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Platelets have a central role in many cardiovascular events. Tirofiban is a glycoprotein (GP) IIb/IIIa receptor inhibitor that prevents platelet aggregation. In this report, it was aimed to review the thrombocytopenia induced by tirofiban treatment and other causes of thrombocytopenia. Key words: Tirofiban, Thrombocytopenia, GP IIb/IIIa İnhibitors, Trombositler birçok kardiyovasküler olayda merkezi role sahiptirler. Tirofiban, trombosit agregasyonunu önleyen bir glikoprotein (GP) IIb/IIIa reseptör inhibitörüdür. Bu olguda tirofiban tedavisi sonrası gelişen trombositopeni ve trombositopeni yapan diğer nedenlerin gözden geçirilmesi amaçlandı. Anahtar kelimeler: Tirofiban, Trombositopeni, GP IIb/IIIa İnhibitörleri

Aim: Although previous studies have shown a significant association between coronary risk factors or carotid atherosclerosis and valvular calcifications, there is conflicting evidence about which clinical cardiovascular risk factors are related to valvular calcifications.We aimed to evaluate the cardiovascular risk factors and carotid intima media thicknesses in patients with single and double valve calcifications in whom echocardiography has been performed prior to elective coronary angiography. Materials and Methods: 100 patients having double valve calcifications (aortic valve calcification and mitral annular calcification; 47 female and 53 male; mean age 68.1±8.7 years) and 90 patients having single valve calcification (aortic valve calcification; 29 female and 61 male; mean age 62.8±9.8 years) were enrolled into the study. All patients underwent transthoracic echocardiography, carotis ultrasonography and coronary angiography. Results: Age, female gender and hypertension were found to be significantly higher in patients with double valve calcifications (p=0.0001, 0.038 and 0.027; respectively). In means of hyperlipidemia, smoking, diabetes mellitus, body mass index, coronary artery disease and carotis intima media thickness, no significant difference was observed between the both groups. Age and female gender were found to be independent predictors in patients with double valve calcifications. Conclusion: These data have suggested that aortic and mitral valve calcifications may have different pathogenetic mechanisms and mitral annular calcification may also have some additional pathogenetic factors. Key words: Aortic Valve Calcification; Mitral Annular Calcification; Carotis Intima Media Thickness; Cardiovascular Risk Factors., Amaç: Önceki çalışmalarda, kapak kalsifikasyonları ile koroner arter hastalığı veya karotid aterosklerotik hastalık arasındaki yakın ilişki gösterilmiş olmasına rağmen, hangi klinik kardiyovasküler risk faktörlerinin kapak kalsifikasyonları ile ilişkili olduğu hakkında çelişkiler mevcuttur. Bu çalışmada, elektif koroner anjiyografi öncesi ekokardiyografi yapılan tek kapak ve çift kapak kalsifikasyonlu hastalarda kardiyovasküler risk faktörlerini ve karotis intima media kalınlıklarını değerlendirmeyi amaçladık. Gereç ve Yöntem: Çalışmaya çift kapak kalsifikasyonu olan 100 hasta (aort kapak kalsifikasyonu ve mitral annüler kalsifikasyon; 47 kadın ve 53 erkek; ortalama yaş 68,1±8,7 yaş) ve tek kapak kalsifikasyonu olan 90 hasta (aort kapak kalsifikasyonu; 29 kadın ve 61 erkek; ortalama yaş 62,8±9,8 yaş) alındı. Tüm hastalara transtorasik ekokardiyografi, karotis ultrasonografi ve koroner anjiyografi yapıldı. Bulgular: Yaş, kadın cinsiyet ve hipertansiyon çift kapak kalsifikasyonu olan hastalarda anlamlı olarak daha yüksek bulundu (sırasıyla; p=0,0001, p=0,038 ve p=0,027). Her iki grup arasında hiperlipidemi, sigara içimi, diyabetes mellitus, vücut kitle indeksi, koroner arter hastalığı ve karotis intima media kalınlığı yönünden anlamlı farklılık bulunmadı. Çift kapak kalsifikasyonu olan hastalarda, yaş ve kadın cinsiyet bağımsız belirleyiciler olarak bulundu. Sonuç: Bu veriler, aort ve mitral kapak kalsifikasyonlarının farklı patojenik mekanizmaları olabileceğini ve mitral annüler kalsifikasyon gelişiminde ayrıca bazı ek faktörlerin rol oynayabileceğini düşündürmektedir. Anahtar kelimeler: Aort Kapak Kalsifikasyonu; Mitral Annüler Kalsifikasyon; Karotis İntima Media Kalınlığı; Kardiyovasküler Risk Faktörleri.

Accurate diagnosis of tachyarrhythmias is of vital importance for correct management. Diagnosis of wide QRS complex tachycardias sometimes pose serious difficulties. We aimed to present the differential diagnosis and ablative treatment of a young man with a wide QRS complex tachycardia with left bundle branch block pattern and left axis deviation, further complicated by the presence of a persistent vena cava superior., Taşiaritmilerin doğru tanı ve tedavisi hayati öneme sahiptir. Geniş QRS kompleks taşikardilerin doğru tanısı bazen ciddi sıkıntılara yol açabilmektedir. Biz bu yazıda çarpıntı esnasında alınan yüzey EKG kaydında sol dal bloğu ve sol aks morfolojili geniş QRS kompleksler saptanan, ayrıca persistan sol superior vena kava varlığı ile komplike olan olgunun ayrıcı tanısı ve tedavisini sunmayı hedefledik.

ÖZET Çalışmamızda izole KAE olguları ile KAH olgularının yaş, cinsiyet ve diğer risk faktörleri açısından kıyaslamayı amaçladık. Çalışmaya İzole KAE' li 32 hasta ve kontrol grubu olarak 100 KAH hastası alındı. Hastalar yaş gruplarına göre Grup I: < 50 yaş, Grup II: 50-59 yaş, GrupIII: 60-69 yaş, Grup IV: > 70 yaş olarak dörde bölündüler. Çalışmaya alınan izole KAE'li hastaların ortalama yaşları 60.6±9.9, KAH olan kontrol grubunun ortalama yaşları 61.4±9.5 olarak bulundu. Çalışmaya alman 32 izole KAE' li hasta grubunun erkek sayısı 21/32 (%66), 100 KAH' lı kontrol grubunun erkek sayısı 76/100 (%76) olarak bulundu. Ayrıca çalışmaya alınan her iki grup hasta tarif edilen yaş grupları açısından da kıyaslandı. KAE' li hastalar ile KAH' lı kontrol hastaları arasında yaş, cinsiyet ve yaş grupları açısından istatistiki anlamlı fark saptanmadı (p>0.05). Ancak 50 yaşından küçük hastalar (grup I) izole KAE' li hastaların kendi gruplarında ( grup II,III,IV ) istatistiki açıdan anlamlı bir fark oluşturmazken (p>0.05), KAH' lı hastalarda 50 yaşından küçük hastaların sayısı KAH' lı hastaların diğer gruplardan daha azdı ve bu durum istatistiki açıdan anlamlı bir fark oluşturuyordu (p 0. 05). Ayrıca her iki grup hipertansiyon, sigara, sigara yılı, diabet, total kolesterol, LDL,HDL, trigliserit, MI öyküsü ve aile öyküsü açısından da kıyaslandı. Çalışmaya alınan her iki grup arasında hipertansiyon, sigara, sigara yılı, aile öyküsü, total kolesterol, LDL, HDL ve trigliserit bakımından istatistiki anlamlı fark bulunamadı 32ÖZET Çalışmamızda izole KAE olguları ile KAH olgularının yaş, cinsiyet ve diğer risk faktörleri açısından kıyaslamayı amaçladık. Çalışmaya İzole KAE' li 32 hasta ve kontrol grubu olarak 100 KAH hastası alındı. Hastalar yaş gruplarına göre Grup I: < 50 yaş, Grup II: 50-59 yaş, GrupIII: 60-69 yaş, Grup IV: > 70 yaş olarak dörde bölündüler. Çalışmaya alınan izole KAE'li hastaların ortalama yaşları 60.6±9.9, KAH olan kontrol grubunun ortalama yaşları 61.4±9.5 olarak bulundu. Çalışmaya alman 32 izole KAE' li hasta grubunun erkek sayısı 21/32 (%66), 100 KAH' lı kontrol grubunun erkek sayısı 76/100 (%76) olarak bulundu. Ayrıca çalışmaya alınan her iki grup hasta tarif edilen yaş grupları açısından da kıyaslandı. KAE' li hastalar ile KAH' lı kontrol hastaları arasında yaş, cinsiyet ve yaş grupları açısından istatistiki anlamlı fark saptanmadı (p>0.05). Ancak 50 yaşından küçük hastalar (grup I) izole KAE' li hastaların kendi gruplarında ( grup II,III,IV ) istatistiki açıdan anlamlı bir fark oluşturmazken (p>0.05), KAH' lı hastalarda 50 yaşından küçük hastaların sayısı KAH' lı hastaların diğer gruplardan daha azdı ve bu durum istatistiki açıdan anlamlı bir fark oluşturuyordu (p 0. 05). Ayrıca her iki grup hipertansiyon, sigara, sigara yılı, diabet, total kolesterol, LDL,HDL, trigliserit, MI öyküsü ve aile öyküsü açısından da kıyaslandı. Çalışmaya alınan her iki grup arasında hipertansiyon, sigara, sigara yılı, aile öyküsü, total kolesterol, LDL, HDL ve trigliserit bakımından istatistiki anlamlı fark bulunamadı 32 SUMMARY In this study we aimed to compare patients with isolated coronary artery ectasia (CAE) and coronary artery disease (CAD) in respect to age, gender and other risk factors. Thirty two patients with isolated CAE and 100 patients with CAD were included in the study, patients and control group, respectively. Patients were divided into four subgroups regarding the age distribution: Group I: < 50 years old, Group II: 50-59 years old, Group III :60-69 years old, Group IV: > 70 years old. Mean ages of patients with isolated CAE and CAD were 60.6±9.9 years and 61.4±9.5 years, respectively. Sixty six percent (21/32) and %76 (76/100) of patients with isolated CAE and CAD were male, respectively. There was no statistically significant difference between two groups in respect to age, gender and age distribution (p>0.05). The analysis of each group regarding the age subgroups revealed that the number of patients in group I (< 50 years old) was similar to remainders and there was no statistically significant difference (p >0.05) in patients with isolated CAE, however, percentage of patients who were less than 50 years was significantly lower than the other age subgroups in patients with CAD (p 0.05). However, DM and previous MI were more frequent in patients with isolated CAE and the difference was statistically significant (p

BackgroundWhite-coat hypertension (WCH) is a disease based on the disparity of a patient-s blood pressure measurements between the physician-s office and the patient-s home environment. The aim of the present study is to evaluate the left atrial (LA) volume and functions in WCH.MethodsIn total, this study included 37 WCH (17 women, 20 men, mean age 48.45.7 years) and 30 healthy individuals (18 women, 20 men, mean age 47.97.5 years). All patients underwent real-time three-dimensional and comprehensive two-dimensional echocardiography (2DE) with tissue Doppler evaluation to estimate left atrial volumes and mechanical functions.ResultsLA diameters were significantly higher in the patients compared with the controls (37 +/- 2.8 vs. 35 +/- 3.1mm, P=0.017). LA total systolic volume and LA maximal volume were significantly higher in the patients. (41.1 +/- 6.9 vs. 35.5 +/- 3.7ml, P

Objective The aim of this study was to evaluate left atrial (LA) volume and function using real time three-dimensional echocardiography (RT3DE) in patients with cardiac syndrome X (CSX). Methods Fifty patients with CSX (28 females; mean age 50.9±10.9 years) and 50 age- and gender-matched healthy controls (30 females; mean age 52.3±9.8 years) who had negative treadmill exercise test and normal coronary arteries on invasive coronary angiography were included in the study. Comprehensive two-dimensional (2D), pulsed and tissue Doppler, speckle tracking echocardiography, and RT3DE for the assessment of LA dynamics were performed in all study participants. Results Cardiac syndrome X and control groups have similar clinical characteristics regarding age, sex, body mass index, hypertension, diabetes, and smoking habit. 2D echocardiographic parameters were also similar between groups. Pulsed- and tissue Doppler parameters, IVRT, A, and Am values, were higher in CSX group, while Em, E/A, and Em/Am ratios were higher in the control group reflecting mild diastolic dysfunction. Regarding RT3DE parameters, LA maximum volume, minimum volume, volume before atrial contraction, LA maximum volume index, total and active stroke volumes were found to be increased in CSX patients. However, LA total stroke fraction, passive stroke volume, passive stroke fraction, peak systolic, and diastolic longitudinal strains were found to be lower in CSX patients. Conclusion The main finding of this study was that CSX patients had altered LA booster pump, reservoir, and conduit functions. This finding may have clinical implications for early detection of abnormal LA dynamics in CSX patients.

Behçet disease (BD) is a multisystemic disorder characterized by endothelial dysfunction and inflammation. Monocyte to high-density lipoprotein cholesterol ratio (MHR) is a recently emerged indicator of inflammation and oxidative stress. Sixty patients with BD and 50 control individuals were included to investigate the relationship between MHR and endothelial dysfunction. Endothelial function was assessed by flow- and nitroglycerin-mediated dilatation technique (FMD and NMD, respectively). Serum high-sensitivity C-reactive protein (hsCRP) levels were measured in all study participants. The MHR and hsCRP levels were significantly higher in patients with active BD than in controls. Brachial artery FMD was significantly lower in patients with active BD than in controls. Brachial artery NMD was similar between groups. There was a strong inverse correlation between MHR and FMD and a strong positive correlation between MHR and serum hsCRP levels. Thus, elevated MHR may be a useful marker reflecting impaired endothelial function and systemic inflammation in patients with BD.

Objective To evaluate left atrial (LA) volume and functions in obese subjects using real time three-dimensional echocardiography (RT3DE) and also the relationship between LA mechanical functions and N-terminal pro-atrial natriuretic peptide (NT-proANP). Methods This study included 40 obese (26 females and 14 males, mean age 51.9 years) and 40 normal weight subjects (23 females and 16 males, mean age 53.5 years) with normal coronary angiograms. All the study participants underwent RT3DE to assess LA volume and mechanical function. Plasma NT-proANP was determined by ELISA method. Results There was no significant difference between groups in left ventricular (LV) diameters and ejection fraction, which reflect LV systolic function. However, transmitral deceleration time, isovolumetric relaxation time, and peak late diastolic tissue Doppler velocity values, which reflect LV diastolic function, were found to be significantly higher in obese subjects when compared with controls. LA maximum volume (LAVmax), LAVmax index (LAVI), LA minimal volume (LAVmin), before atrial contraction volume (LAVpreA), LA active emptying volume, LA total emptying volume, and LA active emptying fraction, which reflect LA reservoir and pump functions, were also higher in obese subjects when compared with controls. LA passive emptying fraction was significantly lower in obese subjects than in controls. NT-proANP levels were similar between groups. There were positive correlations between NT-proANP level and LAVI, LAVmax, LAVmin, LAVpreA, and LA total and active emptying volumes. Conclusions Left atrial mechanical functions and volumes are impaired in obese subjects. These findings may be regarded as early markers of subclinical cardiac failure in obese subjects who have not yet exhibited any clinical evidence of cardiovascular disease.

Objective Ramadan fasting is one of the five fundamental rituals of Islam. Heart rate variability (HRV) is an independent predictor of increased mortality of patients with myocardial infarction and congestive heart failure. Although many patients in this region fast once a year, the effects of fasting on the HRV, which has a prognostic significance for patients with myocardial infarction and congestive heart failure, are not known. Therefore, the study on the effects of one month fast of HRV in healthy volunteers seems to be reasonable to address. Methods Our study is a prospective cohort study that includes a total of 40 healthy volunteers with sinus rhythm between 19 and 40 years of age (16 female and 24 male). HRV was determined twice by ambulatory 24-hour Holter recordings at fasting in the middle of Ramadan and first week after Ramadan month. Mean values of continuous variables were compared by using the Student t-test or Mann-Whitney U test. Paired t-test or Wilcoxon test were used for comparison of variables between groups. Results When two groups compared, statistically significant differences were found in terms of RR (p=0.049), SDNNI (p=0.010), rMSSD (p=0.009), pNN50 (p=0.015), T power (p=0.009), LF (p=0.008), Lfnu (p=0.002), HF (p=0.022) and Hfnu (p=0.013) values. Conclusion In our study, HRV parameters were found to be increased in Ramadan month, so we think that Ramadan fasting enhances the activity of the parasympathetic system.

Objective: The aim of this study was to evaluate left ventricular (LV) systolic strain by speckle tracking echocardiography (STE) and real-time three-dimensional echocardiography (3-DE) for the early detection of myocardial dysfunction in patients with cardiac syndrome X (CSX). Methods: We compared 34 patients with CSX (18 females, mean age 47.9±10.0 years) with 41 healthy persons as a control group (23 females, mean age 50.6±9.9 years). Inclusion criteria for CSX were typical angina, a positive exercise ECG stress test, and angiographically documented normal coronary arteries. Exclusion criteria for both groups were hypertension, valvular heart disease, cardiomyopathies, inflammatory diseases, myocarditis, vasculitis, arthropathies, Tietze's syndrome, gastrointestinal diseases, aortic diseases, hormone replacement therapy, arrhythmias, liver diseases, and alcohol use. All subjects underwent two-dimensional STE and 3-DE to assess resting LV function. STE measures were taken from the basal septum, mid-septum, apical septum, apex, apicolateral, mid-lateral, basal lateral, anteroseptal, anterior, anterolateral, inferolateral, inferior, and inferoseptal walls. Student's t-test, Mann–Whitney U test, and chi-square test were used to statistically analyze data. Results: LV echo ejection fraction (EF) and systolic wave peak velocity were similar for both groups. Regional mean longitudinal strain (-17.7±2.5% vs. -19.8±1.8%; p

Objective: Non-dipper hypertension is associated with an increased cardiovascular morbidity and mortality. Besides this, the left atrial (LA) size and functions are accepted to be prognostic factors in various cardiovascular diseases. In this study, we aimed to evaluate the effect of non-dipper hypertension on LA volume and functions using real-time three-dimensional echocardiography (RT3-DE). Methods: Forty dipper and 52 non-dipper hypertensives enrolled in this prospective cross-sectional study. Patients with any comorbidities that have a potential for causing structural cardiac alterations were excluded. Two-dimensional echocardiography (2-DE) and RT3-DE were performed to assess LA volumes and functions. The statistical tests used in this study were Shapiro–Wilk's test, Student's t-test, Mann–Whitney U test, chi-square test, Spearman's test, and Pearson's correlation test. Results: LA minimal volume, LA volume before LA contraction, and LA total systolic volume were higher in non-dipper hypertensives than in dipper hypertensives (p

The aim of this study was to evaluate the relationship between cigarette smoking and atrial rhythm disorders with the use of noninvasive methods.The study population consisted of 50 healthy volunteer smokers and 40 healthy volunteer non-smokers who had normal echocardiographic parameters and similar sex and age profiles. P-wave dispersion (PWD) was calculated from the 12-lead surface ECG. Left ventricle (LV) end-systolic and end-diastolic diameters, LV ejection fraction, and interatrial and intraatrial electromechanical delay were measured by tissue Doppler imaging and conventional echocardiography.Isovolumetric relaxation time and deceleration time were significantly higher (91.5 ± 11 vs. 82.35 ± 8.6, p 0.0001; 215.7 ± 37.1 vs. 175.3 ± 17.7, p 0.0001, respectively), and HDL cholesterol was significantly lower in smokers (39.34 ± 7.5 vs.44.3 ± 8.07, p = 0.003). There were no significant differences between the groups with respect to Sm and Em values, Am value, and E/A and E/Em ratios. However, the Em/Am ratio was significantly lower in smokers (1.28 ± 0.21 vs. 1.44 ± 0.33, p 0.006). Inter- and intraatrial electromechanical delay were significantly higher in smokers when compared with non-smokers (51.11 ± 1.54 vs. 27.30 ± 3.36, p 0.0001, and 30.63 ± 3.2 vs. 12.24 ± 3.26, p 0.0001, respectively). The amount of smoking was strongly correlated with interatrial electromechanical delay (r = 0.567, p 0.0001), and a significant correlation was detected between PWD and interatrial electromechanical delay (r = 0.653, p = 0.001).We have demonstrated the relationship between inter- and intraatrial electromechanical delay and PWD. These parameters may be useful predictive markers for the development of AF in the asymptomatic period before cardiac rhythm disturbances occur. This finding may indicate that smokers have an increased risk of developing atrial rhythm disturbances.

Non-dipper hypertension is associated with increased cardiovascular morbidity and mortality. We aimed to evaluate serum gamma-glutamyl transferase (GGT) level, which is accepted as a marker for oxidative stress and its relationship with inflammatory activity in patients with non-dipper hypertension. Age and sex matched 43 dipper hypertensive patients, 40 non-dipper patients, and 46 healthy subjects were included into the study. Serum GGT and C-reactive protein (CRP) levels were measured and compared between each of the groups. Serum GGT activity was higher in the non-dipper and the dipper hypertensive groups than in the control group (33.5 +/- 11.8 and 28.1 +/- 10.1 U/l, respectively, vs. 21.2 +/- 6.5U/l; p < 0.001). There was a statistically significant difference in serum GGT activity between the non-dippers and the dippers (p = 0.021). When compared with the control group, serum CRP levels were significantly increased in both the non-dipper and the dipper hypertensive groups (6.1 +/- 2.6 and 5.4 +/- 2.1 mg/l, respectively, vs. 2.8 +/- 1.7mg/L; p < 0.001). Increased CRP levels were higher in non-dippers than dippers (p = 0.046). A significant correlation was found between GGT and CRP measurements (r = 0.37, p = 0.002). Serum GGT levels, which are markers of the oxidative stress and CRP levels, are both increased in non-dipper hypertension. Increased GGT activity, found to be correlated with CRP levels, may be one of the reasons behind the non-dipper hypertension related cardiovascular complications.

SummaryThis study examines the maternal and fetal effects of arrhythmias detected by electrocardiographic (ECG) monitoring during labour in parturients at term, with no cardiovascular pathology. Pregnant cases were classified into three groups based on determined stages of labour and a standard 12-lead surface electrocardiogram and long-lead 2 rhythm strips were recorded during the labour. Cardiac arrhythmia of any kind was detected in 82.3% of patients in all stages of labour. Sinus tachycardia was the most commonly observed arrhythmia. Arrhythmias in the form of supraventricular tachycardia, T-wave inversion and ventricular extrasystole were also detected. The highest rate of arrhythmia was recorded for the active phase and 2nd phase of labour. Arrhythmias that are detected by ECG during or after the labour in patients with no cardiovascular pathology display a benign nature and do not create any clinical risk for the mother and the baby.

This study evaluated heart rate variability and its changes in 30 patients before and after transcatheter closure of secundum atrial septal defects. Heart rate variability data from 30 healthy volunteers with normal echocardiographic parameters and no history of atrial septal defects were included as controls. Values for the SD of all the normal RR intervals (SDNN), the SD of the means of all the 5-min segment normal RR intervals (SDANN), and the mean of all the 5-min SDs of normal RR intervals during the 24-h period (SDNN index) in patients with atrial septal defects before transcatheter closure were statistically significantly different from controls. At 6 months after closure of the defects these values were not statistically different from controls. It is concluded that transcatheter closure of secundum atrial septal defects had positive effects on heart rate variability and, consequently, may contribute to less mortality and morbidity.

The relationship between Behcet-s disease (BD) and platelet aggregation has not sufficiently been investigated yet. Mean platelet volume (MPV) is a marker of platelet function, and the increase in MPV has been identified as an independent risk factor of recurrent vascular events. BD is characterized by a relapsing vasculitis of the venous as well as arterial thrombosis. However, the precise pathogenic mechanisms underlying thrombotic tendency in BD are not known. We hypothesized that there might be an association between thrombotic complication and MPV in these patients. Therefore, we investigated activation of platelets in patients with BD using a simple marker, MPV, the most accurate measure of platelet size. A total of 60 patients with BD and 40 age- and gender-matched controls were included. The BD patients were divided into subgroups based on the presence (n = 22) or absence of thrombosis (n = 38) and clinically active (n = 30) or inactive (n = 30) state. MPV was higher in patients with BD than controls (8.14 +/- 0.8 vs. 7.48 +/- 0.3 fl, p = 0.001). Among BD patients, MPV was larger in patients with thrombosis than those without thrombosis (8.45 +/- 1.0 vs. 7.96 +/- 0.7 fl, p = 0.038). However, there was no significant difference in MPV between BD patients with active and inactive states. The increase in MPV is independent of the disease activity, and the presence of thrombosis is associated with higher MPV in BD patients. Therefore, antiplatelet therapy may be useful to prevent thrombotic complications in BD patients.

OBJECTIVE The aim of the present study was to assess access site pain levels of patients undergoing coronary catheterization via transradial route. METHODS We performed a prospective and randomized study in which 408 patients underwent coronary angiography (CAG) and/or percutaneous coronary intervention (PCI) via transradial approach (TRA) and 428 patients underwent CAG and/or PCI via transfemoral approach (TFA). Pain levels of patients were assessed with Visual Analog Scale (VAS) after catheterization and at 30 days. Student-t, Mann-Whitney U and chi-square tests were used for statistical analysis. RESULTS Patients in the TRA group showed higher VAS scores than those in TFA group after catheterization [CAG alone, 3 (2-5) vs. 1 (1-3), p

The aim of this study was to evaluate left atrial (LA) volume and mechanical functions by real time three-dimensional echocardiography (RT3DE) in prehypertensive subjects. The study included 54 (34 male and 20 female) prehypertensive subjects and 36 (14 male and 22 female) healthy control subjects. Transthoracic echocardiography and RT3DE were performed in all patients. Interventricular septum thickness and isovolumetric relaxation time were significantly higher in prehypertensives than in controls (10.7 +/- 0.7 vs. 10.1 +/- 0.8 P = 0.001 and 89.9 +/- 10 vs. 82.4 +/- 11 P = 0.002, respectively). LA maximum volume, volume before atrial contraction, total and active stroke volume, total and active emptying fractions, expansion index, and LA max volume index were significantly higher in prehypertensives when compared with controls (P < 0.0001 for all). However, the passive emptying fraction was significantly lower in prehypertensives than controls (45.7 +/- 5.6 vs. 48.6 +/- 4.1, P = 0.006), and the minimum LA volume between the two groups was similar. The main finding of this study was that although LA volume and LA active systolic functions were significantly increased in prehypertensive people, there was a reduction in passive LA systolic functions. These parameters may be important in showing hemodynamic and structural changes in cardiac tissue caused by prehypertension. (Echocardiography 2012;29:1211-1217)

In recent studies, novel corticotropin releasing factor (CRF)- related peptides, named Ucn-1, Ucn-2, and Ucn-3 have been identified (1-3). The actions of these peptides are mediated by binding to two G-coupled receptors; CRF receptor type 1 and 2 (CRF-R1, CRF-R2) (1-4). CRF-R1 is found predominantly in the pituitary and brain regions, whereas the CRF-R2 is more localized in the heart chambers and peripheral vascular system (1-6). Although Ucn-1 binds to both receptors, Ucn-2 and Ucn-3 show more affinity to CRF2 receptor (2, 3). Kimura et al. (7) reported that urocortins and CRF2 receptor were detected in all chambers of human hearts, especially in the left ventricle. The available evidence from animal models and human clinical studies indicate that urocortins have many important pathophysiological and regulatory roles in the cardiovascular system. These effects of urocortins can be summarized as follows; a dose-dependent increase in heart rate, cardiac output, coronary blood flow (8), coronary vasodilatation and positive inotropic effect (9), protection against ischemic and reperfusion injury in ventricular myocytes, a diminution in free radical damage following myocardial infarction (10, 11), stimulation of cardiac natriuretic peptide secretion, decrease in left atrial pressure and peripheral vascular resistance (12), decrease in blood pressure, reduction of serum catecholamine levels in hyperadrenergic hypertension (13)., Amaç: Urocortin (Ucn) hormonları kardiyovasküler sistemde önemli rol oynamaktadır. Sistolik işlev bozukluğu (SD) dışında, diyastolik işlev bozukluğu (DD) veya koroner arter hastalığının (KAH) serum Ucn-2 ile ilişkisine dair yeterli veri bulunmamaktadır. Bu çalışmamızda SD, DD ve KAH’da serum Ucn-2 düzeyini araştırdık. Yöntemler: Bir gözlemsel enine-kesitli olan bu çalışmanın popülasyonu KAH ön tanısı ile koroner anjiyografi işlemine alınan bireyler arasından belirlendi. Koroner anjiyografi sonrası ekokardiyografi yapılarak 86 kişi seçildi. Ucn-2 ile SD arasındaki ilişkiyi araştırmak için ejeksiyon fraksiyonu (EF) farklı üç grup oluşturuldu: orta-ileri düzey SD olanlar (Grup A, EF=%33.6), hafif-orta SD olanlar (Grup B, EF=%46.1) ve SD olmayanlar (Grup C, EF= %64.5). Ayrıca, DD sahip olan ve olmayanlar (EF≥ %45) arasında ve KAH’ı olan ve olmayanlar (EF≥ %55) arasında da Ucn-2 düzeyi karşılaştırıldı. İstatistiksel analizde tek yönlü ANOVA, Kruskal-Wallis, Ki-kare, Mann-Whitney U, Spearman korelasyon ve çoklu regresyon testleri kullanıldı. Bulgular: Grup C’ye göre, Ucn-2 düzeyinin Grup A’da azaldığı ve Grup B’de arttığı saptandı (Grup A, B ve C’de sırasıyla Ucn-2; 9.4±3.4, 12.8±3.6 ve 10.4±3.9 pg/mL, p=0.003). SD’den farklı olarak; Ucn-2 düzeyi bakımından, DD olan ve olmayanlar arasında (11.4±4.1 ve 11.7±3.9 pg/mL, p=0.8) veya KAH olan ve olmayanlar arasında (10.7±4.7 ve 10.2±3.2 pg/mL, p=0.7) anlamlı bir fark saptanmadı. Sonuç: Serum Ucn-2 düzeyi hafif-orta sistolik disfonksiyonda yükselmektedir. Ancak, DD (azalmış gevşeme bozukluğu) veya KAH’ın (miyokart enfarktüsü olmadan) serum Ucn-2 düzeyini etkilemediği görülmektedir. (Anadolu Kardiyol Derg 2012; 12: 115-20)

Aims Behcet's disease (BD), a multisystemic inflammatory disorder, has been associated with a number of cardiovascular dysfunctions, including endomyocardial fibrosis of the right heart, atrial fibrillation, ventricular arrhythmias and sudden cardiac death. The incidence and nature of cardiac involvement in BD are not yet clearly documented. Our aim was to evaluate left atrial (LA) volume and functions using real-time three-dimensional echocardiography (RT3DE) in Behcet's patients without any cardiac symptom. Methods and results The study included 40 BD (16 females, 24 males and mean age of 33 ± 7 years) and 30 healthy (11 females, 19 males and mean age of 35 ± 6 years) subjects. All the patients' demographic parameters such as age, gender, and duration of BD were recorded. All the individuals underwent comprehensive 2D echocardiography examination, and RT3DE was performed to assess LA volumes and mechanical functions. LA maximum volume ( V max) and before atrial contraction volume ( V pre A), LA active stroke volume and total stroke volumes (TSV), total emptying and active emptying fractions and expansion index were significantly higher in Behcet's disease patients when compared with the controls ( P < 0.0001 for all). LA passive emptying fraction was significantly lower in the patients with BD than in the controls (41 ± 7 vs. 44 ± 5, P = 0.039). There were positive correlations between TSV and high-sensitive C-reactive protein level ( r = 0.413, P = 0.008), TSV, and disease duration ( r = 0.417, P < 0.007). Conclusion Our study has shown that LA mechanical functions and volumes are impaired in BD. These results may be an early form of subclinical cardiac involvement in patients with BD who have no clinical evidence for cardiovascular disease.

Objective: The aim of our study was to evaluate serum uric acid level and its relationship with carotid intima-media thickness (CIMT) in patients with cardiac syndrome X (CSX). Subjects and Methods: A total of 50 patients with CSX (28 females/22 males, 51.0 ± 10.9 years) and 40 controls (27 females/13 males, 53.0 ± 10.2 years) were included in the study. All subjects underwent a noninvasive stress test and conventional coronary angiography. Serum uric acid levels were measured and B mode ultrasonography was performed to assess CIMT in all subjects. Results: Serum uric acid levels were higher in patients with CSX than in the control subjects (5.1 ± 1.8 vs. 3.9 ± 1.3 mg/dl; p = 0.002). The CIMT was higher in patients with CSX than in the control subjects (0.75 ± 0.18 vs. 0.63 ± 0.09 mm; p < 0.001). A significant correlation was found between serum uric acid values and CIMT measurements in patients with CSX (r = 0.666, p < 0.001). Conclusions: Serum uric acid levels were higher in patients with CSX and elevated serum uric acid levels were associated with carotid atherosclerosis, thereby indicating that elevated serum uric acid levels might contribute to the development of subclinical atherosclerosis in CSX patients.

OBJECTIVE Cardiomyopathy (CMP) is a disorder associated with an increased risk of thromboembolism due to blood stasis, platelet activation and altered coagulation status. In this study, we aimed to investigate mean platelet volume (MPV) in patients with idiopathic CMP and ischemic CMP and to compare with those of the controls, and aimed to determine whether there is a relationship between MVP and echocardiographic parameters in patients with CMP. METHODS This study was designed as an observational cross-sectional study. A total of 100 subjects with idiopathic CMP (n=35), ischemic CMP (n=35) and controls (n=30) were included in the study. The MPV values were measured in all participants. All subjects underwent transthoracic echocardiography and angiographic evaluation. We used Chi-square test, one-way ANOVA and Pearson correlation tests for statistical analysis. RESULTS The MPV values were significantly higher in patients with idiopathic CMP and ischemic CMP than those of the controls (9.03±1.3 and 8.77±0.9 vs. 7.95±1.0 fl, respectively, p

OBJECTIVE Previous studies have shown an association between high sensitive C-reactive protein (hsCRP) and arterial stiffness in most cardiovascular diseases. High sensitive C-reactive protein and arterial stiffness have been considered as independent predictors of cardiovascular mortality in cardiovascular disease. The aim of this study was to investigate the relationship between hsCRP, a marker of systemic inflammation and aortic stiffness in patients with coronary artery ectasia (CAE). METHODS Our study was designed as cross-sectional study. Serum hsCRP levels and aortic stiffness parameters were measured in CAE patients (n=28) and age - and gender-matched control subjects (n=25). Serum hsCRP levels were determined by an immunonephelometry assay. Aortic strain (AS) and aortic distensibility (AD) were calculated from the aortic diameters measured using M-mode echocardiography and blood pressure obtained by sphygmomanometry. Independent samples "t" test, Chi-square test and Spearman correlation test were used for statistical analysis. RESULTS Serum levels of hsCRP in CAE group were higher than in the controls (p

Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common form of paroxysmal supraventricular tachycardia and is usually treated successfully by radiofrequency catheter ablation. We report on a 38-year-old woman whose AVNRT attacks occasionally degenerated into polymorphic ventricular tachycardia (VT). The patient presented with a complaint of palpitations. The electrocardiogram was in sinus rhythm with a normal corrected QT interval. During Holter monitoring, narrow QRS complex tachycardia with a heart rate of 220 beats/min was noted at nighttime, that lasted for 90 minutes, during which two episodes of polymorphic VT were also seen. The diagnosis of AVNRT was confirmed on an electrophysiologic study and AVNRT was successfully treated by radiofrequency catheter ablation. The patient had no complaint during a follow-up of eight months, with no signs of arrhythmia on repeat Holter monitoring.

Background. The lack of nocturnal BP fall less than 10% of the daytime, called non-dipper hypertension, is associated with increased cardiovascular morbidity and mortality. The aim of our study was to investigate atrial conduction time in patients with non-dipper hypertension using electromechanical coupling interval and P-wave dispersion (PWD), measured with the surface electrocardiogram and tissue Doppler echocardiographic imaging (TDI). Methods. Age-and sex-matched 43 dipper hypertensive patients (19 male, 24 female, mean age: 53.9 +/- 10.5 years), 40 non-dipper patients (18 male, 22 female, mean age 54.3 +/- 9.6 years) and 46 healthy subjects (22 male, 24 female, mean age: 52.8 +/- 9.6 years) were included in the study. The difference between the maximum and minimum P-wave durations was calculated and defined as PWD. Atrial electromechanical coupling (PA), inter-atrial and intra-atrial electromechanical delays were measured with TDI. Results. PWD was significantly higher in patients with non-dippers compared with dippers (p < 0.02) and controls (p < 0.001). The inter-atrial conduction time was delayed in non-dippers compared with dippers (p < 0.01) and controls (p < 0.001). There was a positive correlation between left atrial (LA) diameter and inter-atrial conduction times (r = 0.46, p < 0.001). LA diameter was also correlated with PWD (r = 0.44, p < 0.001). Conclusion. The patients with non-dipper hypertension have higher P-wave duration, PWD and delayed inter-atrial electromechanical coupling intervals compared with those of dippers and controls. This indicates that these subjects may be more prone to atrial rhythm disturbances.

We aimed to evaluate serum gamma-glutamyl transferase (GGT) activity and its relationship with carotid intima media thickness (CIMT) in patients with cardiac syndrome X (CSX).The study population consisted of 40 patients with CSX, 35 controls and 40 patients with coronary artery disease (CAD). All patients underwent a noninvasive stress test and conventional coronary angiography. Serum GGT and C-reactive protein (CRP) levels were measured and CIMT was assessed in all subjects.Serum GGT activity was higher in the CSX and the CAD groups than in the control group (32.6 +/- 16.0 and 30.4 +/- 15.3 U/L, respectively, vs. 17.9 +/- 4.2 U/L; P0.001). There was no statistically significant difference in serum GGT activity between the CSX and the CAD groups. When compared to the control group, serum CRP levels were significantly increased in both the CSX and the CAD groups (4.1 +/- 2.0 and 4.7 +/- 2.6 mg/L, respectively, vs. 2.2 +/- 1.8 mg/L; P0.001). Patients with CSX and CAD had significantly higher CIMT values than the controls (0.74 +/- 0.17 and 0.94 +/- 0.12 mm, respectively, vs. 0.62 +/- 0.08 mm; P0.001). A significant correlation was found between GGT activity and CIMT measurements (r = 0.640, P0.001), but serum GGT activity did not correlate with serum CRP levels in patients with CSX (r = 0.277, P0.05).The present study showed that serum GGT activity in patients with CSX was as high as those in patients with CAD. Increased GGT levels may play a role in the pathogenesis of the microvascular atherosclerotic process of CSX.

The interaction between moderate-to-severe obstructive sleep apnea (OSA) and cardiac arrhythmias, especially atrial fibrillation (AF), is well known. We aimed to determine whether atrial electromechanical parameters assessed by tissue Doppler imaging (TDI) would be affected in moderate-to-severe OSA, and detect the influential factors of atrial electromechanical parameters in these patients. Interatrial and intra-atrial electromechanical delay was measured by TDI in patients with moderate-to-severe OSA (n = 64) and control subjects (n = 39). P-wave dispersion (PWD) was calculated on the 12-lead ECG. Interatrial and intra-atrial electromechanical delay was significantly higher in the OSA group when compared with the controls (52.26 ± 12.9 vs 29.61 ± 11.26, P

Behçet’s disease (BD) is a multisystemic disorder characterized by endothelial dysfunction. However, the relationship between oxidative stress and endothelial function has not been clearly shown. We investigated the relationship between oxidative stress markers and endothelial function in patients with BD. Patients with BD (n = 40) having active disease and sex- and age-matched 40 controls were included. Endothelial function was assessed by flow-mediated dilatation (FMD) technique. Serum gamma-glutamyltransferase (GGT) and high-sensitive C-reactive protein levels (hsCRP) were measured in all participants. Brachial artery FMD was significantly lower in patients with BD than in controls. Gamma-glutamyltransferase and hsCRP levels were higher in patients with BD than in controls. Also, GGT and hsCRP levels were inversely correlated with endothelial function. Oxidative stress markers are elevated in patients with BD having active disease. This may be one of the reasons behind the vasculitis in active BD.

SummaryBackgroundRecently, the Occlutech Figulla ASD Occluder (FSO) has been introduced for transcatheter closure of atrial septal defects. This device can be used for transcatheter closure of small as well as large atrial septal defects.AimsTo evaluate the feasibility and short-term results of transcatheter closure of secundum type atrial septal defects using the FSO device in adult patients.MethodsSeventy-four consecutive adult patients were referred for transcatheter closure of secundum large atrial septal defects (“stretched” diameter>20mm and/or invasive pulmonary/systemic flow [Qp/Qs] ratio>1.5) using the FSO device.ResultsThe FSO device was successfully implanted in 68 patients (mean±SD [range] age: 31.8±12.3 [17–64] years; weight: 71.5±18.4 [49–98]kg). All patients had right atrial and ventricular volume overload with a mean Qp/Qs ratio of 2.5±0.6 (range 1.5–3.8). Mean atrial septal defect diameter was 22.3±4.8 (range 12–33)mm and the size of the implanted FSO was 24.1±4.9 (range 12–36)mm. Two patients had trivial (jet width

The aim of our study was to investigate atrial conduction time in patients with mitral annulus calcification (MAC) using P-wave dispersion (PWD) and electromechanical coupling measured with the surface electrocardiogram and the tissue Doppler echocardiography. Fifty-nine patients with MAC and 43 control subjects underwent resting the surface electrocardiogram and tissue Doppler echocardiography. The difference between the maximum (Pmax) and minimum P-wave durations was calculated and defined as PWD. Interatrial and intraatrial electromechanical delays were measured with tissue Doppler echocardiography. Both Pmax and PWD were higher in patients with MAC compared with controls (111.4 +/- 15.8 vs 97.3 +/- 18.8 milliseconds; P < .0001 and 46.4 +/- 14.6 vs 31.4 +/- 13.1 milliseconds; P < .0001, respectively). Both interatial and intraatrial conduction time were also delayed in patients with MAC compared with controls (29.8 +/- 13.3 vs 17.6 +/- 12.5 milliseconds; P < .0001; 9.4 +/- 5.1 vs 6.8 +/- 4.0 milliseconds; P < .008, respectively). Left atrial (LA) diameter was significantly higher in patients with MAC compared with controls (35.4 +/- 5.0 mm vs 32.3 +/- 4.2 mm; P < .001). The LA diameter correlated significantly with both interatrial conduction times and PWD (r = 0.56; P < .0001 and r = 0.47; P < .0001, respectively). There is a delay in both intraatrial and interatrial electromechanical coupling intervals in patients with MAC. (C) 2010 Elsevier Inc. All rights reserved.