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Objectives: To investigate the diversity and average values of bifurcation angles in a large population to help develop new methods. Methods: One thousand five individuals (504 females, 501 male) who visited the Cardiology Polyclinic of Fırat University Hospital with the complaint of chest pain between 2010 and 2015 were evaluated retrospectively. Bifurcation angle measurements between LMCA-CX, CX-LAD, LMCA-LAD, CX-OM1, CX-OM2, LAD-D1, LAD-D2, RCA-RMD, RCA-RVD and PDA-PL were evaluated in all cases. Results: Bifurcation angles between LMCA-LAD, LMCA-Cx and LAD-Cx branches with “> 90 wide angle bifurcations”, and Cx-OM1, Cx-OM2, LAD-D1, LAD-D2, RCA-RMD and PDA-PL with “ 70-90 T-type bifurcation” in 209 (41.5%) people, and “> 90 wide angle bifurcation” in 281 (55.8%) people. Results for male subjects were compatible with this. The correlations of all angles were examined. Robust positive correlations (p≤0.001) were found for the angular measurements between the main branches and the side branches (Cx-OM1, Cx-OM2, LAD-D1, LAD-D2 and RCA-RMD, PDA-PL). Conclusion: With the help of developing technology, we believe that all this coronary angiography data will guide bifurcation stent techniques, which are essential alternatives to bypass. doi: https://doi.org/10.12669/pjms.38.3.4782 How to cite this:Deniz G, Kavakli A, Kucukukur M, Kose E, Karaca I. Evaluation of major coronary artery Bifurcation angles with digital angiography: A detailed study of prevalence in the Upper Euphrates Basin. Pak J Med Sci. 2022;38(3):---------. doi: https://doi.org/10.12669/pjms.38.3.4782 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

In December 2019, in the city of Wuhan, in the Hubei province of China, treatment-resistant cases of pneumonia emerged and spread rapidly for reasons unknown. A new strain of coronavirus (severe acute respiratory syndrome coronavirus-2 [SARS-CoV-2]) was identified and caused the first pandemic of the 21st century. The virus was officially detected in our country on March 11, 2020, and the number of cases increased rapidly; the virus was isolated in 670 patients within 10 days. The rapid increase in the number of patients has required our physicians to learn to protect both the public and themselves when treating patients with this highly infectious disease. The group most affected by the outbreak and with the highest mortality rate is elderly patients with known cardiovascular disease. Therefore, it is necessary for cardiology specialists to take an active role in combating the epidemic. The aim of this article is to make a brief assessment of current information regarding the management of cardiovascular patients affected by COVID-19 and to provide practical suggestions to cardiology specialists about problems and questions they have frequently encountered.

Background: Heart failure (HF) is an important public health problem. We aimed to investigate the predictors of long-term hospitalization in Turkish HF population. Materials and Methods: Journey-HF-TR study is a multicenter, cross-sectional, noninvasive, and observational study that was conducted in intensive care unit (ICU), coronary care unit (CCU), and cardiology wards in seven geographical regions of Turkey. In this subgroup analysis, patients were classified as two groups according to inhospital stay called the patient with the shorter length of stay (S-LOS) (inhospital stay

Nitric oxide (NO) is an important organizer of the cardiovascular function and is an important mechanism in hampering the pathogenesis of the diseased heart. The scenario of bioavailable NO in the myocardium is complicated: 1) NO obtain from both endogenous and exogenous NO synthases (NOSs) and the number of NO from exogenous sources varies considerably

In December 2019, in the city of Wuhan, in the Hubei province of China, treatment-resistant cases of pneumonia emerged and spread rapidly for reasons unknown. A new strain of coronavirus (severe acute respiratory syndrome coronavirus-2 [SARS-CoV-2]) was identified and caused the first pandemic of the 21st century. The virus was officially detected in our country on March 11, 2020, and the number of cases increased rapidly; the virus was isolated in 670 patients within 10 days. The rapid increase in the number of patients has required our physicians to learn to protect both the public and themselves when treating patients with this highly infectious disease. The group most affected by the outbreak and with the highest mortality rate is elderly patients with known cardiovascular disease. Therefore, it is necessary for cardiology specialists to take an active role in combating the epidemic. The aim of this article is to make a brief assessment of current information regarding the management of cardiovascular patients affected by COVID-19 and to provide practical suggestions to cardiology specialists about problems and questions they have frequently encountered.

Background. The objective of this study was to determine the effects of strict volume control and nondipper situation on cardiovascular disease in chronic hemodialysis patients.Methods. This study is an observational and cross-sectional study including 62 patients with normotensive chronic hemodialysis using no antihypertensive drugs. A series of measurements including ambulatory blood pressure monitoring, left ventricular mass index by echocardiography, common carotid artery intima-media thickness by ultrasound, and body fluids by bioimpedance analysis were conducted for all subjects.Results. The patients were divided into two groups as dippers and nondippers according to their ambulatory blood pressure monitoring results. Average 48 h systolic, diastolic, and mean arterial blood pressure and nocturnal systolic, diastolic, and mean arterial blood pressure were significantly different between the dipper and nondipper groups (pConclusion. According to logistic regression analysis, the odds ratio for daytime diastolic blood pressure indicates that nondippers are 0.45 times more likely to have high blood pressure than dippers in daytime. But in night time, nondippers are about 2.55 times more likely to have high blood pressure comparing to dippers. An important finding of this study is that nondipping pattern is associated with cardiac hypertrophy and lower left ventricle ejection fraction in dialysis of patients with no hypertension. The results also suggest that applying strict volume control to achieve a normal blood pressure alone is not sufficient to reduce the risk of cardiovascular morbidity and mortality if the patients do not have a dipper status of nocturnal blood pressure.

Drug-associated hemolytic anemia is very rare. Hydrochlorothiazides are commonly used as diuretic or antihypertensive agents. In this report, we present an 80-year-old male patient who developed hemolytic anemia 20 days after using a combination of angiotensin receptor blocker and hydrochlorothiazide for the treatment of hypertension.

WOS: 000430041800013, PubMed ID: 29313562, Background: Serglycin plays a key role in the inflammatory status however the relationship between coronary artery disease (CAD) and serglycin is still unknown. Aim: In this study, we aimed to investigate association of serglycin levels with CAD severity in patients with stable angina pectoris (SAP). Methods: In total, 100 SAP patients diagnosed by coronary angiography and clinical manifestations, and 100 control subjects matched for age and sex were enrolled in this case-control study. Plasma levels of serglycin, high-sensitivity C-reactive protein (hsCRP), lipid profiles, and clinical parameters were assayed for all participants. The severity of coronary lesions was evaluated based on the SYNTAX score (SS) assessed by coronary angiography. Results: Positively correlated with the SS (r = 0.564, p < 0.001), the plasma serglycin level in the SAP group was higher than that in the control group (11.17 +/- 1.82 vs. 19.28 +/- 1.88 ng/mL, p < 0.001). The plasma serglycin level was an independent predictor for both SAP (odds ratio [OR] 1.037, 95% confidence interval [CI] 1.020-1.054, p < 0.001) and a high SS (OR = 1.087, 95% CI 1.051-1.124, p < 0.001) in a multivariate logistic regression model. In the receiver operating characteristic curve analysis, the plasma serglycin level was found to have a better predictive value for a high SS (area under the curve [AUC] 0.858, 95% CI 0.788-0.929, p < 0.001) compared with hsCRP (AUC 0.665, 95% CI 0.557-0.773, p = 0.006; Z = 2.94, p < 0.001), with an optimal cut-off value of 17.25 ng/mL (sensitivity 94.3%, specificity 68.2%). Conclusions: Plasma serglycin levels correlate with both the presence and severity of coronary stenosis in patients with SAP, suggesting that it could be a potential predictive marker of severe stenosis in SAP patients.

WOS: 000433285000010, PubMed ID: 28968197, Once-daily dosing of non-vitamin K antagonist oral anticoagulants (NOACs) may increase patient adherence to treatment but may also be associated with a higher risk of bleeding. In this study, we investigated the adherence to once-or twice-daily dosing of NOACs and the risk of bleeding in nonvalvular atrial fibrillation (NVAF) patients. This multicenter cross-sectional study, conducted between 1 September 2015 and 28 February 2016, included 2214 patients receiving NOACs for at least 3 months, due to NVAF. Patients receiving once-daily or twice-daily NOAC doses were 1: 1 propensity score matched for baseline demographic characteristics and the presence of other diseases. The medication adherence was assessed by the 8-item Morisky Medication Adherence Scale. Risk factors were investigated in relation to minor and major bleeding. The mean age of patients was 71 +/- 10 years, and 53% of the patients were women. The medication adherence was lower in patients receiving twice-daily NOAC doses compared to once-daily-dose group (47% versus 53%, p = 0.001), and there was no difference between the groups in terms of minor (15% versus 16%, p = 0.292) and major bleeding (3% versus 3%, p = 0.796). Independent risk factors for bleeding were non-adherence to medication (OR: 1.62, 95% CI: 1.23-2.14, p = 0.001), presence of 3 or more other diseases (OR: 10.3, 95% CI: 5.3-20.3, p < 0.001), and HAS-BLED (Hypertension, Abnormal renal and liver function, Stroke, Bleeding, Labile INR, Elderly, Drugs or alcohol) score (OR: 4.84, 95% CI: 4.04-5.8, p < 0.001). In summary, the once-daily dose of NOACs was associated with increased patient adherence to medication, while it was not associated with bleeding complications.

Coronary artery disease is one of the most common and important health problems in the world. Early diagnosis of this disease is very important to treat before severe myocardial damage occurred. Myocardial perfusion scintigraphy (MPS) and computed tomography coronary angiography (CTCA) which evaluates regional myocardial perfusion and coronary arteries, respectively, are reliable and non-invasive methods in terms of coronary artery disease. In this study we aimed to compare MPS and CTCA based on conventional coronary angiography (CCA). Totally 60 patients were included in the study. CCA and MPS were performed to 30 patients; CCA and CTCA were performed to the rest of the patients (30 patients). Lesions were classified as mild, moderate and severe in these imaging methods. MPS and CTCA were compared with CCA by using chi-square and Fisher’s exact test. MPS and CTCA’s p values were found for left anterior descending artery (LAD) p: 0, p: 0.271; for circumflex artery (Cx) p: 0.256, p: 0.08 and for right coronary artery (RCA) p: 0.033, p: 0.271, respectively. Furthermore MPS and CTCA’s sensitivity, specificity, accuracy, positive predictive value and negative predictive value were calculated 81% to 87%; 70% to 49%; 73% to 72%; 54% to 72%; 90% to 71%, respectively. CCA results were found more concordant with MPS for LAD and RCA lesions and more concordant with CTCA for Cx lesions. It was also found that positive predictive value of MPS and negative predictive value of CTCA were significantly higher than the others. As a result, MPS and CTCA were suggested as complementary techniques for the diagnosis of coronary artery disease, not as alternatives to each other.

Objectives: Chronic inflammatory diseases are associated with an accelerated atherosclerotic process. Recent studies have discussed whether inflammatory bowel diseases (IBDs) can predict early atherosclerosis. We investigated this possibility. Methods: The study consisted of IBD cases (group 1, n = 40) and healthy persons (group 2, n = 40). The IBD group was selected so as not to have vascular disease or the presence of established major cardiovascular risk factors. Results: Group 1 cases showed a significant increase in carotid intima media thickness (cIMT; P = .01). Carotid artery stiffness was impaired in group 1 (P = .03) and high-sensitivity C-reactive protein (hsCRP), homeostasis model assessment of insulin resistance (HOMA-IR), and homocysteine (Hyc) were higher in group 1 patients (P = .02, P = .03, P = .05). Conclusions: Inflammatory bowel disease patients have an increased risk of early atherosclerosis as shown by greater values of cIMT, carotid artery stiffness, Hyc, hsCRP, and insulin resistance.

Etiopathogenesis of coronary artery ectasia (CAE), which is defined as abnormal dilatation of a segment of the coronary artery to 1.5 times of an adjacent normal coronary artery segment, is unclear. However, it is speculated that CAE develops in the atherosclerosis process through degeneration of coronary artery media layer. Our objective in this study is to compare levels of adiponectin between cases with CAE and normal coronary anatomy, and to examine whether adiponectin plays a role in CAE etiopathogenesis. The study registered a total of 66 cases, consisting of CAE cases (group 1, n = 36) and cases with normal coronary anatomy (group 2, n = 30). Taking coronary artery diameters of the control group cases as the reference, patients with abnormal segments 1.5 times larger than the adjacent segments were accepted as CAE. Serum adiponectin levels were 4.31 +/- 2.02 microg/ml in group 1 and 6.73 +/- 4.0 microg/ml in group 2 (P = 0.02). High-sensitivity C-reactive protein was 4.8 +/- 3.8 mg/l in group 1 and 3.6 +/- 3.4 mg/l in group 2 (P0.05). There was a negative correlation between ectatic coronary artery diameter and plasma adiponectin level (P = 0.03; r = -0.339). It was known that adiponectin levels dropped in atherosclerotic heart disease. In this study we found low plasma adiponectin levels in acquired CAE, attributed to atherosclerosis. Therefore, we think that adiponectin might be playing a role in etiopathogenesis and progression of CAE. This in turn may indicate that hypo-adiponectinemia may be useful in revealing a realized risk in CAE. However, larger, randomized, multicenter studies are required to examine the role of adiponectin in the development of CAE.

The objective of the present study was to compare the early effects of treatment with nebivolol and quinapril on the endothelial function in hypertensive patients. A total of 54 hypertensive patients was enrolled in the present study. One of the groups (n = 27) received quinapril 20 mg/day, and the other group (n = 27) received nebivolol 5 mg/day for a period of 4 weeks. The endothelial dysfunction was assessed using FMD (flow-mediated vasodilation) of the brachial arteries. The baseline characteristics of both groups were similar in age, gender, left venticular ejection fraction, left ventricular mass index, and body mass index. No significant difference was also found between the groups in the distribution of atherosclerotic risk factors as well as other echocardiographic, demographic, and biochemical measurements. Although the reduction of diastolic blood pressure was more pronounced in the nebivolol group after a 4-week treatment, the change in the systolic blood pressure was found to be similar in both treatment arms. Although a statistically nonsignificant increase was observed in flow-mediated vasodilation in the quinapril group (4.77% +/- 3.92%, 5.60% +/- 6.18%; p = .587), the increase in the post-treatment FMD was statistically significant in the nebivolol group (3.78% +/- 4.25%, 8.56% +/- 6.39%; p = .002). A significant change was observed in the resistive index value following flow-mediated vasodilation for both groups after treatment (p = .043; p = .027), whereas the change in the value of flow volume was significant only in the nebivolol group (p = .019).

Background P-wave dispersion (PWD) is defined as the difference between the maximum and the minimum P-wave (Pmax and Pmin, respectively) duration. Significant variation in cardiac atrial PWD has been correlated with changes in systemic autonomic tone such as during periods of anxiety. It is also known that the degree of PWD seen on 12-lead electrocardiogram (ECG) may be a predictor of susceptibility of the atrial myocardium to future atrial fibrillation (AF). Therefore, we firstly aimed to show an association between PWD and panic disorder, a state of high sympathetic tone. Methods PWD was measured in 40 outpatients with panic disorder and in 40 physically and mentally healthy age- and gender-matched controls. In addition, the Panic Agoraphobia Scale (PAS) and the Hamilton Depression Rating Scale (HDRS) were scored concomitantly. Results Both Pmax and Pmin were significantly higher than those of healthy controls. PWD was significantly greater in the panic disorder group than in the controls. As expected, the mean score on PAS was significantly higher for the panic disorder group than for the controls and correlated significantly with PWD. Heart rate (measured as RR intervals in milliseconds on electrocardiogram) did not differ significantly between the groups. Conclusions The findings of the present study suggest that the disorder may be associated with an increase in PWD. This association may result from prolonged anxiety and increase in sympathetic modulation, which are main characteristics of panic disorder.

Neointimal hyperplasia is in the forefront in in-stent restenosis. Prevention of in-stent restenosis is possible by reducing and inhibiting the hyperplasia of smooth muscle cells. The authors planned this study to test the hypothesis that when administered orally, mycophenolate mofetil (MMF) could inhibit in-stent neointimal hyperplasia. The study included 14 New Zealand rabbits. The rabbits were allocated to 2 different groups: Group 1 included 7 rabbits that were given MMF, 40 mg/kg/day by oral route. Group 2 included 7 rabbits that were not given MMF after the stenting. Sampling materials were taken before and after stenting by incising the artery so as to cover a 5-mm area. The samples taken from the edge of the stent in Group 1 showed focal neointimal cell proliferation, but it was less than that from the control group. Neointimal thickness was 0.048 ±0.009 mm and neointimal area was 0.0925 ±0.019 mm2. Apparent neointimal cell proliferation and thickening of the intimal layer were observed in Group 2. Neointimal thickness at the stent edge was 0.147 ±0.051 mm and the neointimal area was 0.154 ±0.023 mm2. The differences between groups in terms of neointimal thickness and neointimal area were statistically significant (p=0.001 for thickness and p=0.001 for area). In-stent artery samples of Group 1 showed that some subjects had no neointimal cell proliferation, while others had very limited focal intimal thickening. Neointimal thickening was 0.071 ±0.003 mm and neointimal area was 0.073 ±0.003 mm2. In Group 2 apparent, and mostly focal, neointimal cell proliferation and formation of intimal layer were observed in the stent. Neointimal thickening was 0.154 ±0.069 mm and neointimal area was 0.279 ±0.059 mm2. The comparison between groups showed significant differences (p=0.011 for thickness and p=0.001 for area). It was established in the third month that endothelialization was completed in both groups. Oral MMF decreased in-stent intimal hyperplasia without edge effect. It was concluded that for the prevention of in-stent restenosis, studies should be conducted for using systemic immunosuppressive treatments in humans as well.

We evaluated the short-term results of percutaneous excimer laser angioplasty in acute myocardial infarction. Of the 18 patients studied, 2 were female and 16 male with a mean age of 56.6 ± 12.1 years. Thrombolysis in myocardial infarction grades 0, 1, and 2 flow was observed in 10, 5, and 3 cases, respectively, prior to the procedure. The degree of stenosis was 97.9% ± 5.1%. The lesion was crossed with a laser catheter in all cases, using a mean number of 808 ± 384 laser pulses. Type C dissection developed in only 1 case (6%). Except for this case, distal flow was grade 3 in all the patients. Following the procedure, ST segment resolution exceeding 70% was achieved in 14 cases (78%) within the first 90 minutes. The success rate of laser ablation was 94% (17 patients). Stent implantation was performed in all the cases. In conclusion, laser angioplasty is an effective and reliable treatment for acute myocardial infarction.

OBJECTIVE The purpose of this study was to evaluate the long term effect of clopidogrel-based antiplatelet therapy on neointimal formation. METHODS This study comprised 78 patients with typical stable angina pectoris or documented myocardial ischaemia, and with only one angiographic lesion in one native coronary artery undergoing successful stent implantation without predilatation with C-reactive protein levels < or =5 mg/l at 72 h after the procedure. All patients received dual antiplatelet therapy with 75 mg/day clopidogrel and 300 mg/day aspirin for four weeks. Clopidogrel was switched to isochronous placebo in half of the patients (n=39) at the end of the fourth week. This allocation was maintained for 20 weeks, and at week 24 of the study, coronary angiography and intravascular ultrasound imaging were performed again in all cases in order to evaluate the changes that had occurred in the in-stent neointimal formation; rates of restenosis were also recorded RESULTS At the end of the follow-up period, angiographic stenosis diameter and restenosis rates were smaller in the clopidogrel group than in the placebo group (23.3% versus 35.6%, p=0.05 and 5.12% versus 10.25%; p=0.03 respectively); the intravascular ultrasonographic neointimal cross sectional area was also smaller in the clopidogrel group (3.6 +/- 2.7 mm(2) versus 5.2 +/- 2.5 mm(2), p=0.03). CONCLUSIONS Long-term clopidogrel administration significantly reduced neointimal formation at the stent site as well as reducing major clinical events in patients who did not develop high-risk systemic inflammatory response after percutaneous coronary intervention.

Department of Cardiology, Firat University, School of Medicine, Elazig ˘, TurkeySummaryBackground: It has been reported that reperfusion treat-ment reduces QT dispersion (QTD) in cases of acute myocar-dial infarction (AMI). Successful myocardial perfusion is notsynonymous with Thrombolysis in Myocardial Infarction(TIMI) III flow. It has been demonstrated that in AMI, thegrade of ST-resolution correlates strongly with left ventricu-lar (LV) function, enzyme elevation, and mortality after pri-mary angioplasty.Hypothesis: This study investigated the relation betweenST-resolution grade and QTD and the feasibility of using QTDas a determinant of successful myocardial tissue perfusion inpatients in whom TIMI III flow in the infarct-related artery(IRA) is restored by interventional treatment for AMI. Methods:The study included 57 patients (38 men, 19 wom-en, average age 54.4 ± 11.6 years), whose IRA was perfusedby primary angioplasty after the diagnosis of anterior AMIwith ST elevation. Electrocardiograms of patients were taken45 ± 12 min post procedure, and patients were divided intothree groups depending on the grade of ST resolution: Group1, full ST resolution; Group 2, partial ST resolution; andGroup 3, unsuccessful ST resolution.Results:Full ST resolution was seen in 19 cases (33%), par-tial resolution in 26 cases (47%), and unsuccessful resolutionin 12 cases (20%). There were no differences among groups interms of risk factors, stent diameters, symptom onset–balloontime, LV function, and preprocedure corrected QTD (QTcD)(p = 0.274). After the procedure, a significant reduction inQTcD was found within the groups (p = 0.0001 in Group 1, p = 0.004 in Group 2, and p = 0.011 in Group 3). Reductions inQTcD post procedure were 24.21 ±14.27, 11.85 ±16.18, and12.50 ± 11.58 ms in Groups 1, 2, and 3, respectively. Therewas a statistically significant difference of p = 0.015 betweenGroups 1 and 2 and a difference of p = 0.028 between Groups1 and 3. There was no statistically significant difference be-tween Groups 2 and 3 (p = 0.916).Conclusion:In acute MI, TIMI III flow led to a reduction inQTcD, and full myocardial perfusion made an additional con-tribution to the electrical stability of the myocardium.Key words: acute myocardial infarction, ST resolution, QTdispersionIntroductionIn this study, interlead QT change in the surface electrocar-diogram (ECG) is defined as QT dispersion (QTD), which canbe used to measure regional differences in ventricular repo-larization, which play an important role in the pathogenesis ofventricular arrhythmias.

The aim of this study was to evaluate the effects of stenting on blood pressure and renal functions in azotemic patients with proximal/ostial atherosclerotic renal artery stenosis. Thirteen azotemic patients (5 females, 8 males, average age, 62.7 +/- 8.3 years) who had renal artery stenosis were included in the study. Their blood pressure, estimated glomerular filtration rate (EGFR), and creatinine levels were measured at baseline and during follow-up. Stents were implanted successfully in all of the cases. The average stent diameter and stent length were 7.2 +/- 0.5 mm and 17.2 +/- 3.4 mm, respectively. Antihypertensive drug was abandoned in 1 (7.6%) patient, reduced in 10 patients (76.9%), and not changed in 2 (15.3%) patients. Significant improvement was observed in the mean serum creatinine level at the 12th month when compared with baseline (2.56 +/- 0.88; 1.83 +/- 0.62, P < 0.001). EGFR was 18.38 +/- 4.64 before the procedure and 22.67 +/- 3.81 during follow-up (P < 0.0001). According to the GFR criteria, renal function was determined to be worse in 1 (7.6%) patient, stabilized in 2 (15.3%), and improved in 10 (76.9%) patients. One patient died during the follow-up period. Angiographic restenosis was observed in 2 (15.3%) patients. Follow-up major events were observed in 3 (23%) patients. Stenting azotemic patients with renal artery stenosis is a reliable and effective procedure for achieving an improvement in renal function.

Background It is still not clear whether hypertension and left ventricular hypertrophy (LVH) are more common in continuous ambulatory peritoneal dialysis (CAPD) than in hemodialysis (HD) patients. Methods To examine this subject, the indices of cardiac performance were compared between 50 HD and 34 CAPD patients. Patients were further divided into two subgroups [long-term (L) CAPD and L-HD] according to dialysis modality and duration of dialysis (more than 60 months’ duration). Results The blood pressure and cardiothoracic index of CAPD patients did not differ from HD patients. On average, the left atrial index was 2 mm/m2 higher in HD patients than in CAPD patients. Left ventricular chamber sizes, wall thickness, and left ventricular mass index (LVMI) in patients on CAPD were similar to those of HD patients. Isovolumic relaxation time (IVRT) of CAPD patients was insignificantly less than that of HD patients (101 ± 22 and 115 ± 27 msec respectively). There was no significant difference between the two subgroups (L-HD and L-CAPD) in blood pressure, left atrial diameter, left ventricular chamber size, wall thickness, LVMI, ejection fraction, or IVRT. Conclusion If normovolemia and normotension are obtained by strict volume control without using antihypertensive drugs, the effects of the two modalities of chronic dialysis treatment (HD and CAPD) on cardiac structure and function are not different from each other.

Diffuse in-stent restenosis remains an important problem in percutaneous transluminal coronary angioplasty (PTCA). In this trial, we studied the early and mid-term outcomes of excimer laser coronary angioplasty (ELCA) on diffuse in-stent restenosis. ELCA was performed in 23 patients (19 males). The mean length of the lesions was 14.3 +/- 3 mm and the mean age was 58 +/- 7 years. The minimal lumen diameter (MLD) was measured by on-line quantitative coronary angiography. Before the procedure, MLD was 0.9 +/- 0.4. The Q/non-Q-wave myocardial infarction (MI), coronary artery bypass graft (CABG), PTCA, and mortality were recorded during the procedure and at 6 months follow up. The fluence of laser emission was 45 mj/m2 and the repetition rate was 25 pulses per second. Adjunctive balloon angioplasty was performed in all of the cases at a mean 7 +/- 2 atm pressure. The procedure was successfully performed in all of the cases. Type-B dissection developed, after ELCA in 1 patient (4%). Perforation, death, cerebrovascular accidents, emergency CABG, PTCA or Q/non-Q wave myocardial infarction were not observed. MLD was 0.9 +/- 0.4 mm before ELCA, 1.8 +/- 0.9 mm (P0.05) after ELCA, and 3.1 +/- 0.7 mm after PTCA. At 6 months follow up, there were 2 (8.7%) Q-wave myocardial infarctions and 2 (8.7%) recurrent anginal pain cases. Control angiography was obtained in 20 cases (87%). Control angiography was not accepted by 3 patients. Their maximal exercise test was negative. Angiographic restenosis was observed in 6 cases (30%). The rate of target lesion revascularization (TLR) was 5 of 23 (22%) in the patients treated with ELCA. It is concluded, ELCA is a safe and efficient debulking technology for treating diffuse in-stent restenosis.

Elevated levels of C-reactive protein (CRP) are considered to be one of the indicators of poor prognosis in coronary artery disease (CAD). The aim of this study was to evaluate anti-inflammatory effects of atorvastatin in patients with CAD by measuring serum CRP levels.After measuring the baseline levels of CRP and lipid fractions, the patients were divided into two groups. In Group A (n = 46), atorvastatin (20 mg/day) was administered in addition to classic antianginal treatment (beta-blocker, nitrate and aspirin). In Group B (n = 32), the usual antianginal treatment was continued. Following 4 weeks of treatment the same measurements were repeated.In Group A, CRP decreased from 20.3 mg/dl (95% CI, 9-31.8) to 10.8 mg/dl (95% CI, 2.7-18.9) (p0.001). In Group B, CRP decreased from 17 mg/dl (95% CI, 13.1-21) to 12.8 mg/dl (95% CI, 9.7-15.9) (p0.01). The decrease in group A was more than in group B (p = 0.003).In patients with CAD, atorvastatin exerted an anti-inflammatory effect represented by decreasing CRP levels. This effect was independent of the change in low density lipoprotein cholesterol (LDL-C) or high density lipoprotein cholesterol (HDL-C) levels.

Transcatheter aortic valve implantation (TAVI) is a novel method for patients with severe aortic stenosis at high surgical risk. Although short- and medium-term outcomes after TAVI are encouraging, long-term data on valve function and clinical outcomes are limited. Hence, our case can make a contribution to literature. An 80-year-old patient with severe aortic stenosis underwent TAVI in our clinic in October 2015. After 5 months, she admitted to our emergency department with severe dyspnea. Her symptoms were started within 2 days and getting worse day by day. Echocardiography revealed us a severe aortic regurgitation due to dislocation of the valve to the left ventricular outflow tract side. After diagnosis, aortic regurgitation was treated by valve-in-valve technique. TAVI may provide an alternative therapeutic approach to ineligible or poor surgical candidates of degenerative aortic stenosis. However, this technique also has some complications such as mortality, atrioventricular (AV) block, stroke, and coronary obstruction. Valve embolization is an another rare complication of this procedure and usually can be prevented by careful preprocedure annulus measurements, stable lead positioning for rapid pacing, optimal valve positioning, full balloon inflation at the time of valve deployment, and complete balloon deflation before stopping rapid pacing. At this point, our case became important for the complication literature with its time, about 5 months. Because it is the more recently used technique, we need much more time to detect the usefulness and complications of TAVI and learn how to avoid these complications.

Objectives: Our study aims to determine the role of serum adiponectin in chronic heart failure (CHF) and cardiac cachexia (CC). Methods: Ninety consecutive patients were included in the study. Patients were divided into three groups: 30 CHF patients with CC, 30 CHF patients without CC, and 30 healthy individuals. Adiponectin levels were measured through human ELISA kits. Results: Levels of serum adiponectin were significantly higher in the CHF patients with cachexia in comparison with the other groups (CHF with CC: 58.4 ± 15.5 ng/ml vs. CHF without CC: 24 ± 6.7 ng/ml and controls: 7.7 ± 3.4 ng/ml; p = 0.001). Serum adiponectin was negatively correlated with BMI, high-sensitivity C-reactive protein, and hemoglobin (r = -0.37, p = 0.02; r = -0.29, p = 0.02; r = -0.18, p = 0.03, respectively) in the CHF patients with cachexia. Additionally, serum adiponectin levels were positively correlated with B-type natriuretic protein levels, left ventricle end-diastolic and end-systolic diameters (r = 0.36, p = 0.02; r = 0.46, p = 0.01; r = 0.49, p = 0.006, respectively) in the CHF patients with cachexia. Conclusion: Our findings suggest that adiponectin may play a critical role in the pathogenesis of cardiac remodeling and anemia in CC.

Between 1996 and 1998, surgery was carried out in 4 patients with myocardial bridging who had angina refractory to medical therapy. Two patients were treated by supraarterial myotomy and 2 underwent coronary artery bypass grafting. One patient suffered a right ventricular perforation that was successfully repaired. Surgery is recommended for a grade-III myocardial bridge.

Systemic lupus erythematosus (SLE) patients have increased risk of coronary heart disease (CHD) that cannot be fully explained by the traditional risk factors. Metabolic alterations like oxidative stress and insulin resistance may be additional risk factors to contribute early and accelerated atherosclerosis in SLE. Our aim was to evaluate malondialdehyde (MDA) level, oxidative stress indicator, and homeostasis model assessment of insulin resistance (HOMA-IR), and possible relationship between oxidative stress and insulin resistance, in SLE.This cross-sectional controlled study included 30 SLE patients (SLE group) and 15 age- and sex-matched healthy controls (HC group). The SLE patients were classified into subgroups based on the disease activity index as active or inactive. Serum MDA, insulin, C-peptide, fasting blood glucose, lipid profile, acute phase reactants, tumor necrosis factor (TNF)-a, interleukin (IL)-6 and HOMA-IR were determined. Statistical analyses were performed using Kruskal-Wallis, Mann-Whitney U and Pearson tests.In the SLE group, TNF-a (7.9 [0.5-57.8] vs. 3.9 [0.3-6.3] pg/ml, p0.01), IL-6 (9.2 [0.1-33.9] vs. 2.2 [0.1-4.8] pg/ml, p0.01), MDA (2.3 [0.1-6.7] vs. 0.95 [0.5-2.96] nmol/ml, p0.01) and C-peptide (1.9 [0.9-3.5] vs. 1.5 [1.1-2.4] ng/ml, p0.01) levels were higher than in the HC group, while HOMA-IR index (1.7 [0.5-6.5] vs. 1.2 [0.8-2.9], p0.05) was nonsignificantly higher. In the SLE group, MDA levels were correlated with insulin (r=0.614, p0.05) and HOMA-IR (r=0.601, p0.05).In inflammatory diseases, relations between oxidative stress and insulin resistance, each of them triggers or enhances the other one, come to an impasse. In conclusion, this modifiable impasse might be important to prevent the development of atherosclerosis in SLE.

A sharp increase in blood pressure, increase in atrial pressure and atrial strain, left ventricular diastolic dysfunction, and left ventricular hypertrophy (LVH) lead to heterogeneity and instability in atrial conduction. The resulting physiopathological situation may elevate maximum Pwave duration (P(max)) and P-wave dispersion (PWD) in electrocardiography. The objective of our study was to explore the effect of the sudden change in atrial hemodynamics on P(max) and PWD, which may indicate the risk of atrial fibrillation (AF) development in hypertensive urgency.The study included patients diagnosed as hypertensive urgency (systolic blood pressureor =180 mmHg, diastolic blood pressureor =110 mmHg). Nitroprusside was started at a dose of 0.2 microg/kg/min, and the ensuing dose was arranged according to blood pressure. Echocardiography and electrocardiography were used to noninvasively measure changes in diastolic function and PWD and P(max), respectively.The study enrolled 102 patients (mean age 57.9+/-11.6 years; 32 [31.4%] males, and 70 [68.6%] females). P(max) decreased from 99.9+/-11.1 msec (95% confidence intervals [CI] 97.7, 102) to 88.5+/-9.3 msec (95% CI 86.6, 90.3) (P0.001), while PWD decreased from 60.1+/-7.4 msec (95% CI 58.7, 61.6) to 43.9+/-6.7 msec (95% CI 42.5, 45.2) (P0.001). In addition, most patients had LVH and diastolic dysfunction. After nitroprusside treatment improvements in indicators of diastolic functions such as E/A ratio, deceleration time, and isovolumetric relaxation time were observed.The change observed in P(max) and PWD in hypertensive urgency may be associated with the rapid change in blood pressure and atrial strain, sympathetic nervous system activation, relative myocardial ischemia, and left ventricular diastolic dysfunction. Rapid regulation of blood pressure with nitroprusside brought about a marked decrease in P(max) and PWD in our patients. This improvement was interpreted as atrial conduction acquiring a stable and homogeneous character, which may reduce the risk of AF development in hypertensive urgency.

It has been emphasized recently that there is a strong association between atrial fibrillation and inflammation. Rheumatoid arthritis (RA), characterized by ongoing inflammatory activity, can increase the risk of atrial arrhythmia. P-wave dispersion has been encountered as a risk factor for atrial fibrillation and the effect of inflammation on P-wave dispersion has not been studied thoroughly. The aim of this study was to examine the effect of ongoing inflammatory activity in RA on P-wave dispersion. The study comprised 82 patients diagnosed with RA and 41 healthy volunteers as controls. Systolic functions of all participants were evaluated by echocardiography. Maximum P-wave duration and dispersion were calculated and found to be significantly increased in the RA group compared with the healthy controls. These parameters were also significantly correlated with C-reactive protein levels. The findings of this study suggest that RA may be associated with increases in P-wave dispersion and maximum P-wave duration, and that this association may result from ongoing inflammation.

Brain natriuretic peptide (BNP) reflects the left ventricular pressure and volume overload. It is known that it increases in systolic dysfunction proportionally with left ventricular pressure increase. The BNP levels are well correlated with NYHA classification and prognosis. Our aim was to evaluate the predictive value of BNP in patients with diastolic dysfunction but normal systolic dysfunction demonstrated by echocardiography.Fifty patients (mean age: 48.5+/-6.75 years; 29 males, 21 females) were included in this cross-sectional, case-controlled study. Systolic dysfunction was the exclusion criterion. The following parameters were used to evaluate diastolic function: isovolumetric relaxation time, transmitral early to late filling flow velocities (E/A) ratio, deceleration time E, pulmonary vein Doppler findings and color mitral flow propagation velocity. Diastolic dysfunction was determined in 30 hypertensive patients (Group 1), whereas 20 patients who had normal diastolic flow patterns on echocardiography (Group 2). Blood samples were taken for serum BNP level measurements.The BNP levels were 12.0+/-4.97 pg/ml in individuals with normal filling pattern and 66.17+/-17.56 pg/ml in individuals with abnormal filling patterns (p0.001). The accuracy of BNP in detection of diastolic dysfunction was assessed with receiver-operating characteristic (ROC) analysis. The area under the ROC curve for BNP test accuracy in detection any abnormal diastolic dysfunction was 0.969 (95% CI, 0.909 to 1.029; p0.001). A BNP value of 37.0 pg/ml had sensitivity of 80%, specificity of 100%, a positive predictive value of 100%, a negative predictive value of 23% and accuracy of 88% in identifying asymptomatic prolonged relaxation pattern. We found a strong correlation between left ventricular mass index and plasma BNP levels (r=0.62, p0.05).Estimation of BNP values could be accepted as a fast and reliable blood test in the diagnosis of asymptomatic diastolic dysfunction.

High blood pressure, left ventricular hypertrophy and diastolic dysfunction may cause hemodynamic and morphological changes in the left atrium, consequently instability and heterogeneity in atrial conduction. This is seen as an increase in maximum P wave duration (P(max)) and P wave dispersion (PD) on the electrocardiogram (ECG). P wave dispersion on ECG has been encountered as a risk factor for atrial fibrillation (AF). The aim of this study is to examine whether PD and P(max) can be used as a non-invasive marker of target organ damage (LVH and diastolic dysfunction) in a hypertensive population.The study registered a total of 120 cases (mean age 46.9 +/- 10.6 years; 58 [48.3%] males and 62 [51.7%] females), of whom 60 were patients diagnosed as essential hypertension (group 1), and 60 were healthy individuals, who constituted the control group (group 2). Systolic and diastolic functions of all cases were evaluated by echocardiography, and maximum P wave duration (P(max)), and PD was calculated.Maximum P wave duration was 91.6 +/- 10.2 ms in group 1, and 64 +/- 10.2 ms in group 2 (p0.01), while PD was 56.1 +/- 5.8 ms in group 1, and 30.3 +/- 6.6 ms in group 2 (p0.01). Blood pressure, left atrium diameter, DT, IVRT, and E/A ratio, as well as left ventricular mass index increased markedly in group 1.High blood pressure, LVH, diastolic dysfunction and increased left atrium diameter and volume shows parallelism in hypertensive cases. These physiopathological changes may cause different and heterogeneous atrial electrical conduction. This led to a marked increase in P(max) and PD in our cases. Thus, the results support the hypothesis that PD can be used as a non-invasive marker of target organ damage (LVH and LV diastolic dysfunction) in the hypertension population.

Patients presenting with chest pain and nondiagnostic electrocardiograms (ECG) in the emergency department (ED) often pose a challenge to physicians. QT dispersion (QTD) is an electrocardiographic marker of myocardial ischemia due to nonhomogenous ventricular repolarization. We hypothesized that QTD could accurately identify patients with acute coronary syndrome (ACS) who presented with chest pain and nondiagnostic initial ECGs.All patients admitted to the ED with chest pain and nondiagnostic initial ECGs were included in the study prospectively. QTD and QTc dispersion (QTcD) were measured at the initial ECGs and compared for ACS patients vs. non-ACS patients. A receiver operating characteristic curve was drawn to evaluate the diagnostic value of QTD and QTcD for ACS.Of the 137 patients with an initially nondiagnostic ECG, 51 were finally diagnosed with ACS (37%). Mean QTD and QTcD of patients with ACS were significantly greater than those of patients without ACS (39.61 +/- 12.9 vs. 32.56 +/- 15.1, p=0.004; 46.12 +/- 16.3 vs. 38.10 +/- 18.2, p=0.009, respectively). The area under the curve was 0.624, p=0.015 for QTD, and 0.603 and p=0.049 for QTcD. When various cut-off points were evaluated, potentially useful values were determined between 30 and 50 ms for QTD (sensitivity 86% and 10%, specificity 35% and 97%, respectively). These values were 40.5 and 49.5 ms for QTcD (sensitivity was 96% and 32%, specificity was 12% and 77%, respectively).For patients with chest pain and nondiagnostic initial ECG, ACS risk is high if QTD and QTcD values are greater than 40 ms. Therefore, QTD and QTcD can help identify patients with acute coronary syndrome who present with chest pain and a nondiagnostic initial ECG. However, poor operator characteristics of QT dispersion could limit its value as a diagnostic test in the clinical setting.

OBJECTIVE Recent studies demonstrate that the serum inflammatory markers increase in patients with atherosclerosis. We aimed to assess whether a difference exists between patients with acute coronary syndrome and patients with stable angina pectoris in respect to serum neopterin, procalcitonin (PCT) and C-reactive protein (CRP) levels. METHODS AND RESULTS A total of 52 patients (42 male, 10 female) who had atherosclerosis confirmed by angiography and were being followed up for an acute coronary syndrome were recruited and for control group, 45 patients with stable angina pectoris (SA) (35 male and 10 female) who underwent coronary angiography, were examined. Serum concentrations of neopterin, CRP and PCT in the study group (acute coronary syndrome) were compared to control group (stable angina pectoris). The mean neopterin level of the study group was 22.47 +/- 2.93 nmol/l, the mean CRP level was 30.40 +/- 8.05 mg/l and the mean PCT level was 0.40 +/- 0.04 ng/ml. In control group these levels were 12.26 +/- 0.61 nmol/l (p < 0.05), 5.26 +/- 0.64 mg/l (p < 0.001) and 0.19 +/- 0.02 ng/ml (p < 0.001), respectively. CONCLUSION In the presented study our results showed that these markers can be useful for the assessment of inflammation related to atherosclerosis.

In-stent restenosis is a major problem following coronary stent implantation, and inflammation plays an active role. We evaluated the effectiveness of the inflammatory marker C-reactive protein (CRP) as a predictor of in-stent restenosis after successful stent implantation, in 86 patients with unstable angina pectoris. Plasma CRP was measured in all patients before the procedure, and at 48-72 h and 1, 2 and 3 months post-procedure. An angiographic loss of 50% at follow-up was accepted as in-stent restenosis. We found negative and positive predictive values of the pre-procedural plasma CRP for determining 6-month in-stent restenosis of 34% and 61%, respectively. We also found a strong correlation between the 3-month post-procedural CRP value and 6-month in-stent restenosis; the negative and positive predictive values being 8% and 76%, respectively. In conclusion, we showed that a plasma CRP value > 3 mg/l in the third month after coronary stent implantation was a strong predictor of angiographic in-stent restenosis.

The treatment methods for acute myocardial infarction (MI) have started to change in the new millennium. Myocardial perfusion (ST-segment resolution) is the target rather than achieving TIMI-III flow in the infarct-related artery. In this study the authors compared the effect of percutaneous transluminal coronary angioplasty (PTCA) and excimer laser angioplasty (ELCA), which was accepted as one of the thrombolysis methods, on ST-segment resolution. A stent was applied after ELCA to 36 patients (4 women, 32 men; mean age 50.44 ±9.8 years) in group I and a stent was applied after balloon angioplasty to 44 patients (5 women, 39 men; mean age 50.77 ±12.2 years) in group II. Fisher’s exact test was used in the analysis of data, and p

The aim of this study was to evaluate the effects of stenting on blood pressure and renal functions in azotemic patients with proximal/ostial atherosclerotic renal artery stenosis. Thirteen azotemic patients (5 females, 8 males, average age, 62.7 +/- 8.3 years) who had renal artery stenosis were included in the study. Their blood pressure, estimated glomerular filtration rate (EGFR), and creatinine levels were measured at baseline and during follow-up. Stents were implanted successfully in all of the cases. The average stent diameter and stent length were 7.2 +/- 0.5 mm and 17.2 +/- 3.4 mm, respectively. Antihypertensive drug was abandoned in 1 (7.6%) patient, reduced in 10 patients (76.9%), and not changed in 2 (15.3%) patients. Significant improvement was observed in the mean serum creatinine level at the 12th month when compared with baseline (2.56 +/- 0.88; 1.83 +/- 0.62, P0.001). EGFR was 18.38 +/- 4.64 before the procedure and 22.67 +/- 3.81 during follow-up (P0.0001). According to the GFR criteria, renal function was determined to be worse in 1 (7.6%) patient, stabilized in 2 (15.3%), and improved in 10 (76.9%) patients. One patient died during the follow-up period. Angiographic restenosis was observed in 2 (15.3%) patients. Follow-up major events were observed in 3 (23%) patients. Stenting azotemic patients with renal artery stenosis is a reliable and effective procedure for achieving an improvement in renal function.

Background: It has been reported that reperfusion treatment reduces QT dispersion (QTD) in cases of acute myocardial infarction (AMI). Successful myocardial perfusion is not synonymous with Thrombolysis in Myocardial Infarction (TIMI) III flow. It has been demonstrated that in AMI, the grade of ST‐resolution correlates strongly with left ventricular (LV) function, enzyme elevation, and mortality after primary angioplasty. Hypothesis: This study investigated the relation between ST‐resolution grade and QTD and the feasibility of using QTD as a determinant of successful myocardial tissue perfusion in patients in whom TIMI III flow in the infarct‐related artery (IRA) is restored by interventional treatment for AMI. Methods: The study included 57 patients (38 men, 19 women, average age 54.4 ± 11.6 years), whose IRA was perfused by primary angioplasty after the diagnosis of anterior AMI with ST elevation. Electrocardiograms of patients were taken 45 ± 12 min post procedure, and patients were divided into three groups depending on the grade of ST resolution: Group 1, full ST resolution; Group 2, partial ST resolution; and Group 3, unsuccessful ST resolution. Results: Full ST resolution was seen in 19 cases (33%), partial resolution in 26 cases (47%), and unsuccessful resolution in 12 cases (20%). There were no differences among groups in terms of risk factors, stent diameters, symptom onset–balloon time, LV function, and preprocedure corrected QTD (QTcD) (p = 0.274). After the procedure, a signiFICAnt reduction in QTcD was found within the groups (p = 0.0001 in Group 1, p = 0.004 in Group 2, and p = 0.011 in Group 3). Reductions in QTcD post procedure were 24.21 ± 14.27, 11.85 ± 16.18, and 12.50 ± 11.58 ms in Groups 1, 2, and 3, respectively. There was a statistically signiFICAnt difference of p = 0.015 between Groups 1 and 2 and a difference of p = 0.028 between Groups 1 and 3. There was no statistically signiFICAnt difference between Groups 2 and 3 (p = 0.916). Conclusion: In acute MI, TIMI III flow led to a reduction in QTcD, and full myocardial perfusion made an additional contribution to the electrical stability of the myocardium.

The presence of thrombus in the lesion before balloon angioplasty increases the complications arising from mechanical intervention. It is known that the use of Gp llb/llla receptor blockers before the intervention enhances the reliability of the procedure. Laser thrombolysis was applied to a patient who underwent coronary angiography due to recurrent chest pain after thirty six hour administration of tirofiban and who was found to have a thrombus so large as to block the distal vessel bed of the right coronary artery. Following the procedure, the entire thrombus was broken down and Grade III distal myocardial perfusion was achieved. This case is important in demonstrating that laser application is a viable alternative in such instances, especially considering that intervention in acute coronary syndromes is on the increase and cardiologists will frequently encounter such cases.

We evaluated the effects of stenting on blood pressure and renal functions in hypertensive patients with proximal/ostial atherosclerotic renal artery stenosis.Twenty-six hypertensive patients (9 female, 17 male, mean age 59.0+/-7.4 years) who had renal artery stenosis were included into this study. Their blood pressure, urea and creatinine levels were measured at 24 hours, 3 months and 9 months after procedure.Stents were implanted successfully in all cases. Implanting of stent was done with predilatation in 16 (5%) cases and without predilatation (direct stenting) in 10 (49%) cases. Mean stent diameter and stent length were 7.11+/-0.3 mm and 15.0+/-2.2mm respectively. The antihypertensive drug therapy was stopped in 6 (23%) patients, decreased in 15 patients (58%) and did not change in 5 (19%) patients. No significant changes were observed in urea and creatinine levels. However, creatinine levels were lower after procedure in direct stenting patients than in patients in whom predilatation was applied (0.78+/-0.3 mm; 1.32+/-0.6, p=0.003). This difference disappeared on the 3rd month of follow-up. One patient died during follow-up period. Control angiography was performed in 23 patients. Angiographic restenosis was found in 1 (4.3%) patient. Major events during follow-up period occurred in 2 (8%) patients.Stenting in hypertensive patients with renal artery stenosis is reliable and effective procedure. Selection the stenting procedure with or without predilatation depends on the clinical status of patient and the choice of the interventional team.

Background. Nephrogenic ascites refers to the condition of refractory ascites of unknown aetiology and occurs mainly in patients with end-stage renal disease who are undergoing haemodialysis. Despite many treatment modalities, nephrogenic ascites remains difficult to control and has a poor prognosis. Methods. We investigated six such patients who had developed severe, apparently refractory ascites during haemodialysis. They all had seriously disturbed cardiac dimensions and function. They were treated with repeated isolated ultrafiltration and severe salt restriction, while their cardiac functions were monitored with echocardiography. Results. After a mean of 18"4 l of fluid per patient was removed in 27"8 days, ascites disappeared in all patients. Blood pressure and cardiothoracic indices were decreased from 130"20u83"10 to 95"11u 60"6 mmHg (P-0.02) and from 0.61"7 to 0.47"5 (P-0.02), respectively. At the end of treatment, heart rates had decreased from 102"10 to 85"6 beatsumin. Previously increased left atrial diameters, end-systolic and end-diastolic dimensions of the left ventricles, and right ventricular diameters reached normal values. Ejection fractions initially decreased in all patients, and then increased slightly to markedly after treatment. Conclusion. Nephrogenic ascites is a component of right-sided cardiac congestion mediated by volume overload, and it should be treated with severe salt restriction and frequent ultrafiltration with haemodialysis and, if that fails, with daily isolated ultrafiltration.