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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.

WOS: 000269807700004, PubMed ID: 19654563, Aim The aim of this study was to evaluate the myocardial viability in nondiabetic patients with chronic coronary artery disease (CCAD) or past myocardial infarction (MI), using thallium-201 infusion myocardial perfusion single-photon emission computed tomography (MPSPECT) imaging after oral glucose application (Glu + Tl-201-infusion). Materials and methods In this study, 33 nondiabetic patients (three female, 30 male, mean age: 55.24 +/- 11 years, range: 33-77 years) with MI history or known CCAD were included. Rest/redistribution/24 h-late-MPSPECT imaging was performed for all patients. In all patients in whom fixed perfusion defect was observed on any wall of the left ventriculi, after 24 h-late-MPSPECT imaging, 75g oral glucose was given. Thirty minutes later, 1 mCi thallium-201 in 100 ml of physiological saline solution was applied in a period of 20 min by slow infusion. After infusion at the 10th minute, MPSPECT imaging was performed. Perfusion was evaluated visually for a total of 3432 segments with the 26-segment 5-point scoring technique. Scoring measured perfusion as 0=no perfusion defect, 1=mildly reduced, 2=moderately reduced, 3=severely reduced, and 4=absent uptake. Scores '0 and 1' were considered normal and scores '2-4' were considered abnormal. Results For serum insulin levels measured after glucose application, a significant increase was determined, according to the period before glucose application (P= 90% narrowing. In rest images, in segments with segmental scores of 3 and 4, when the total reversibility ratio was evaluated, this ratio was calculated to be 0.7% for redistribution images and 4.5% for 24 h-late-M PSPECT. The highest total reversibility ratio in these segments was detected with Glu + Tl-201-infusion images to be 10.3%. When we evaluated the patients with respect to the MI history time, the highest segmental perfusion improvement was detected in patients with 0-3 months of MI history. Conclusion We conclude that in nondiabetic patients who are known to have CCAD or past MI history, Glu + (TI)-T-201-infusion is an easily applicable method that gives better results for the evaluation of myocardial viability. Nucl Med Commun 30:779-788 (C) 2009 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.

WOS: 000272359300008, PubMed ID: 19669399, Atrial fibrillation (AF) is the most frequently encountered chronic arrhythmia associated with significant morbidity. It is generally encountered in the elderly, and will presumably become more prevalent in the future due to the increasing proportion of the elderly in the population. Major studies on AF have demonstrated no significant difference between rhythm and rate control in terms of mortality. However, young population with new-onset or lone AF, or patients in whom the maintenance of sinus rhythm is a must (due to recurrent thromboembolic events etc.) still gives rise to significant concerns related to the obligatory long-term prophylaxis. The long-term administration of the currently available conventional agents (amiodarone, dofetilide, sotalol, propafenone,flecainide etc.) is considered as a 'double edged sword' due to the presence of life-threatening adverse effects including pro-arrhythmia and organ toxicity associated with these agents. Several molecules are being developed for the management of AF. However, only a few novel agents confer promising results with respect to safety and efficacy issues in the major studies. Dronedarone is an amiodarone analogue without iodine moiety in its structure, and is similar to amiodarone with regard to its structural and electrophysiological properties. Dronedarone is largely denuded of the potentially life-threatening adverse effects of anti-arrhythmics. Major clinical studies have demonstrated both rhythm and rate-controlling efficacy of dronedarone compared to placebo without any serious adverse effects in patients with AF. However, the ANDROMEDA trial, a large scale study including patients hospitalized for symptomatic congestive heart failure (with severely depressed left ventricular systolic functions) was prematurely terminated due to the increased mortality in the dronedarone arm compared to placebo indicating a lack of safety in this group of patients. Conversely, the recently published ATHENA study (including more than 4,600 high risk patients, but excluding those with severe heart failure) demonstrated a significant reduction in cardiovascular hospitalizations and cardiovascular mortality with dronedarone compared to placebo. In contrast, the DIONYSOS study, comparing dronedarone with amiodarone, demonstrated better safety, but lower efficacy of dronedarone for the maintenance of sinus rhythm in patients with AF. Further clinical trials (including head to head comparison with other conventional anti-arrhythmics) are still required to determine the place of dronedarone in the management of AF. The present review focuses on basic and clinical aspects of dronedarone, a novel agent for the management of AF.

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: 000250983000007, PubMed ID: 17182136, Background: Herbal products have been widely used by many patients with cardiovascular problems solely expecting benefit out of them. Since, it is important to consider patients' needs and believes to prevent breaking off the relationship of patients and physicians, we conducted a survey on patients admitted to our outpatient Cardiology department. Methods: A questionnaire was prepared including 49 questions. After giving informed consent, 310 participants were enrolled into our survey. Participants were asked about disease states, use of herbal products and their tendencies. Results: There were 169 male ( mean age: 54.7 +/- 13.3 years) and 141 female participants ( mean age: 56.2 +/- 14.7 years). 54.5% ( n= 169) had hypertension ( HT), 48.7% ( n= 151) had coronary artery disease ( CAD). Among all participants, 38.7% ( n= 120) stated that they have used herbals in part of their lives. Presence of dyslipidemia was associated with herbal use. Three fourths of herbal users ( 73.3%, n= 88) stated that they thought they benefited some extent from the use of herbals, and 25% ( n= 30) of herbal users stated that they did not take their medicine regularly. Herbal users more frequently agreed the statement " herbals are beneficial when added to medicine" compared to nonusers ( 20.8% vs. 15.8%, p

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

QT interval dispersion reflects regional variations in ventricular repolarization and cardiac electrical instability. Previous studies have showed that QT interval dispersion changes during episodes of myocardial ischemia. Slow coronary flow (SCF) in epicardial coronary arteries is a rare and unique angiographic finding. Whether this pattern of flow is associated with electrocardiographic abnormalities is unknown. Therefore, this study was designed to investigate whether SCF results in electrocardiographic (ECG) changes compared to normal coronary flow. For this aim 24 patients with angiographically proven SCF who had no obstructive coronary lesion (group I) and 25 patients without coronary artery disease (group II) were included in the study. Both groups underwent a routine standard 12-lead surface electrocardiogram recorded at 50 mm/s during rest. QT dispersion (QTd), corrected QT (QTc), and corrected QT dispersion (QTcd) were calculated. Distributions of sex, age, body mass index (BMI), and cardiac risk factors were similar in the 2 groups. Mean heart rate was similar in the 2 groups (74 ±8 vs 77 ± 7 p > 0.05). Mean QRS interval durations were similar in the groups (92 ±7 vs 90 ±6 ms p > 0.005). In group I, QTd, QTcd, and QTc, were significantly higher than in group II (QTd: 73 ±14 vs 40 ±14; QTcd: 71 ±15 vs 42 ±9; QTc: 414 ±14 vs 388 ±13, respectively 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: 000244518100023, PubMed ID: 17276973, Myocyte necrosis has been considered to play a fundamental role in the pathophysiology of congestive heart failure (CHF), which has usually evolved as a consequence of depletion of compensatory mechanisms and contractile reserve of myocardium. Elevated levels of creatine kinase MB (CK-MB) and troponin I (Tn-I) have been regarded as biochemical markers of myocyte necrosis. This study was planned to investigate the specificity and sensitivity of Tn-I and CK-MB in CHF and to examine the correlation of these markers with disease severity. A total of 104 patients (38 female, 66 male; mean age, 66 y [range, 36-89]) with symptoms and signs of heart failure on admission and with a reduced left ventricular ejection fraction (EF; by transthoracic echocardiography) were labeled "the patient group," and 58 patients (40 female, 18 male; mean age, 61 y [range, 34-77]) with no signs or symptoms of CHF and with a normal EF detected by transthoracic echocardiography were included in the study as "the control group." Left ventricular EFs, end-diastolic diameters, and end-systolic diameters of patients in both groups were measured. Blood samples were drawn from all patients in both groups on admission, so that levels of CK-MB and Tn-I could be measured. All patients in both groups also underwent coronary angiography. Conditions leading to elevation of CK-MB or Tn-I were considered exclusion criteria. The 2 groups failed to show any significant differences in terms of mean age and the presence of coronary artery disease, hypertension, or diabetes mellitus (P >.05). Mean EF in the patient group was lower than that in the control group (P .05). The mean EF in group 2 was significantly lower than that in group I and in the control group (P .05), but group 2 had significantly higher mean values of CK-MB and Tn-I than were noted in the control group (P

WOS: 000234323900007, PubMed ID: 16374140, Background Coronary artery bypass grafting has been performed for a long period utilizing saphenous vein grafts, the fate of which might be crucial to prognosis following the operation. Metabolic syndrome, on the other hand, has become an increasingly important part of cardiovascular practice. We examined whether there was any negative effect of metabolic syndrome on saphenous vein graft patency in a relatively short term (

WOS: 000233222200004, PubMed ID: 16255750, Objective: We investigated whether mobile telephones affect the function of implantable cardioverter defibrillators (ICDs). Background: It is well known that electromagnetic fields can affect medical devices. Methods: The study included 43 patients with ventricular tachycardia and/or fibrillation treated with transvenous pectoral ICDs. Testing was done under continuous electrocardiograph monitoring under supervision of an ICD programmer. Initially, each patient was tested during spontaneous rhythm. Then the ICD was programmed to a pace rhythm higher than the patient's heart rate, and the tests were repeated at paced rhythm. In 7 patients, tests were performed during the implantation procedure as well. In 3 of the patients, only a single defibrillation zone was active. The other 40 patients had one or more active ventricular tachycardia zones. Two mobile phones (both GSM 900 MHz) were positioned 50 cm away from the implanted device in opposite directions and switched on. Communication was established between these phones, two investigators had a 20-second conversation, and then the phones were switched off. The same procedure was repeated at 30, 20, and 10 cm away from the implantation site, respectively. Finally, the procedure was performed-with the antennae of both phones touching the device pocket. In the above-mentioned 7 cases where testing was done during implantation of the ICD, a call was made from one phone to the other, ringing occurred for 5 seconds, and then two investigators conversed while the device was implanted. Results: There was no change in the function of the ICDs during any of the phone testing procedures. In 5 cases, artifacts were noted on the surface lectrocardiographic (ECG) screen of the programmer during the tests, but no such changes were observed on the simultaneous intracardiac ECGs. Conclusion: The results of the study suggest that mobile phones have no effects on ICD function.

Slow coronary flow (SCF) in a normal-appearing coronary angiogram is a well-recognized clinical entity, but its etiopathogenesis remains unclear. The aim of the study was to evaluate echocardiographic features in patients with SCF. Thirty-four patients with angiographically proven SCF (group I) and 25 patients with normal coronary flow (group II) were enrolled in the study. The diagnosis of SCF was made with use of the “TIMI frame count (TFC)” method. All patients underwent complete transthoracic echocardiographic examination (M-mode, 2-dimensional [2-D], and Doppler parameters such as color, continuous, pulsed wave). There were no significant differences with respect to systolic parameters between the 2 groups; in spite of these, group I showed impaired left ventricular diastolic patterns compared to group II. Group I patients had higher peak late diastolic filling velocities due to enhanced atrial systole (A), lower peak (E/A) diastolic filling velocity ratios, and longer isovolumetric relaxation times compared with group II, and these were statistically significant (p

The Thrombolysis in Myocardial Infarction (TIMI) frame count is a simple clinical tool for assessing quantitative indexes of coronary blood flow. This measurement has been significantly correlated with flow velocity measured with a flow-wire by several investigators during baseline conditions or hyperemia. In this study we aimed to evaluate the coronary flow in patients with isolated coronary artery ectasia by means of the TIMI frame count and to compare the results with those of patients with angiographically normal coronary arteries. The study population consisted of 37 patients with coronary artery ectasia only in the right coronary artery (RCA). The control group consisted of 31 patients with angiographically proven normal coronary arteries. Coronary artery ectasia was defined as nonobstructive lesions of the coronary arteries with a luminal dilatation 1.5-fold or more of the adjacent normal coronary segments. The TIMI frame count was determined for each major coronary artery in each patient according to the methods first described by Gibson et al. The TIMI frame count of RCA in the study group was significantly higher than in that of the control group (51 +/- 17 vs 25 +/- 8, P < 0.0001). The TIMI frame counts of the study group for the left anterior descending and left circumflex coronary artery were also significantly higher than those of the control group (corrected TIMI frame count for LAD = 42 +/- 11 vs 24 +/- 7, P < 0.001; TIMI frame count for LCx = 44 +/- 15 vs 25 +/- 9, P < 0.001). In patients with coronary artery ectasia, the TIMI frame count of the RCA was higher than that of the left anterior descending and left circumflex coronary artery (51 +/- 17 vs 42 +/- 11 and 44 +/- 15, respectively, P < 0.05). We have shown increased TIMI frame counts in patients with isolated coronary artery ectasia and suggest that the pathophysiological mechanism of coronary artery ectasia is not a focal disease. TIMI frame counts can be regarded as an index of the severity of impaired coronary flow in patients with coronary artery ectasia.

Aortic valve calcification (AVC) is correlated with atherosclerotic risk factors; however, its significance remains largely unknown. The aim of this study was to investigate whether AVC detected by transthoracic echocardiography can be a useful marker for the identification of significant coronary artery disease (CAD), particularly in elderly patients. The study included 432 consecutive patients with suspected CAD who were admitted for the first time for coronary angiography. Two-dimensional transthoracic echocardiography and selective coronary angiography were performed in all patients. Aortic valve calcification was defined as bright dense echoes of > 1 mm on one or more cusps and decreased mobility of the involved cusp. Aortic valve calcification was detected in 64 of the 337 patients with significant CAD, but only in 9 of 95 cases with normal or mildly stenotic coronary arteries (19% vs 9%, p < 0.001). The severity of coronary artery disease (defined as the number of obstructed vessels) was not related to the presence of AVC (p > 0.05). Stepwise multiple logistic regression analysis of the study patients revealed only age (p = 0.003, odds ratio = 1.56) and AVC (p < 0.001, odds ratio = 2.03) as independent predictors of CAD. When the study population was divided into two groups as those below (n = 338) and above (n = 94) 75 years old, AVC failed to be a predictor of CAD in those > 75 years old (p > 0.05, odds ratio = 0.8) while it remained the most significant predictor of CAD (p < 0.001, odds ratio = 2.19 in patients aged < 75 years. In conclusion, detection of AVC by transthoracic echocardiography may be a useful noninvasive marker for identification of significant CAD in patients younger than 75 years old. Its clinical usefulness is limited in elderly patients.

Atrial fibrillation (AF) is the most common arrhythmia encountered in acute medical practice. One-third of hospitalizations for cardiac rhythm disturbances are attributed to AF, with increasing rates in the past decade. Significant morbidity and mortality, including 15% to 20% of all ischemic strokes and 20% of all strokes, result from AF. The overall mortality rate for patients with AF is approximately double that for patients in normal sinus rhythm. Atrial flutter (AFL) has many clinical aspects that are similar to AF, AF and AFL have same management strategies in emergency settings. The major goals of treatment include alleviation of the associated symptoms and/or hemodynamic disturbance, reduction of the risk of systemic thromboembolism, reduction in hospital length of stay. The very large scaled AFFIRM and AF-CHF clinical trials compared rate and rhythm control (cardioversion), but did not explore the optimal management for recent-onset AF/AFL patients presenting to the emergency department (ED) with in 48 hours of symptoms. Although international standard guidelines are available, AF treatment in ED is still heterogeneous in terms of the management strategy (rate or rhythm) chosen. National based guidelines or consensus documents specific to ED management of AF has recently been developed and published in order to solve this problem. Aim of this review is to give detailed information for ED team about echocardiographic criterias supporting cardioversion (CV) of AF, CV procedure itself and new antiarrhythmic and oral anticoagulant drugs by adhering to the guidelines.Keywords: Cardioversion, recent-onset atrial fibrillation, flutter, emergency ÖzetAtriyal fibrilasyon, akut tıbbi uygulamada karşılaşılan en sık aritmidir. Kalp ritm bozuklukları nedeniyle hastaneye yatanların üçte birinde neden AF olup son on yılda sıklığı giderek artmaktadır. AF belirgin mortalite ve morbiditeye neden olmaktadır. Tüm iskemik inmelerin %15-%20’si ve tüm inmelerin %20’si AF nedenlidir. AF’si olan hastalarda genel ölüm oranı, normal sinus ritmi olanlara göre yaklaşık iki kat fazladır. Atriyal flutter (AFL)’in AF’e benzer birçok klinik yönleri bulnumaktadır, acil durumlarda AF ve AFL aynı tedavi stratejilerine sahiptir. Tedavinin başlıca hedefleri, ilgili semptom ve/veya hemodinamik bozukluğun azaltılması, sistemik tromboembolik riskin azaltılması ve hastanede kalış süresinin kısaltılmasını içermektedir. Çok büyük ölçekli AFFIRM ve AF-CHF çalışmaları, hız ve ritim kontrolü (kardiyoversiyon) stratejilerini kıyasladı, fakat, semptom başlangıcının 48 saati içerisinde acile servise(AS) başvuran, yeni başlangıçlı AF/AFL hastalarında optimal tedavi yöntemini açığa kavuşturamadı. Uluslararası standart kılavuzlar bulunmasına rağmen AS’de AF tedavisi, seçilen tedavi stratejisi (hız veya ritim) yönünden hala heterojendir. Son zamanlarda bu sorunu çözmek amacıyla, AS’de AF tedavisine yönelik ulusal kaynaklı kılavuzlar ve konsensüs belgeleri geliştirilmiş ve yayınlanmıştır. Bu derlemenin amacı, AS ekibine, kılavuzlara bağlı kalınarak kardiyoversiyonu destekleyen ekokardiyografik parametreler, kardiyoversiyon işleminin kendisi ve yeni antiaritmik ve antikoagulan ilaçlar hakkında ayrıntılı bilgi sunmaktır.Anahtar sözcükler: Kardiyoversiyon, atrial fibrilasyon, flutter, acil, Atriyal fibrilasyon, akut tıbbi uygulamada karşılaşılan en sık aritmidir. Kalp ritm bozuklukları nedeniyle hastaneye yatanların üçte birinde neden AF olup son on yılda sıklığı giderek artmaktadır. AF belirgin mortalite ve morbiditeye neden olmaktadır. Tüm iskemik inmelerin %15%20’si ve tüm inmelerin %20’si AF nedenlidir. AF’si olan hastalarda genel ölüm oranı, normal sinus ritmi olanlara göre yaklaşık iki kat fazladır. Atriyal flutter (AFL)’in AF’e benzer birçok klinik yönleri bulnumaktadır, acil durumlarda AF ve AFL aynı tedavi stratejilerine sahiptir. Tedavinin başlıca hedefleri, ilgili semptom ve/veya hemodinamik bozukluğun azaltılması, sistemik tromboembolik riskin azaltılması ve hastanede kalış süresinin kısaltılmasını içermektedir. Çok büyük ölçekli AFFIRM ve AF-CHF çalışmaları, hız ve ritim kontrolü (kardiyoversiyon) stratejilerini kıyasladı, fakat, semptom başlangıcının 48 saati içerisinde acile servise(AS) başvuran, yeni başlangıçlı AF/AFL hastalarında optimal tedavi yöntemini açığa kavuşturamadı. Uluslararası standart kılavuzlar bulunmasına rağmen AS’de AF tedavisi, seçilen tedavi stratejisi (hız veya ritim) yönünden hala heterojendir. Son zamanlarda bu sorunu çözmek amacıyla, AS’de AF tedavisine yönelik ulusal kaynaklı kılavuzlar ve konsensüs belgeleri geliştirilmiş ve yayınlanmıştır. Bu derlemenin amacı, AS ekibine, kılavuzlara bağlı kalınarak kardiyoversiyonu destekleyen ekokardiyografik parametreler, kardiyoversiyon işleminin kendisi ve yeni antiaritmik ve antikoagulan ilaçlar hakkında ayrıntılı bilgi sunmaktır.

The purposes of this study are to evaluate the clinical usefulness of maximum QTc and QTc dispersion determination in aortic stenosis, and to compare the effects of maximum QTc and QTc dispersion on the risk of syncope in aortic stenosis. The QT interval dispersion has long been known to be a marker of dispersion of ventricular repolarization and, hence, electrical instability. Additionally, it has been shown that these patients have a propensity to ventricular tachyarrhythmic syncope. The study included 86 patients with aortic stenosis who underwent left-heart catheterization and coronary angiography during investigation of syncope and 30 healthy subjects. The patients were characterized with regard to the presence or absence of a history of syncope and the severity of aortic stenosis (the degree of peak transvalvular gradient). In addition, QT max and QT dispersion measurements were corrected for heart rate according to Bazett's formula. The QTc max and QTc dispersion were greater in patients with aortic stenosis than in the healthy subjects (477 ±49 ms vs 370 ±22 ms, p < 0.001; 60 ± 13 ms vs 38 ± 1 ms, p < 0.001). Similarly, the QTc max and QTc dispersion were greater in the patients with a history of syncope than in the patients with no history of syncope (493 ±48 ms vs 459 ±4 ms, p < 0.001; 68 ±12 ms vs 53 ± 10 ms, p < 0.001). In addition, both parameters were greater in the patients with a high transvalvular gradient than in the patients with a low transvalvular gradient (489 ±49 ms vs 451 ±39 ms, p < 0.001; 65 ± 12 ms vs 50 ±9 ms, p < 0.001). Multivari ate logistic regression analysis showed that only a increased QTc dispersion had significant value for the risk of syncope in aortic stenosis. An increased QTc dispersion caused a 10.4% increase in the occurrence of syncope in aortic stenosis. These results suggest that high values of QTc dispersion are sensitive noninvasive markers to determine the risk for syncope in aortic stenosis.

The present study assessed and compared the diagnostic accuracy of thallium-201 (Tl-201) exercise myocardial single photon emission computerised tomography (SPECT) and dobutamine stress echocardiography (DSE) for detection of coronary artery disease (CAD) in patients with left bundle branch block (LBBB). Study population consisted of 26 consecutive patients with permanent LBBB who were suffering from chest pain. Patients (8 women, 18 men mean age = 57+/-8 years) were studied with DSE, Tl-201 SPECT and coronary angiography (CAG). Three different approaches for diagnosis of CAD were used to identify CAD in left arterial descending (LAD) coronary artery territories in scintigraphic studies: (1) Approach A (conventional approach): involvement of septal, and/or anterior, and/or apical wall. (2) Approach B: involvement of anterior and septal wall irrespective of apical wall. (3) Approach C: involvement of septum, anterior and apical wall. DSE gave a sensitivity of 91%, specificity of 92% and accuracy of 92% for diagnosis of CAD in the LAD coronary artery territory. Tl-201 SPECT (conventional approach) gave a sensitivity of 100%, specificity of 42% and diagnostic accuracy of 69% for diagnosis of CAD in the LAD coronary artery territory. Sensitivity, specificity and diagnostic accuracy of approach C were 33, 85 and 57% respectively. The specificity of Tl-201 SPECT significantly increased in approach C when compared with approach A and B (p < 0.02). However sensitivity of the Tl-201 SPECT with approach C showed significant decrease when compared with DSE and approach A and B (p < 0.005). Specificity of DSE for diagnosis of CAD in LAD were significantly higher than those of Tl-201 SPECT regarding the approach A and B (p < 0.01). In conclusion the use of DSE for diagnosis of CAD in patients with LBBB seems to be more suitable than Tl-201 SPECT.

WOS: 000288462900006, PubMed ID: 20682610, Impairment of endothelial functions has been shown to occur after acute and chronic exposure to passive smoking (PS), as assessed by flow-mediated dilatation (FMD) of the brachial artery. A total of 61 participants, 30 male and 31 female, mean ages 26 (18-36) were enrolled in the study. All were clinically well and nonsmokers. All participants stayed for 30 minutes in the smoking room. Carbon monoxide (CO) level was 7.42 +/- 0.98 ppm (4.71-10.50). Mean carboxyhemoglobin (COHb) levels of participants were significantly elevated after PS. Mean FMD was 18.6% +/- 9% and decreased to 12.4% +/- 7% after PS (P < .001). In the current study, with more number of participants at lower CO concentrations (7.42 ppm) and with smaller increase in COHb (51%) significant reduction (33%, P < .001) in FMD was observed.

Chronic renal failure patients on maintenance hemodialysis (HD) have a number of ECG abnormalities and cardiac arrhythmias. Clinical and experimental data have shown that increased QT dispersion is associated with severe ventricular arrhythmias and sudden cardiac death. Therefore, the aim of this study was to investigate whether the uremic patients receiving long-term HD have increased QTc interval and/or QTc dispersion compared to normal subjects and to evaluate the effect of electrolyte changes between the predialysis and postdialysis phases on these parameters. Forty patients with end-stage renal failure on long-term HD (22 men, 18 women, mean age 44 years) were included in this study. Serum concentrations of K+, Na+, Ca++, Mg++, Cl-, phosphate, urea, creati nine, HCO3-, and arterial blood gases (PO2, PCO2), together with blood pH, were monitored and QTc intervals and QTc dispersion were measured from 12-lead ECG in predialysis and postdialysis phases. The hemodialyzed patients had an increased predial ysis QTc maximum interval and QTc dispersion compared to normal subjects (480 ±51 vs 310 ±38 msec, p < 0.001 and 61 ±17 vs 42 ±14 msec, p < 0.001, respectively). Both QTc maximum interval and QTc dispersion increased significantly at the end of the HD (480 ± 51 vs 505 ±49 msec p< 0.001 and 61 ± 17 vs 86 ± 18 msec, p< 0.001, respec tively). The serum K+(5.3 ±0.56 vs 3.36 ±0.41 mEq/L, p < 0.001), phosphate (7.19 ± 1.62 vs 3.81 ± 1.02 mg/dL, p ++(2.21 ±0.18 vs 2.47 ±0.24 mg/dL, p < 0.001), HCO3-(15.5 ±3.2 vs 20.1 ±3.4 mmol/L, p< 0.001) concentrations and pH (7.27 ± 1.1 vs 7.43 ± 1.2, p < 0.001) significantly increased after HD compared to predialysis values. There was significant correlation between the QT dispersion increase and serum electrolyte changes (K+, Ca++, and pH levels) (p < 0.05). The association between serum electrolyte changes, acid-base status and QT measurements might provide new insights into the evaluation of the ionic bases involved in inhomogeneous ventricular repolarization.

Background: Previous studies have reported controversial results regarding the effectiveness of systemic thrombolysis in preventing left ventricular (LV) thrombus after acute myocardial infarction (MI). Hypothesis: This study was performed to evaluate the influences of thrombolysis, and particularly successful reperfusion, on the incidence of LV thrombus formation after acute anterior MI. Methods: in all, 191 patients suffering from a first attack of acute anterior MI were prospectively evaluated by two‐dimensional echocardiography and coronary angiography, performed at the end of the first week and within the first two weeks of MI, respectively. Of these, 98 who presented within 12 h of onset of symptoms received intravenous streptokinase (1.5 million IU), while the remaining 93 patients who, either because of contraindications or late admission, did not receive thrombolytic treatment served as control group. All patients received aspirin and full‐dose anticoagulation with intravenous heparin. Successful reperfusion in the streptokinase group was assessed by enzymatic and electrocardiographic evidence. Results: The overall incidence of LV thrombi was 24.6% (47/191). When all patients were evaluated, no statistically significant difference was found between the frequency of LV thrombi in the patients who had thrombolysis (22.4%) and those who did not (26.8%), despite a trend toward the formation of fewer thrombi in the initial group (p > 0.05). However, the patients who had successful reperfusion with streptokinase (n = 64) had significantly reduced incidence of LV thrombi compared with those who did not receive thrombolytic therapy (20 vs. 26.8%, p < 0.05). Stepwise multivariate analysis suggested that LV abnormal wall motion score (p = 0.01) and presence of LV aneurysm were independent predictors of LV thrombus formation in patients with acute anterior MI. Conclusion: Not all patients who received streptokinase for acute anterior MI, but only those with successful reperfusion had reduced incidence of LV thrombi. The favorable effects of thrombolysis on LV thrombus formation are probably due to the preservation of global LV systolic function.

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

WOS: 000323683500013, PubMed ID: 23267239, Coronary collaterals (CCs) serve as alternative conduits for blood flow in obstructive coronary artery disease. We investigated the association of various components of blood pressure (BP) parameters with the the degree of coronary collateralization. Patients (n = 245) who underwent coronary angiography were included. Intraarterial BP in the ascending aorta was determined using a standard fluid-filled system. Readings of the conventional peripheral pressure were measured using a manual sphygmomanometer. All blood samples were drawn at admission, before coronary angiography. A total of 65 patients were found to have adequate CC development. Central diastolic BP and peripheral diastolic BP were found to be lower in the group with adequate CC. In multivariate logistic regression model, central diastolic BP and Gensini score were found to be independent predictors of adequate CC. In conclusion, low central diastolic BP in the case of severe coronary stenosis may be an important stimulus for adequate CC development.

29th Turkish Cardiology Congress of the Turkish-Society-of-Cardiology (TSC) with International Participation -- OCT 26-29, 2013 -- Antalya, TURKEY, WOS: 000329858401055, …, Turkish Soc Cardiol

WOS: 000323324400012, PubMed ID: 23728224, Objective: Renal dysfunction commonly accompanies the course of cardiac disorders and strongly associates with increased morbidity and mortality. Elevated central venous pressure is related to worsening renal function in patients with heart failure. However, predictors of worsening renal function in mitral stenosis-whose pathophysiologic process is similar to heart failure with regard to right heart dysfunction-are unknown. This study aimed to evaluate whether clinical and echocardiographic parameters might predict worsening renal function in patients with mild-to-moderate mitral stenosis. Methods: The current study has a prospective cohort design. Sixty consecutive patients (9 male, 51 female, mean age 50 +/- 13 years) with mild-to- moderate mitral stenosis were followed up for 34 +/- 13 months (range 1-60) and their renal functions were monitored. Worsening renal function was defined as a decline in glomerular filtration rate of >= 20% on follow-up. In order to presence or absence of worsening renal functions, study patients divided into two groups. Statistical analysis was performed using the Chi-square, Independent samples t / Mann-Whitney U tests, univariate and multivariate Cox proportional hazards analyses, receiver operating characteristic (ROC) and Kaplan-Meier curve analyses. Results: Worsening renal function was observed in 14 patients (23%). In univariate analysis, male gender, mean pulmonary artery pressure (mPAP), peak tricuspid regurgitation velocity, systolic pulmonary artery pressure, digitalis and antiplatelet usage, right atrial size, and TEI index were determined to be predictors of worsening renal function. In a multivariate Cox proportional hazards model, mPAP (HR=1.136, 95% CI: 1.058-1.220, p21 mmHg, and those who did not have, in terms of worsening renal function (p=0.006), and the difference between the groups increased after 30 months of follow-up. Conclusion: Elevated mean pulmonary artery pressure at the time of initial evaluation, in patients with mild-to-moderate mitral stenosis, might help to predict worsening renal function.

WOS: 000322171400012, PubMed ID: 22994845, Platelet abnormalities in diabetes mellitus (DM) and atrial fibrillation (AF) may underline the etiology of a prothrombotic state in these conditions. Increased mean platelet volume (MPV) is a marker of abnormal platelet function and activation. We aimed to investigate the possible association of chronic AF with MPV in patients who have type 2 DM. Patients who had type 2 DM with either chronic (>= 6 months) AF or normal sinus rhythm (NSR) were included in the study. A total of 162 patients (aged 38-89 years) were divided into 2 groups according to the presence of either AF or NSR. Group 1 consisted of 81 diabetic patients with AF, and group 2 consisted of 81 diabetic patients with NSR. The two groups were not significantly different in terms of age, and gender, as well as in hypertension, smoking, history of coronary artery disease, previous cerebrovascular accidents, microalbuminuria, retinopathy, duration of DM, body mass index, hemoglobin A(1c), total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglyceride (p > 0.05 for all variables). Although no significant difference was present between groups concerning platelet count; for patients with AF, MPV was higher compared with patients with NSR (9.0 +/- 0.2 fl vs. 8.4 +/- 0.2 fl; p = 0.001). Furthermore, no significant difference was noted between groups regarding routine medications received by patients. In multivariate logistic regression analysis, MPV was the only variable independently related to AF (OR = 2.659; 95% CI, 1.286-5.498; p = 0.008). Consequently, it is concluded that AF is associated with increased MPV in patients with type 2 DM, suggesting the presence of tentatively related processes leading to reciprocal interaction.

(2016). Effects of right ventricular systolic functions and COPD on cancer antigen-125 levels which are associated with atrial fibrillation in patients with heart failure? Acta Cardiologica: Vol. 71, No. 4, pp. 503-503.

WOS: 000303845000005, PubMed ID: 21996616, BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a progressively debilitating disease limiting patients' survival. The prognosis of COPD worsens with the addition of right ventricular (RV) failure. Red cell distribution width (RDW) is a measure of variability in the size of circulating erythrocytes, and is a powerful predictor of outcomes in patients with both chronic and acute left heart failure. Here we attempted to test whether RDW could provide an early marker of RV failure in patients with COPD. METHODS: Thirty-nine consecutive patients with COPD were enrolled in the study. All patients had at least 10 years' history of COPD, and all were treated appropriately. Thirty-nine age-matched and sex-matched individuals were enrolled for comparison. Red cell distribution width was obtained in all patients before transthoracic echocardiography. Right ventricular parameters were evaluated, and RV failure was identified via lateral tricuspid annulus longitudinal motion and systolic-tissue Doppler velocity, using transthoracic echocardiography. RESULTS: Patients with COPD had significantly higher RDW values compared with control subjects (patients with COPD, mean +/- SD, 16.1 +/- 2.5; range, 12.3 to 23.3; control subjects, mean +/- SD, 13.6 +/- 1.3; range, 11.7 to 18.3; P < .001). In multivariable logistic regression, the presence of high RDW was the only parameter independently predicting RV failure in patients with COPD (odds ratio, 2.098; P = .017). Levels of RDW, obtained before echocardiography, predicted the presence of RV failure with a sensitivity of 70% and specificity of 93.1%, with a cutoff value of >17.7. CONCLUSION: Red cell distribution width may be used to identify COPD patients with RV failure. Cite this article: Sincer, I., Zorlu, A., Yilmaz, M. B., Dogan, O. T., Ege, M. R., Amioglu, G., Aydin, G., Ardic, I., & Tandogan, I. (2012, MAY/JUNE). Relationship between red cell distribution width and right ventricular dysfunction in patients with chronic obstructive pulmonary disease. Heart & Lung, 41(3), 238-243. doi:10.1016/j.hrtlng.2011.07.011.

WOS: 000303508600007, PubMed ID: 22139027, Heart failure (HF) is one of the most common and leading cause of death worldwide. Clinical trials provide evidence that the development of atrial fibrillation (AF) is a marker of poor prognosis in patients with HF. Furthermore, elevated D-dimer level is associated with increased cardiovascular mortality independent of AF in HF patients. We investigated whether plasma D-dimer levels in patients with hospitalized systolic HF could predict development of AF. A total of 150 consecutive patients with sinus rhythm who admitted to the emergency department with hospitalized systolic HF were evaluated. All hospitalized patients were obtained D-dimer levels within the first 24 h following admission. Atrial fibrillation developed in 31 (20.7%) patients during follow-up period of 6.3 +/- A 5 months. Patients who developed atrial fibrillation had significantly increased levels of D-dimer [608 (339-1,022) ng/ml versus 1,100 (608-2,599) ng/ml, P = 0.001]. Optimal cut-off level of D-dimer to predict development of AF was found to be > 792 ng/ml. D-dimer > 792 ng/ml, right ventricular dilatation, age, systolic pulmonary pressure, left atrium size, moderate to severe tricuspid regurgitation, and beta blocker usage were found to have prognostic significance in univariate analysis. In multivariate Cox proportional-hazards model, D-dimer levels > 792 ng/ml (HR = 3.019, P = 0.006), and right ventricular dilatation (HR = 8.676, P = 0.003) were associated with an increased risk of new-onset AF. In conclusion, D-dimer could predict development of AF in patients with hospitalized systolic HF.

WOS: 000298900400023, PubMed ID: 21958741, Red cell distribution width (RDW) is strongly associated with prognosis in cardiopulmonary disorders such as coronary artery disease, acute myocardial infarction, acute and chronic heart failure, and pulmonary hypertension. However, its prognostic significance in acute pulmonary embolism (PE) is unknown. The aim of this study was to investigate the relation between admission RDW and early mortality in patients with acute PE. One hundred sixty-five patients with confirmed acute PE were included. Patients with previous treatment for anemia, malignancy, or chronic liver disease, those with dialysis treatment for chronic renal failure, and those who received erythrocyte suspension for any reason were excluded. A total of 136 consecutive patients with acute PE were evaluated prospectively. According to receiver-operating characteristic curve analysis, the optimal cut-off value of RDW to predict early mortality was >14.6%, with 95.2% sensitivity and 53% specificity. Patients were categorized prospectively as having unchanged (group 1) or increased (group 2) RDW on the basis of a cut-off value of 14.6%. The mean age of patients was 63 +/- 15 years. The mean follow-up duration was 11 +/- 7 days, and 21 patients died. Among these 21 patients, 1 (1.6%) was in group 1 and 20 (27%) were in group 2 (p 14.6% on admission, age, presence of shock, heart rate, oxygen saturation, and creatinine level were found to have prognostic significance in univariate Cox proportional-hazards analysis. Only increased RDW >14.6% on admission (hazard ratio 15.465, p.= 0.012) and the presence of shock (hazard ratio 9.354, p

Amaç: Kardiyorenal anemi sendromu kalp yetersizliği (KY) hastalarında tanımlanmıştır. Renal bozukluğun ve aneminin ayrı ayrı etkileri daha önce ortaya konmuş olsa da, böbrek, kemik iliği ve kalp arasındaki karmaşık etkileşim, hastalığı daha hafif olan kişilerde karar verme işlemini nispeten verimsiz kılar. Bu çalışmada, tahmini glomerül filtrasyon hızı (eGFR) ve hemoglobin (Hb) çarpımının KY hastalarında sonlanımı öngörmedeki rolünü araştırmayı amaçladık. Çalışma planı: Çalışmaya, akut dekompanse sistolik KY tanısıyla hastaneye yatırılıp taburcu edilen ardışık 148 hasta (89 erkek, 59 kadın; ort. yaş 68±10) alındı. Taburcu edilirken Hb düzeyleri ölçüldü, böbrek fonksiyonu MDRD (Modification of Diet in Renal Disease) formülü ile belirlendi. eGFRxHb çarpımı hesaplanarak, ROC (alıcı işletim karakteristiği) analiziyle kesim değeri çıkarıldı. Hastaların 34 aya varan takipleri (ort. 8.2±5.5 ay) sonrasında eGFRxHb çarpımı değerinin ölüm üzerindeki etkisi araştırıldı. Bulgular: Hasta grubunda ortalama Hb 12.7±2 gr/dl, ortalama kreatinin 105±46 ?mol/l ve ortalama eGFR 61±23 ml/dk/1.73 m2 bulundu. Seksen iki hastada (%55.4) eGFR, Objectives: Cardiorenal anemia syndrome is defined in patients with heart failure (HF). Although individual influ- ences of renal impairment and anemia were shown pre- viously, complex interaction between the kidney, bone marrow, and the heart renders decision making relatively inefficient in patients with milder forms of these diseases. We aimed to investigate whether product of estimated glo- merular filtration rate (eGFR) and hemoglobin (Hb) pre- dicts outcomes in patients with HF. Study design: The study included 148 consecutive pa- tients (89 males, 59 females; mean age 68±10 years) who were hospitalized with acutely decompensated systolic HF and discharged alive. Discharge Hb levels were measured. Renal function was estimated via the MDRD (Modification of Diet in Renal Disease) formula. The eGFR x Hb product was derived, and cut-off was defined using the ROC (re- ceiver operating characteristic) analysis. The influence of eGFR x Hb product on mortality was analyzed after a fol- low-up period of up to 34 months (mean 8.2±5.5 months). Results: The mean Hb was 12.7±2 g/dl, the mean creati- nine was 105±46 μmol/l, and the mean eGFR was 61±23 ml/min/1.73 m2. Eighty-two patients (55.4%) had an eGFR of

WOS: 000303508600004, PubMed ID: 21901368, D-dimer is a fibrin degradation product, and is implicated in pathologies of cardiovascular system. Thrombosis within the vascular system in relation with inflammation and stasis might be associated with poor prognosis in patients with systolic heart failure (HF). In this study we aimed to investigate for relationship between d-dimer levels and cardiovascular mortality in patients with systolic HF. A total of 174 consecutive patients with hospitalized systolic HF were evaluated. All hospitalized patients were obtained d-dimer levels within the first 24 h following admission after obtaining informed consent. Patients were followed up for cardiovascular mortality and 40 (23%) patients died. d-dimer levels were higher among those who died compared to those who survived (2727 +/- A 2569 (710-4438) versus. 1029 +/- A 1319 (303-1061) ng/ml, P < 0.001). Optimal cut-off level of d-dimer to predict cardiovascular mortality was found to be > 1435 ng/ml. D-dimer levels were negatively correlated with ejection fraction, positively correlated with left atrium size and left ventricular diastolic diameter. D-dimer > 1435 ng/ml, age, diabetes mellitus, presence of atrial fibrillation, and creatinine level were found to have prognostic significance in univariate analyses. In multivariate Cox proportional-hazards model, d-dimer > 1435 ng/ml (HR = 3.250, 95% CI 1.647-6.414, P = 0.001), creatinine level (HR = 1.269, 95% CI 1.008-1.599, P = 0.043), and presence of atrial fibrillation (HR = 2.159, 95% CI 1.047-4.452, P = 0.037) remained associated with an increased risk of death after adjustment for variables found to be statistically significant in univariate analysis and correlated with d-dimer level. In conclusion, d-dimer measurement could help risk stratification in patients with systolic HF.

WOS: 000296230200011, PubMed ID: 21968258, Objectives: We aimed to evaluate echocardiography-guided hemodynamic determinants of quality of life (QoL) via the Medical Outcomes Study Short Form (SF-36) questionnaire in patients with mild to moderate mitral stenosis (MS). Methods: Eighty consecutive patients with rheumatic MS, who were admitted to the outpatient department, were enrolled into the study upon obtaining informed consent. Forty age-sex-matched healthy individuals were enrolled as a control group. Results: All subscale scores and total SF-36 scores were significantly lower in the patient group representing a worse QoL. In multivariable logistic regression analysis, only mean pulmonary artery pressure (OR 1.138, 95% CI 1.049-1.234, p = 0.002) was found to be an independent predictor of poor QoL in patients with mild to moderate MS. Conclusion: During follow-up of MS patients before intervention, physicians should consider that mean pulmonary artery pressure is the main factor which influences the patients' QoL. In patients with MS, it seems that referral to intervention should consider components and derivatives of QoL. Copyright (C) 2011 S. Karger AG, Basel

WOS: 000290430300029, PubMed ID: 20022645, Objective: CA-125 is an old marker, recently shown to be associated with systolic heart failure. We aimed to search for factors influencing its plasma level. Design: 430 patients with one available CA-125 level were investigated retrospectively. 150 patients who had echocardiographic records were enrolled into final analysis. Patients were followed up, hospitalization and mortality were noted. Results: CA-125 levels were negatively correlated with ejection fraction (r=-0.269,p=0.001) and positively correlated with systolic pulmonary artery pressure (r=0.370, p < 0.001). In the whole group, patients with right ventricular dilatation (n=68) had significantly higher CA-125 levels compared to those without right ventricular dilatation (n=82) (125.8 +/- 118.4 U/ml vs. 16.9 +/- 16.5 U/ml, p < 0.001). Presence of depressed ejection fraction (B=1.837, p=0.004), presence of right ventricular dilatation (B=4.294, p=0.002) and presence of pericardial effusion (B=1.913, p=0.018) were independent predictors of high CA-125 levels. After follow up, patients with high CA-125 level encountered more frequent hospitalization and mortality, and atrial fibrillation was more frequent among those with high CA-125. Conclusion: Our data suggests that plasma levels of CA-125 seem to be determined by left ventricular ejection fraction, right ventricular dilatation and presence of pericardial effusion in a group of all comers. It seems prudent to consider these factors before integrating CA-125 into clinical practice. (c) 2009 Elsevier Ireland Ltd. All rights reserved.

WOS: 000290695400012, PubMed ID: 21371938, …

WOS: 000289266500009, PubMed ID: 21404303, Background: Chronic obstructive pulmonary disease (COPD) is a progressive and debilitating disease. Cor pulmonale, characterized by right ventricular (RV) failure, can severely influence prognosis in these patients. Hence, early recognition might be important for tailoring therapy. An old biomarker, CA-125, seems to be associated with the right heart. We aimed to show the relationship between CA-125 levels and RV failure in patients with COPD. Hypothesis: CA-125 might be a useful biomarker in identification of RV failure in patients with COPD. Methods: Forty patients with recent exacerbation of COPD were enrolled into the study. Another 40 age- and sex-matched individuals were enrolled for comparison. Levels of CA-125 were measured in the patients during the hospital stay. The COPD patients underwent echocardiographic study on the same day. Right-ventricular parameters were evaluated, and RV failure was identified via transthoracic echocardiography. Results: Patients with COPD had significantly higher CA-125 levels compared with controls (median 33.94 U/mL vs 9.76 U/mL, respectively; P < 0.001). Levels of CA-125 were correlated with systolic pulmonary artery pressure (r = 0.550, P < 0.001), tricuspid annular plane systolic excursion ( r = -0.496, P = 0.001), and tricuspid lateral annulus S velocity (r = -0.549, P = 0.002). High CA-125 levels, obtained in hospitalized patients with COPD before echocardiography, enabled identification of RV failure with a sensitivity of 89.5% and specificity of 85.7%. Conclusions: The CA-125 biomarker can be used to identify COPD patients with RV failure.

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WOS: 000281309900004, PubMed ID: 20693125, Objective: Leyosimendan is a relatively new inotropic agent. Unlike other inotropic agents, Levosimendan does not increase cellular calcium intake, so that, does not cause intracellular calcium overload and related arrhythmias. Atrial fibrillation (AF) was shown to be an independent risk factor for mortality and morbidity in large heart failure (HF) trials. Heart failure induces AF, AF aggravates HF and therefore they generally coexist. We conducted a study to investigate if there is any differential effect of Levosimendan in HF patients with chronic AF and without AF. Methods: This is a prospective study. Consecutive patients, who were hospitalized because of acutely decompensated HF due to systolic dysfunction and decided Levosimendan administration, were enrolled. Patients were classified into two as those with AF (group A) and those with sinus rhythm (control group, group S). All patients had echocardiography before and after administration. Echocardiographic data were evaluated by ANOVA repeated measurements test. Results: Baseline left ventricle ejection fraction (LVEF) was poorer in group with AF (mean LVEF for group A: 20.9%, for group S: 26.4%, p=0.04). Baseline diastolic parameters were equally impaired. After infusion, diastolic parameters like velocity of propagation (Vp) and isovolumic relaxation time (IVRT) improved almost to same extent in both groups but deceleration time (DT) did not. IVRT values decreased (p=0.012) both in group S (from 108.6 +/- 23.2 msec to 100.4 +/- 28.4 msec) and group A (from 117.3 +/- 25.1 msec to 92.0 +/- 20.9 msec) without a significant difference between groups (p=0.180 for interaction). Another valuable diastolic parameter, Vp was also similarly improved (p

WOS: 000280010500023, PubMed ID: 19108911, Coronary angiography, despite current shortcomings, has been regarded as golden standard for the assessment of coronary arteries. Geodesic pattern of coronary arteries characterized by curvature, torsion and tortuosity parameters can also be determined through angiography. Apart from atherosclerosis; age, hypertension, left ventricular hypertrophy and coronary flow are some of the determinants for the geodesic pattern of coronary arteries. Besides, a unique feature of coronary vasculature that differs from all other arterial sites is the repetitive flexion during each cardiac contraction. Thus, the geodesic pattern of coronary arteries may conceivably possess an adjunctive merit in estimating cardiovascular risk and have promising implications for discerning those who require meticulous follow-up. A more thorough understanding of the precise determinants for the coronary geodesic pattern would help establish its potential causal interaction with cardiovascular risk. (C) 2008 Elsevier Ireland Ltd. All rights reserved.

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WOS: 000282679000004, PubMed ID: 19150141, Free-floating intracardiac thrombi represent a severe yet uncommon condition and mostly coexist with thromboembolism. Notably, mobile right heart thrombus can occur in patients with massive pulmonary embolism. Early diagnosis and management can be life-saving. Spontaneous atrial thrombosis due to restrictive cardiomyopathy has also been rarely reported. We describe here an unusual case of free-floating biatrial thrombi with concomitant saddle pulmonary embolism in a patient with idiopathic restrictive cardiomyopathy and sinus rhythm who had lower extremity deep vein thrombosis following the left knee arthroplasty. In the absence of treatment, mortality from pulmonary embolism remains high. Nevertheless, in our patient, blood stasis with dilated atria, resulting from restrictive hemodynamics, and deep venous thrombosis were the most likely causes for the formation of biatrial thrombi and concomitant pulmonary embolism. (C) 2008 Elsevier Ireland Ltd. All rights reserved.

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WOS: 000272343300014, PubMed ID: 20025625, (J Interven Cardiol 2009;22:576-577).

WOS: 000272402700022, PubMed ID: 18684526, Coronary collateral circulation provides an important response to ischemic heart disease and partially determines the severity of ischemic myocardial damage. Practical significance of coronary collateral circulation has long been a matter of uncertainty due to concerns about the means for gauging coronary collateral circulation and the modest populations to be representative for all patients with ischemic heart disease. It is possible that prognosis may be defined by the balance between the harm of atherosclerotic burden, and the benefit from coronary collateral circulation. Atherosclerosis acts as a potent trigger for the formation of coronary collateral circulation, but at the same time it has deleterious effects on cardiovascular morbidity and mortality. Coronary collateral circulation has a complex role in modifying the risk of cardiovascular morbidity and mortality in ischemic heart disease. A more comprehensive insight into the exact determinants of coronary collateral circulation would help establish its potential implications in clinical and epidemiological realm.(C) 2008 Elsevier Ireland Ltd. All rights reserved.

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.

WOS: 000259244900009, PubMed ID: 18388064, Coronary collateral circulation determines the severity of ischemic myocardial damage. Increased P-wave dispersion is an independent predictor for atrial fibrillation. Consistent evidence is little about the relation between coronary collateral circulation and arrhythmia risk. In this article, the effect of coronary collateral circulation on P-wave dispersion was evaluated. Collateral grade and p-wave dispersion were ascertained in 100 patients with >= 85% diameter stenoses in left anterior descending or right coronary arteries. Left ventricular function score was also determined in all patients. Coronary collateral circulation was absent in 32 patients, whereas 68 patients had coronary collateral circulation. Patients with collateral grade A had greater left ventricular function score than did patients with collateral grade 0 (P = .048). However, there was no significant difference between P-wave dispersion of patients with and without coronary collateral circulation (P = .45). The presence of coronary collateral circulation failed to exert a beneficial decreasing effect on P-wave dispersion.