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Cardiac and cerebrovascular illnesses are among the leading causes of mortality and morbidity today. Thromboembolic cases, which are the result of cardiac arrhythmia, are one of the important causes of cerebral stroke. However, various abnormalities, especially ST-T wave changes on electrocardiography can be seen in patients who do not have any heart disease history but had ischemic cerebral stroke. In this study, we have presented an interesting case of Torsades de Pointes due to ischemic cerebral stroke.

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

In this study, we aimed to investigate the relationship between glycated haemoglobin (HbA1c) levels and the severity of coronary artery disease (CAD) in40 years old patients.The study population consisted of 211 premature coronary atherosclerotic patients (pCAP) (aged 36.4 ± 2.5 years) and 160 control subjects (36.4 ± 2.4 years). The severity of CAD was evaluated by the Gensini scoring system. HbA1c levels and the other basic biochemical parameters were analysed, and relations with severity of CAD were evaluated.There were statistically significant differences in serum HbA1c levels between the two groups (pCAP = 6.1 ± 1.8%, control = 4.7 ± 1.2%, p0.001). HbA1c levels significantly positively correlated with the Gensini score in pCAP (r = 0.662, p0.001). In linear multivariate regression analysis (including age, sex, HbA1c, smoking, diabetes mellitus and hypertension as dependent parameters), only HbA1c was found to be an independent risk factor for the presence of severe CAD (Beta = 0.374, p0.001). In ROC curve analysis, the optimal cut-off value of HbA1c to predict severe CAD was 6.52%, with 74.4% sensitivity and 75.1% specificity (area under the curve 0.781, 95% confidence interval 0.661 to 0.901, p0.001).HbA1c levels were found to be correlated with the Gensini score in pCAP with and without diabetes. In this respect, glucose metabolism abnormalities, indicated by HbA1c, may play an important role in premature CAD.

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

Changes of thyroid hormones levels may lead to effects, not only in ventricular function, but also atrial function. The aim of this study was to investigate left atrial (LA) mechanical functions, atrial electromechanical coupling and P wave dispersion in patients with subclinical thyroid disorders.Eighty patients with subclinical thyroid disorders and forty controls were included. A diagnosis of subclinical thyroid disorders were reached with increased or decreased serum TSH and normal 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 were measured by tissue Doppler imaging (TDI).All groups had similar demographic findings. LA mechanical functions significantly impaired in subclinical thyroid disorders than control group. Intra- and Interatrial delay, were measured significantly higher in patients with subclinical thyroid disorders than control group. PA lateral and interatrial delay were positively correlated with TSH (r = 0.507, p = 0.006 and r = 0.455, p = 0.015, respectively) in subclinical hypothyroid patients. There was negative correlation between TSH and interatrial delay (r = -0.492, p = 0.006) in subclinical hyperthyroid patients. Linear multivariate regression analysis demonstrated that, TSH was the only an independent factor of interatrial delay in patients with subclinical thyroid disorders.This study showed that impaired LA mechanical and electromechanical function in subclinical thyroid disorders. TSH was an independent determinant of interatrial delay. Prolonged atrial electromechanical coupling time and impaired mechanical atrial functions may be related to the increased incidence of arrhythmias.

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

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.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).In Group1 and Group2, resting heart rate averages were found to be 83.61 ± 18.01/min and 85.10 ± 13.40/min, respectively (P0.05), 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 (P0.001). 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; P0.05). 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 (P0.05).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.

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

We examined the relationship between glycosylated hemoglobin (HbA1c) level and coronary flow rate in patients with type 2 diabetes mellitus (DM) and angiographically normal coronary arteries.The study included 54 consecutive patients (36 males, 18 females; age range 37 to 72 years) with type 2 DM, whose coronary arteries were found normal on coronary angiography. All patients underwent echocardiography and plasma HbA1c levels were measured before coronary angiography. To determine slow coronary flow (SCF), coronary flow rates of the left anterior descending (LAD), circumflex (Cx), and right coronary (RCA) arteries were assessed using the TIMI frame count (TFC) method.None of the patients had echocardiographic abnormalities. The mean HbA1c level was 7.4±2.0%, and the mean TFCs were 34.3±6.5, 22.4±3.5, and 20.4±2.2 for the LAD, Cx, and RCA, respectively. HbA1c levels were7% in 26 patients, and ≥7% in 28 patients. Thirty-eight patients (70.4%) were found to have SCF in at least one coronary artery. TIMI frame counts of all three coronary arteries were significantly greater in patients in whom HbA1c was ≥7% (p0.001). TIMI frame counts showed significant correlations with the HbA1c level (LAD: r=0.782; Cx: r=0.707; RCA: r=0.515; p0.001 for all). The mean HbA1c level was significantly higher in patients with SCF compared to patients without SCF (7.8±1.9% vs. 5.6±0.9%; p0.001). The incidence of SCF was significantly greater in patients with HbA1c ≥7.0% than those with HbA1c7.0% (96.4% vs. 61.5%; p=0.004). Increased HbA1c (≥7%) significantly increased the risk for SCF in at least one coronary artery (OR=16.875; 95% CI 1.972-144.38).Our findings suggest that there is a strong correlation between the HbA1c level and coronary flow rate.

Amaç: Bu çalışmada kronik solunum yetmezliği nedeni ile uzun dönem nonin­vaziv mekanik ventilasyon (NİMV) uygulanan ileri solumnum yetersizlikli KOAH hastalarının kalp hızı değişkenliği (KHD) araştırıldı. Hastalar ve Metod: Evde uzun dönem noktürnal NİMV kullanan sinüs ritminde 27 çok ağır KOAH hastası (58±8 yaş, 9 K) ile kontrol grubu olarak yaş ve cinsiyet olarak eşleştirilmiş solunum sıkıntısı olmayan 23 gönüllü (56±8 yaş, 11 K) çalış­maya alındı. Olgulara solunum fonksiyon testi, arter kan gazı analizi, transtorasik ekokardiyografi, 24 saatlik ambulatuvar elektrokardiyografi incelemesi yapıldı. Ambulatuvar EKG kaydında zaman-alan KHD analizi yapıldı. Bulgular: NİMV kullanırken hastaların %52’si NYHA fonksiyonel kapasite sınıf II, %36’sı sınıf III, %12’si sınıf IV idi. Hasta grubu yaş ve cins yönünden kontrol grubuyla benzerdi (her ikisi için de p>0.05). KOAH olgularının kalp hızı anlamlı yüksek (p0.05), sistolik pulmoner arter basıncı ise KOAH olgularında anlamlı olarak yüksek (p, Aims: This study aimed to investigate heart rate variability (HRV) of patients with severe COPD who are treated by noninvasive mechanic ventilation (NIMV). Patients and Method: Twenty-seven patient (58±8 years, 9 F) with severe COPD treated by nocturnal NIMV at home and 23 sex and age matched volunte­ers (56±8 years, 11 F) who has not dyspnea as a control group recruited in the study. Subjects underwent spi­rometry, blood gas analysis, transthoracic echocardiography, 24 hours ambulatory ECG analysis. Time domain HRV analysis performed from ambulatory ECG records. Results: 52% of patients at NYHA functional class II, 36% at class III, and 12% at class IV when they have been treated by NIMV. Groups were similar for age and sex (p>0.05 for both). Heart rates of patients were higher significantly than controls’ (p0.05). But, systolic pulmonary pressures were higher of COPD group (p

In Wolff-Parkinson-White Syndrome (WPW), presence of accessory pathways causes various tachyarrhythmias that lead to different symptoms and clinical conditions in patients. Atrial fibrillation is observed in about 20-30% of this group of patients. Life threatening malignant ventricular arrhythmias and sudden cardiac deaths are observed in patients having rapid conduction in accessory pathways and short antegrade refractory periods (

Levosimendan is a novel inotropic agent that enhances cardiac contractility without increasing cellular calcium intake, so that it is not supposed to cause intracellular calcium overload and related arrhythmias. In patients with heart failure, prolonged QRS duration is associated with increased risk of mortality and sudden cardiac death. Structural changes in the left ventricle may lead to asynchronous contraction, causing conduction delay and a prolonged QRS on the surface electrocardiogram.We aimed to compare the acute effects of levosimendan and dobutamine on QRS duration in patients with severe heart failure and sinus rhythm.Sixty consecutive patients with ischemic heart failure were enrolled for the study and randomized into two groups for levosimendan (n=37) or dobutamine (n=23) infusions. 67.2 % were male; mean age was 66.4 ± 9.2 years for all patients. Baseline QRS durations in levosimendan and dobutamine groups were, 120.44 ± 23.82 ms vs 116.59 ± 13.80 ms respectively. Baseline ejection fractions were both depressed (23.15 ± 8.3% vs 24.56 ± 7.5%).In the levosimendan group, QRS duration shortened from baseline value to 116.47 ± 24.56 msec (p=0.006), whereas dobutamine group showed no significant change (p=0.605). Both drugs caused an increase in ejection fraction, but only the levosimendan group showed significance (27.95 ± 8.9% p=0.003 vs 26.67 ± 7.6%, p=0.315).We suggest that the administration of levosimendan, not dobutamine, shortens QRS duration on the surface ECG, possibly by means of providing collective contraction in the left ventricle muscle fibers. The molecular basis of this effect remains to be clarified.

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.

The Fontan procedure has become a generic term to define a surgical procedure that orients the systemic venous return directly to the pulmonary arteries, and has been used as a palliative operation for pulmonary atresia, tricuspid atresia, double inlet ventricle and complex single ventricle. The earliest type of Fontan procedure was a simple atriopulmonary anastomosis between the right atrium and the pulmonary artery. Atrial arrhythmias, particularly atrial flutter and sinus node dysfunction may occur in the early and late postoperative period after simple atriopulmonary anastomosis. The case presented here represents a much delayed occurrence of an initial syncope due to alternating attacks of SVT (supraventricular tachycardia) and second degree heart block on admission 21 years after simple atriopulmonary anastomosis performed for the correction of tricuspid atresia.

Previous studies have focused mainly on the acute effects of smoking on the diastolic function of the heart. The present study was conducted to demonstrate the chronic effects of smoking on the diastolic functional parameters of the heart, including transmitral M- mode coloured flow propagation velocity (Vp), among relatively younger asymptomatic adults.Hundred smokers with histories of incessant smoking for at least one year prior to the time of the investigation were included in the prospectively designed study as group I. Group II consisted of 35 non-smokers, matched for age and gender. Addiction to smoking was graded according to the modified Fagerström test for nicotine dependence (M-FNDT). Each smoker was designated by a nicotine dependence index (NDI) according to the M-FNDT. Groups I and II were compared with respect to major diastolic functional parameters on transthoracic echocardiography (TTE), including the E/A ratio, deceleration time (DT), isovolumic relaxation time (IVRT) and Vp, along with basic clinical and echocardiographic parameters.Thirty one smokers in group 1 and 5 non-smokers in group 2 were excluded from the study according to the pre-defined exclusion criteria. Therefore 69 smokers (mean age: 30 +/- 4.9 years, M/F: 32/37) in group I were compared with 30 non-smokers (mean age: 31.4 +/- 4.8 years, M/F: 15/15) in group II. In group I the mean values of E/A and Vp were significantly lower (p0.001), whereas the mean values of IVRT and DT were significantly higher (p0.001) than in group II. In group I the value of NDI was positively correlated with the values of DT and IVTR (p0.001) and negatively correlated with the value of Vp (p0.001).Conventional and relatively new parameters of cardiac diastolic function, in particular Vp, were found to be impaired in smokers demonstrating the chronic adverse effects of smoking on the diastolic function of the heart. The severity of this impairment was closely correlated with the degree of addiction to smoking. (Cardiol J 2007; 14: 281-286).

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.

Kardiyovasküler alanda yüksek riskli vakaların belirlenmesinde kullanılan noninvazif tanı yöntemlerinin tanısal değeri, yüksek orandaki yalancı pozitif sonuçlar nedeniyle oldukça kısıtlıdır ve bu durum invazif tanı yöntemlerinin daha fazla kullanılmasına neden olmaktadır. Son yıllarda kullanılmaya başlayan kalp hızı türbülansı (heart rate turbulence, HRT) noninvazif ve pozitif prediktif değeri oldukça yüksek bir tanı yöntemi olarak karşımıza çıkmıştır. Bu derlemede HRT detaylı bir şekilde gözden geçirilmeye çalışılmıştır., Department of Cardiology, Cumhuriyet University, Faculty of Medicine, Sivas, Turkey. Diagnostic value of noninvasive diagnostic methods to use for detection of high risk cases on cardiovascular area are quite limited due to high rate of false positive results and this situiation bring about more use of invasive diagnostic methods. Recently been started to use heart rate turbulence (HRT) is a noninvasive diagnostic method and its positive predictive value is quite high. In this composition we studied the detailed inspection of HRT.

WOS: 000208702502314, …

Amaç: Hipertansiyon ciddi bir sağlık sorunudur. Antihipertansif tedavideki gelişmelere rağmen hastaların önemli bir kısmında kan basıncı kontrol altında değildir. Kan basıncının kontrolsüz olmasını etkileyen faktörleri araştırmak amacıyla son 1 yıldır antihipertansif tedavi alan hastaların sağlık karnelerini geriye doğru inceledik. Gereç ve Yöntem: En az 1 yıldır düzenli ilaç kullanan 107 ardışık hasta çalışmaya alındı. Kan basınçları değerlendirildi. Sağlık karneleri, antihipertansif ilaçlar yönünden son 1 yılı içerecek şekilde incelendi. Tüm değişiklikler not edildi. Bulgular: Çalışmaya katılanların %25.3’ünde son ofis ölçümüne göre kan basıncı kontrol altındaydı. Katılımcıların %74.8’inde son 1 yılda ekleme haricinde ilaç değişikliği yapıldığı, %65.4’ünde hastanın kullanmakta olduğu ilaç ya da ilaçlara ekleme tarzı değişiklik yapıldığı saptandı. Son 1 yılda ekleme haricinde ilaç değişikliği yapılması kan basıncının kontrol altında olmaması riskini 9.124 kat arttırıyordu. Sonuç: Hipertansif hastaların önemli bir kısmında kan basıncı kontrol altında değildir. Hipertansiyon hastalarında kontrolsüz kan basıncının hekim ve ilaç temelli nedenleri olduğunu düşünmekteyiz., Aim: Hypertension is a serious health problem. High blood pressure is uncontrolled among most of the patients despite improvements in the antihypertesnive therapy. In order to search for factors associated with uncontrolled blood pressure, we retrospectively reviewed the previous recipes of the patients. Material and Methods: 107 consecutive patients, who were on regular therapy with drugs for at least 1 year, were enrolled into study. Blood pressure measurements were evaluated. Previous recipes were searched for antihypertensive drugs back to 1 year. All changes were noted. Results: High blood pressure was under control among 25.3% of the participants. 74.8% of participants were noticed to have a modification, which was a kind of replacement with another drug, in their antihypertensive drugs, and 65.4% had an add on modification in their antihypertensive drugs. Replacement of drugs with another one within the last one year increased the risk of having uncontrolled blood pressure by 9.124 folds. Conclusion: A significant proportion of hypertensive patients had their blood pressure uncontrolled. We think that there are physician and medication based reasons for uncontrolled blood pressure among hypertensive patients.

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.

Heart rate turbulence (HRT) is a relatively newer parameter which has predictive value for mortality and severity in a variety of cardiovascular diseases. The study aim was to investigate the relationship between HRT and isolated acquired mitral stenosis (MS) on the basis of symptoms considered important in prognosis and for determining mechanical relief of the stenotic valve.Among 46 patients with MS undergoing transthoracic echocardiography (TTE), 22 with moderately severe or severe symptoms of MS (NYHA class 3-4) (group 1) were compared with 24 with mild to moderate or no symptoms of MS (NYHA class 1- 2) (group 2). Particular comparison was made with regards to HRT parameters of turbulence onset (TO) and turbulence slope (TS), along with basic clinical and conventional echocardiographic parameters.Group 1 differed significantly from group 2 in terms of mean mitral valve orifice area (p0.001), mean transmitral gradient (p0.001), and left atrial diameter (p0.05). Among the Holter parameters, TO in group 1 was significantly higher than in group 2. Overall, in MS, an abnormal TO value (or =0) was found to have sensitivity and specificity of 81.9% and 83.3%, respectively (p0.05) in distinguishing cases with moderately severe or severe symptoms.TO, a parameter of HRT, may be useful in the distinction and confirmation of severe symptoms in MS, and may aid in determining the need for mechanical relief of MS, which is especially difficult when discrepancies occur between echocardiographic findings and symptoms.

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.

Background: The aim of this study is to evaluate the affect of rapid maxillary expansion (RME) on cardiologic parameter.Methods: 12 patients (4 male and 8 females) with maxillary deficiency and bilateral cross-bite were selected to this study group. Before RME 24 h Holter monitoring of electrocardiography was used on patients. The prevalence analysis of arrhythmias, mean heart rate (MHR) and ventricular premature contraction (VPC) analysis was assessed over a 24-h period. Six months after achieving successfully expansion the Holter procedure was repeated again on patients.Results: VPC count per day and MHR, detected on 24 h ambulatory electrocardiography, showed significant statistical difference was present in pre and post-treatment periods. (VPC; 54.25±69.56/day, 6.50±5.98/day pConclusion: The patients with maxillary deficiency may have been a potential with cardiologic abnormalities. The expansion may improve the cardiac problems by expansion.

Ortner’s syndrome is a rare cause of hoarseness. It occurs due to left recurrent laryngeal nerve paralysis caused by an identifiable cardiovascular disease. Here, we present a case of Ortner's syndrome emerging due to pulmonary artery dilatation in a patient with idiopathic dilated cardiomyopathy.

The abuse of hydrocarbon by inhalation in adolescent ages has increased in last years due to the euphoric effect it provokes. Butane, which is a kind of hydrocarbon compound, may be abused by inhalation and thus lead to addiction. Inhaling lighter fluid containing butane can cause lung toxicity, brain damage, myocardial effects, and neurologic problems. We reported, in parallel to literature, a 19-year-old patient who inhaled lighter fluid and who presented with lung hemorrhage, hypoxia and acute coronary syndrome.

WOS: 000272763800023, PubMed ID: 19467925, …

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Poor RV function is a prognostic marker for mortality in patients with severe HF. We compared Levosimendan (L) versus Dobutamine (D) in patients with significant RV dysfunction (RVD) on top of severe left HF. Forty consecutive patients, with systolic HF and having moderate-tosevere RVD were randomized to L and D in a 2:1 fashion. Two groups were comparable in degree of RVD, EF, SPAP and creatinine values at baseline. After the infusion, EF improved, SPAP decreased significantly in both groups. TAPSE, having an independent prognostic role in HF, and RVFAC were improved significantly in patients with L compared to patients with D (Table 1). Furthermore, L improved both 24-hour urine output and creatinine, whereas, D did only small, but significant, improvement in urine output without in the creatinine levels. On the other hand, mean time period of hospitalization was significantly less in the L arm compared to D arm (9±1.8 vs. 11.3±3.1 days, p=0.024) with less requirement for intravenous loop diuretic (total dose divided by number of days of hospitalization) during the hospitalization period (mean intravenous dose per day 44mg vs. 72 mg, p=0.003). Furthermore, hospitalization period was negatively correlated with the percent change in 24-hour urine output in all group (r= -0.573, p=0.007).

OBJECTIVE: The recurrences and efficacy of classical approach and alternative approach anterior localization of the coronary sinus ostium for the slow pathway ablation using radiofrequency energy and a transcatheter technique in patients with atrioventricular nodal reentrant tachycardia AVNRT were evaluated.METHODS: We retrospectively reviewed all patients for AVNRT at the Sivas Numune Hospital from January 2010 to April 2012. The localization of the slow pathway ablation using radiofrequency energy and successfully procedure was documented. AVNRT recurrence was documented from hospital automation system or induced AVNRT who underwent second electrophysiology study.RESULTS: One hundred twenty two patients, 24% male n=30 , 76% female n=92 ; age 29,23±12,12 years who underwent radiofrequency ablation for AVNRT were included the study. Classical approach was used 43,4% n=56 ; alternative approach was used 51,2% n=66 of AVNRT patient. AVNRT recurrence was documented 5,6% n=3 in classical approach; also 4,7% n=3 in alternative approach p=0.837 . Follow-up was available for all patients at 15,1±3,5 month in classical approach group, and 16,4±4,4 month in alternative approach group p=0.082 . Multivariate analysis failed to identify any significant predictor of AVNRT recurrence.CONCLUSION: We could not identify any differences between recurrences ratio between classical approach and alternative approach for the AVNRT slow pathway ablation. In addition; anterior localization of the coronary sinus ostium ablation may be used, because of low complication risk., AMAÇ: Çalışmamızda yavaş yolağın ablasyonu için kullanılmakta olan klasik hedef bölge ile daha yakın zamanda kullanılmaya başlanan koroner sinüs ostiumu anterior komşuluğundan yapılan ablasyonun takibinde görülen rekürrens oranlarını karşılaştırmayı amaçladık.YÖNTEMLER: Sivas Numune Hastanesi Kardiyoloji Kliniği’nde 2010 yılından günümüze kadar elektrofizyolojik çalışma yapılmış ve AVNRT tanısı alıp radyofrekans ablasyon uygulanmış hastalar geriye dönük olarak taranarak bulundular. Bu hastaların işlem raporları ve intrakardiyak kayıtları incelenerek ablasyonda hangi hedef bölgelerin seçildiği ve işlemin başarılı olup olmadığı tespit edildi. Nüks takibinde ise hastaların dosyalarında ya da otomasyon sisteminde taşikardinin dökümante edildiği elektrokardiyogram/holter kaydının olup olmadığına; yada var olan şikayeti nedeniyle tekrar EPS işlemine alınıp taşikardi indüklenip indüklenmemesine göre tarandı.BULGULAR: Retrospektif olarak taranan toplam 122 hastadan %24’ü erkek n=30 , %76’sı kadındı n=92 . Hastaların yaş ortalaması 29,23±12,12 yıl idi. Hastalardan %43,4’ünde n=56 klasik yaklaşım, %51,2’sinde n=66 alternatif yaklaşım kullanılmıştı. Klasik yaklaşımda nüks %5,6 n=3 iken alternatif yaklaşımda %4,7 n=3 idi p=0.837 . Hastaların ortalama takip süreleri klasik yaklaşım kullanılan grupta 15,1±3,5 ay iken alternatif yaklaşım kullanılan grupta 16,4±4,4 ay idi p=0.082 . Yapılan multivariate regresyon analizinde nüksü göstermede bağımsız bir prediktör saptanmadı.SONUÇ: AVNRT ablasyonunda koroner sinüs ostium komşuluğunun tercih edilmesinin işlem başarısı, uzun süreli takiplerde nüks oranı açısından klasik yaklaşımdan aşağı olmadığını ve komplikasyon riskinin daha az olması nedeniyle tercih edilmesinin avantaj yaratacağını düşünüyoruz.