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Anomalous coronary artery (ACA) has either an unusual origin or different anatomical course and is associated with sudden cardiac death. The absence or nonspecific symptoms of ACA make its diagnosis difficult. Mostly, ACA is diagnosed coincidentally during invasive coronary angiogram (ICA). A conventional computed tomography (CT) cannot provide detailed images of coronary arteries of the moving heart, but 64-slice CT, with its short acquisition time, can provide detailed anatomy of coronary arteries non-invasively. In this study, we assessed the validity of contrast-enhanced 64-slice CT in the evaluation of ACA. ICA was performed in 7,574 patients for the diagnosis or evaluation of occlusive coronary artery disease and detected coronary anomalies in 56 patients (0.7%). We then performed 64-slice CT in 53 patients out of the 56 patients with demonstrated or suspected coronary anomaly, showing the origin and the course of the ACA along with stenosis, except for one patient who could not be evaluated due to image distortion artifacts. Contrast-enhanced 64-slice CT was also performed in 374 patients with vague signs and symptoms, detecting coronary anomalies in 7 patients (1.2%). Thus, in the total of 59 patients undergone 64-slice CT, we were able to visualize the entire abnormal coronary tree with a high diagnostic image quality. This is the first study to demonstrate the utility of 64-slice CT in a large series of ACA. Contrast-enhanced 64-slice CT is superior to ICA to identify the presence and course of ACA and should be the first line diagnostic tool in the evaluation of ACA.

Left ventricular hypertrophy (LVH) is a significant risk factor for cardiovascular complications in hemodialysis (HD) patients. Hypervolemia has been accepted as an independent risk factor for progressive LVH in HD patients. Additionally, high FGF23 levels have been a significant predictor of cardiovascular mortality and morbidity in chronic kidney disease and HD patients. The aim of our study is to investigate the correlation among LVH, interdialytic volume increase and FGF-23 in the patients on a chronic hemodialysis program.A total of 97 chronic hemodialysis patients (64.43 ± 11.28 years old, M/F:47/50) were included in the study. Human FGF-23 ELISA kit was used for FGF-23 analysis of predialysis blood samples. Echocardiographic evaluation was performed in all of the patients after dialysis. Left Ventricular Mass Index (LVMI) was calculated by using the Devereux Formula. We collected the following data: LVMI, FGF-23 levels, interdialytic fluid gain, blood pressure changes, and the other biochemical and clinical parameters.Mean LVMI of the patients was 184.41 ± 48.62 g/m(2). LVMI of the patients with daily urine output250 mL was found significantly lower. Statistically significant positive correlation was found between predialysis systolic blood pressure, predialysis diastolic blood pressure, predialysis mean arterial blood pressure and LVMI measurements (p0.01). Mean interdialytic volume excess was correlated with LVMI measurements of the patients (r = 0.459; p0.01). Increased FGF-23 levels (159.79 ± 134.99 ng/L) predicted increased LVMI measurements of the patients (r = 0.322; p0.01). In addition, FGF-23 levels were also increased as the interdialytic fluid volume increased (r = 0.326; p0.05). A positive correlation was also found between FGF-23 levels and interventricular septum thickness (r = 0.238; p0.05). Predialysis mean arterial blood pressure, predialysis volume overload and presence of diabetes were determined to be independent risk factors on LVMI on multivariate regression analysis.Our study showed that interdialytic volume overload increased both LVMI and FGF-23 values. We can consider that interdialytic volume control exerts positive effects on increased FGF-23 levels which predict the negative cardiovascular outcomes.

Aim: We aimed to present a case with ventricular myocardial noncom- paction involving both ventricles. Methods and results: Noncompaction of ventricle is a rare and unclassified congen- ital cardiac malformation is due to an arrest in intrauterine endomyocardial mor- phogenesis. We presented a ventricular myocardial noncompaction case involving both left and right ventricles. The physical examination of this case is consistent with mitral regurgitation and the echocardiographic findings are consistent with noncompaction of ventricular myocardium involving both ventricles with left ven- tricular systolic failure. Conclusion: Transthoracic echocardiography is a useful clinical tool for diagnosing noncompaction of both the right and left ventricular myocardium. The LVNC defini- tion can also be utilized for RVNC, which this diagnosis has never been reported in a Turkish patient. a 2005 Published by Elsevier Ltd on behalf of The European Society of Cardiology.

Objective: To report a case of comorbidity of constrictive pericarditis and hemophilia A. Clinical Presentation and Intervention: A 21-year-old male with hemophilia A was referred to our clinic and was examined with the subsequent evaluation of shortness of breath, leg edema and ascites. Clinical and laboratory examinations were performed. The results were consistent with constrictive pericarditis (CP), and the symptoms were completely relieved following institution of medical therapy. Conclusion: Because hemophilia A and pericarditis may be coincidentally present clinical conditions, avoidance of surgical procedures in hemophilic patients is preferable unless the resolution of the symptoms of pericarditis cannot be effected by medical therapy.

Background: Thorax impedance cardiography (TIC) can provide important information about the hemodynamic state of patients. In this study, we aimed at finding out if TIC can be used in the early follow-up of acute right ventricular myocardial infarction (RVMI). Methods: The study consisted of patients with RVMI who were admitted to our coronary care unit between March 1998 and October 1999. The patients were divided into two groups: group A: patients with hemodynamically significant RVMI, and group B: patients with hemodynamically insignificant RVMI. All impedance measurements were performed with the commercially available device BoMed NCCOM3. We measured stroke volume index, cardiac index and ejection fraction by TIC. The measurements were done on the day of admittance (day O), first day and second day continuously, and on the third to fifth day during bed rest. Comparisons of TIC measurements and vital signs were made by Friedman analysis. Group A and group B were compared by Mann Whitney U test and chi square. The level of statistical significance was set at P < 0.05. Results: There were 26 patients in group A (mean age: 62 ± 10) and 14 patients in group B (mean age: 61 ± 12). There were no statistically significant differences between the groups in age and sex. There were statistically significant differences between group A and B with regard to stroke volume index (32 ± 5 vs 28 ± 5; P = 0.0147), total peripheral resistance (19 ± 5 vs 23 ± 5; P = 0.0084); ejection fraction (0.44 ± 0.16 vs 0.58 ± 0.08; P = 0.0131). The vital signs with statistically significant differences were systolic arterial blood pressure (110 ± 17 vs 88 ± 7, P < 0.0001); diastolic arterial blood pressure (72 ± 12 vs 55 ± 13; P = 0.0002) and heart rate (89 ± 12 vs 71 ± 11; P < 0.0001). The differences disappeared on the second day. The lack of significance continued on the fifth day. Friedman analysis revealed that all the TIC parameters except for left ventricular ejection fraction change towards the normal range. Ejection fraction did not change in group B but decreased in group A on the second day; however it was stable later. Conclusion: TIC can provide easily obtained parameters which may have a role in the treatment of hemodynamically significant RVMI. This is particularly important in coronary care centers with limited invasive capabilities. A.N.E. 2000;5(4):330–335

Amaç: Sağ ventrikül (SV) fonksiyonu birçok kardiyopulmoner hastalıklarda klinik sonlanım olarak önemli rol oynar. Pulmoner emboli (PE) ve ciddi pulmoner darlık (PD) SV basınç yüklenmesi ile seyreden iki ayrı hastalıktır. SV’ nin artmış basınç yüklenmesine karşı verdiği uyum mekanizmaları iyi bilinmesine karşın hala bazı tanımlanmamış boşluklar devam etmektedir. SV basınç yüklenmesinin elektrokardiyografik (EKG) olarak nasıl bir deği- şiklik yaptığı pek bilinmemektedir. Çalışmamızdaki amaç akut ve kronik basınç yüklenmesini EKG olarak ayrımının yapılabileceğini araştırmaktır. Yöntemler: Bu retrospektif gözlemsel çalışmamıza 20 PD ve 38 PE tanısı kesinleşmiş hasta dahil edildi. SV yüklenmesini gösterdiği daha önceki çalışmalarda kabul edilmiş EKG kriterleri her iki grupta araştırıldı. Logistic regression analysis was used to define the predictors of chronic RV overload. Bulgular: Bakılan EKG değişikliklerinden, prematür atriyal atım (OR-12.2, %95 CI, 1.3-107, p0.008), sağ aks deviasyonu (OR-20.4, %95 CI 4.2-98, p0.001), indetermine aks (OR-0.11, %95 CI 0.02-0.44, p0.001), inkomplet sağ dal bloğu (OR-4.2, %95 CI, 1.1-15.4, p0.02), aVR de geç R dalgası (OR-8.3, %95 CI 1.2-74.8, OR-8.4, %95 CI 2.1-33.2 p0.001), V1’ de qR dalgası (OR-8.3, %95 CI 1.2-74.8 p0.02) SV kronik basınç yüklenmesini gös- teren bağımsız prediktörlerdir. Sonuç: PE için kabul edilen EKG kriterleri PD grubunda daha sık saptandı. Daha da ötesi istatiksel olarak anlamı bulunan EKG kriterlerin basınç yüklenmesinin zamanlaması hakkında sınırlı tanısal değeri olduğu saptandı. Objective: Pulmonary embolism (PE) and severe pulmonary stenosis (PS) are two distinct conditions accompanied by increased pressure load of the right ventricle (RV). Despite major advances in our understanding of the mechanisms of RV adaptation to the increased pressure, substantial gaps in our knowledge remain unsettled. One of much less known aspect of pressure overload of RV is its impact on electrocardiographic (ECG) changes. In this study, we aimed to study whether acute and chronic RV overload are accompanied by different ECG patterns. Methods: Thirty-eight patients with PE underwent ECG monitoring were compared with 20 matched patients with PS in this observational retrospective study. ECG abnormalities suggestive of RV overload were recorded and analyzed in both groups. Logistic regression analysis was used to define the predictors of chronic RV overload. Results: Among the ECG changes studied, premature atrial contraction (OR-12.2, 95% CI, 1.3-107, p0.008), right axis deviation (OR-20.4, 95% CI 4.2-98, p

Aim We aimed to report the clinical features related to torsades de pointes (TdP) in patients with complete AV block (CAVB). Methods Patients with CAVB who were admitted to our instituition between January 2007 and January 2010 were retrospectively evaluated in terms of the occurence of TdP. The clinical features were compared in patients with and without TdP using the software of SPSS. Results Sixty-four patients were determined to have CAVB. Three of them had documented episodes of TdP. All three patients experiencing TdP were females, whereas 48% of the patients with CAVB were females. The mean age of patients with TdP was significantly greater than the mean age of the other patients (85 ±3 vs. 78±7.6, respectively; p

Anemia of chronic disease is the second most encountered anemia following iron deficiency in patients who develop acute or chronic immune activation. Pulmonary tuberculosis is an infectious disease which results in an inflammatory response frequently causing anemia. We investigated whether prohepcidin can be used successfully to disclose the cause of anemia and to monitor the result of the therapy in patients with pulmonary tuberculosis.The study was performed in 40 male patients and 15 healthy controls that had a diagnosis of tuberculosis with a positive sputum smear and did not receive any previous treatment. They were treated for 6 months.The study revealed a significant elevation of prohepcidin in patients with tuberculosis in comparison to those of healthy control subjects. Additionally, prohepcidin levels significantly decreased after treatment in the patient group but remained high in comparison to control group.We conclude that prohepcidin is high in pulmonary tuberculosis and might be a marker for monitoring the response to treatment.

Metabolic syndrome (MetS) is associated with increased risk for cardiovascular events. We evaluated heart dimensions in hypertensive patients with MetS.The study included 75 hypertensive patients (34 males, 41 females; mean age 51+/-9 years) without coronary artery disease. Patients were evaluated in two groups depending on the presence or absence of MetS. Age- and gender-matched 20 healthy subjects (9 males, 11 females; mean age 50+/-5 years) comprised the control group. The diagnosis of MetS was based on the presence of at least three of five MetS criteria. Hypertension was defined as arterial blood pressure exceeding 140/85 mmHg on three consecutive measurements or the use of antihypertensive drugs. Echocardiographic measurements included interventricular septal thickness, left ventricular internal diameter, posterior wall thickness, aortic diameter, left atrial diameter, relative wall thickness, and left ventricular mass.Metabolic syndrome was present in 32 hypertensive patients (42.7%; 18 males, 14 females). The mean number of MetS criteria was 2.6+/-1.0 in the hypertensive group. Compared to the control group, patients with or without MetS exhibited significantly increased interventricular septum and posterior wall thickness, left atrial diameter, relative wall thickness, and left ventricular mass (p0.05). The only significant difference between the two patient groups was that MetS was associated with a greater left atrial diameter (p=0.019). Left atrial diameter was correlated with the number of MetS criteria (r=0.51; p0.001).Left ventricular dimensions are not influenced by MetS. Rather than MetS, hypertension is primarily responsible for changes in left ventricular dimensions. However, left atrial enlargement is more prominent in patients with MetS, suggesting that each MetS criterion contributes to left ventricular diastolic dysfunction.

We have read the article by Schoen et al. entitled ‘Nomograms for severity of aortic valve using peak aortic valve pressure gradient and left ventricular ejection fraction’.1 The authors have developed a nomogram to quantify the aortic valve area. As the authors have notified, the nomogram has a number of advantages: (a) The errors in measuring the left ventricular outflow tract diameter is eliminated; (b) the systolic function of the left ventricle is taken into consideration; (c) it eliminates the need for the complex computation process of continuity equation. …