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Endocan is a soluble proteoglycan, secreted by human vascular endothelial cells. Endocan is a marker for vascular pathologies and an important mediator of angiogenesis, strongly associated with inflammation, vascular endothelial dysfunction, and atherosclerosis. The relationship between coronary artery ectasia (CAE) and endocan has not been evaluated. We aimed to investigate this association. Fifty-four patients with isolated CAE without coronary stenosis and 30 controls with normal coronary angiogram were included in this study. Endocan plasma concentrations were measured using an enzyme-linked immunosorbent assay. Patients with isolated CAE had significantly higher levels of endocan compared to the controls (18.9 ± 7.3 vs 15.6 ± 3.6 ng/mL; P = .007). There was a significant correlation between endocan levels and severity of isolated CAE according to the Markis classification ( r = −.593, P < .001). Plasma endocan levels may reflect the presence and severity of isolated CAE, suggesting that endocan may be involved in pathogenesis of isolated CAE.

BACKGROUND Stiffness of large arteries has been related to cardiovascular mortality. The cardioankle vascular index (CAVI) is a novel parameter of arterial stiffness. The main aim of the present study was to investigate the association between presystolic wave (PSW) on left ventricular outflow tract (LVOT) and CAVI. PATIENTS AND METHODS Patients admitted to the cardiology outpatient clinic were consecutively enrolled. Arterial stiffness was assessed by the CAVI. It was measured using a VaSera VS-1000 CAVI instrument. Pulse Doppler flow evaluation in LVOT was performed just proximal to the aortic valve in an apical five-chamber view. The presence of a PSW preceding the LVOT flow was assessed in all patients. RESULTS A total of 200 patients were enrolled consecutively. Patients with PSW had higher CAVI values compared with those without PSW (8.6±1.6 vs. 7.3±1.5). There was a significant correlation between PSW velocity and CAVI (r=0.34, P

Introduction: Nitrates, which lead to vasodilation in vessels, is one of the cornerstone drugs of antianginal therapy. The most frequently encountered side effect of nitrates is headache, which is linked to vasodilation of the cerebral arteries. Vasodilator response to nitrates is significantly reduced in patients with atherosclerosis. The aim of present study was to assess the relationship between nitrate-induced headache (NIH) and systemic and coronary atherosclerotic burden in patients with stable coronary artery disease. Patients and Methods: Overall, 40 patients with NIH (group I: 61.2 ± 8.56 years, 32 males) and 62 patients without headache (group II: 63.5 ± 8.45 years, 41 males) were included in the study. Systemic atherosclerotic burden was evaluated by carotid intima-media thickness (CIMT) and cardio-ankle vascular index (CAVI). Coronary atherosclerotic burden was assessed by the Gensini score. Results: CIMT and CAVI were significantly greater in group II than in group I (0.8 ± 0.20 vs. 0.6 ± 0.20 and 9.5 ± 1.0 vs. 8.4 ± 1.2, respectively; p< 0.001). The Gensini score was also higher in group II than in group I [median 32 (16.7-45.2) vs 12.5 (5.2-19.2); p< 0.001]. In multivariate analysis, headache was found as an independent determinant of CIMT, CAVI, and Gensini score (p< 0.001). Conclusion: Patients with NIH had a low level systemic and coronary atherosclerotic burden, evaluated by CIMT, CAVI, and Gensini score, compared with those without NIH.

Cardiovascular disease (CVD) is one of the main causes of morbidity and mortality in chronic obstructive pulmonary disease (COPD) patients however data regarding left ventricle (LV) function in COPD is limited. We, in this study, aimed to evaluate the LV systolic function and its relation to BODE index in COPD patients with the utility of two-dimensional speckle tracking echocardiography (2D-STE). The study involved 125 COPD patients and 30 control subjects. All patients underwent 2D-echocardiography, pulmonary function tests and -minute walk tests. The patients were divided into four quartiles according to BODE index score. COPD patients had lower mitral annulus systolic velocity (Sm), average global longitudinal strain (GLS), average global longitudinal strain rate systolic (GLSRs), average GLSR early diastolic (GLSRe), average GLSR late diastolic (GLSRa), tricuspid annular plane systolic excursion (TAPSE) and peak systolic myocardial velocity (Sm-RV) (p0.001, p0.001, p0.001, p0.001, p0.001, p0.001 and p = 0.002 respectively) than control subjects. There were significant differences between BODE index quartiles in terms of Sm, average GLS and average GLSRs. Patients were divided into two groups according to median value of GLS (-18.6 and ≤ -18.6). BODE index quartiles were found to be independent predictors of decreased GLS in multivariate logistic regression analysis (p = 0.030). Increased BODE index was associated with impaired LV mechanics in patients with COPD.

OBJECTIVE: Transradial approach (TRA) for coronary angiography is a popular alternative approach to transfemoral coronary angiography due to the infrequent occurrence of access site complications such as bleeding, hematoma and pseudoaneursym formation. However, not all patients are suitable for TRA. This study aimed to determine the predictors of radial artery diameter in patients who are candidates for TRA. METHODS: The study included 222 consecutive patients who underwent TRA due to suspected stable coronary artery disease. Radial artery diameter was evaluated prior to the procedure using B-mode ultrasonography. RESULTS: Radial artery diameter was correlated with wrist circumference (r=0.539, p

Introduction: Stress imaging tests are recommended in patients with positive exercise electrocardiography (EECG) and intermediate pretest probability. However the role of coronary computed tomography angiography (CCTA) in young women with intermediate pretest probability and positive EECG is under debate. The aim of this study was to assess the diagnostic value of CCTA in young women patients with low-intermediate pretest probability and positive EECG results. Patients and Methods: From a retrospective registry of 67 young women with positive EECG between January 2011 and January 2014 were included in this study. Of these 67 patients 32 patients underwent CCTA and 35 patients underwent MPS after EECG. Results: There were no statistically significant differences between groups in demographic variables, or cardiovascular risk profile. The exercise test was positive in all patients. Both groups were similar for exercise capacity and Duke treadmill score. Blood chemistry of the patients were similar. The median pre-test probability of obstructive coronary artery disease (CAD) was lower in CCTA group 28% (15-45%) than in MPS group (15-50) (p= 0.045). Overall 3 patients in the CCTA and 7 patients in the MPS group had significant lesions. All patients in the CCTA positive group had significant CAD, while 3 out of 7 patients with positive MPS findings had significant CAD in coronary angiography. Conclusion: CCTA may be a valuable alternative of stress imaging tests in women patients with low-intermediate pretest probability and positive EECG.

Objective: The ambulatory arterial stiffness index has been proposed as an indicator of arterial stiffness. The aim of this study was to test the hypothesis that increased ambulatory arterial stiffness index might be related with impaired left atrial function in hypertensive diabetic patients with no previous history of cardiovascular disease. Methods: Inclusion criteria included office systolic BP> 130 mm Hg or diastolic BP> 80 mm Hg and absence of secondary causes of HT, whereas exclusion criteria LV ejection fraction

Background Recently, the role of osteoprotegerin (OPG) in the pathogenesis of heart failure through different mechanisms has received much attention. Subclinical changes in left ventricular (LV) function can be identified using quantification of myocardial strain, and global longitudinal strain (GLS) is a superior predictor of outcomes than ejection fraction. We hypothesized that increased OPG levels could predict subclinical LV systolic dysfunction in treated diabetic hypertensive patients with preserved LV ejection fraction. Methods The study was composed of 86 diabetic hypertensive and 30 nondiabetic hypertensive patients. All patients underwent echocardiography and venous blood samples were taken for determination of OPG. The relation between OPG levels and LV GLS was investigated using 2-dimensional speckle tracking echocardiography. Results Diabetic hypertensive patients had higher diastolic peak early/early diastolic tissue velocity and lower systolic tissue velocity, GLS, GLS rate systolic, and GLS rate early diastolic than nondiabetic hypertensive patients ( P = 0.009, P = 0.049, P P = 0.004, and P 18.5 and ≤ 18.5). The patients with GLS ≤ 18.5 had higher diastolic blood pressure (mm Hg; P = 0.048), OPG (pmol/L; P P = 0.042) values than those with GLS > 18.5. In multivariate logistic regression analysis, OPG was found to be an independent predictor of impaired GLS ( P = 0.001). Receiver operating characteristic curve analysis revealed that OPG values of > 6.45 (pmol/L) identified the patients with GLS ≤ 18.5. Conclusions Plasma OPG values could predict subclinical LV systolic dysfunction in diabetic hypertensive patients.

OBJECTIVE It is important to know the elapsed symptom-to-door (StD) time between the emergence of ST-elevation myocardial infarction (STEMI) symptoms and admission to the hospital in terms of the selection of appropriate treatment and prognosis. In this study, we aimed to assess the relationship between serum C-reactive protein (CRP) and StD time after STEMI. METHODS 436 of the patients admitted to our center with STEMI between August 2012-February 2013 (338 male, mean age, 63.9±12.8) were included in this prospective-observational cohort study. Blood samples were obtained from laboratory results of the first reference period. Patients were divided into four groups according to the duration of StD time [0-1. hour; group 1 (G1), 1-3. hour; group 2 (G2), 3-6. hour; group 3 (G3), 6-12. hour; group 4 (G4)]. Statistical analysis was performed via chi-squre test, ANOVA test, Pearson's correlation analysis and receiver operator charecteristic (ROC) analysis. RESULTS As the time progressed, an increase in CRP levels was observed. The difference among the means of the G1-G3 (p=0.002), G1-G4 (p

Introduction: Stroke is one of the leading causes of permanent disability and death. Stroke is generally associated with ischemia and carotid artery stenosis is the reason in nearly one third of the cases. The aim of the present study was to investigate the short and mid term results of carotid artery stenting (KAS) procedures performed in high risk patients due to carotid artery disease who were admitted to cardiology clinic of our institution. Patients and Methods: The study group consisted of 14 consecutive high risk patients in whom KAS was performed in the cardiology clinic of our institution due to atherosclerotic carotid artery disease between October 2011 and October 2013. Procedural success, in-hospital and out-hospital stroke, myocardial infarction and all causes of mortality were evaluated. Results: Angiographic success was achieved in all patients. In-hospital and out-hospital acure coronary syndrome was not observed. One patient developed permanent stroke 24 hours after the procedure. This stroke was related with non-intervened carotid artery. This patient died 32 days after the procedure. Procedure related stroke or death was not occurred in any of the patients. Conclusion: KAS is a safe procedure in high risk patients for appropriately equipped experienced operators.

OBJECTIVE More cardiovascular events are seen in nephrotic syndrome (NS) patients than in the normal population. Fragmented QRS (fQRS) includes various RSR' patterns with different morphologies of the QRS complexes with or without the Q wave on a resting 12-lead ECG. A relationship between the presence of fQRS and myocardial function impairment has been shown in several studies. The purpose of this study was to evaluate the presence of fQRS in this patient group and the relationship with myocardial functions. METHODS Thirty-four NS patients were included in the cross-sectional study. Demographic data were recorded, and electrocardiograms (ECGs) were analyzed for the presence of fQRS following investigation of biochemical parameters and 24-h protein excretion. In addition to classic echocardiographic parameters, the myocardial performance (Tei index) was calculated as an indicator of cardiac function. For comparison of group's data Student's t-test and Mann-Whitney U test were used. Multiple linear regression analysis was performed for parameters affecting presence of fQRS. RESULTS We identified fQRS in half of our patients group. Patients with fQRS had significantly greater proteinuria level and Tei index than those without (p

The aim of this study is to evaluate the incidence and predictors of silent neuronal injury (SNI) after coronary angiography (CAG) and intervention by serial measurement of serum neuron-specific enolase (NSE) in patients presented with acute coronary syndrome (ACS). Ninety-eight consecutive patients presented with ACS and underwent CAG and intervention were included in the study. The NSE levels significantly increased after CAG and intervention compared to baseline levels (22.03 ± 27.70 and 10.08 ± 3.15 consecutively). Left ventricular ejection fraction in the SNI+ group was significantly lower than that in the SNI− group (43.71% ± 12.51%, 50.84% ± 9.34%, P = .002). Maximal creatinine kinase myocardial band, troponin I, and SYNTAX score of the SNI+ group were significantly higher than those of the SNI− group (103.83 ± 99.22, 51.92 ± 78.33, P = .006; 50.04 ± 66.18, 19.18 ± 30.50, P = .002; 103.83 ± 99.22, 51.92 ± 78.33, P = .006; and 50.04 ± 66.18, 19.18 ± 30.50, P = .002 successively). SYNTAX score and performing percutaneous coronary intervention were the independent predictors of SNI ( P = .009, odds ratio [OR] = 1.06, 95% confidence interval [CI] = 1.014-1.107, P = .036, OR = 4.262, 95% CI = 1.097-16.56). Percutaneous coronary intervention and coronary artery lesion complexity may increase the risk of SNI in patients with ACS.

Introduction: Peripheral artery disease (PAD) is a marker of systemic atherosclerosis and most patients with PAD also have concomitant coronary artery disease (CAD). Aim: There are no published data investigating the relationship between PAD and CAD complexity assessed by a well-accepted classification system such as the SYNTAX score (SS) or Trans-Atlantic Inter-Society Consensus II (TASC II). Material and methods: The study population consisted of 72 patients who underwent coronary angiography for the assessment of CAD. At the same session, peripheral angiography was performed in cases of suspected PAD. A coronary lesion was defined as significant if it caused a 50% reduction of the luminal diameter by visual estimation in vessels ≥ 1.5 mm. The SYNTAX score was computed by dedicated software. Results: Patients with peripheral artery disease were divided into four groups according to the Trans-Atlantic Inter-Society Consensus II classification. Numbers of patients with peripheral artery disease classified as A, B, C, and D by the Trans-Atlantic Inter-Society Consensus II classification were 27, 16, 18 and 11, respectively. SYNTAX scores for each group from A to D were 10 ±9, 11 ±10, 24 ±13 and 27 ±12, respectively; p for trend < 0.001. Conclusions: Higher Trans-Atlantic Inter-Society Consensus II classification is associated with higher SYNTAX score in patients who underwent coronary and peripheral diagnostic angiography. It may suggest that arterial atherosclerotic disease complexity is a systemic panvascular phenomenon.

OBJECTIVE 24-h ambulatory blood pressure monitoring (24-h ABPM) is a better predictor of cardiovascular events (CVEs) than spot blood pressure (BP) measurements in hypertensive diabetic patients. In this patient group, the underlying mechanism of the relationship between a nondipper pattern determined with 24-h ABPM and increased incidence of CVE is unknown. Cardioankle vascular index (CAVI) is a new index of the overall arterial stiffness from the aorta to the ankle. The objective of the present study was to evaluate the relationship between a dipper/nondipper pattern and arterial stiffness in hypertensive diabetic patients using the CAVI method. METHODS We enrolled 99 hypertensive patients with type-2 diabetes mellitus. 24-h ABPM and CAVI measurements were performed for all patients. The relationship between a dipper/nondipper pattern and CAVI measurements was analyzed. RESULTS Sixty-three (63.6%) patients had a nondipper pattern. In univariate analysis, CAVI, mean arterial pressure (MAP)-asleep, overall diastolic BP, overall systolic BP, duration of hypertension, and statin use were significantly higher among patients with a nondipper pattern than that in dippers. Multivariate linear regression analyses showed that the difference between MAP-asleep and MAP-awake was associated independently with CAVI (β coefficient=0.514, P

Introduction: Radiofrequency ablation of tachyarrhythmia is effective in the treatment of tachycardia. In this study, we evaluated the results of radiofrequency catheter ablation of tachyarrhythmia. Patients and Methods: From December 2010 to January 2012, 114 consecutive patients with symptomatic drug-resistant typical slow-fast atrioventricular nodal reentrant tachycardia, 17 patients with atrioventricular reentrant tachycardia (five Wolf Parkinson White syndrome), eight patients with atrial tachycardia, seven patients with atrial flutter, five patients with right ventricular outflow tract tachycardia and three patients with atrial fibrillation underwent an invasive electrophysiology study and radiofrequency ablation. Results: The 154 patients (age: 39.1 ± 17.2 years, body mass index: 24.3 ± 5.2 kg/m2, waist/ hip ratio: 0.88 ± 5.2, systolic blood pressure: 128.3 ± 22.4 mmHg, diastolic blood pressure: 75.30 ± 9.0 mmHg, resting heart rate: 76.10 ± 8.2 beat/minute) with tachycardia (89 women, 65 men) were ablated. Procedure and fluoroscopy times were 57.5 ± 19.0 and 14.4 ± 4.1 minute respectively. The mean follow up period was 10.2 ± 4.3 months. During follow up period three patients with atrioventricular nodal reentrant tachycardia, two patients with atrioventricular reentrant tachycardia, one patient with right ventricular outflow tract tachycardia and one patient with atrial fibrillation had recurrence. Conclusion: The transvenous radiofrequency ablation therapy is a safe and effective approach for the treatment of tachyarrhythmia under experienced hands.

Cetin, Mustafa/0000-0001-6342-436X; Durakoglugil, Emre/0000-0001-5268-4262; Erdogan, Turan/0000-0003-2986-5457; duman, hakan/0000-0002-1441-7320 WOS: 000397578400002 PubMed: 28932490 Background: Prolonged QRS duration is associated with decreased left ventricular (LV) systolic function. However, the relation between LV restrictive filling pattern (RFP) and QRS duration has not been investigated yet. the purpose of our study was to assess this relationship. Methods: We analyzed standard 12-lead surface electrocardiogram (ECG) of 155 consecutive patients. Mitral inflow and septal tissue velocities were obtained using the apical 4-chamber view with pulsed Doppler echocardiography. Patients were divided into 2 groups according to measured deceleration time (DT): restrictive (with DT 130 ms). Results: QRS duration was significantly longer in the restrictive group than in the non-restrictive group (0.101 vs. 0.090 s, p < 0.0001). QRS duration of > 0.10 s was highly specific (82.6%), but modestly sensitive (64.7%), for the prediction of LV RFP. Multivariate analyses demonstrated that E/A ratio, peak E, peak A, septal e', and a' velocities were significantly associated with RFP. Conclusions: Prolonged QRS duration (>0.10 s) obtained from a standard resting 12-lead ECG is associated with LV RFP. However, the relationship of QRS duration with RFP was not independent of echocardiographic parameters.

Objectives: Arterial stiffness and epicardial fat thickness (EFT) are associated with coronary artery disease (CAD). The cardio-ankle vascular index (CAVI) is a novel marker of arterial stiffness. The SYNTAX score (SS) reflects the complexity of CAD. We aimed to evaluate the relation of EFT and CAVI with CAD complexity in nondiabetic patients. Method: We enrolled 121 patients undergoing coronary angiography. In all patients, CAVI and EFT were determined. SS were calculated. The relationship between EFT, CAVI and SS was analyzed. Results: CAVI and EFT were significantly correlated with SS (r = 0.537, p < 0.001, and r = 0.629, p < 0.001, respectively) and found to be independent predictors of intermediate-high SS. For the prediction of intermediate-high SS, receiver-operating characteristic curve analysis revealed a cutoff value of 5 mm for EFT (area under the curve, AUC = 0.851, 95% confidence interval, CI, 0.775–0.910) with a specificity of 92.2% and a sensitivity of 77.4% and 8.6 for CAVI (AUC = 0.877, 95% CI 0.805–0.929) with a specificity of 68.9% and a sensitivity of 93.5%. Conclusion: CAD complexity is associated with adverse cardiovascular events. It can be predicted noninvasively with EFT and CAVI in nondiabetic patients with suspected CAD. Thus, patients at high risk for cardiovascular events may be detected early and managed with appropriate treatment strategies.

Objective: The aim of this study was to evaluate the relationship between peripheral artery disease (PAD) severity and complexity, as evaluated by TransAtlantic Inter-Society Consensus-II (TASC-II) classification, and neutrophil-to-lymphocyte (N/L) ratio. Methods: A total of 407 patients underwent peripheral angiography due to signs and symptoms of PAD; of these, 64 patients were excluded and the remaining 343 patients were enrolled in this cross-sectional study. Patients with previous peripheral revascularizations, acute coronary syndrome, vasculitis, non-atherosclerotic stenosis, and malignancy were excluded. Patients were divided into 4 groups according to TASC-II classification, and clinical and laboratory data were compared. The chi-square test, Student’s t-test, Mann–Whitney U test, analysis of variance, Kruskal–Wallis test, Spearman’s correlation analysis, multiple logistic regression analysis, and receiver operating characteristic (ROC) curve analysis were used for statistical analysis. Results: Lymphocyte count was weakly correlated (r=–0.169, p=0.002) whereas neutrophil count and N/L ratio were moderately correlated with the TASC score (r=0.432, p3.05 (sensitivity=75.0%, specificity=62.9%, area under the curve=0.678, 95% CI=0.688–0.784, p

In the present study, we aimed to evaluate temporal changes in heart-type fatty acid-binding protein (h-FABP) and myocardial performance index (Tei index) following administration of 5-fluorouracil (5-FU), a chemotherapeutic agent associated with myocardial ischemia induced by coronary vasospasm. Thirty-two patients with cancer receiving their first 5-FU-based chemotherapy were included in the study. Prior to chemotherapy and 24 hours after the initiation of chemotherapy, all patients underwent a comprehensive echocardiographic examination. Blood samples were taken for h-FABP and troponin I (TnI) measurements at different time points during the first 24 hours of 5-FU administration. Postinfusion echocardiography revealed worsening in Tei index (0.37 ± 0.08 vs 0.43 ± 0.07, P < .001). Clinically overt cardiotoxicity was evident in 4 (12.5%) of our patient population. Heart-type fatty acid binding protein and TnI levels were within normal ranges at all time points. Our results suggest that ischemia coronary vasospasm due to 5-FU cardiotoxicity should be reviewed. Furthermore, Tei index might be a sensitive indicator of occult 5-FU cardiotoxicity.

Objectives: Ankylosing spondylitis (AS) is a chronic inflammatory disease that often leads to cardiovascular complications including aortic regurgitation and conduction disturbances. Left ventricular (LV) systolic asynchrony is defined as loss of the simultaneous peak contraction of corresponding cardiac segments. The aim of this study was to evaluate LV systolic asynchrony noninvasively in patients with AS by using tissue synchrony imaging (TSI). Methods: Asynchrony was evaluated in 77 AS patients (61 male, mean age 36.4 ± 10 years) and 40 controls (35 male, mean age 39.1 ± 8.2 years). All study population underwent a comprehensive echocardiographic evaluation including TSI. The time to regional peak systolic velocity (Ts) during the ejection phase in LV was measured from TSI images by the six-basal and six-midsegmental model, and four TSI parameters of systolic asynchrony were computed. Results: The baseline demographic and echocardiographic characteristics were similar between the patients enrolled and controls. All TSI parameters of LV asynchrony were prolonged in patients with AS compared to controls: the standard deviation (SD) of the 12 LV segments Ts (39.6 ± 19.6 vs. 24.7 ± 11.6, P < 0.001); the maximal difference in Ts between any 2 of the 12 LV segments (122.1 ± 52.9 vs. 82.2 ± 38.6, P < 0.001); the SD of the six basal LV segments (33.5 ± 20.2 vs. 23 ± 13.3, P = 0.008); and the maximal difference in Ts between any two of the six basal LV segments (84.6 ± 48.1 vs. 60.4 ± 34.6, P = 0.008). The asynchrony parameters were significantly correlated with index of myocardial performance (Tei index) and peak systolic mitral annular velocity. Conclusion: TSI showed presence of LV systolic asynchrony in patients with AS which may account for the cardiovascular complications of AS. (Echocardiography 2012;29:661-667)

OBJECTIVES: We aimed to assess arterial stiffness parameters and to investigate the relationship between these parameters and aortic calcification in patients with aortic arch calcification and without symptomatic atherosclerotic disease. STUDY DESIGN: The population of this study consisted of 41 patients with aortic arch calcification verified by chest X-ray (group I, 17 males, mean age 70±5 years) and individuals without aortic arch calcification (group II, 17 males, mean age 68±6 years). Subjects with symptomatic or known vascular disease were excluded from the study. The arterial stiffness parameters of all subjects were measured non-invasively with a SphygmoCor device. Aortic pulse wave velocity (PWV), augmentation pressure (AP), augmentation index (AIx) and heart rate normalized augmentation index (AIx@75) were used as parameters of arterial stiffness. RESULTS: The two groups were compared according to demographic characteristics, medications currently being taken, and levels of serum lipids. There was no significant difference between the groups. AP in group I was significantly higher than that of group II (p=0.002). AIx and AIx@75 were similar in both groups. Aortic PWV of group I was significantly higher than that of group II (p

Aims: There is limited data on alterations in novel right ventricular (RV) function indices like tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular systolic velocity (TASV) after transcatheter atrial septal defect (ASD) closure. We aimed to evaluate RV function by echocardiography (ECG) with these novel indices in early period in patients with secundum-type ASD that was closed percutaneously. Methods: Patients were enrolled to study if they had secundum-type ASD that was suitable for percutaneous closure. Patient population consisted of 4 men and 16 women. Echocardiography was performed before and 1 month after closure. Results: Mean age was 37 ± 16. Mean diameter of ASD and total atrial septum length measured by ECG were 19 ± 6 mm and 49 ± 7 mm, respectively. Mean diameter of defect in transesophageal echocardiography was 20 ± 6 mm. Stretched mean diameter in catheterization was 23 ± 6 mm. One month after closure, there were statistically significant decreases in RV end-diastolic diameters (43.3 ± 10.7 mm vs. 34.9 ± 5.5 mm; P < 0.001), RV/left ventricular (LV) end-diastolic diameter ratio (1.1 ± 0.3 vs. 0.87 ± 0.1; P < 0.001), TASV (16.9 ± 3.2 cm/sec vs. 14.3 ± 3.3 cm/sec; P < 0.05), early diastolic tricuspid annular velocity (15.3 ± 3.1 cm/sec vs. 13.4 ± 2.4 cm/sec P

Stenting is a safe and efficient method for treatment of ischaemic heart disease. Nevertheless, it gives rise to some additional problems, especially in-stent restenosis. Several techniques including balloon angioplasty, restenting, rotaablation, excimer laser angioplasty, directional coronary atherectomy, cutting balloon angioplasty, brachitherapy and radioactive stents have been performed to treat in-stent restenosis. Balloon angioplasty is preferred in focal lesions (

The Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure classifies blood pressure (BP) as normal, prehypertension, and hypertension. Although it has been shown that there is a relationship between hypertension and arterial stiffness, there is not sufficient data about arterial stiffness in patients with prehypertension. The present study was designed to evaluate arterial stiffness and wave reflections in subjects with prehypertension. We evaluated arterial stiffness and wave reflections of 45 subjects with prehypertension and an age-matched control group of 40 normotensive individuals, using applanation tonometry (Sphygmocor, AtCor Medical, Sydney, Australia). Aortic pulse wave velocity (PWV) was measured as indices of elastic-type aortic stiffness. The heart rate-corrected augmentation index (AIx@75) was estimated as a composite marker of wave reflections and arterial stiffness. Aortic PWV (10 +/- 2.5 vs. 8.6 +/- 1.7, m/s, p = 0.004) and AIx@75 (21 +/- 8.3 vs. 10 +/- 9.1, %, p = 0.0001) were significantly higher in subjects with prehypertension than in the control group. In multiple linear regression analysis, we found that the presence of the prehypertension was a significant predictor of aortic PWV (beta = 0.26, p = 0.009) and AIx@75 (beta = 0.46, p = 0.0001). Our results suggest that arterial functions were impaired even at the prehypertensive stage.

PURPOSE: We investigated the relationship between scintigraphic infarct size and neutrophil counts after acute myocardial infarction (AMI), which has not been adequately studied with imaging tools. METHODS: Twenty-eight consecutive patients with anterior AMI were included in the study. Total white blood cell (WBC), neutrophil counts, creatine kinase-myocardial band (CKMB), and cardiac troponin (cTnT) were obtained at admission and daily during the first 72 h after a patient's arrival. Single photon emission computed tomography studies were performed at a median interval of 4 days (range, 3-5 days) after the AMI. The severity scores of perfusion defects were calculated. WBC and neutrophil counts correlated with enzymatic and single photon emission computed tomography infarct size. RESULTS: Leukocyte and neutrophil counts on admission and first day were positively correlated with peak CKMB, peak cTnT, and scintigraphic infarct size. There were no statistical correlations on the second and third days (P>0.05). The most significant relationship was between basal neutrophil counts and scintigraphic infarct size (r = 0.602, P

It is well known the relationship between oxidative stress and vascular function. However, association between total antioxidative capacity and arterial stiffness was not studied in patients with hypertension (HT). This study investigated whether total antioxidative capacity is associated with arterial stiffness and wave reflections. We studied 46 (age 48.5 +/- 10.6 years) never treated patients with HT and age-matched control group of 40 (age 47 +/- 8.6 years) normotensive individuals. Total antioxidative capacity level was determined in all subjects. We evaluated arterial stiffness and wave reflections of the study population, using applanation tonometry (SphygmoCor). Carotid-femoral pulse-wave velocity (PWV) was measured as index of aortic stiffness. The heart rate-corrected augmentation index (AIx@75) was estimated as a composite marker of wave reflections and arterial stiffness. Carotid-femoral PWV (10.5 +/- 2.2 vs 8.7 +/- 1.6, m/s, P = 0.0001) and AIx@75 (22.7 +/- 9.5 vs 15 +/- 11, %, P = 0.001) were significantly higher in patients with HT compared with age-matched control subjects. Total antioxidative capacity level (274 +/- 70 vs 321 +/- 56 micromol/l, P = 0.001) was significantly lower in hypertensive patients than controls. In the whole population, total antioxidative capacity level negatively correlated with AIx@75 (r = -0.24, P = 0.02) in univariable analysis, but not with carotid-femoral PWV (r = -0.08, P = 0.43). Also, we found that total antioxidative capacity level (beta = -0.21, P = 0.03) was an independent determinant of AIx@75 in multivariable analysis. Our results suggest that the decrease in the ability of antioxidant defenses contributes significantly to increased wave reflections.

OBJECTIVE The evidence of structural and functional cardiac abnormalities has been demonstrated by echocardiography in patients with chronic kidney disease (CKD). This study investigated whether left ventricular (LV) asynchrony is present in patients with CKD and normal QRS duration. METHODS Tissue synchronization imaging (TSI) was performed in 25 (56 +/- 14 years) patients with CKD and narrow QRS complexes and 25 (51 +/- 12 years) control subjects. LV asynchrony was identified on TSI images and the time to regional peak systolic velocity (Ts) in LV was measured by the six-basal-six-midsegmental model. Four TSI parameters of systolic asynchrony were computed when Ts was measured in ejection phase. RESULTS The standard deviation of Ts of 12 LV segments (33.6 +/- 17.8 vs 16.7 +/- 10 ms, P = 0.0001), standard deviation of Ts of the six basal LV segments (30 +/- 20 vs 17.6 +/- 9.6 ms, P = 0.008), maximal difference in Ts between any two of the 12 LV segments (102 +/- 45 vs 54 +/- 32 ms, P = 0.0001), and maximal difference in Ts between any two of the six basal LV segments (78 +/- 50 vs 46 +/- 22 ms, P = 0.007) were prolonged in patients with CKD compared with controls. The prevalence of LV systolic asynchrony was significantly higher in patients with CKD compared with controls (44% vs 12%, P = 0.01). The standard deviation of Ts of 12 LV segments were significantly associated with LV diameters, LV volumes, LV mass, blood pressure levels, and renal functions in univariate analysis. CONCLUSION The results of this study indicate that LV systolic asynchrony may develop in patients with CKD.

Objective: The aim of this study was to assess flow-mediated dilatation (FMD) of the brachial artery in patients with acromegaly. Subjects and Methods: We prospectively evaluated 25 patients with acromegaly (14 females, 11 males; aged 42 ± 12 years; growth hormone (GH) levels 34 ± 14 ng/ml) and 27 control subjects (15 females, 12 males; aged 45 ± 8 years; GH levels 3 ± 1.5 ng/ml). The patients and controls were matched for age, gender, body mass index, cigarette smoking, blood pressure, lipid levels, diabetes mellitus, hypertension, and its duration. Endothelial function, measured as FMD of the brachial artery using ultrasound, was calculated in the 2 groups. The endothelial function was evaluated by assessing 1-min postischemic FMD of the brachial artery. Results: The FMD was lower in patients with acromegaly (9.97 ± 3.5%) than in controls (16.1 ± 3.4%), and the difference was statistically significant (p = 0.0001). Conclusion: Endothelial dysfunction may develop in the preclinical phase of atherosclerosis in patients with acromegaly. Endothelium-dependent FMD may be impaired in acromegalic patients, and measurement of endothelial function may identify high-risk individuals earlier.

The role of endogenous relaxin on hypertensive cardiovascular damage remains unknown. We investigated the relaxin level and its relation to cardiovascular function in patients with never treated hypertension (HT).We studied 42 (47.8+/-10 years) never treated patients with HT and 40 age-matched (47+/-8.6 years) normotensive individuals. Serum relaxin levels were determined in all subjects using enzyme-linked immunosorbent assay. Left ventricular (LV) diameters were evaluated by transthoracic echocardiography. Ejection fraction and LV mass index were measured. Diastolic functions were evaluated with both conventional and tissue Doppler echocardiography. We evaluated central aortic pressures, heart rate-corrected augmentation index (AIx@75), a marker of wave reflections, and aortic pulse wave velocity (PWV) as indices of elastic-type aortic stiffness of the study population using applanation tonometry (SphygmoCor).Relaxin levels were significantly lower in hypertensive patients as compared with controls (36.5+/-7.3 vs 49.7+/-39.8 pg/ml, p=0.03). The relaxin level was negatively correlated with brachial and central aortic pressure. However, serum relaxin was not significantly associated with LV diameters, ejection fraction, LV mass index, LV diastolic function, AIx@75 or aortic PWV in our study.Serum relaxin is decreased in patients with HT. However, low endogenous relaxin is not related to cardiovascular function.

Background Aortic stiffness is an independent risk factor for cardiovascular events and mortality. The measurement of pulse-wave velocity (PWV) is the most simple, noninvasive, and robust method to determine aortic stiffness. Whether aortic stiffness contributes to aortic valve sclerosis (AVS) remains unknown. The aim of the present study was to examine the relationship between PWV and AVS in subjects free of clinically evident atherosclerotic disease. Methods We enrolled 62 patients (48 men; age 65 +/- 8 years) diagnosed with AVS and an additional 62 age-, hypertension-, diabetes mellitus-, and history of smoking-matched subjects without AVS. Applanation tonometry was applied to assess the augmentation index and aortic PWV. The subjects with symptomatic vascular disease were excluded from the study. AVS was defined by echocardiography as thickening and calcification of the normal trileaflet aortic valve without obstruction to the left ventricular outflow. Results There was no significant difference between the two groups regarding the aortic PWV and augmentation index (11.7+/-3.3 vs 11.8+/-3.7, P=0.85; 28.0+/-9.4 vs 25.0+/-8.6, P=0. 17, respectively). The presence of AVS was significantly correlated with ejection fraction (r=0.211, P=0.011), male gender (r=0.362, P=0.0001), and age (r=0.200, P=0.026). Conclusions The lack of an association between the aortic PWV and AVS suggests that AVS is a complex phenomenon consisting of several distinct processes, related to both atherosclerotic and nonatherosclerotic processes.

Objective: In the present study, we aimed to compare the amount of epicardial adipose tissue in subjects with and without xanthelasma. Subjects and Methods: Fifty-two subjects with xanthelasma and 52 age- and gender-matched control subjects were enrolled in this study. Epicardial adipose tissue was assessed by measuring epicardial fat thickness (EFT) with echocardiography. Participants were dichotomized according to median EFT, which was 4 mm. The group with EFT >4 mm was defined as the supramedian group. Body mass index (BMI) was calculated by weight (kilograms) divided by height (meters) squared. Conditional logistic regression analysis was performed to find independent factors associated with supramedian EFT (>4 mm). Results: Subjects with xanthelasma had higher BMI (31.2 ± 5.6 vs. 28.6 ± 5.7, p = 0.01) and higher levels of total cholesterol (216 ± 54 vs. 181 ± 42 mg/dl, p < 0.001), LDL cholesterol (142 ± 45 vs. 115 ± 36 mg/dl, p = 0.003) and triglycerides (median, 154 vs. 101 mg/dl, p = 0.01) than control subjects. EFT was significantly higher in subjects with xanthelasma than in controls (5.04 ± 2.02 vs. 3.81 ± 2.03 mm, p = 0.002). In the conditional logistic regression analysis, the presence of xanthelasma (OR, 3.55; 95% CI, 1.43-8.78, p = 0.006) and lower HDL cholesterol level (OR, 0.96; 95% CI, 0.92-0.99, p = 0.023) were independently associated with supramedian EFT. Conclusion: The amount of epicardial adipose tissue found in subjects with xanthelasma was higher than in subjects without xanthelasma. In addition, the presence of xanthelasma was independently associated with supramedian EFT.

BackgroundThe main aim of the current study was to investigate the association between presystolic wave (PSW) and subclinical left ventricular (LV) dysfunction.Patients and methodsA total of 139 patients admitted to the cardiology outpatient clinic with hypertension were consecutively enrolled. The patient population included 79 men and 60 women. The presence of a PSW on the left ventricular outflow tract flow was evaluated in all patients. Subclinical LV dysfunction was defined as the presence of a tissue Doppler-derived myocardial performance index (MPI) of at least 0.5 in the absence of impaired left ventricular ejection fraction (

Background: The aim of this study was to assess left ventricular (LV) function and the Tei index by tissue Doppler imaging (TDI), and also to evaluate the relationship of serum cortisol level with the Tei index and LV function in patients with Cushing's Syndrome (CS). Methods: We prospectively evaluated 22 patients with CS and 23 control subjects. LV function was assessed by echocardiography. Early diastolic (Em), late diastolic (Am), peak systolic (Sm), mitral annular velocities, Em/Am, the Tei index, and E/Em were calculated by TDI. Mitral inflow velocities, color M-mode flow propagation velocity (Vp), relative wall thickness (RWT), and LV mass index (LVMI) were assessed by two-dimensional echocardiography. Result: Peak (E) velocity and the ratio of E to peak late (A) velocity (E/A) were lower in those with CS than in those without. Patients with CS had significantly higher RWT, IVRT, and LVMI than those controls. Vp was lower in the CS-patients than that in control subjects. Em and Em/Am were lower in patients with CS than those in controls. In patients with CS, the Tei index was significantly higher than control subjects. Conclusion: Serum cortisol level was positively correlated with the Tei index and E/Em ratio but negatively correlated with Em, Sm, and EF only in patients with CS. Serum cortisol level positively correlated with the Tei index and E/Em ratio but negatively correlated with Em, EF, and Sm. The parameters obtained from lateral mitral annulus by TDI can be used for identification of LV diastolic dysfunction in patients with CS.

Cushing's Syndrome (CS) is associated with excess and premature cardiovascular disease. Endothelial dysfunction is the initiating event in the development of atherosclerosis. Endothelial function is assessed by flow-mediated dilatation (FMD) of brachial artery. The aim of this study was to assess FMD in patients with CS.We prospectively evaluated 22 patients with CS (12 women, 10 men; aged 42 +/- 11 years, serum cortisol 28.2 +/- 14 microg/dl, 24-h urinary free cortisol (UFC) 269 +/- 92 microg/day), and 23 control subjects (13 women, 10 men; aged 43 +/- 10 years, serum cortisol 14 +/- 4 microg/dl, 24 h cortisol 60 +/- 22 microg/day). Endothelial function, measured as FMD of the brachial artery using ultrasound, was calculated in two groups. Endothelial function was evaluated by assessing 1-min postischemic FMD of the brachial artery.FMD was lower in patients with CS than that in those without (11.7 +/- 4.8% vs. 15.8 +/- 3.2%, P = 0.0001, respectively). There was no significant difference between two groups regarding baseline diameter of brachial artery. But, hyperemia diameter was lower in patients with CS than without CS (3.6 +/- 0.22 mm vs. 3.9 +/- 0.19 mm, P = 0.04, respectively).Endothelium-dependent FMD may impair in patients with CS compared to controls. Measurement of endothelial function may identify high-risk individuals early and therapy to reduce or retard endothelial dysfunction in patients with CS may lead to decreased cardiovascular morbidity and mortality.

Background The diagonal ear-lobe crease (ELC) has been suggested as a simple marker of cardiovascular disease in the general population. There is no knowledge concerning the relation between carotid intima-media thickness (IMT), an index of subclinical atherosclerosis, and diagonal ELC. The aim of our study was to assess this relation. Methods and results The study population was prospectively selected from apparently healthy subjects. Sixty-five consecutive subjects with ELC and 65 age- and gender-matched control subjects without ELC were included in this study. These were examined by B-mode ultrasound to measure the IMT at the far wall of the common carotid artery. Subjects with ELC had significantly higher carotid IMT compared to control subjects without ELC (0.88±0.14 versus 0.69±0.14mm, respectively, p =0.0001). The presence of ELC was independently associated with IMT in the multivariate logistic regression analysis. In addition, we detected a significant positive correlation between the presence of ELC and carotid IMT ( r =0.558, p =0.0001). Conclusions We have shown for the first time an association between increased carotid IMT and diagonal ELC in apparently healthy subjects.

Hyperparathyroid condition might influence endothelial cells. The aim of this study was to assess flow mediated dilatation (FMD) in patients with primary hyperparathyroidism (PHPT).We prospectively evaluated 21 patients with PHPT (9 women, 12 men; aged 50 +/- 11 years, serum calcium 11.6 +/- 0.7 mg/dl, intact parathyroid hormone (iPTH) 489 +/- 495 pg/ml) and 27 healthy control subjects (13 women, 14 men; aged 49 +/- 10 years, serum calcium 9.4 +/- 0.5 mg/dl, iPTH 28 +/- 8.5 pg/ml). Endothelial function, measured as FMD of the brachial artery using ultrasound, was calculated in two groups. To avoid confounding factors, conditions known to affect endothelial function like diabetes mellitus, hypertension, dyslipidemia, smoking, coronary and peripheral artery disease were excluded from both groups.FMD was lower in patients with PHPT than that in those without (10.2 +/- 5.8 vs. 19.8 +/- 5.8, P = 0.0001). FMD negatively correlated with serum calcium (r = -0.55, P = 0.002).Endothelium-dependent FMD may impair in patients with PHPT compared to controls. Endothelial dysfunction can contribute to the deleterious cardiovascular effects of PTH excess. Therapy to reduce or retard endothelial dysfunction in patients with PHPT may lead to decreased cardiovascular morbidity and mortality.

The aim of this study was to assess the relationship between flow-mediated dilatation (FMD) and left ventricular (LV) systolic and diastolic function in type 2 diabetic patients with or without microalbuminuria.We prospectively evaluated 68 consecutive patients (36 women, 32 men; mean age 57 +/- 11 yr) with type 2 diabetes mellitus (DM). Patients were divided into two groups according to whether or not they had microalbuminuria: group 1 (n = 29, mean age 58 +/- 10 yr) with microalbuminuria and group 2 (n = 39, mean age 56 +/- 10 yr) without microalbuminuria. LV function was assessed by classical methods and Doppler tissue imaging (DTI). Left ventricular ejection fraction (EF), interventricular (IVS) and posterior wall (PW) thickness, peak early (E) and late (A) transmitral filling velocities, their ratio (E/A) and deceleration time of the mitral E wave (DT), LV isovolumetric relaxation time (IVRT), flow propagation of velocity (Vp), and E/Vp were evaluated by conventional echocardiography. Early diastolic (Em), late diastolic (Am), and peak systolic (Sm) mitral annular velocities were measured. Em/Am and the ratio of early diastolic mitral inflow velocity to Em (E/Em), which is a reasonably good index for predicting elevated LV filling pressure, were calculated by DTI. Endothelial function, measured as flow-mediated dilatation of the brachial artery using ultrasound, was calculated in two groups.FMD was lower in those with microalbuminuria than those without (8.8 +/- 6.44% vs 12.6 +/- 7.24%, p = 0.03). Group 1 had longer DT (223 +/- 39 ms vs 199 +/- 37 ms, p = 0.01) and longer IVRT (109 +/- 13 ms vs 100 +/- 13 ms, p = 0.03) than that of group 2 with conventional echocardiography. Group 1 had significantly lower Em/ Am (0.79 +/- 0.27 cm/s vs 1.02 +/- 0.44 cm/s, p = 0.01), lower Vp (40.4 +/- 9.98 vs 50.4 +/- 19.01 cm/s, p = 0.01) than that of group 2. Group 1 had significantly higher serum creatinine (1 +/- 0.33 mg/dL vs 0.7 +/- 0.19, p = 0.001). In logistic regression analysis, FMD was the only variable independently related to microalbuminuria. FMD was positively correlated with EF (r = 0.43, p = 0.02) and E/A (r = 0.40, p = 0.03), and negatively correlated with E/Em (r = 0.41, p = 0.04) and E/Vp (r = 0.41, p = 0.04) only in patients with microalbuminuria.It was found that left ventricular diastolic function and FMD are impaired in type 2 diabetic patients with microalbuminuria. FMD may be related to LV diastolic dysfunction only in patients with microalbuminuria.

We studied tissue Doppler parameters in patients with atrial fibrillation following acute myocardial infarction, and their relation to P wave durations and P dispersion.Echocardiographic examination was performed in 84 consecutive patients with first anterior acute myocardial infarction. In addition to other conventional echocardiographic parameters, the peak systolic (Sm), early diastolic (Em) and late diastolic (Am) velocities were obtained at the lateral corner of the mitral annulus by pulsed wave tissue Doppler. The Em/Am ratio and the ratio of early diastolic mitral inflow velocity to Em (E/Em), which is a marker of diastolic filling pressure, were calculated. Electrocardiogram was recorded from all patients on admission; P wave measurements were also performed.Atrial fibrillation occurred in 20 (23.8%) of 84 patients. The patients with atrial fibrillation had significant reduction of Em (5.6+/-1.5 vs. 8.7+/-2.7 cm/s, p0.001), Em/Am (0.61+/-0.27 vs. 0.84+/-0.23, p = 0.001) and Sm (7.1+/-1.0 vs. 8.3+/-1.9 cm/s, p0.001) values compared with those without. The E/Em ratio (14.45+/-4.62 vs. 7.47+/-2.79, p0.001), P maximum (102+/-11 vs. 95+/-11 ms, p = 0.02) and P dispersion (35+/-7 vs. 26+/-7 ms, p0.001) were significantly higher in patients with atrial fibrillation than in those without. In all patients, P dispersion showed significant correlation with Em (r = -0.33, p = 0.002), Sm (r = -0.40, p0.001) and E/Em (r = 0.32, p = 0.003). When E/Emor = 10 was used as cutpoint, atrial fibrillation could be predicted with a sensitivity of 90%, and a specificity of 84%.The patients with atrial fibrillation following acute myocardial infarction have reduced systolic and diastolic mitral annular velocities and increased E/Em ratio, P maximum and P dispersion values compared to those without. P dispersion is correlated with systolic and diastolic left ventricular function after acute myocardial infarction. The E/Em ratio appears to be a useful parameter for assessing the risk of atrial fibrillation occurrence after anterior acute myocardial infarction.

Objective - Within the last few years a number of thrombophilic mutations have been identified. Pre-symptomatic testing for these established genetic risk factors identifies individuals predisposed to a disease and often allows to select suitable prophylactic interventions in time. We investigated wether or not the prothrombin G20210A allele, the factor V Leiden G1691A, and MTHFR C677T allele are risk factors for left ventricular thrombus (LV) in patients with myocardial infarction (AMI) or not. Methods and results - We analysed clinical, echocardiographic and biochemical data in 183 consecutive patients (aged 58 ′ 12 years; 34 women) with a first anterior acute myocardial infarction. Two-dimensional echocardiographic examination was performed on days 1, 3, 7, 15, and 30. LV thrombi were detected in 42 (23%) of the 183 patients with acute myocardial infarction. We have used multiplex assays based on PCR and DNA hybridization in microtitre plates for the simultaneous analysis of three mutations (FV Leiden G1691A, prothrombin G20210A, and MTHFR C677T). No significant differences in allele frequencies of FV Leiden G 1691 A (9.5% vs. 8.5%, p = 0.75), prothrombin G20210A (9.5% vs 7.1%, p = 0.74) and MTHFR C677T (47.6% vs. 50.3%, p = 0.74) were found in patients with LV thrombus when compared with those without LV thrombus. No significant differences in haemostatic factor levels were found in patients with LV thrombus when compared with those without LV thrombus. Conclusion - FV Leiden, prothrombin 20210 variant, and MTHFR mutation are no risk factors for left ventricular thrombus in patients with myocardial infarction. The presence of multiple mutations did not influence the development and outcome of LV thrombus in patients with myocardial infarction.

Objectives: The aim of the present study was to investigate whether ST segment depression in precordial leads at the time of acute inferior myocardial infarction represents a reciprocal change rather than concurrent anterior wall ischemia on the surface electrocardiography. Background: The mechanism of reciprocal ST segment depression during acute myocardial infarction is controversial. “Ischemia at a distance” or a benign electrical phenomenon has been implicated in numerous reports. Pulsed-wave tissue Doppler (PWTD) echocardiography can be used to examine the regional diastolic motion of the left ventricular myocardial wall and may allow the detection of ischemic segments. Methods: We evaluated regional myocardial ischemia using PWTD echocardiography in 48 patients with a first inferior wall myocardial infarction. The left ventricle was divided into 16 segments. PWTD echocardiographic velocities were obtained from each left ventricular segments. Results: Reciprocal ST segment depression was present in 35 patients (Group 1) but not in the remaining 13 patients (Group 2). There were no significant differences between groups 1 and 2 with respect to systolic (S) (7.4 ± 1.1 vs 6.8 ± 0.9 cm/s; P > 0.05), early (E) (10.5 ± 2 vs 9.4 ± 1.2 cm/s; P > 0.05), and late (A) (9.5 ± 3.2 vs 8.5 ± 2.3 cm/s; P > 0.05) diastolic waves peak velocities, E/A ratio 1.1 ± 0.2 vs 1.1 ± 0.1; P > 0.05), Ewave deceleration time (DT) (92 ± 17 vs 101 ± 16 ms; P > 0.05) and regional relaxation time (RT) (82 ± 19 vs 93 ± 21 ms; P > 0.05) in anterior wall (basal levels), which correspond to reciprocal ST segment depression on electrocardiography. According to E/A ratio detected by PWTD echocardiography in anterior wall and anterior septum, patients with reciprocal ST segment depression were also divided into two groups: Group A, with E/A ratio > 1; Group B, with E/A ratio < 1. Among the 35 patients with reciprocal ST segment depression, anterior wall ischemia was present in 10 patients and absent in 25 patients, whereas anterior septal ischemia was present 12 patients and absent in 23 patients. Conclusions: Reciprocal ST segment depression during the early phases of inferior infarction is an electrical reflection of primary ST segment elevation in the area of infarction.

Introduction: Atrial septal defect (ASD) is the most common congenital heart disease in adults and constitutes 5-10% of all congenital heart disease. Primary surgical closure has been the standard approach for many years with high success rate. Transcatheter closure of ASD in selected patients has became the contemprorary practice that has the advantages of short hospital stay and relative ease of prosedure. In this article, we reported the results of percutaneous closure of ASD in our center. Methods: Between 2009-2011, thirty-two patients (mean age 36±18 years and 24 females) who had secundum type ASD which detected by transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) were included in this study. Twenty-nine (90,6%) patients were closed percutaneously. Tree patients were referred for surgery because of failure of percutaneous closure. Amplatzer Septal Occluder was used in 25 (86,2%) patients and Occlutech device was used in other patients. All procedures were performed under local anesthesia. All of the patients were examined with TTE before the procedure and, at the 1st, 3rd, 6th and 12th month follow-up visits. Results: Pre-operative mean pulmonary artery pressure was 33,3±7,5 mmHg and mean pulmonary to systemic flow (Qp/Qs) ratio was 2,9±1,1. Mean ASD diameter measured by TEE was 20,1±6,6 mm and mean streched diameter measured by balloon catheter was 22,1±5,9 mm. Mean device size 24±6 mm (range 12-36 mm). In the follow-up period no major complication was observed, but mild to moderate residual shunt flow was detected in two patients (% 6,8). Conclusion: Percutaneous ASD closure has been performed with high success and low complication rates in patients with secundum atrial septal defect in our center, Giriş: Atriyal septal defekt (ASD), erişkinlerdeki en sık doğuştan kalp hastalığıdır ve tüm doğuştan kalp hastalıklarının % 5-10' unu oluşturmaktadır. Cerrahi tedavi yüksek başarı oranı ile uzun zamandır standart tedavi metodu olarak kullanılmıştır. Uygun vakalarda, günümüzün popüler tedavi yöntemi perkütan ASD kapamadır. Bu yöntem görece işlem kolaylığı ve nekahat süresinin kısalığı gibi avantajlar sağlamaktadır. Bu makalede, merkezimizde yapılan perkütan ASD kapama sonuçları bildirildi. Metod: Bu çalışmaya, 2009-2011 yılları arasında transtorasik ekokardiyografi (TTE) ve transözofajiyel ekokardiyografi (TÖE) aracılığı ile tespit edilen sekundum tipi ASD'li 24'ü kadın 32 hasta (ortalama yaş; 36±18 yıl) dahil edildi. 29 hastada ASD (% 90,6) perkütan yolla kapatılırken; 3 hasta işlem başarısızlığı nedeni ile cerrahiye yönlendirildi. 25 olguda (% 86,2) Amplatzer Septal Occluder cihazı kullanılırken; diğer olgularda Occlutech cihazı kullanıldı. Tüm hastalarda işlem lokal anestezi altında yapıldı. Perkütan kapama yapılan hastaların tümü işlem öncesi ve işlemden 1, 3, 6 ve 12 ay sonra TTE ile takip edildi. Bulgular: Olgularımızda, işlem öncesi ortalama pulmoner arter sistolik basınçları 33,3±7,5 mmHg ve pulmoner/sistemik kan akım oranı (Qp/Qs) 2,9±1,1 idi. TÖE ile ölçülen ortalama ASD çapı 20,1±6,6mm, balon kateter ile ölçülen ortalama gerilmiş çap 22,1±5,9 mm idi. Ortalama cihaz boyutu 24±6 mm (12-36 mm arası) idi. Takipte, herhangi bir major komplikasyon izlenmezken; 2 (%6,8) hastada hafif-orta düzeyde rezidüel kaçak saptandı. Sonuç: Merkezimizde, sekundum tipi ASD' li hastalarda, perkutan ASD kapama yöntemi yüksek başarı ve düşük komplikasyon oranları ile uygulanabilmektedir. Anahtar Kelimeler: Sekundum ASD, perkütan kapama, transtorasik ekokardiyografi, transözofajiyel ekokardiyografi.