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    Echocardiographically Measured Epicardial Fat Predicts New-onset Atrial Fibrillation after Cardiac Surgery
    (Soc Brasil Cirurgia Cardiovasc, 2020) Gunturk, Ertugrul Emre; Topuz, Mustafa; Serhatlioglu, Faruk; Akkaya, Hasan
    Objective: The current study aims to investigate the role of echocardiographically measured epicardial adipose tissue (EAT) thickness in the prediction of new-onset atrial fibrillation (AF) following coronary artery bypass grafting (CABG) surgery. Methods: One hundred and twenty-four patients scheduled to undergo isolated on-pump CABG due to coronary artery disease were enrolled to the current study. Patient characteristics, medical history and perioperative variables were prospectively collected. EAT thickness was measured using transthoracic echocardiography (TTE). Any documented episode of new-onset postoperative AF (POAF) until discharge was defined as the study endpoint. Forty-four participants with POAF served as AF group and 80 patients without AF served as Non-AF group. Results: Two groups were similar in terms of baseline echocardiographic and laboratory findings. In laboratory findings, the groups were similar in terms of the studied parameters, except N-terminal pro-brain natriuretic peptide (NT Pro-BNP), which was higher in AF group than in Non-AF group (P=0.035). The number of left internal mammary artery (LIMA) grafts was not different in both groups. AF group had higher cross-clamp (CC) and cardiopulmonary bypass (CPB) times than Non-AF group (P=0.01 and P<0.001). In multivariate logistic regression analysis, EAT was found an independent predictor for the development of POAF (OR 4.47, 95% CI 3.07-5.87, P=0.001). Conclusion: We have shown that EAT thickness is associated with increased risk of AF development and can be used as a prognostic marker for this purpose.
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    Epicardial adipose tissue thickness predicts non-dipper statue in newly diagnosed hypertensive patients
    (Edizioni Minerva Medica, 2021) Emre Gunturk, Ertugrul; Topuz, Mustafa; Akkaya, Hasan; Topuz, Ayse N.
    BACKGROUND: Hypertension is known to be a major reason for adverse cardiovascular events and increases morbidity and mortality rates. In individuals with a normal circadian rhythm, nocturnal blood pressure falls at a rate of 10-20%. Conversely, <10% of nocturnal blood pressure decline is defined as non-dipping circadian blood pressure (BP) profile. It has been reported that this is an independent predictor of cardiovascular morbidity and mortality both in those with and without hypertension. METHODS: This cross-sectional study included newly diagnosed hypertensive patients who presented at our clinic. All patients underwent a physical examination and the medical history was recorded. Patients with chronic hypertension, any known cardiac or valve disease, cancer, chronic kidney or liver disease, endocrinological disorders, alcohol or drug abuse, or rheumatological disorders were excluded from the study. RESULTS: Group 1 (non-dipper) comprised 50 patients and group 2 (dipper), 40 patients. The baseline characteristics of the study groups are summarized in Table I. In the laboratory analyses, group I had higher total-C, LDL-C, and TG values and lower HDL-C levels than group 2 (P<0.05 for all). Plasma fasting glucose was higher in group 1 than in group 2 (P<0.01). CONCLUSIONS: According to the results of this study, epicardial adipose tissue (EAT) thickness can be classified as an independent factor for the development of non-dipper hypertension. As a simple and inexpensive method, the role of EAT thickness should be kept in mind when physicians encounter a newly diagnosed hypertensive patient.
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    Serum interleukin-18 levels are associated with non-dipping pattern in newly diagnosed hypertensive patients
    (Lippincott Williams & Wilkins, 2021) Gunturk, Ertugrul Emre; Gunturk, Inayet; Topuz, Ayse Nur; Akkaya, Hasan; Topuz, Mustafa
    Background Interleukin-18 (IL-18), a pro-inflammatory cytokine, increases inflammation in the endothelium. Increased inflammation plays an important role in the development of hypertension (HT). IL-18 level is higher in hypertensives than normotensives. Objective To investigate the relationship between IL-18 level and diurnal blood pressure (BP) variations in newly diagnosed HT patients. Methods This prospective study included 130 subjects referred to outpatient cardiology clinic with an initial diagnosis of HT. The patients were classified as dipper HT (n = 40), non-dipper HT (n = 50), and normotensive (control, n = 40) according to 24-hour ambulatory BP monitoring. All subjects underwent blood sampling after 12 hours of fasting and transthoracic echocardiography. Results The serum IL-18 level was significantly higher in the patient group compared with the controls (195.17 +/- 93.00 mg/dl vs. 140.75 +/- 71.11 mg/dl, P < 0.01) and also in the non-dipper group than in the dipper group (217.3 +/- 96.90 mg/dl, 167.5 +/- 80.79 mg/dl, P = 0.011). IL-18 level was positively correlated both the night-time SBP and DBP levels (r = 0.29, P = 0.02 and r = 0.34, P < 0.01, respectively). On multivariate linear regression analysis, left atrium diameter, left ventricular mass index, and serum IL-18 level were independent predictors of non-dipping pattern in newly diagnosed HT patients. Conclusion Higher IL-18 level was particularly associated with an increase in the night-time BP levels. IL-18 can be used as a predictor for non-dipper HT in newly diagnosed HT patients.