate regression analysis showed multivessel coronary artery disease as independent predictor of renal artery stenosis, with odds ratios of 8.7. Conclusions: RAS is not uncommon among hypertensive patients undergoing elective coronary angiography for known or suspected CAD. Screening for RAS by invasive renal angiography might be performed at the time of catheterization in hypertensive patients with multivessel coronary disease.
OP-125 RELATIONSHIP BETWEEN LEFT VENTRICULAR MASS AND CIRCADIAN BLOOD PRESSURE PATTERN IN ELDERLY POPULATION WITH NEWLY DIAGNOSED HYPERTENSION Ali Oto 1 , Sercan Okutucu 1 , Guliz Erdem Yazici 2 , Hakan Aksoy 1 , Sefik Gorkem Fatihoglu 1 , Ugur Nadir Karakulak 1 , Muhammet Dural 1 , Ergun Baris Kaya 1 , Kudret Aytemir 1 , Giray Kabakci 1 , Lale Tokgozoglu 1 , Hilmi Ozkutlu 1 1 Department of Cardiology, Hacettepe University, Ankara, Turkey 2 Cardiology Clinics, Kirikkale Research Hospital, Kirikkale, Turkey Objective: The prevalance of hypertension and other cardiovascular diseases increases with age. The lack of nocturnal decline in blood pressure (BP) is associated with increase in cardiovascular events. The purpose of this study was to examine the echocardiographic parameters in recently diagnosed hypertensive geriatric patients according to their circadian blood pressure. Methods: Total number of 145 geriatric patients (≥65 years) with recently diagnosed hypertension were enrolled in this study. Demographic properties like gender, smoking status; comorbid diseases including diabetes mellitus, coronary artery disease; and information about their hypertension such as the duration of hypertension, prescribed drugs were recorded. All patients underwent 24-h ambulatory BP monitorization (ABPM) and transthoracic echocardiographic examination (TTE). Patients with a decline in mean night-time blood pressure of more than 10% were accepted as dippers. Results: Patients were allocated into 2 groups according to the circadian blood pressure pattern as dippers (n=75) and non-dippers (n=70). The dipper and non-dipper groups were similar with respect to age (69.9±3.2 vs. 70.1±3.1 years), gender distribution ([male/female] 44/31 vs. 41/29), smoking status (30% vs. 28%), total cholesterol (186.5±19.0 vs. 192.0±30.6 mg/dl), LDL cholesterol (113.7±15.3 vs. 116.4±15.7 mg/dl) and HDL cholesterol levels (45.9±11.7 vs. 43.8±11.8 mg/dl) and left ventricular ejection fraction (LVEF) (65.7±3.6 vs. 64.8±3.0%). Mean left ventricular mass (156±40 vs. 142±39, p=0.034), left ventricular posterior wall end diastolic thickness (1.0±0.3 vs. 0.9±0.2, p=0.018) and interventricular septal end diastolic thickness (1.1±0.3 vs. 1.0±0.3, p=0.046) were significantly higher in non-dipper group. Conclusions: As a conclusion, blunting of the nocturnal fall in BP associates with a higher left ventricular mass in geriatric age group with recently diagnosed hypertension.
OP-126 ASSOCIATION OF SERUM FETUIN-A WITH CALCIUM CONCENTRATION IN THE MITRAL VALVE TISSUE IN PATIENTS WITH RHEUMATIC MITRAL VALVE DISEASE Kumral Cagli 1 , Nurcan Basar 1 , Kerim Cagli 2 , Ferah Armutcu 3 , Firdevs Aylak 4 , Adnan Yalcinkaya 2 , Gonul Erden 5 , Ersin Kadirogullari 2, Ozgul Malcok Gurel 1 , Selcuk Kanat 1 , Abdullah Tuncez 1 , Zehra Golbasi 1 1 Turkiye Yuksek Ihtisas Hospital, Department of Cardiology, Ankara, Turkey 2 Turkiye Yuksek Ihtisas Hospital, Department of Cardiovascular Surgery, Ankara, Turkey 3 Fatih University, Faculty of Medicine, Department of Biochemistry, Ankara, Turkey 4 Suleyman Demirel University, Faculty of Medicine, Department of Biochemistry, Isparta, Turkey 5 Ankara Numune Education and Research Hospital, Department of Biochemistry, Ankara, Turkey
Objective: Fetuin-A is an acute-phase glycoprotein that inhibits ectopic calcification. In this study we sought to assess serum fetuin-A levels in patients with rheumatic mitral valve disease (RMVD) and to evaluate the association of fetuin-A with the extent of MV calcification determined either by transesophageal echocardiography or by measurements of calcium and phosphorus concentrations in the resected valves. Methods: Twenty-one patients with RMVD (Study group, 14 female, mean age 47.9±12.4 years), who have scheduled for MV replacement surgery, and 30 age- and gender-matched healthy subjects (Control group, 17 female, mean age 43.6±11.1 years) were enrolled into the study. Baseline serum fetuin-A levels were measured by ELISA and high-sensitivity C-reactive protein (hs-CRP) levels by immunonepholometry. A Wilkins score was calculated in all patients by transesophageal echocardiography and the resected valves were analyzed for tissue concentrations of calcium and phosphorus. Results: Serum fetuin-A levels were significantly lower and hs-CRP levels were significantly higher in study group than in control group (300.4±92.5μ g/ml vs. 352.6±55.3μ g/ml, p=0.028, and 1.9±1.2 mg/dl vs. 0.3±0.2 mg/dl, p<0.0001, respectively). An inverse correlation was found between serum fetuin-A levels and hs-CRP levels (r=-0.596, p<0.0001). A significant association of either serum fetuin-A or hs-CRP was also found to be with calcium concentration in the MV tissue (r=-0.684, p=0.001, and r=0.510, p=0.018, respectively), but not with Wilkins calcium score. Conclusions: Serum fetuin-A concentration is significantly decreased in patients with rheumatic mitral valve disease and shows an inverse association with calcium concentration in the mitral valve tissue. These data support the hypothesis that fetuin-A may have a role in the pathophysiology of rheumatic valve calcification.
OP-127 LOW MOLECULAR WEIGHT HEPARINS: IS IT A SUITABLE ANTICOAGULATION OPTION IN PREGNANT WOMEN WITH MECHANICAL HEART VALVES? Sercan Okutucu, Kudret Aytemir, Banu Evranos, Hakan Aksoy, Ergun Baris Kaya, Cingiz Sabanov, Farzin Jam, Janar Akbarovna, Giray Kabakci, Lale Tokgozoglu, Hilmi Ozkutlu, Ali Oto Department of Cardiology, Hacettepe University, Ankara, Turkey Objective: There is no available definitive recommendation concerning optimal anticoagulant therapy in pregnant women with a mechanical heart valve. The purpose of the current study was to present the clinical results of low molecular weight heparin (LWMH) treatment (enoxaparin or nadroparin) with respect to pregnancy outcome and maternal complications. Methods: Baseline data recorded at the first prenatal visit include age, gestational age, New York Heart Association functional class, parity status, other medical conditions, previous cardiac events, type of mechanical valve, previous surgery or intervention, and medications. All women undergo 12lead electrocardiography and transthoracic echocardiography at the first antenatal visit. Follow-up data are obtained during each of the antenatal visits and up to 6 months postpartum. Echocardiographic variables include prosthetic valve peak and mean gradients, calculated valve areas, the size and function of the left ventricle, and right ventricular systolic pressure. Our anticoagulation protocol was as follows. When pregnancy was desired, oral anticoagulants were stopped and changed to subcutaneous nadroparin (n=3 patients) (7,500 U, twice daily) or enoxaparin (5 patients) (enoxaparin 60 mg every 12 h), until pregnancy was completed. Results: Of 8 patients (20.4±4.1 years); 4 have mitral valve replacement (MVR), 3 have aortic valve (AVR) replacement and 1 has both MVR and AVR. There was no valve thrombosis, need for valve replacement, or stroke during pregnancy or postpartum. There was no fetal loss, bleeding complication and fetal malformation. Conclusions: In conclusion, LMWH may be a suitable anticoagulation strategy in pregnant women with mechanical heart valves who are unwilling to use warfarin.