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Introduction: An association between psychological factors and cardiovascular disease, has long been suspected. However, it is not clear whether chest pain is caused by emotional distress or whether coronary spasms are caused by the onset of coronary artery disease (CAD). We aimed to predict the risk for CAD in patients referred to myocardial perfusion imaging (MPI) with chest pain using depression, stress, and anxiety symptoms.Methods: The emotional status of all patients was evaluated using the Hospital Anxiety and Depression Scale (HADS-A and HADS-D), the State and Trait Anxiety Inventory (STAI-1 and STAI-2), the Perceived Stress Scale (PSS), and the Anxiety Sensitivity Index-3 (ASI). Myocardial perfusion was measured using a 17-segment model and 5-point scoring system (0: normal perfusion; 4: no perfusion). Results: MPI revealed reversible perfusion defects in 24 of 141 patients and no perfusion defects in 117 patients. The STAI-2 and HADS-A and HADS-D scores were significantly higher in patients with myocardial ischemia than in those without (STAI-2: 50.8 ± 7.5 vs. 46.3 ± 7.1, respectively; p = 0.008; HADS-A: 9.5 ± 3.9 vs. 7.8 ± 3.4, respectively; p = 0.033; HADS-D: 8.7 ± 3.0 vs. 7.3 ± 3.0, respectively; p = 0.05). Unadjusted correlation analysis showed that there was statistically significant correlation between reversible perfusion defects and anxiety scores (r=0.186, p= 0.029).Conclusion: The patients with symptoms of depression and high-trait anxiety may be at higher risk of myocardial ischemia than patients without such symptoms. Thus, the emotional status of patients should be taken into consideration during clinical evaluation for CAD.

Heart rate (HR) reduction with ivabradine improves left ventricle filling by the prolongation of the diastolic time and increases stroke volume. But, it remains unclear what ivabradine’s effect is on atrial conduction time and atrial mechanical functions. The aim of our study was to evaluate in stable outpatients with systolic heart failure (HF) the 3 months effect of ivabradine on atrial conduction time and mechanical functions. We evaluated prospectively 43 (31 males, 12 females) patients with HF. Before and after treatment, all patients were evaluated by transthoracic M mode, two dimensional (2D), pulsed-wave (PW), continuous wave (CW), color flow and tissue Doppler imaging (TDI), and LA volumes were obtained apical four-chamber views by a disc’s method. LA maximum volume (Vmax) at the end-systolic phase, LA minimum volume (Vmin) at the end-diastolic phase, and LA volume before atrial systole (Vp) were evaluated. The LA function parameters were calculated as follows: LA passive emptying volume = Vmax − Vp; LA passive emptying fraction = [(Vmax − Vp)/Vmax] × 100%, LA active emptying volume = Vp − Vmin; LA active emptying fraction = [(Vp − Vmin)/Vp] × 100%. Thirty men and 13 women with mean ± SD age of 63.9 ± 10.1 years were included in this study. Resting heart rate was significantly reduced after ivabradine treatment. There were no significantly difference in LVEF, and E/A before and after ivabradine treatment. LA diameter and Vmin were similar before and after ivabradine treatment (p = 0.793 and p = 0.284). However, Vmax and Vp were significantly decreased after ivabradine treatment (p = 0.040 and p = 0.012). Moreover, LA active emptying volume and LA active emptying fraction were significantly decreased after ivabradine treatment (p = 0.030 and p = 0.008). The PA lateral, septal, and tricuspid durations were significantly reduced after ivabradine treatment (p

Introduction: Carbon monoxide (CO), which is commonly referred to as the silent killer, can cause deleterious and unwanted cardiac effects. Some of these are arrhythmias, acute myocardial infarction (AMI), cardiogenic shock, heart failure, and pulmonary edema.Case Report: A 50-year-old man, complaining of dyspnea and chest pain, presented to the emergency room approximately half an hour after exposure to fire smoke. He had a history of anterior myocardial infarction 3 years previously and had been treated with a tacrolimus-eluting stent at that time. On admission, electrocardiography showed ST segment elevation in the leads D1, aVL, and V1–3, and ST segment depression in the reciprocal leads. The patient was transferred to the cardiac catheterization laboratory, and coronary angiography revealed stent thrombosis in the proximal part of the left anterior descending artery, causing 100% occlusion. The patient underwent successful balloon angioplasty and stenting. For the treatment of acute CO poisoning, he was administered oxygen. The patient’s condition continued to be stable, and he was discharged from the coronary intensive care unit.Conclusion: Patients who have undergone coronary stenting, particularly those in whom drug-eluting stents have been implanted, should be carefully investigated for AMI, stent thrombosis, or any other cardiac complications in the emergency room after CO poisoning

Our aim was to compare the effect of smoking on cardiac automaticity between pre- and postmenopausal women by using heart rate variability (HRV) parameters. Thirty three premenopausal (mean age; 32.4 ± 9.2 years) and 29 postmenopausal (mean age; 49.0 ± 6.1 years) smoker women were enrolled. Basic clinical, echocardiographic, Holter parameters and HRV values were compared between the two groups. The high frequency (HF) and low frequency (LF) power spectrum of HRV and HF/LF were significantly higher (p< 0.05) and standard deviation of the averages of NN intervals in all 5-min segments of the entire recording (SDANN) from the time-domain criteria was significantly lower (p< 0.05) in postmenopausal smokers. Linear logistic regression analysis revealed that smoking duration, oestrogen level and age were significant and independent factors for impaired HRV parameters in postmenopausal smoker women (OR=3.142; 95% CI = 2.78–6.89; p = 0.001; OR=2.394; 95% CI = 1.1–4.9; p = 0.03; OR=1.4; 95% CI = 1.03–2.03; p = 0.04, respectively). Smoking impairs cardiac autonomic function both in pre- and postmenopausal women, while the effect is more prominent in the latter group. Smoking together with aging and decrease in oestrogen levels might be related with a higher degree of cardiac autonomic alterations. Key words: Post-menopausal, women, smoking, cardiac automaticity, heart rate variability. DOI: 10.12973/ejms.2014.127p

Objectives: It has been shown that the neutrophil to lymphocyte ratio (N/L ratio) is associated with cardiovascular events and mortality. In this study, we investigated the N/L ratio in patients with coronary artery ectasia (CAE). Study design: Fifty patients diagnosed with CAE using coronary angiography were included in the study (29 male, 21 female; mean age, 51.1+-7.1 years). The control group consisted of 28 patients who had normal coronary arteries as determined by coronary angiography (16 male, 12 female; mean age, 49.5+-9.4 years). Basal characteristics were recorded. The number of ectatic segments was noted. Hematologic parameters were measured and the N/L ratio was calculated. Results: The N/L ratio was significantly higher in the CAE group compared with control group (median [25-75% percentile] 2.2 [1.6-3.0] vs. 1.8 [1.4-2.0], p=0.014, respectively). The Spearman correlation analysis demonstrated that the N/L ratio positively correlated with number of ectatic segments (r=0.35; p

WOS: 000321268700008, PubMed ID: 23625275, It is still unknown whether left ventricular ejection fraction (LVEF) might affect the magnitude of improvement after atrial fibrillation (AF) ablation on cardiac function in persistent or longstanding persistent AF (CAF) patients. We performed echocardiography in 35 patients with CAF before and after catheter ablation (CA). Patients were stratified by LVEF into two groups prior to CA-normal LVEF (a parts per thousand yen50 % LVEF, N group, n = 24) and a low LVEF group (< 50 % LVEF, L group, n = 11). Patients were followed at 1 month, 3 months, 6 months, 1 year, and 2 years after ablation. After 15.8 +/- 7.4 months follow-up, the L group showed greater improvement in LVEF and left atrial ejection fraction (LAEF; N group vs L group: LVEF difference (%), 5 +/- 8 vs 20 +/- 13, p < 0.01; LAEF difference (%), 11 +/- 12 vs 21 +/- 10, p < 0.05). LA maximal volume and E/e' showed the same tendency after ablation, although the extent of improvement was not statistically significant. Both groups showed almost the same time course of improvement up to 2 years, although the L group showed earlier recovery in LVEF. The greater improvement in several cardiac functions was seen in patients with greater LV dysfunction, after the CA for CAF.

Background Heart rate decrease after exercise, that is associated with reactivation of parasympathetic system, is important, as it is also associated with mortality. Previous studies have shown that this is an independent mortality predictor in patients having no coronary artery disease and having normal left ventricular function. In our study, we aimed to study heart rate recovery (HRR) after exercise in patients having impaired left ventricular function. Methods One hundred and two consecutive patients (68 males, 34 females) requested to perform an exercise stress test were included in our study. Patients were divided into two groups as those having a normal heart rate reserve (Group1, n = 72) and those having an abnormal heart rate reserve (Group2, n = 30). Results In Group1 and Group2, resting heart rate averages were found to be 83.61 ± 18.01/min and 85.10 ± 13.40/min, respectively (P > 0.05), and maximum heart rates during exercise were 141.42 ± 19.70/min and 121.17 ± 19.01/min while those in Group1 had statistically significantly higher heart rates (P < 0.001). A statistically significant positive association was found in the correlation test carried out between the maximum heart rate during the treadmill exercise test and ejection fraction (EF) value (r = 0.201; P < 0.05). Metabolic equivalents of task values obtained during the treadmill exercise test in Group1 and Group2 were 9.48 ± 2.28 and 8.36 ± 2.50, respectively, and the difference between the said values was statistically significant (P < 0.05). Conclusions We believe that the association between low EF and abnormal HRR is worth studying and randomized large-scale studies are needed to determine mortality risk.

Longed QT syndromes are cardiac repolarization disorders characterized by longed QT intervals on ECG. This electrophysiological abnormality may lead to syncope or sudden cardiac death due to rapid, polymorphic ventricular tachycardia (VT). Licorice root (Glycyrrhizin glabra root) contains Glycyrrhizin, sterols and many flavones. Glycyrrhizin may have effects on cardiac repolarization and depolarization through the autonomic nervous system. We present a case of polymorphic VT (torsades de pointes) secondary to drinking 5-6 glasses of licorice root tea for constipation for 2 days prior to admission to emergency department. Licorice root consumption should be taken into account in all patients admitted to the hospital for cardiac arrhythmia. It may cause cardiac arrhythmia when consumed regularly and in excessive amounts.

Objective: The aim of the present study was to investigate the pre-hospitalization prevalence of psychiatric disorders among patients who were admitted to coronary intensive care unit with a diagnosis of Acute Coronary Syndrome ACS . Method: This study included patients with ACS who were admitted to the coronary care unit of Abant İzzet Baysal University Hospital between January 2011 and April 2013. The files of the patients were searched for psychiatric diagnoses and psychotropic medication use retrospectively. Results: Four hundred sixty-seven eligible patients were screened. Of these, 373 were male and 94 were female with a mean age of 63.2 ± 15.4 years. Eighty-two patients 17.5% had a psychiatric diagnosis. In this group, psychiatric diagnoses were as follows: depressive disorder 42.2% , anxiety disorders 10.5% , anxiety disorders and depression 10.5% , somatoform disorders 10.2% , psychotic disorders 4.8% , and bipolar disorder 1.7% . Of the patients with a psychiatric diagnosis, 53 were female %64.6 and 29 were male %35.4 p, Amaç: Koroner yoğun bakım ünitesine Akut Koroner Sendrom AKS tanısı ile yatırılan hastalardaki yatış öncesi psikiyatrik hastalık sıklığını belirlenmesi amaçlandı. Yöntem: Bu çalışmada Ocak 2011- Nisan 2013 yılları arasında Abant İzzet Baysal Üniversitesi Hastanesine başvurup Koroner yoğun bakım ünitesine AKS tanısı ile yatırılan hastaların retrospektif olarak dosyalar ve bilgisayar ortamındaki hasta bilgileri taranarak bu grup hastalardaki psikiyatrik ilaç kullanımı ve bu hastalara konulan psikiyatrik tanılar saptandı. Bulgular: Bu tarihler arasında koroner yoğun bakıma yatış yapılmış toplam 467 hasta saptandı. Bu hastaların 373 tanesi erkek, 94 tanesi kadın olup, bu hastaların yaş ortalaması 63,2 ± 15.4 yıldı. Bu hastaların %17.5’ünde n=82 psikiyatrik hastalık tanısı mevcuttu. Bu hastaların % 42.2 depresyon, %30.6 anksiyete bozukluğu, %10.5’nin anksiyete bozukluğu+depresyon, %10.2’sindede somatoform bozukluk, %4.8’nin psikotik bozukluk ve %1.7’ninde bipolar bozukluk olduğu saptandı. Psikiyatrik hastalık tanısı alan hastaların %64.6’i kadın n=53 , %35.4’ü erkekti n=29 p

WOS:000311771900011 PubMed: 23042315 Background: Metabolic syndrome (MetS), which includes a cluster of risk factors, is being increasingly recognized as a new risk factor for cardiovascular disease. Heart rate turbulence (HRT) is a Holter-based non-invasive method for detecting cardiac autonomic imbalance and is an independent, powoful predictor of cardiac arrhythmias and sudden cardiac death in different patient groups. This study evaluated the effect of MetS on HRT in non-diabetic patients. Methods: This study included 80 non-diabetic MetS subjects and 50 healthy subjects. All 130 subjects underwent a 24-h ambulatory Holter electrocardiogram recording. Two indices of HRT were analyzed: turbulence onset (TO) and turbulence slope (TS). HRT values were classified into 3 categories for risk stratification: 1) Category 0, TO and TS were normal; 2) Category 1, either TO or TS was abnormal; 3) Category 2, both TO and TS were abnormal. Results: When we compared MetS rates in the HRT risk stratification groups, there were significant differences for all groups as compared with the controls (Category 0 = MetS 28.8%, n = 15, Control 71.2%, n = 37, p < 0.001; Category 1 = MetS 80.8%, n = 42, Control 19.2%, n = 10, p

Non-dipping blood pressure pattern was shown to be associated with increased cardiovascular events. In addition, cardiac autonomic dysfunction was found to be associated with non-dipper phenomenon. In this study, we aimed to evaluate the cardiac autonomic functions in dipper and non-dipper pre-hypertensive subjects. A total of 65 pre-hypertensive subjects were enrolled in this study. They were divided into two groups as non-dippers (40 subjects, 52% female) and dippers (25 subjects, 52.5% female). Cardiac autonomic functions of the two groups were compared with the aid of heart rate variability, heart rate turbulence (HRT), atrial premature contractions (APCs), ventricular premature contractions (VPCs), and mean heart rate (MHR). There was no significant difference between non-dippers and dippers in basal characteristics. The two parameters of HRT, turbulence onset and turbulence slope, were found to be significantly abnormal in non-dippers than in dippers (P < .011 and P < .002, respectively). Heart rate variability parameters, including SDNN, SDANN, RMSSD, and pNN50, were found to be similar in dipper and non-dipper pre-hypertensive subjects (P < .998, P < .453, P < .205, and P < .788, respectively). APCs, VPCs, and MHR were compared, and there were statistical differences between the groups (APCs 5.80 ± 4.55, 9.14 ± 7.33, P < .024; VPCs 8.48 ± 8.83, 13.23 ± 9.68, P < .044; and MHR 70.16 ± 11.08, 76.26 ± 11.31, P < .035; respectively). This study demonstrated a possible cardiac autonomic dysfunction in pre-hypertensive subjects with non-dipper pattern. This may be a basis for future studies related to pre-hypertension and non-dipping BP pattern.

Alcelik, Aytekin/0000-0002-3156-1076 WOS: 000307428200010 PubMed: 22641548 Background: The aim of this study was to investigate left atrial (LA) mechanical functions, atrial electromechanical delay and P wave dispersion in hypothyroid patients. Methods: Thirty-four patients with overt hypothyroid and thirty controls were included. A diagnosis of overt hypothyroid was reached with increased serum TSH and decreased free T4 (fT4) levels. LA volumes were measured using the biplane area length method and LA active and passive emptying volumes and fraction were calculated. Intra- and interatrial electromechanical delay (EMD) were measured by tissue Doppler imaging (TDI). P wave dispersion was calculated by 12 lead electrocardiograms. Results: LA diameter were significantly higher in patients with overt hypothyroid (p = 0.021). LA passive emptying volume and LA passive emptying fraction were significantly decreased with hypothyroid patients (p = 0.002 and p < 0.001). LA active emptying volume and LA active emptying fraction were significantly increased with hypothyroid patients (p < 0.001 and p < 0.001). Infra- and interatrial EMD, were measured significantly higher in hypothyroid patients (30.6 +/- 6.1 vs 18.0 +/- 2.7, p < 0.001; and 10.6 +/- 3.4 vs 6.9 +/- 1.4, p < 0.001, respectively). P wave dispersion were significantly higher in hypothyroid patients (48.8 +/- 6.2 vs 44.3 +/- 7.2, p = 0.022). In stepwise regression analysis demonstrated that, interatrial EMD and LA active emptying fraction related with TSH and fT4. Conclusions: This study showed that impaired LA mechanical and electromechanical function in hypothyroid patients. TSH and T4 were independent determinant of interatrial EMD and LA active emptying fraction. (Cardiol J 2012; 19, 3: 287-294)

Background: The relationship between γ-glutamyltransferase (GGT) and coronary artery disease (CAD) has been revealed in several previous studies. However, the relationship between the severity of CAD and GGT levels has not been previously studied in a premature group ( 0.05). γ-Glutamyltransferase levels in group 1 were found not to be correlated with the severity of premature CAD (r = –0.016, p = 0.828). Furthermore, in subgroup analyses we found glycated hemoglobin (HbA1c) levels significantly correlated with the severity of CAD in diabetic premature CAD patients, but not GGT (r = 0.448, p < 0.001; r = 0.157, p = 0.127, respectively). Conclusions: γ-Glutamyltransferase level was not associated with severity of CAD in the premature group. Possibly, there is no predictive importance of GGT in patients with premature CAD.

The cardiac electrophysiology study EPS is an invasive procedure which tests the electrical conduction system of the heart to assess the electrical activity and conduction pathways of the heart. The EPS is indicated to investigate the cause, location of origin, and best treatment for various abnormal heart rhythm. In this report, we present a review of current literature about the basic principles and clinical uses of the cardiac electrophysiologic study., Kardiyak Elektrofizyolojik çalışma EPS kalbin elektriksel ileti sisteminin inceleyen invaziv bir işlemdir. Kalbin elektriksel aktivitesi ve ileti yollarının değerlendirilmesinde kullanılır. EPS işlemiyle anormal kalp ritimlerinin tanısı, nedenleri, orijin aldığı lokalizasyon ve tedavi yöntemleri belirlenir. Bu derlememizde klinik kardiyak elektrofizyolojik çalışmanın temel esasları ve klinik kullanımlarından literatürler eşliğinde bahsedilecektir.

Ventricular mural aneurysms especially in the left ventricle represent an increased risk for life-threatening arrhythmias. We present a case of ventricular tachycardia originating from an inferobasal left ventricular aneurysm. A 25-year-old male patient presented with complaints of palpitation, breathlessness, and dizziness of two-hour onset. The electrocardiogram showed wide-QRS tachycardia at which time his blood pressure was 80/40 mmHg. The patient suddenly developed collapse and ventricular tachycardia was diagnosed on the monitor, and he returned to sinus rhythm following successful cardioversion. He remained stable during hospitalization. The electrocardiogram was in sinus rhythm with right bundle branch block and small Q waves in inferior leads. He had an eight-year history of surgery for ventricular septal defect closure, during which a ventricular aneurysm was detected but left untreated. Echocardiographic examination showed a dyskinetic aneurysmal region extending from the inferobasal segment to the posterior wall of the left ventricle. Coronary arteries were normal on angiography, and ventriculography confirmed the aneurysm. Electrophysiologic study was recommended, but the patient refused any treatment. He remained asymptomatic during 18 months of follow-up.

FUNDAMENTO: La levosimendana es un nuevo agente inotropico que aumenta la contractibilidad cardiaca sin aumentar la captacion celular de calcio, de forma de no causar sobrecarga de calcio y arritmias relacionadas. En pacientes con insuficiencia cardiaca (IC), la duracion prolongada del QRS esta asociada a un aumento en el riesgo de mortalidad y muerte subita cardiaca. Cambios estructurales en el ventriculo izquierdo pueden llevar a la contraccion asincrona, causando atraso de conduccion y un QRS prolongado en el ECG de superficie. OBJETIVO: EL objetivo del presente estudio fue comparar los efectos agudos de levosimendana y dobutamina en la duracion del QRS en pacientes con IC grave y ritmo sinusal. METODOS: 60 pacientes consecutivos con IC isquemica fueron incluidos en el estudio y randomizados en dos grupos para infusion de levosimendana (n=37) o dobutamina (n=23). 67,2 % eran hombres; la media de la edad era 66,4±9,2 para todos los pacientes. La duracion basal del QRS en los grupos levosimendana y dobutamina fue 120,44±23,82 vs. 116,59±13,80 respectivamente. La fraccion de eyeccion del ventriculo izquierdo (FEVI) estaba disminuida en ambos grupos (23,15±8,3 vs. 24,56±7,5). RESULTADOS: En el grupo levosimendana, la duracion del QRS disminuyo del valor basal para 116,47±24,56 ms (p=0,006), en cuanto no hubo diferencia significativa en el grupo dobutamina (p=0,605). Ambos medicamentos causaron un aumento en la FEVI, pero este fue significativo apenas en el grupo levosimendana (27,95±8,9 p=0,003 vs. 26,67±7,6, p=0,315). CONCLUSION: El estudio sugiere que la administracion de levosimendana, pero no de dobutamina, acorta la duracion del QRS en el ECG de superficie, posiblemente por causar una contraccion colectiva en las fibras del musculo del ventriculo izquierdo. La base molecular de ese efecto aun precisa ser aclarada.

WOS:000378141400009 PubMed: 27092194 Background: We sought to validate total atrial conduction time (TACT) measurement via tissue Doppler imaging (TDI) by comparing the electrophysiological study (EPS) measurements of healthy subjects, according to age and sex. Methods: Eighty patients with normal EPS results were included. TACT was measured by EPS and TDI. For validation, the results of TDI were compared with those of EPS. TACT was assessed by measuring the time interval between the beginning of the P-wave on the surface ECG, and the peak A-wave on TDI from the left atrial lateral wall, just over the mitral annulus. Electrophysiological TACT was defined as the time from the high right atrial electrogram to the distal coronary sinus atrial electrogram around the left lateral portion of the mitral ring. Results: EPS and TDI measurements of the TACT were significantly and positively correlated among men and women in 20-30 years (p=0.008, r=0.412; p > 0.001, r=0.706, respectively), and those in the 30-40 years group (p=0.001, r=0.649; p=0.001, r=0.696). In contrast, EPS and TDI measurements of TACT were not significantly different among men and women in the 20-30 years and those in the 30-40 years group (p > 0.05, for both). On univariate regression analyses, TACT was independently associated with age (beta=0.342, =0.001). Conclusions: When assessed according to the age and sex of healthy participants, TDI and EPS measurements during TACT assessments were similar and correlated with each other. The measurement of TACT via TDI may be used accurately and confidently than the measurement via EPS in healthy individuals. (C) 2015 Japanese Heart Rhythm Society. Published by Elsevier B.V.

WOS: 000251425300006, PubMed ID: 17952581, Background Levosimendan is a relatively new cardiac inotropic agent with calcium sensitizing activity. This study was conducted to investigate the effects of levosimendan (L) and dobutamine (D) on renal function in patients hospitalized with decompensated heart failure (HF). Method The present study included 88 consecutive patients hospitalized with acutely decompensated HF (New York Heart Association (NYHA) Class 3-4) requiring inotropic therapy. Patients were randomized 2:1 to either L or D for intravenous inotropic support. Diuretic therapy was kept constant during infusions. Renal function values, including serum creatinine (CR), blood urea nitrogen, 24-h urinary output levels and calculated glomerular filtration rate (GFR) were measured just prior to and 24 h after the infusions in all patients, and 48 and 72 h after the infusions in every second patient in both groups. The pre and post-infusion values of renal function and left ventricular ejection fraction (LVEF) were evaluated. Results LVEF increased significantly in both groups. Those in L showed a significant improvement in calculated GFR after 24 h, whereas those in D showed no significant change (median in change in L:+15.3%, median change in D: -1.33%). Furthermore, in the L group a significant improvement was observed in calculated GFR after 72 h compared to baseline levels, whereas in D no significant change (median change in L:+45.45%, median change in D: +0.09%) was seen. Both agents improved 24-h urinary output. Conclusion Levosimendan seems to provide beneficial effects in terms of improvement in renal function compared to dobutamine in patients with heart failure who require inotropic therapy.

WOS: 000251636700015, PubMed ID: 18029333, Myocardial performance index (MPI) has been regarded as an important parameter in the evaluation of ventricular systolic function in congestive heart failure. This study was designed to investigate the relationship between the ratio of isovolumic contraction time/left ventricular ejection time (IVCT/LVET), MPI, and LV systolic function. A total of 43 patients (patient group) with LV ejection fractions (LVEFs) = 55%. LVEF was measured in all cases by 2-dimensional echocardiography via the modified Simpson method. Isovolumic relaxation time (IVRT), IVCT, LVET, ratio of IVCT/LVET, and MPI ([IVRT+IVCT]/LVET) were measured via Doppler echocardiography. The mean value for lVCT was found to be significantly higher (P

Coronary artery anomalies occur in less than 1% of patients who undergo coronary angiography and they account for 1% to 2% of all cases of congenital heart disease. The most commonly encountered anomaly, the circumflex artery originating from the right coronary artery or the right sinus of Valsalva, is usually well tolerated. The patient in the case presented here was found to have a left anterior descending artery arising from the right sinus of Valsalva-a situation that is very rarely encountered. ©2007 Health Communications Inc.

WOS:000386539200004 PubMed: 27904509 Introduction: The aim of this study was to evaluate the relationship between masked hypertension and impaired sleep quality. Additionally, we evaluated the diagnostic role and prevalence of poor sleep quality among patients with newly diagnosed masked hypertension. Material and methods: A total of 112 individuals, 72 patients with newly diagnosed masked hypertension and 40 normotensive healthy volunteers, were included in this study. All patients underwent evaluation comprising 12-lead electrocardiography, transthoracic echocardiography, 24-hour Hotter ECG, and basic laboratory tests. Additionally, all participants completed questionnaires, including the Pittsburgh Sleep Quality Index (PSQI). Results: The total PSQI score was significantly higher in the masked hypertension group than in the normotensive healthy volunteers (4.13 +/-2.43 vs. 2.33 +/-1.67, p < 0.001). A PSQI score > 5 was found in 45.8% (n = 33) of patients in the masked hypertension group and 15% (n = 6) of patients in the normotensive group (p < 0.001). The non-dipper pattern was found in 17.5% of the healthy volunteer group and 59.94% (n = 41) of the masked hypertension group (p < 0.001). When we compared the dipping pattern of the masked hypertension groups, there was a significant difference in PSQI score between the dipper and non-dipper groups (4.87 +/-3.21 vs. 3.58 +/-2.33, p < 0.001). Multiple logistic regression analyses showed that masked hypertension, LV mass, and LV mass index score were independent predictors of poor PSQI. Conclusions: This study demonstrates impaired sleep quality in subjects with masked hypertension, particularly those with a non-dipper pattern. Additionally, this study indicates that impaired sleep quality may help diagnose masked hypertension, particularly in the non-dipper group.

Objective: Health care workers are at risk for infections caused by hepatitis B HBV , hepatitis C HCV and human immunodeficiency HIV viruses that transmit via blood and body fluids. In the present study, it was aimed to investigate the seroprevalences of HBsAg, anti-HCV and anti-HIV in patients who admitted in cardiology clinics and who underwent angiography. Method: HBsAg, anti-HCV and anti-HIV test results and demographical data of the patients who underwent angiography in cardiology clinics between May 2008-2011 were evaluated retrospectively. HBsAg, anti-HCV and anti-HIV tests were assayed with macro-ELISA method AxsymAbbott; Architect i2000-Abbott, USA . Statistical analysis was performed Chi-square test Results: Among 415 patients, 177 42.6% were female and 238 57.3% were male. The mean age was 61.5±5.4. HBsAg was positive in nine 2.2% patients; among these eight 2.0% were male and one 0.2% was female. Anti-HCV was positive in only one 0.2% female patient. No patients were positive for anti-HIV. No significant associations were found between sexuality and positivity rates of HBsAg and antiHCV. Conclusion: In the present study, it was observed that the seroprevalences of HBsAg, anti-HCV and anti-HIV were not higher than the population. Taking the safety precautions of the health care workers during surgical or invasive procedures such as angiography without any information about the serological test results of the patients will reduce the contamination of these agents., Amaç: Sağlık çalışanları kan ve vücut sıvılarıyla bulaşan hepatit B HBV , hepatit C HCV ve insan immun yetmezlik virüslerinin HIV neden olduğu infeksiyonlar açısından risk altındadırlar. Bu çalışmada kardiyoloji kliniğine başvuran ve anjiyografi uygulanan hastalarda HBsAg, anti-HCV ve antiHIV seroprevalansının araştırılması amaçlanmıştır. Yöntem: Kardiyoloji kliniğinde Mayıs 2008-2011 tarihleri arasında anjiyografi yapılan hastaların HBsAg, anti-HCV ve anti-HIV test sonuçları ile demografik verileri retrospektif olarak incelendi. HBsAg, anti-HCV ve anti-HIV testleri makroELISA yöntemiyle Axsym-Abbott; Architect i2000-Abbott, ABD çalışıldı. İstatistiksel değerlendirme Ki-kare testi ile yapılmıştır Bulgular: Toplam 415 hastanın 177 %42.6 ’si bayan, 238 %57.3 ’i erkek idi. Tüm hastaların yaş ortalaması 61.5±5.4 dir. Hastaların dokuzunda %2.2 HBsAg pozitif olup sekizi %2.0 erkek, biri %0.2 bayandı. Anti-HCV pozitifliği sadece bir %0.2 bayan hastada rastlandı. Anti-HIV pozitifliğine rastlanmadı. HBsAg ve anti-HCV pozitiflik oranları ile cinsiyet arasında anlamlı ilişki bulunamadı. Sonuç: Çalışmamızda HBsAg, anti-HCV ve anti-HIV seroprevalansının toplumdakinden yüksek olmadığı görülmektedir. Anjiyografi gibi girişimsel işlemler ve cerrahi müdahaleler sırasında tüm sağlık personelinin hastaların serolojik tetkiklerine bakılmaksızın virüs bulaşabilme ihtimalini düşünerek güvenlik önlemlerini alması bu etkenlerin bulaşmasını azaltacaktır

Ibn Sina (980-1037) was born in the village of Afshana, near Bukhara. Ibn Sina received his early education in his town and by the age of 10 he became a Quran Hafiz. He had exceptional intellectual skills. In some of his teenage years he lived in Anatolia. At the age of sixteen he dedicated all his efforts to learn medicine and when he was eighteen, he gained the status of a reputed physician. His synthesis of Islamic medicine, al Qanun reputed physician fi’l tibb (The Canon of Medicine), was the final authority on medical problems in the world for several centuries. His most significant medical works are the Qanun (Canon) and a thesis on cardiac drugs”. The Canon of Medicine (Qanun: Law of Medicine) is one of the most famous books in the history of medicine. This book is a five volume medical encyclopedia that was completed in 1025. The eleventh section of the third book primarily deals with different kinds of heart diseases, their effects, and treatment. It should be remembered that the Canon of Avicenna was written in early 11th century and it should be reviewed in the light of the state of knowledge concerning heart diseases and their treatment attained at that time. Researchers today have the advantage of highly advanced instruments which were not available to Ibn Sina 1000 years ago. That he wrote this section of the Canon in such detail and compiled a separate thesis on heart drugs are enough to prove that he had a clear understanding of the fatal character of heart diseases. He was a really scientific genius and medical practitioner. About 1000 years ago, he created many medical hypotheses and tried to discover unknown things related with humanity. Especially anatolian muslim researchers have to follow this way if they want to be succeeded or add some fantastic discoveries on science.

Mechanical alternans, an ominous sign of terminal systolic heart failure, could be indirectly shown by Doppler analysis. On the other hand, Levosimendan, a novel agent, improves contractility in patients with HF. We searched the effect of L versus dobutamin onto Doppler alternans in patients with systolic HF. We found that Levosimendan improves beta-to-beat alteration in patients with systolic HF, demonstrated by pulsed Doppler compared to dobutamin. © 2007 Elsevier Ireland Ltd. All rights reserved., Yilmaz, M.B.; Cumhuriyet University Faculty of Medicine, Department of Cardiology, Sivas, Turkey; email: cardioceptor@gmail.com

Background/Aims: Abnormalities in atrial electromechanical delay (EMD) times and mechanical functions are considered as independent predictors of atrial fibrillation. However, to date, effects of a single hemodialysis (HD) session and acute volume-preload changes on atrial-EMD functions have not been investigated by Tissue Doppler Echocardiography (TDE). The aim of the present study was to evaluate atrial-EMD times and mechanical functions in HD patients. Methods: Thirty-five non-diabetic, normotensive HD patients and 35 healthy control subjects were enrolled in the study. Standard and TDE performed before mid-week dialysis session for hemodialysis group and on admission for control group. Results: Interatrial and left-right intraatrial-EMD intervals and left atrial mechanical volumes were significantly longer in hemodialysis group compared to controls (all pp were independent predictors of interatrial-EMD. Conclusions: The present study confirms negative effects in HD patients of structural remodeling and reveals negative effects of electrical remodeling. Prolonged inter and intraatrial-EMD intervals should be the underlying pathophysiological factors of increased rate of atrial fibrillation in the HD population.

WOS: 000326838600006, PubMed ID: 24107209, Introduction: Crimean-Congo hemorrhagic fever (CCHF) is a zoonotic viral disease with a high mortality rate. In clinical practice, we observed bradycardia in some pediatric patients with CCHF during the clinical course. So we aimed to report CCHF cases that presented bradycardia during the clinical course and the relation of bradycardia with the clinical findings and ribavirin therapy. Methods: Charts of all hospitalized pediatric CCHF patients were reviewed with respect to age, sex, history of tick bite or history of removing a tick, other risk factors for CCHF transmission, and interval between the tick bite and the onset of symptoms. Outcomes and clinical and laboratory findings and medications were recorded for each patient. We searched the patient records for information regarding the existence of bradycardia. Bradycardia was accepted as the heart rate 2 standard deviations (SD) lower than the suspected heart rate based on age. Results: Fifty-two patients (mean age 11.24.4 years, 31 female) were enrolled into the study. Bradycardia was seen in seven patients. Six patients with bradycardia were male and only one was female, and the mean age was 13.1 +/- 1.6 years. It was observed that male gender is frequent among patients with bradycardia, as compared with those without bradycardia (p=0.01). Bleeding was found to be more frequent in patients with bradycardia (p=0.02). There were significant differences between the bradycardia and nonbradycardia groups with regard to the requirements for fresh frozen plasma transfusion, the number of platelet suspension given, requirement for intravenous immune globulin (IVIG) and in the days of stay in hospital (p=0.01, p=0.03, p=0.03, p=0.04, respectively). Conclusion: Reversible bradycardia might be seen in the clinical course of pediatric CCHF patients, and the clinicians must be aware of this finding. The possibility that ribavirin may potentiate bradycardia cannot be assessed without a placebo-control study. So further studies may help to reveal the cause of the bradycardia, the disease itself, or the ribavirin therapy. Hence this study supports the need for a randomized, placebo-controlled study to assess intravenous ribavirin in treating CCHF and to support approval of the drug.

WOS:000335444500040 PubMed: 26060489 Background: The diagnosis of palpitation can be difficult in the emergency department (ED) and the waiting time for a first appointment with an arrhythmia clinic can be very long. The inflammation is sufficient to facilitate the initiation of supraventricular tachyarrhythmia (SVT). The increased mean platelet volume (MPV) is closely correlated with inflammation and to reflect inflammatory burden in different condition. Objective: In this study, we aimed to investigate the relation between MPV and SVT in patient with documented atrial tachyarrhythmia in ED. Methods: Two study groups were compared; a SVT group with arrive at the ED with documented SVT (n=122) and 100 healthy adult without any palpitation symptom, arrhythmic disease, and with normal physical examination results that were brought for checkups to the cardiology polyclinic were classified as control group. Blood samples were obtained from all patients for determining the hematologic counts and MPV during first hour in ED period. Results: In terms of the focus of the study, hemoglobin, neutrophil count, mean cell volume (MCV), red cell distribution width (RDW), platelet, white blood cell (WBC), and lymphocyte counts were similar in both group (p>0.05). MPV in the SVT group was significantly higher than in the control group (9.12 +/- 1.22 fl vs 8.64 +/- 0.89 fl, p

TO THE EDITORS: With great interest, we read the recent article by Desai et al 1 regarding the effect of maternal metformin treatment on fetal inflammation in a rat model of obesity and metabolic syndrome (MetS). The authors very clearly discussed the relation between metformin treatment and inflammation. They concluded that diet-induced obesity/ MetS during pregnancy significantly enhanced fetal and placental cytokine production. Maternal metformin reduced fetal cytokine levels, in addition; metformin treatment of a placental cell line suppressed tumor necrosis factor alphae induced interleukin-6 levels by nuclear factor kappa B inhibitor. In addition to their fluent discussion, we aimed to emphasize the possible other effective mechanism of metformin treatment on MetS and obesity: the contribution of autonomic nervous system function. MetS is a combination of metabolic abnormalities, such as abdominal obesity, dyslipidemia, hypertension, and impaired glucosemetabolism,whichisassociatedwithinsulinresistance. Recently, we found that autonomic nervous system function is also impaired in this disease group. Previously, Erdem et al 2 showed that the relationship between MetS and impaired autonomic nervous system function is detected by different methods,inMetSpatientswithoutcoronaryarterydiseasesand diabetes mellitus (DM). 2 Together with this, MetS-related impairment in autonomic nervous system function is thought to play a central role in the risk of cardiovascular death. Metformin is an insulin sensitizer that has been shown to reduce insulin resistance and hyperglycemia with DM and to reduce progression of impaired glucose tolerance to DM in those without DM. 3 Interestingly, Manzella et al 4 showed

The aim of our study was to investigate the effect of zinc supplemented diet on the cigarette smoke-induced changes on toll-like receptor (TLR), nuclear factor of kappa light polypeptide gene enhancer in B-cells (NFKB) and cytokine gene expression in renal tissue of rats. A total of 24 Wistar albino rats were allocated into four groups as group A: Non-smoke controls (n:6), group B: Non-smoke+zinc (n:6), group C: Smoke (n:6), and group D; smoke+zinc (n:6). RNA isolation was performed from the renal tissues of the rats which were sacrificed at the end of the 12th week. The expression levels of TLR2, TLR4, NFKB1, NFKB2 and interleukin 1 alpha (IL1A), interleukin 10 (IL10) genes were evaluated using the Reverse Transcription Polymerase Chain Reaction (RT-PCR). In addition, these tissues were examined histopathologically and the direct protective effect of zinc on these tissues was investigated. No significant difference was found between the groups in terms of TLR2 and TLR4, NFKB1 and NFKB2, IL1 and IL10 gene expression levels. As a result of the histopathological assessment, a statistically significant difference was detected between Group A, C and D in terms of hemorrhage, congestion, inflammation, glomerular atrophy and tubular injury (p

Objectives: To compare the quality of life and anxiety levels of patients with normal and abnormal results detected during an electrophysiological study (EPS) that was performed due to undocumented palpitations. Study design: Patients (n=128) who underwent EPS without documented arrhythmia of unexplained palpitations were included in the study. The quality of life and anxiety levels of patients with abnormal EPS results were compared with those with normal results by using the 26-item short form of the World Health Organization quality of life scale and statetrait anxiety inventory. Results: SVT was found in 72 patients by diagnostic EPS. Quality of life scores were significantly poorer in the SVT group than of the normal EPS group (p=0.000-0.001). Likewise, the anxiety scores of the patients in the SVT group were higher than normal in the EPS group (p=0.000). Age, physical quality of life, psychological quality of life, state anxiety and trait anxiety were found to be independent predictors of SVT in multivariate regression analysis. Conclusion: The level of anxiety was found to be higher and quality of life was found to be lower in patients with palpitations due to SVT. In clinical practice it should be kept in mind that noticed psychiatric symptoms may be secondary to an underlying arrhythmia in the evaluation of patients with palpitations.

In Wolff-Parkinson-White Syndrome (WPW), presence of accessory conduits causes various signs and clinical conditions in patients. WPW syndrome is presently defined as a congenital defect involving the occurrence of abnormal conductive tissue between the atria and the ventricles in relation to supraventricular tachycardia (SVT). SVT is observed in this group of patients. WPW syndrome at high rates can be mixed with SVT. Calcium channel blockers (diltiazem, verapamil) that are one of the most preferred medicines for rate control in patients with SVT may lead to fatal risks in individuals with WPW syndrome. In our presentation, we studied, in parallel to the literature, the case of a patient who presents the WPW syndrome but who is followed as a SVT without performing the electrophysiological tests in parallel to the literature. J. Exp. Clin. Med., 2013; 30:357-359

Objectives: It is well known that inflammation plays a key role in both initiation and propagation of acute coronary syndrome (ACS). White blood cell (WBC) and its subtypes are an indicator of inflammation in patients with ACS. We aimed to evaluate the WBC and its subtypes in patients aged

OBJECTIVE: This prospective study investigated the diagnostic significance of the N-terminal pro-brain natriuretic (NT-proBNP) and troponin I peptides in emergency department patients presenting with palpitations. METHODS: Two groups of patients with palpitations but without documented supraventricular tachycardia were compared: a group with supraventricular tachycardia (n = 49) and a control group (n = 47). Both groups were diagnosed using electrophysiological studies during the study period. Blood samples were obtained from all of the patients to determine the NT-proBNP and troponin I levels within the first hour following arrival in the emergency department. RESULT: The mean NT-proBNP levels were 207.74±197.11 in supraventricular tachyarrhythmia group and 39.99±32.83 pg/mL in control group (p0.001). The mean troponin I levels were 0.17±0.56 and 0.01±0.06 pg/mL for the patients with and without supraventricular tachycardia, respectively (p

Amaç: Metabolik sendrom ve non -dipper kan basıncı paterni kardiyovasküler hastalıklarla ilişkilidir. Bu klinik durumların ortak patofizyolojik mekanizmalarıyla ilişkili olabilir. Metab olik sendrom ile non -dipper kan basıncı arasındaki ilişkiyi araştırmayı amaçladık. Yöntem: 24 saatlik ambulatuar kan basıncı takibi yapılan yeni tanı almış 118 obez metabolik sendromlu hasta çalışmamıza dahil edildi. Bunlar dipper (n = 46) ve non -dipper (n = 72) olmak üzere iki gruba ayrıldı. Gece non -dipper kan basıncı, gece ortalama sistolik ve/veya diastolic kan basıncı azalması %10 dan daha az azalma oluşu olarak tanımlandı. Bulgular: Ça lışma gurubumuzun ortalama 24 saatlik kan basıncı ortalaması 146/96 mmHg idi. İki grubun temel karakteristik özellikleri benzer olmasına rağmen, non -dipper tansiyon paterni olan grupta metabolik sendrom sıklığı a nlamlı derecede daha fazla idi (p=0.038). Sonuç: Bu çalışmada non -dipper kan basıncı paterni olan hastalarda metabolik sendromun daha fazla bulunduğu saptandı . Bu durum, obez hastalarda metabolik sendrom ile non-dipper kan basıncının ortak bir patofizyolojik mekanizma içerdiğini belirtebilir., Background: Metabolic syndrome and non -dipping blood pressure pattern are related with cardiovascular disease. It is considered that there may be common pathophysiological mechanisms of these clinical entities. We aimed to investigate the association between metabolic syndrome and nondipping blood pressure pattern. Method: 118 consecutive newly diagnosed metabolic syndrome patients with obesity who underwent 24 -hour ambulatory blood pressure monitoring were included in the study. They were divided into dipper (n = 46) and non -dipper (n = 72) groups. Nocturnal non -dipping blood pressure pattern is defined as the lower than 10 % reduction in nocturnal mean systolic and/or diastolic blood pressure. Results: In the whole population, mean 24 -hour ambulatory blood pressure was 146/96 mmHg. Although, the two groups was similar in terms of basic characteristics; the frequency of metabolic syndrome was significantly greater in patients with non -dipping pattern (p=0.038). Conclusion: In this study metabolic syndrome was fou nd to be more prevalent among patients with non -dipping pattern of hypertension. This may indicate a common pathophysi ologic mechanism of metabolic syndrome and non -dipping blood pressure pattern in obese patient.

The present study examined the heart rate turbulence (HRT) and heart rate variability (HRV) parameters in healthy young smokers (

WOS:000317361900009 PubMed: 23086804 Objective: Platelets play an important role in both initiation and propagation of acute coronary syndromes. We sought to evaluate the predictive value of mean platelet volume (MPV) in young patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS). Methods: This is a retrospective observational study; evaluating the MPV values of 79 NSTE-ACS patients aged under 45 years and 45 control subjects having normal coronary anatomy. NSTE-ACS group was composed of 41 non-ST elevation myocardial infarction (NSTEMI) and 38 unstable angina pectoris (USAP) patients. MPV was measured using an automated hematologic analyzer called Coulter counter. The predictive value of MPV was evaluated using logistic regression analysis and comparison of MPV between NSTE-ACS and control groups was performed by Mann-Whitney U test. Results: The MPV was found to be significantly higher in the NSTE-ACS compared with control group (8.49 +/- 1.22 versus 7.78 +/- 0.65 fL, p=0.001). In logistic regression analysis, MPV was found to be an independent predictor of NSTE-ACS (OR=3.1, 95% CI 1.2-8.2, p=0.022). The MPV values of NSTEMI group were not significantly different from USAP group (8.78 +/- 1.38 versus 8.17 +/- 0.95 fL, p=0.66). Similarly, the MPV values of the 3 groups (Control, USAP and NSTEMI) were found to be significantly different (7.78 +/- 0.65, 8.18 +/- 0.95, 8.78 +/- 1.38 fL respectively, p=0.001). Conclusion: In conclusion, MPV was found to be elevated in NSTE-ACS patients compared with control subjects in young population. In addition, increased MPV was established to be an independent predictor of NSTE-ACS. (Anadolu Kardiyol Derg 2013; 13: 57-61) Amaç: Trombositler akut koroner sendromların oluşumu ve ilerlemesinde önemli bir rol oynamaktadır. Bu çalışmada ST yükselmesi olmayan akut koroner sendromlu (NSTE-AKS) genç hastalarda ortalama trombosit hacminin öngördürücü değerini araştırmayı amaçladık. Yöntemler: Bu, 45 yaş altındaki 79 NSTE-AKS hastasının ve normal koroner anatomiye sahip 45 kontrol bireyinin MPV değerlerini karşılaştıran geriye dönük gözlemsel bir çalışmadır. NSTE-AKS grubunu 41 ST yükselmesi olmayan miyokart enfarktüsü (NSTEMI) ve 38 kararsız angina pektoris (USAP) hastası oluşturmuştur. MPV, Coulter Sayaç adı verilen otomatik bir hematolojik tahlil cihazı kullanılarak ölçülmüştür. MPV’nin prediktif değeri lojistik regresyon analizi kullanılarak ve NSTE-AKS ve kontrol grupları arasında MPV karşılaştırılması Mann-Whitney U testi ile değerlendirilmiştir. Bulgular: NSTE-AKS grubundaki MPV değerleri kontrol grubuna göre anlamlı olarak yüksek bulundu (8.49±1.22’a karşılık 7.78±0.65 fL, p=0.001). Lojistik regresyon analizinde, MPV’nin NSTE-AKS’nin bağımsız bir belirleyicisi olduğu bulunmuştur (OR=3.1, %95 CI 1.2-8.2, p=0.022). NSTEMI grubunda MPV değerleri USAP grubundan anlamlı olarak farklı değildi (8.78±1.38 versus 8.17±0.95 fL, p=0.66). Benzer şekilde, 3 grubun (Kontrol, USAP ve NSTEMI) MPV değerleri arasında anlamlı derecede farklılık olduğu tespit edilmiştir (7.78±0.65, 8.18±0.95, 8.78±1.38 fL respectively, p=0.001). Sonuç: Sonuç olarak, kontrol grubu ile karşılaştırıldığında genç NSTE-AKS hastalarında MPV değerleri daha yüksek bulunmuştur. Aynı zamanda artmış MPV, NSTE-AKS’ın bağımsız bir belirleyicisi olarak bulunmuştur.

Objective: The aim of our study was to investigate total atrial conduction time and left atrial (LA) mechanical function in patients with isolated coronary artery ectasia (ICAE). Methods: Sixty patients with ICAE without any visible coronary stenosis were enrolled to this cross-sectional observational study. The control group consisted of 40 age- and gender-matched patients. Left atrial mechanical functions were measured by the method of discs in the apicalfour chamber echocardiographic view. LA mechanical function parameters were calculated. P wave dispersion was measured on electrocardiography (ECG). The total atrial conduction time (PA-tissue Doppler imaging (TDI) duration) was assessed by measuring the time interval between the beginning of the P wave on the surface ECG and point of the peak A wave on TDI from LA lateral wall just over the mitral annulus. Student t, Mann-Whitney U, Pearson’s, and Spearman’s correlation analysis and multiple regression analysis were used for statistical analysis. Results: The clinical and laboratory characteristics were similar in two groups. Both groups were similar in terms of Vmax and LA total emptying volume (29.0±7.3 vs. 31.9±6.5 mL/m2, p=0.082 and 19.9±5.1 vs. 20.0±5.2 mL/m2, p=0.821). However, LA passive emptying volume and LA passive emptying fraction were significantly decreased with ICAE patients (11.1±3.2 vs. 13.5±3.8 ml/m 2 , p=0.005 and 35.2±7.2 vs. 47.8±9.4 mL/m 2 , p

Postoperative atrial fibrillation (POAF) complicating coronary artery bypass grafting surgery (CABG) increases morbidity and stroke risk. Total atrial conduction time (PA-TDI duration) has been identified as an independent predictor of new-onset atrial fibrillation (AF). We aimed to assess whether PA-TDI duration is a predictor of AF after CABG. In 128 patients who had undergone CABG, preoperative clinical and echocardiographic data were compared between patients with and without POAF. The PA-TDI duration was assessed by measuring the time interval between the beginning of the P wave on the surface ECG and point of the peak A wave on TDI from left atrium (LA) lateral wall just over the mitral annulus. Patients with POAF (38/128, 29.6 %) were older (68.1 ± 11.1 vs. 59.3 ± 10.2 years; p

Alcelik, Aytekin/0000-0002-3156-1076 WOS: 000309036000007 PubMed: 22825898 Background: The heart was very sensitive to fluctuating thyroid hormone levels. To assess intra-left ventricular (LV) systolic asynchrony in patients with subclinical thyroid dysfunction. Methods: Fifty patients with subclinical hypothyroidism and 40 controls were included. A diagnosis of subclinical hypothyroidism was reached with increased TSH and normal free T4. All subjects were evaluated by echocardiography. Evaluation of intra-LV systolic asynchrony was performed by tissue synchronization imaging (TSI), and four TSI parameters of systolic asynchrony were calculated. LV asynchrony was defined by these parameters. Results: All of the groups were similar in terms of demographic findings and conventional and Doppler echocardiograpic parameters except peak systolic velocity and early diastolic velocity. LV systolic asynchrony parameters of TSI including; standard deviation of Ts of the 12 LV segments (Ts-SD-12), maximal difference in Ts between any 2 of the 12 LV segments (Ts-12), standard deviation of TS of the 6 basal LV segments (Ts-SD-6), maximal difference in Ts between any of the 6 basal LV segments (Ts-6) were significantly lengthened in patients with subclinical hypothyroidism than controls (p < 0.001, p < 0.001, p < 0.001 and p < 0.001, respectively). The prevalence of LV asynchrony was significantly higher in patients with subclinical hypothyroidism than control. Conclusions: Patients with subclinical hypothyroidism present evidence of LV asynchrony by TSI. LV systolic asynchrony could be a warning sign of the early stage in cardiac systolic dysfunction in subclinical hypothyroid patients. (Cardiol J 2012; 19, 4: 374-380)

Prolonging atrial conduction time, as measured by tissue Doppler imaging (TDI), is an independent predictor of new onset or recurrent atrial fibrillation (AF). We investigated atrial conduction time and cardiac mechanical function in patients with impaired fasting glucose (IFG) using echocardiography.Thirty patients with IFG (19 males and 11 females; age, 46.9 ± 9.5 years) and 30 control subjects (18 males and 12 females; age, 46.7 ± 8.2 years) were included. Atrial conduction time was determined from the lateral mitral annulus (PA lateral), septal mitral annulus (PA septal), and lateral tricuspid annulus (PA tricuspid) by TDI. Inter- and intra-atrial electromechanical delays (EMDs) were calculated. Left atrial (LA) volumes were determined according to the biplane area-length method. LA mechanical function parameters were calculated.LA passive emptying volume and LA passive emptying fraction decreased significantly in patients with IFG as compared with control subjects (p 0.001 and p 0.001, respectively). PA lateral and PA septal durations were significantly higher in patients with IFG than in the control group. However, no difference in PA tricuspid duration was observed between the two groups. Inter- and intra-atrial EMDs were significantly higher in patients with IFG as compared with the control subjects (median [interquartile range], 34.0 [17.0] vs. 17.0 [4.0], p 0.001 and 15.0 [8.5] vs. 7.5 [2.0], p 0.001, respectively). Positive correlations were detected between both inter- and intra-atrial EMD and glucose levels (r = 0.76, p 0.001 and r = 0.68, p 0.001, respectively). Additionally, a multiple linear regression analysis revealed that glucose levels were independently associated with inter-atrial EMD (β = 0.753, p 0.001).We showed that IFG was associated with inter- and intra-atrial EMD. Our findings suggest that IFG is an etiological factor for the development of AF.

The aim of this study was to investigate the frequency of mitral valve prolapse (MVP) in patients with supraventricular tachycardia (SVT) who were diagnosed by intracardiac electrophysiological study (EPS).The study was a retrospective cohort of 378 adult patients (128 males and 250 females, 17 to 63 years) admitted with EPS. We included 267 SVT patients (58.4 % (n = 156) atria-ventricular nodal reentrant tachycardia (AVNRT), 30 % (n = 80) atria-ventricular reentrant tachycardia (AVRT), 6.4 % (n = 17) atrial tachycardia (AT), and 5.2 % (n = 14) other). MVP prevalence was compared in individuals with SVT.MVP prevalence was found 27.7 % (n = 74) in patients with SVT. In subgroup analyses, there was a significant difference between AVRT and others about MVP prevalence (AVRT 52.7 % n = 39, AVNRT 33.8 % n = 25, AT 9.5 % n = 7, and others 4.1 % n = 3; p 0.005). Also, there was a significant difference between females and males (75.7 % (n = 56); 24.3 % (n = 18); p 0.05). There was a significant negative correlation between age and MVP just in female group (r = -0.116, p = 0.024).It was demonstrated in our study that AVRT and female sex may be related to MVP in SVT patients. It was dedicated from these results that the existence of arrhythmia should be focused on young female subjects with MVP more than the others.

WOS: 000298576700010, PubMed ID: 22088859, Objective: The difference of the conduction velocity (CV) around the tricuspid valve annulus between the counter-clockwise (CCW) atrial flutter and the clockwise (CW) atrial flutter has not been well clarified. This study was undertaken to evaluate the CV and the conducting area (CA) per millisecond around the tricuspid valve annulus using the electroanatomical mapping. Methods: The electroanatomical mapping was performed during the tachycardia for 30 consecutive patients (mean age: 61 16 years) with isthmus-dependent atrial flutter (CCW, 25; CW, 5). We measured the CV and the CA of five divided areas of the right atrium, that is, upper septum (US), lower septum (LS), isthmus (I), upper lateral wall (UL) and lower lateral wall (LL) using the novel measurement method in the isochronal map. Statistical differences of these data between the two groups were assessed by the Student's t-test and one-way analysis of variance methods. Results: In total, the CV of the LS was significantly slower than other areas (m/sec: US, 0.57 +/- 0.18; LS, 0.43 +/- 0.18; UL, 0.60 +/- 0.26; LL, 0.53 +/- 0.20; I, 0.50 +/- 0.17; p

WOS: 000266176800016, PubMed ID: 18980852, Objective: Crimean-Congo hemorrhagic fever (CCHF) is an acute viral hemorrhagic fever with a high mortality rate. Despite increasing knowledge about viral hemorrhagic fevers, the pathogenesis of CCHF and causes of death have not been well described. In this study, we aimed to evaluate the cardiac functions of CCHF patients. Methods: This prospective study was performed among confirmed CCHF cases in Turkey in 2007. All the patients underwent a thorough cardiologic evaluation and transthoracic echocardiography examination within 24 hours of hospitalization. In addition, the patients were classified into two groups - 'severe' CCHF and 'non-severe' CCHF. Demographic characteristics, findings of echocardiography, and outcomes were recorded for each patient. Results: Among 52 consecutive patients with a tentative diagnosis of CCHF, 44 were confirmed as having CCHF. Seventeen (38.6%) patients were classified as severe, whereas the remaining 27 (61.4%) patients were classified as non-severe. Five of 17 severe CCHF patients died. Severe cases had a tower left ventricular ejection fraction (p = 0.04), a higher systolic pulmonary artery pressure (p = 0.02), and more frequent pericardial effusion (p < 0.001) compared to non-severe cases. Fatal CCHF cases also had a lower left ventricular ejection fraction (p = 0.03), a higher systolic pulmonary artery pressure (p = 0.03), and more frequent pericardial effusion (p = 0.01) compared to survivors. Conclusions: The results of this study indicate that severe and fatal CCHF cases have impaired cardiac functions, which may be associated with fatality in CCHF infection. Direct invasion of the heart muscles by the virus or endothelial damage of cardiac structures may have a rote in this. Molecular testing methods would be useful in order to investigate direct invasion by the CCHF virus. Clinicians should be aware of this complication. (C) 2008 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

WOS: 000259554600004, PubMed ID: 18758699, Introduction: Sleep is an innate and essential part of human life. Various aspects of sleep are negatively affected by beta-blockers. We compared the impact of two beta-blockers, metoprolol succinate (extended release) and nebivolol, on sleep quality in patients with stage 1 hypertension. Methods: This was a prospective, randomized, open-label, parallel-group study. Eligible patients were administered the Pittsburgh Sleep Quality Index (PSQI) questionnaire by a blinded interviewer and were randomized to receive metoprolol (starting dose 25 mg) or nebivolol (starting dose 2.5 mg) once daily for 6 weeks. The first dose was administered before patients left the clinic. Visits were scheduled for 1, 2, 4, and 6 weeks after the initiation of therapy. At the end of the study, patients were readministered the PSQI questionnaire by the same interviewer, as before blinded to treatment allocation. Results: A total of 22 patients in the nebivolol group and 17 patients in the metoprolol group completed the study and were included in the data analysis (mean age of patients, 40.7 years). At study entry, systolic blood pressure (BP), diastolic BP, and PSQI scores were similar in the two groups. Over 6 weeks of treatment, systolic and diastolic BP normalized in both groups. Global PSQI score improved significantly in patients in the nebivolol group, whereas it worsened in the metoprolol group. The difference in effect of two beta-blockers was statistically significant (P < 0.001). Conclusion: Nebivolol was associated with improved sleep (as assessed by the PSQI), whereas metoprolol was associated with a worsening of sleep characteristics., Ibrahim Etem Ulagay-Menarini Group, Istanbul, Turkey; Menarini International, Florence, Italy, We would like to thank Ibrahim Etem Ulagay-Menarini Group, Istanbul, Turkey and Menarini International, Florence, Italy for their sponsorship.

WOS: 000262697000003, PubMed ID: 19165563, Severe heart failure represents a major source of morbidity and mortality. Poor right ventricular function is an independent prognostic marker for mortality in patients with chronic heart failure. In this study, levosimendan (L) and dobutamine (D) in patients with severe chronic biventricular failure were compared. Forty consecutive patients, who were judged for inotropic therapy by their primary physicians, with acutely decompensated systolic heart failure and having moderate-to-severe right ventricular dysfunction with right ventricular fractional area change of a parts per thousand currency sign24%m were randomized to L and D in a 2:1 fashion. Echocardiographic parameters including tricuspid annular motion and clinical issues were considered. Mean age and sex distribution were not different between the two groups. After the infusion, ejection fraction improved and systolic pulmonary artery pressure decreased significantly in both arms. Longitudinal systolic function of tricuspid annulus improved significantly better in patients with L compared to patients with D (15% +/- 12% vs. 2% +/- 6% improvement, P < 0.001). Furthermore, L improved both 24-h urine output and creatinine, whereas D showed only a small, but significant improvement in urine output without any improvement in the creatinine levels. Levosimendan seems to offer more beneficial effects compared to dobutamine in a specific group of patients with biventricular failure.

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WOS: 000262080200016, PubMed ID: 19157176, A 58-year-old male patient was admitted to the emergency service with dyspnoea. The patient underwent several laboratory and imaging tests including echocardiography and a diagnosis of descending aortic aneurysm was suspected. After computerised tomography scanning, a normal-size descending aorta was found so that echocardiography was done once more. Intravenous contrast examination revealed a giant coronary sinus in this patient.

The American Journal of Cardiology MARCH 26e29, 2015 11 IN AND C Acute procedural success rate ( 3 PV isolation) was 97.2 % with radiofrequency technique (82.2% paroxysmal AF, 18.8% persistan AF). Major complications were observed in one of patients which treated with radiofrequency technique (cardiac perforation). PVI with radiofrequency, mean procedural and fluoroscopy times were 124.2 25.2 (110-210) min and 15.3 6.3 (14-23) min. Additionally, 4 of patients which treated with radiofrequency technique mitral isthmus and roof ablation line were performed together with PVI. At the time of followup, 93.28% of patients were free from AF recurrence. Conclusion: The efficacy and safety of radiofrequency and cryoballoon AF ablation technique was shown due to the acceptable success and low complication rates in either paroxysmal or permanent AF patients. A number of the complications early in the experience of PVI isolation have been addressed, especially with radiofrequency PVI, but further experience is required to increase the efficacy and safety of these techniques.