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    Effects of cigarette smoking on heart rate variability and plasma N-terminal pro-B-type natriuretic peptide in healthy subjects
    (Wiley, 2008) Alyan, Omer; Kacmaz, Fehmi; Ozdemir, Ozcan; Maden, Orhan; Topaloglu, Serkan; Ozbakir, Cemal; Metin, Fatma
    Background: Cigarette smoking increased the risk of acute cardiac events related with endothelial dysfunction and increased sympathetic activity. Impaired autonomic nervous activity is recognized as a considerable symptom of cardiac dysfunction and is strongly associated with increased risk overall mortality. Methods: A total of 75 healthy habitual smokers (40 female, 35 male, mean age 36.5 +/- 8.5 years), and 73 non-smokers subjects (45 female, 28 male, mean age 34.6 +/- 7.2 years) were studied. LF and LF/HF ratio were significantly higher in smokers than in non-smokers. On the contrary, SDNN, SDANN, RMSSD, and HF values were lower in smokers compared to those in non-smokers. Not the duration of smoking but the number of cigarettes smoked per day was correlated with the HRV parameters and NT-pro BNP. Furthermore, the average levels of NT-pro BNP were found to be positively correlated with LF, LF/HF and inversely correlated with SDNN, SDANN, RMSSD and HF. Results: As a result, smoking impaires sympathovagal balance and decreases the heart rate variability in healthy subjects. And even a one cigarette smoking leads to overt sympathetic excitation. Furthermore, smoking results in an increase in NT-proBNP levels and the changes in adrenergic nervous system and NT-proBNP levels are well correlated. Conclusion: These findings could contribute to the higher rate of cardiovascular events in smokers.
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    Sympathetic overactivity in patients with pulmonary stenosis and improvement after percutaneous balloon valvuloplasty
    (Wiley, 2008) Alyan, Omer; Ozdemir, Ozcan; Kacmaz, Fehmi; Topaloglu, Serkan; Ozbakir, Cemal; Gozu, Ayfer; Korkmaz, Sule
    Objective: Percutaneous balloon valvulotomy (PBV) is the procedure of choice for the treatment of valvular pulmonary stenosis (PS) with similar results comparable to surgical valvotomy but less invasive. . Methods and Results: Twenty-seven consecutive patients with PS being evaluated for PBV were enrolled in the study. Peak instantaneous transvalvular gradient, right ventricle (RV) diameter, mean atrial pressures, RV systolic pressure (RVSP), pro-brain natriuretic peptide (proBNP) levels significantly decreased immediately after PBV. Regarding heart rate variability (HRV) parameters, mean HR (heart rate), LF (low frequency) day and night, LF/HF day and night significantly decreased and standard deviation of all NN intervals (SDNN), root mean square of successive differences (RMSSD), P number of NN intervals that differed by more than 50 ms from adjacent interval divided by the total number of all NN intervals (PNN50), HF (High frequency) day and night significantly increased 1 day after PBV and these changes were shown to be preserved at the first month. The increase in SDNN was correlated with the decrease in right atrial pressure (RAP) (r = -0.5, P = 0.04); the increase in standard deviation of the 5-minute mean RR intervals (SDANN) was correlated with the decrease in proBNP (r = -0.4, P = 0.03). Conclusions: Sympathetic overactivity and increased proBNP levels were associated with the symptomatic status of patients with PS. Associated with a decrease in atrial pressures and proBNP levels, PBV yielded a decrease in adrenergic overactivity in the patients with PS.