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Aim:Heart-type fatty acid binding protein (H-FABP), an early marker of cardiac necrosis, is released rapidly from myocardium as a consequence of ischemic injury. We hypothesized that more severe and extensive coronary atherosclerosis would result in more pronounced myocardial injury and necrosis in patients with acute myocardial infarction (AMI). Therefore, we sought the relationship between serum H-FABP levels and the severity and extent of coronary artery disease (CAD) assessed using the Gensini score.Materials and Methods:Fifty patients with AMI who underwent invasive coronary angiography were divided into 2 groups according to the angiographic Gensini score, namely the moderate to severe CAD group (group 1) and the mild CAD group (group 2). A point of care test and Cardiodetect Quant device were used to detect whether H-FABP was positive and the quantitative measurements. The data obtained from this study were evaluated using the PASW statistic programme.Results:Mean serum H-FABP concentration was significantly higher in group 1 when compared to that in group 2. Furthermore, a strongly positive correlation was found between the Gensini score and serum H-FABP levels.Conclusion:The findings of our study suggest that the quantity of myocardial necrosis demonstrated by serum H-FABP levels is higher in patients with AMI who have more severe and extensive CAD. H-FABP levels are also positively correlated to the Gensini score. We propose that H-FABP, an early marker of myocardial necrosis, may also provide a clue about the severity and extent of CAD, especially in the setting of AMI.

Introduction: Type 2 diabetes mellitus (DM) is a major risk factor for cardiovasculardiseases and is responsible for the increase in cardiovascular mortality.Chronic hyperglycemia is related to accelerated atherosclerosis. In this study,we tried to demonstrate the relation between glycosylated hemoglobin (HbA1c)level, which is a marker of long-standing hyperglycemia, and aortic stiffness,which is a marker of cardiovascular disease.Patientsand Methods: In total, 100 patients withtype 2 DM were included in this study. Patients were divided into three groupsaccording to the HbA1c level (group 1 HbA1c ≤ 6, group 2 HbA1c between 6 and 7,and group 3 HbA1c ≥ 7).Results: Significant correlation was found between aortic distensibility andHbA1c level (r= 0.283, p= 0.004). Moreover, aortic distensibility was alsocorrelated with the duration of DM (r= −0.172, p= 0.05) and age (r= -0.27, p=0.006). Significant correlation was determined between aortic strain andfasting blood glucose level, HbA1c level, and the duration of DM (r= −0.265, p=0.008; r= 0.279, p= 0.005; and r= −0.14, p= 0.03, respectively).Conclusion:In this study, we showed that aortic stiffness was increased in patients withtype 2 DM who have high blood fasting glucose and HbA1c levels. Our study alsoshowed that the duration of DM was related to aortic stiffness.Echocardiographic non-invasive evaluation of aortic stiffness may be helpful inthe estimation of cardiovascular risk in patients with DM., Giriş: Tip 2 diabetes mellitus (DM) kardiyovasküler hastalıklar için major riskfaktörüdür ve DM’li hastalar artmış kardiyovasküler mortalite ve morbiditeyesahiplerdir. Kronik hiperglisemi ile ilişkili olan birçok mekanizma buhızlanmış aterosklerozdan sorumlu tutulmaktadır. Bu çalışmada amaç DM’lihastalarda uzun dönem glisemik kontrolün belirteci olan HbA1c seviyesi ilekardiyovasküler hastalıkların belirteci olan aortik sertlik arasındaki ilişkiyisaptamaktır.Hastalarve Yöntem: Çalışmamıza kliniğimize başvuran Tip 2 DM’li 100hasta alındı. Hastalar HbA1c değerlerine göre üç gruba ayrıldı.Bulgular: Gruplar arasında açlık kan şekerleri, DM süresi ve oral antidiyabetik yada insülin kullanımında istatistiksel olarak anlamlı şekilde farklı bulundu.Aortik esneyebilirlik ve HbA1c düzeyi arasında önemli ilişki bulundu (r= 0.283;p= 0.004). Bunun yanı sıra, DM süresi (r= -0.172; p= 0.05) açlık kan şekeri(r=0.292; p= 0.003) ve hasta yaşı ile (r= -0.27; p= 0.006) aortikesneyebilirlik arasında da istatistiksel anlama ulaşan korelasyon tespitedildi. Bunun yanında aortik gerilim ile açlık kan şekeri, HbA1c, DM süresiarasında (sırasıyla; r= -0.265; p= 0.008, r= 0.279; p= 0.005 ve r= -0.14; p=0.03) anlamlı korelasyon bulundu.Sonuç:Bu çalışmada, yüksek açlık kan şekeri ve HbA1c düzeyine sahip tip 2 diyabethastalarında aortik sertliğin arttığını gösterdik. Aynı zamanda çalışmamızdiyabetin süresi ile aortik sertliğin ilişkili olduğunu göstermiştir. Ekokardiyografiylenoninvaziv yöntem olarak ölçülen aortik elastisite parametreleri hastalığın erkendöneminde kardiyovasküler riski tahmin etmede ve önlemede faydalı olabilir.

Isolated systolic hypertension (ISH) is generally encountered in elderly patients and there are scarce data regarding the renin-angiotensin-aldosterone system (RAAS) activity in patients with ISH. We aimed to determine the plasma renin activity (PRA), plasma aldosterone levels (PAL) and aldosterone/PRA ratio (PAL/PRA) in patients (age50 years) with ISH and to compare these values with patients with essential hypertension (EH) as well as subjects with normal blood pressure values (control) who have similar age and cardiovascular risk profile.Consecutively, 42 untreated ISH patients, 30 patients with EH and 29 normal subjects were included in the study. Parameters were presented as median (interquartile range).There were no significant differences regarding age, gender and other cardiovascular risk factors among groups. As expected, systolic, diastolic blood pressure and pulse pressure values were significantly different among groups. Besides, PRA values were found to be significantly lower in patients with ISH (0.4 [0.2-1.1] ng/ml/h) compared with the EH (0.95 [0.5-2.6] ng/ml/h, p =0.024) and control (1.3 [0.7-2.1] ng/ml/h, p =0.001) groups. Although, PAL were similar among groups, PAL/PRA ratio was significantly higher in ISH group (134.1 [73-224]) compared with those with EH (42.2 [35-84], p0.001) and the control group (53.3 [30-106], p =0.001). No significant difference was present with respect to PAL/PRA ratio between EH and control groups.Our findings suggested that in patients with ISH, despite lower PRA levels, PAL/PRA ratio is significantly higher compared with the patients with EH and subjects with normal blood pressure. Since higher PAL/PRA levels is an indicator of relative aldosterone excess, medications blocking RAAS activity including aldosterone antagonists may have useful cardiovascular consequences in addition to their antihypertensive effects in ISH.

Aim: In mitral stenosis (MS), left atrial (LA) compliance plays a crucial role in the occurrence of symptoms and pulmonary arterial hypertension and can alter pulmonary venous flows (PVF). The aim of present study is to compare LA compliance (net atrioventricular compliance-Cn) and PVF velocities in patients with different functional status despite similar mitral valve area (MVA). Additionally, the relationships of the same variables with each other and other echocardiographic parameters showing the hemodynamic severity of mitral stenosis were investigated. Methods: Thirty-one patients with moderate to severe mitral stenosis were studied. The patients were divided into two groups according to their NYHA functional classes (FC). The patients with lower FC (NYHA FC1 and FC2) were included in Group I(n = 15), and those with FC ≥ 3 included in Group II (n = 16). All patients underwent comprehensive transthoracic and transesophageal echo Doppler examination. Results: Despite similar LA size, MVA, and transmitral diastolic pressure gradients, systolic pulmonary artery pressure (SPAP) was significantly higher and LA compliance was significantly lower in Group II as compared to group I. Also, systolic PVF velocity (PVs), diastolic PVF velocity (PVd), and PVs/PVd ratio were significantly lower in Group II as compared to Group I. In whole group, significant positive correlations between LA compliance and PVs (r = 0.38, P = 0.035), as well as PVd (r = 0.40, P = 0.023) and, significant negative correlation between LA compliance and SPAP (r =– 0.36, P = 0.047) were noted. Conclusion: Our findings suggested that in patients with MS, when there is inconsistency between symptomatic status and conventional echocardiographic variables, simple and noninvasive Doppler parameters, LA compliance, and PVF could be measured before cardiac catheterization for more accurate and complete evaluation of patients. (ECHOCARDIOGRAPHY, Volume 26, November 2009)

Objective: Percutaneous balloon valvulotomy (PBV) is the procedure of choice for the treatment of valvular pulmonary stenosis (PS) with similar results comparable to surgical valvotomy but less invasive. . Methods and Results: Twenty-seven consecutive patients with PS being evaluated for PBV were enrolled in the study. Peak instantaneous transvalvular gradient, right ventricle (RV) diameter, mean atrial pressures, RV systolic pressure (RVSP), pro-brain natriuretic peptide (proBNP) levels significantly decreased immediately after PBV. Regarding heart rate variability (HRV) parameters, mean HR (heart rate), LF (low frequency) day and night, LF/HF day and night significantly decreased and standard deviation of all NN intervals (SDNN), root mean square of successive differences (RMSSD), P number of NN intervals that differed by more than 50 ms from adjacent interval divided by the total number of all NN intervals (PNN50), HF (High frequency) day and night significantly increased 1 day after PBV and these changes were shown to be preserved at the first month. The increase in SDNN was correlated with the decrease in right atrial pressure (RAP) (r =−0.5, P = 0.04); the increase in standard deviation of the 5-minute mean RR intervals (SDANN) was correlated with the decrease in proBNP (r =−0.4, P = 0.03). Conclusions: Sympathetic overactivity and increased proBNP levels were associated with the symptomatic status of patients with PS. Associated with a decrease in atrial pressures and proBNP levels, PBV yielded a decrease in adrenergic overactivity in the patients with PS.

WOS: 000257946700009, PubMed ID: 17705053, Background: Acute coronary syndromes, characterized by the rupture of unstable plaque and the subsequent thrombotic process involving platelets, have been increasing in relative frequency. The central role of platelet activation has long been noticed in this pathophysiology; hence, many therapies have been directed against it. In this study, we have aimed to search prospectively the value of mean platelet volume (MPV), which is a simple and accurate measure of the functional status of platelets, in patients hospitalized with diagnosis of acute coronary syndromes (ACS). Materials and methods: A total of 216 consecutive patients (156 male, 60 female) hospitalized with the diagnosis of non-ST segment elevation (NSTE) ACS within the first 24 h of their chest pain were enrolled. One hundred and twenty patients, matched according to sex and age, with stable coronary heart disease (CHD) (85 male, 35 female) were enrolled as a control group. Patients were classified into two group: those with unstable angina (USAP, n = 105) and those with non-ST segment elevation myocardial infarction (NSTEMI, n = 111). Results: MPVs were 10.4 +/- 0.6 fL, 10 +/- 0.7 fL, 8.9 +/- 0.7 fL consecutively for NSTEMI, USAP and stable CHD with significant differences. Patients with ischemic attacks in the first day of hospitalization accompanied by > 0.05 mV ST segment shift had significantly higher MPV compared to those without such attacks (P = 0.001). Multivariable logistic regression analysis yielded that MPV (P = 0.016), platelet count (P < 0.001), and the presence of > 0.05 mV ST segment depression at admission (P = 0.002) were independent predictors of development of NSTEMI in patients presenting with NSTE ACS. Conclusion: In patients presenting with NSTE ACS, higher MPV, though there are overlaps among subgroups, indicates not only more risk of having NSTEMI but also ischemic complications.

Background - Coronary artery bypass surgery with saphenous vein grafts is a well accepted treatment method of coronary artery disease despite the diminishing patency rates of saphenous vein grafts over time mainly due to the atherosclerotic process. Obesity has been shown to be a risk factor for coronary artery disease, but the impact of obesity on saphenous vein graft patency is less well described.This study was designed to examine the effect of obesity on the early and late saphenous venous graft stenosis. Methods - 676 consecutive patients (mean age 62.9 ± 9.7 years), undergoing a first-time coronary angiography after bypass surgery for recurrent angina were evaluated: body mass index was measured for 323 patients with at least one saphenous vein graft stenosis (group I) and 353 patients without saphenous vein graft stenosis (group 2). Results - There were no statistically significant differences in terms of hypertension, diabetes, smoking, hyperlipidaemia and gender as well as body mass index (BMI) status of the patients between the two groups (P > 0.05).The patients in both groups divided into obese and non-obese subgroups using a definition for obesity of BMI ≤ 30 and cumulative saphenous vein graft patency rates were evaluated as a function of time. Kaplan Meier curves showed that obese and non-obese patients had similar patency rates according to time since coronary artery bypass surgery (P > 0.743). Conclusion - Body mass index seems not to have an impact on the early and late saphenous venous disease in a group of consecutive patients admitted with recurrent angina.

Significant tricuspid regurgitation (TR) can contribute to increased morbidity and mortality in patients undergoing mitral valve surgery for mitral stenosis. The aim of this study was to evaluate the association between the severity of preoperative functional TR and late adverse outcomes in patients undergoing mitral valve replacement (MVR). The study group comprised 68 patients (54 women, 14 men; mean age 45 ±10 years) with rheumatic mitral stenosis (MS) who had undergone MVR without tricuspid valve surgery between 4 and 13 years (mean 8.1 ±2.6 years) before their last clinical examination. All patients underwent a complete preoperative and late postoperative color-Doppler echocardiographic examination. The severity of TR was assessed echocardiographically by using color-Doppler flow images and flow direction in the inferior vena cava or hepatic veins. Patients were classified into 2 groups; 42 with mild (62%) and 26 with significant (38%) TR. Patients with significant TR showed longer preoperative symptomatic period and more atrial fibrillation than those with mild TR. All patients had medical treatment. Functional capacity and NYHA class of the patients in both groups improved significantly after MVR. Freedom from symptomatic heart failure (functional class III or IV) was higher (86% vs 54%) and the need for hospitalization was significantly lower for the mild TR group. Significant preoperative functional TR diagnosed by echocardiography was associated with an adverse outcome. Therefore, further studies are needed to evaluate the effect of concomitant tricuspid valve repair on the late outcome of patients undergoing mitral valve surgery in order to prevent significant late morbidity.

Anticoagulation treatment can prevent systemic embolism in patients with mitral stenosis (MS) and atrial fibrillation (AF), but this treatment is under debate if patients are in sinus rhythm. The authors aimed to determine the hemostatic changes in patients with MS and sinus rhythm. Forty-six patients (28 in sinus rhythm and 18 in AF) with mitral stenosis were enrolled in this study. They studied systemic venous fibrinogen, D-dimer, antithrombin-III, tissue plasminogen activator (tPA), plasminogen activator inhibitor-I (PAI-I), von Willebrand factor (vWF), and platelet factor 4 (PF 4) in these patients. The patients were first classified according to their rhythm as sinusal and AF, and then according to the presence of left atrial spontaneous echo contrast (LASEC). Fibrinogen, D-dimer, antithrombin-III, vWF, and PF 4 levels were significantly greater in patients with MS and sinus rhythm or atrial fibrillation compared to the control group (p

Systolic heart failure (SHF) is associated with increased morbidity and mortality. Beta-blockers (BB) were shown to provide mortality benefit in patients with SHF, and currently indicated in all stages of patients with SHF. We evaluated the factors influencing the prescription of BBs at discharge in patients hospitalised with HF. Hospital discharge records of consecutive 1418 patients (996 men, 422 women) with a mean age of 57 +/- 15 years, hospitalised and treated for SHF (EF < 45%), were retrospectively reviewed. Mean age of female (n = 422) and male patients (n = 996) was similar (58 +/- 15 years vs. 58 +/- 14 years, p = 0.654). Mean EF was 33 +/- 7%, and not different for each sex (p = 0.288). BBs were present in 47.4% of patients at hospital discharge, and female patients were more frequently prescribed than men (51.7% vs. 45.7%, p = 0.036). Patients who were prescribed BBs at discharge were younger than those who were not (p = 0.034). Patients who were prescribed BBs at discharge had significantly higher EF than those who were not (p = 0.019). Older patients were prescribed low-dose BBs. Besides, creatinine level was significantly higher in the group who were prescribed low-dose BBs than those who were prescribed high dose. However, EF was significantly lower in the group, who were prescribed low-dose BBs than in those prescribed moderate-high dose (33 +/- 7% vs. 35 +/- 7%, p = 0.023). There exist several factors associated with underuse of this highly recommended medication in patients with HF.

Cardiac syndrome X (CSX) is a condition characterized by exercise-induced chest pain that occurs considering a normal coronary angiogram. We aimed to investigate the total serum antioxidant capacity (TAC) and biventricular global functions using echocardiography in patients with CSX.The study population included 55 patients with typical anginal symptoms and a positive exercise stress test, or ischemia in myocardial perfusion scintigraphy and normal coronary arteries detected angiographically, and 49 healthy volunteers with atypical chest pain and a negative stress test. TAC was assessed from blood samples. Transthoracic echocardiography was performed for the entire study population. The Tei index was calculated using the formula IVCT+IVRT/ET.TAC was found to be significantly lower in the CSX group compared with the control group (0.70±0.37 vs. 1.5±0.30, respectively, P0.001). The Tei index was significantly higher in patients with CSX than the control group (0.60±0.18 vs. 0.42±0.12, respectively, P0.001).There was a significant and inverse relationship between TAC and the Tei index (r=-0.41, P0.001). When we divided the study population according to the normal range of TAC into the decreased TAC group (1.30 mmol/l), the normal TAC group (1.30-1.77 mmol/l), and the increased TAC group (1.77 mmol/l), it was found that the Tei index was higher in the decreased TAC group compared with the other groups (0.66±0.18 vs. 0.49±0.10 and 0.46±0.13 mmol/l, P0.001, respectively).Our study suggested that TAC was significantly decreased in CSX patients and decreased antioxidant levels were related to impaired Tei index in echocardiography in patients with microvascular angina.

WOS: 000360292000004, PubMed ID: 26301344, Objective: Ischemia-modified albumin (IMA) is a sensitive biomarker of myocardial ischemia. However, data on IMA levels in acute heart failure (HF) are still lacking. In this study, we aimed to evaluate serum IMA levels in acute decompensated HF and the effects of dobutamine and levosimendan treatments on IMA levels. Methods: This was a prospective, multicenter study that included 70 patients hospitalized with acute decompensated HF and left ventricular ejection fraction

To determine whether plasma level of soluble P-selectin (sP-selectin) increases in rheumatic mitral stenosis (MS) patients with sinus rhythm, who have scheduled for percutaneous mitral balloon valvuloplasty (PMBV), and to examine the effect of PMBV on sP-selectin level.Twenty-six patients with MS and sinus rhythm (study group, 20 female, mean age 33 +/- 8 years) and a well-matched control group composed of 21 healthy volunteers (15 female, mean age 35 +/- 6 years) were enrolled in the study. In each patient left atrial (LA) thrombus was excluded by transesophageal echocardiography. sP-selectin levels were compared between study patients and controls, and between peripheral and LA blood. Changes in sP-selectin level 24 h and 4 weeks after PMBV were also analyzed.A significantly higher basal sP-selectin level was noted in study group. After PMBV, the mitral valve area (MVA) increased and the transmitral mean gradient decreased significantly. At 24th hour after PMBV, sP-selectin level decreased from 1080.38 +/- 143.87 ng/ml to 960.00 +/- 103.26 ng/ml (p0.0001) and at 4th-week follow-up it was decreased from 960.00 +/- 103.26 ng/ml to 879.61 +/- 98.16 ng/ml (p0.0001). No significant difference was found between peripheral and LA blood regarding the sP-selectin level. Correlation analysis between the difference in MVA measured 24-hour after and before PMBV and the difference in sP-selectin level measured 24-hour after and before PMBV showed a significant direct relationship between these variables.This study suggests that in patients with MS and sinus rhythm sP-selectin level increases probably due to turbulent flow across the stenotic valve. After PMBV sP-selectin shows a progessive decline, which is directly correlated with the increase in MVA.

WOS: 000242209100008, PubMed ID: 16943646, Background: Atrial fibrillation (AF) is a frequent arrhythmia, associated with morbidity and mortality. It is identified by two types on surface electrocardiogram as fine and coarse AF. We aimed to search the association of subtypes of AF with clinical parameters. Methods: Eight hundred and eleven consecutive patients, who had AF attack which lasted longer than 24 h or more, were evaluated along with clinical and laboratory data. Results: Coarse AF was noticed in 51.7% (n = 419), and fine AF in 48.3% (n = 392). Sex was associated with subtype of AF such that coarse AF was present in 46.5% of male patients, but in 56.1% of female patients (p = 0.009). Coarse AF was present in 85.3% of patients with mitral stenosis, whereas it was present in 35.3% of patients with normal heart valve (p < 0.001).). Patients having fine AF were significantly older than those having coarse AF (64 +/- 12, 57 +/- 13 years, p < 0.001). 19.6% of those with coarse AF had history of cerebrovascular event (CVE), whereas 13.5% of those with fine AF had history of CVE (p = 0.021). After controlling for age in the multivariable logistic regression analysis, presence of coarse AF (B = 1.585, p = 0.031) was found to be independently associated with the history of CVE. Conclusion: AF is identified by two morphological forms on the surface electrocardiogram. These two forms were found to be associated with different clinical parameters, acting on vascular endpoints differently. Copyright (c) 2007 S. Karger AG, Basel.

WOS: 000236020200010, PubMed ID: 16490428, Development of coronary collaterals (CCs) is triggered by the gradient between arteries due to obstruction and myocardial ischemia. Presence of CCs that feed the jeopardized myocardial area may limit the infarct size after coronary occlusion and may even provide a survival benefit. However, some patients develop good CCs, whereas others do not. The metabolic syndrome (MS) has been identified as a secondary target to decrease cardiovascular risk, although the effect of MS on development of CCs has not been investigated. We prospectively enrolled 596 consecutive patients (337 men and 259 women; mean age 56 +/- 8 years) who underwent coronary angiography at our center and were found to have total occlusion of the right coronary artery. Patients were then classified as having good CCs (Rentrop's grades 2 to 3) or poor CCs (Rentrop's grades 0 to 1). There were significant differences in terms of body mass index (kilograms of body weight divided by square meters of height), glucose levels, triglyceride levels, and years with angina pectoris between those with good and poor CCs. Prevalences of diabetes mellitus were 27.1% among patients with good CCs and 44% among those with poor CCs (p

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

To assess the diagnostic importance of serum-solubilized adhesion molecules, vascular cell adhesion molecule-1, intercellular adhesion molecule-1, sE-selectin and sP-selectin in aortocoronary saphenous vein graft disease.The study population was composed of two groups consisting of 41 patients with saphenous vein graft stenosis (stenosis group) and 43 patients without saphenous vein graft stenosis (no-stenosis group) based on the results of coronary angiography. All patients underwent coronary artery bypass graft operation involving the use of at least one saphenous vein graft for bypass. At the time of cardiac catheterization, it had been more than 1 year since the operation.Serum level of sP-selectin was significantly higher in the stenosis group than in the no-stenosis group (72.9+/-21.7 versus 48.7+/-18.6 ng/ml, P0.001). No differences were found between the two groups with respect to serum levels of sE-selectin, intercellular adhesion molecule-1 and vascular cell adhesion molecule-1. Multivariate analysis revealed that only serum levels of sP-selectin, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol were independently correlated with the stenosis of saphenous vein grafts. A cutoff value of serum sP-selectin57.5 ng/ml yields a specificity of 79.5%, a sensitivity of 73.3% and a positive predictive value of 80.5% for saphenous vein graft stenosis.In this study, sP-selectin level was found to be significantly higher in the group that had late aortocoronary saphenous vein bypass graft disease. This result suggests that platelet activation may play a causal role in late graft disease.

Reports of massive myocardial calcification are limited mainly to case reports and this type intracardiac calcifications have been usually identified postmortem. We present a very interesting case of massive calcification of the left ventricular myocardium, interventricular and interatrial septae causing restrictive physiology and coronary artery obstruction in a 46-year-old Turkish woman. The diagnosis of myocardial calcification was suspected from chest X-ray and confirmed with computerized tomography and cardiac catheterization. The findings of the chest computed tomography were very similar to those previously reported cases of endomyocardial fibrosis (EMF) with massive calcification of the left ventricle.

Although cardiovascular manifestations in thyroid disorders are frequently encountered in clinical practice, atrioventricular (AV) conduction disorders, especially in hyperthyroidism, are rare. There are some proposed mechanisms for AV blocks in hyperthyroidism but the exact mechanism is still unknown. The authors report 2 cases with thyroid function disorders and complete AV block, and the electrophysiologic characteristics of these 2 patients, and they review and speculate on similar reported cases.

Statins are frequently prescribed drugs for patients with coronary heart disease according to evidence-based medicine. However, compliance with these agents has still been far from ideal, since they require long term, probably life long therapy. We conducted a survey on patients who were already on statin treatment and evaluated their level of awareness of prescribed statins.236 participants (117 male, 119 female), who had been on treatment with statins for at least three months, were enrolled in our study after giving informed consent. Patients were asked close-ended survey questions.Only 5.5% of participants were on statin treatment for primary prevention, and 16.1% of them had a CHD equivalent, defined as those with clinical manifestations of noncoronary forms of atherosclerotic disease (peripheral arterial disease, abdominal aortic aneurysm, carotid artery disease) and diabetes mellitus. Most participants (70%) stated that they had been using statins to decrease cholesterol, whereas 16.5% stated that they had no idea. More than half of the participants (58%) stated that they did not know how long they would have to keep using their statins, whereas 21% replied that they would use them continuously. One fifth of participants had some idea about side effects. Participants in whom statin therapy was started during hospitalisation for coronary angiography and/or PCI more frequently answered that statins should be used continuously (49% vs. 12% not hospitalised, p0.01). Also, therapy adjustment by the physician led to a better understanding of the need for continuous use (55% vs. 31% without medication change, p0.001), as was the case for patients with2 co-medications (36% vs. 17% with2 co-medications, p 0.002). Presence of other risk factors did not have any impact on level of awareness.Comprehensive information at initial prescription, initiation of statins during hospitalization, dose adjustment during follow up, and as little co-medication as possible seem to increase the level of awareness of the benefits of long-term statin treatment. This might result in better compliance rates.

OBJECTIVES Restenosis is the major limitation of coronary interventions occurring in nearly a third of the patients undergoing percutaneous transluminal coronary angioplasty (PTCA) with no single, definite predictor demonstrated in an individual patient. Platelets are known to play an important role in the pathogenesis of subsequent restenosis. METHODS AND RESULTS In a prospective study, follow-up coronary angiographies were performed in 102 consecutive patients with stable angina who underwent a successful PTCA for single-vessel coronary artery disease. Demographics, baseline lipid profiles (total cholesterol, HDL- and LDL-cholesterol, triglycerides) and haematological parameters (red cell, white cell and platelet counts, haemoglobin concentration, haematocrite %, mean platelet volume, platelet mass and fibrinogen levels) were compared between patients with and without restenosis. In the restenosis group, mean platelet volume (8.82 +/- 0.78 fl vs. 8.13 +/- 0.64 fl, p < 0.001), white cell count (8673 +/- 322 x 10(3)/microl vs. 7513 +/- 232 x 10(3)/microl, p < 0.01) and fibrinogen level (4.2 +/- 1.4 g/l vs 3.6 +/- 1.1 g/l) were significantly higher. The relative odds for developing angiographically defined restenosis were 2.49 times greater in diabetics (p = 0.11) and 2.54 times greater in men (p = 0.13). It is 1.43 times greater in patients with higher fibrinogen levels (p = 0.16). But, the relative odds for developing restenosis were 10.43 times greater in patients with larger pre-procedural mean platelet volumes (p < 0.01). CONCLUSIONS There was a positive correlation between mean platelets volume and loss in luminal diameter between post-angioplasty and follow-up angiographies (r = +2.345, p = 0.01). There was no association between restenosis and haemoglobin, haematocrit, red cell count, white cell count, platelet count, platelet mass and plasma fibrinogen level. The development of restenosis after successful coronary angioplasty may be mainly influenced by the platelet size.

Atherothrombosis is a generalized disease process that affects large- and medium-diameter arteries throughout the arterial tree. In this study, we aimed to evaluate the correlation between collaterals in different vascular beds. Patients who had undergone digital subtraction angiography for symptomatic lower extremity peripheral arterial disease and coronary angiography after an acute anterior myocardial infarction (MI) were compared with a control group composed of those patients who were hospitalized for acute anterior MI and underwent coronary angiography but had no claudication and had an ankle-brachial index of greater than 0.9 in both legs. In claudicants, stenosis in the left anterior descending artery (LAD) (90.3 +/- 17.5 vs 78.6 +/- 13.8, P = 0.005) was greater compared with the patients without claudication. The collaterals to the LAD (88% vs 37.5%, P = 0.001) and the collateral grades (1.7 +/- 0.7 vs 0.7 +/- 0.9, P = 0.001) were higher in the patients with claudication compared with those without claudication. A previous history of angina (52.2% vs 16.3%, P = 0.001), claudication (39.1% vs 4.6%, P = 0.001), and peripheral collaterals (45.7% vs 6.9%, P = 0.001) were higher in the patients with coronary collaterals than in those without. The factors affecting the development of coronary collaterals were claudication [relative risk (RR): 8.8; 95% confidence interval (CI): 2.1-39.8], peripheral collaterals (RR: 1.1; 95% CI: 1.1-1.3), and LAD stenosis (RR: 1.2; 95% CI: 0.03-29.1). Our results suggest that the presence of collateralization or angiogenesis in one vascular bed highly predicts collateralization in another arterial bed.

Aortic stenosis is one of the most commonly encountered valvular pathology requiring surgery in developed countries. There are similarities between risk factors for coronary atherosclerosis and the development of aortic stenosis. We designed a retrospective study, evaluated the lipid profile and previous echocardiographic recordings of patients with aortic stenosis, and searched the association of rate of progression and lipid profile.The annual rates of progression in the peak and mean aortic gradients were 8.5 +/- 3.2 and 6.7 +/- 2.2 mm Hg/year, respectively. We classified the annual rate of progression of peak aortic gradient into 2 groups, group 1 with10 mm Hg ("slow progressors") and group 2 withor =10 mm Hg annual rate of progression ("fast progressors"). The annual rate of progression in group 1 was significantly higher than that in group 2, both in peak and mean aortic gradients (12 +/- 2 mm Hg and 6.4 +/- 1.6 mm Hg; 9 +/- 1.3 mm Hg and 5.2 +/- 1.1 mmHg; P.001 for both). There was a highly significant difference between group 1 and group 2 for total cholesterol/high-density lipoprotein (HDL) cholesterol level ratio (7.1 +/- 1.4 vs 5.2 +/- 1.3, P.001). There was a significant correlation between annual rate of progression in peak gradient and total cholesterol/HDL cholesterol level ratio (r = 0.399, P =.009). Smoking (P =.024, Beta = 0.26), presence of coronary heart disease (P =.011, Beta = 0.31), and total cholesterol/HDL cholesterol level ratio (P =.004, Beta = 1.98) were independently predictive of fast progression of the peak aortic gradient in the regression analysis.In a small group of patients from Turkey with aortic stenosis, there seems to be an association between the rate of progression and total cholesterol/HDL cholesterol level ratio, with fast progression occurring in the group with higher ratios.

Long-term moderate or strenuous physical activity is associated with a considerable reduction in cardiovascular morbidity and mortality. However acute exercise leads to a transient activation of the thrombotic system. Healthy individuals can react this by increasing their fibrinolytic capacity acutely. However, patients with ischemic heart disease, lacking fibrinolytic potential, may be at considerable risk for acute ischemic events if exposed to heavy physical exertion. Platelet size has been shown to reflect platelet activity. The mean platelet volume (MPV) can reflect changes in either the level of platelet stimulation or rate of platelet production.We evaluated Treadmill exercise test (TMET) and compared MPV values (fl) before and after TMET in 63 consecutive patients who, then, underwent coronary angiography and found to have significant coronary artery disease in more than one coronary artery (70% diameter stenosis in left anterior descending, right coronary or circumflex artery and50% diameter stenosis in left main coronary artery). Sixty-three male patients were enrolled as a patient group with a mean age of 52.43 +/- 4.08 years and with strongly positive exercise test (or =2 mm ST segment depression, horizontal or down-sloping). Thirty-five patients without significant coronary artery disease were selected as a control group with a mean age of 52.66 +/- 4.39 years having undergone TMET.In the patient and control groups, mean MPV values before TMET were the same, 8.52 +/- 0.63 and 8.45 +/- 0.58 respectively. Following TMET within 30 minutes, mean MPV were 10.03 +/- 0.96 and 8.50 +/- 0.45 respectively ( p0.001). When pre and post-TMET MPV values were evaluated together, the patient group had a significant increase in the MPV ( p0.001), whereas, the control group had no significant increase in the MPV ( p = 0.379). It was concluded that exercise possibly makes patients with significant coronary artery disease, more susceptible to a thrombotic event through various routes, one of that is platelet activation that could be measured indirectly via MPV. Healthy subjects react this thrombotic process by increasing their fibrinolytic capacity acutely. Patients with ischemic heart disease, particularly those with significantly narrowed coronary arteries, known to lack fibrinolytic capacity and have high shear stress, on the other hand, might face ischemic events, including sudden death following acute exercise.

Objective - Dilated cardiomyopathy has been associated with left ventricular thrombosis, which leads to substantial morbidity and mortality as a site for peripheral emboli.There are some studies on patients with dilated cardiomyopathy showing altered haemostasis and platelet behaviour despite sinus rhythm. Mean platelet volume, which is the most accurate and simple estimate of platelet reactivity, may be associated with the development of left ventricular thrombosis. Methods and results - We prospectively enrolled 48 consecutive patients with dilated cardiomyopathy and sinus rhythm with left ventricular thrombosis and compared them with an age-sex-matched control group having dilated cardiomyopathy without left ventricular thrombosis.We found that in patients with left ventricular thrombosis mean platelet volume is significantly higher than those without (9.5 ′ 0.8 vs. 8.7 ′ 0.6, p < 0.001). Conclusions - Mean platelet volume is increased in patients with dilated cardiomyopathy and sinus rhythm having left ventricular thrombosis. This might be reflecting a causal relationship, which in turn requires further study to establish the role of antiplatelet agents both in prevention and in treatment.

In this study, the effect of valve replacement on diastolic parameters was evaluated preop eratively and postoperatively at 3, 6, and 12 months by comparing diastolic parameters in patients after aortic valve replacement with freestyle stentless porcine xenografts for aortic stenosis. Depending on deceleration time (DT) and isovolumetric relaxation time (IVRT) with preoperative echocardiographic assessment, patients were divided into two groups: restrictive physiology (DT ≤ 150 msec and IVRT < 100 msec, 20 patients), and nonrestrictive physiology (DT > 150 msec and IVRT ≥ 100 msec, 27 patients). Although left ventricular mass index signif icantly decreased in both groups, improvement in DT, IVRT, and ejection fraction occurred only in patients with restrictive physiology. As a result, the patients with restrictive diastolic characteristics had more benefit than the patients with nonrestrictive physiology after aortic valve replacement.

Occurrence of AF in a pacemaker implanted patient is a significant cause of morbidity and mortality. The aim of this study was to prospectively investigate the clinical, echocardiographic, and electrocardiographic determinants of persistent AF in patients with DDD pacemakers. A 101 consecutive patients were followed for an average of 19.8 +/- 11.8 months. Persistent AF was documented in 21 (20.8%) patients and 80 (79.2%) patients were in sinus or physiologically paced rhythm. In patients with persistent AF, previous AF attacks were observed more frequently (P < 0.03) and left atrial dimension was higher (3.5 +/- 0.6 vs 3.0 +/- 0.5 cm, P < 0.001). Average P maximum and P wave dispersion (PWD) values calculated in a 12-lead surface electrocardiogram were also found to be significantly higher in patients with persistent AF (P < 0.001). Cox regression analysis demonstrated that the presence of previous AF attacks (RR 8.95, P < 0.001), increased left atrial dimension (RR 2.1, P < 0.02), P maximum duration 120 ms (RR 6.1, P < 0.001), and PWD 40 ms (RR 12.2, P < 0.001) were associated with an increased risk of persistent AF. Cut-off points were 120 ms for P maximum and 40 ms for PWD. Sensitivity, specificity, and positive and negative predictive values were calculated as 76.2, 82.5, 53.3, and 92.9 for P maximum and as 85.7, 87.5, 64.3, and 95.9 for PWD, respectively. In patients with DDD pacemakers, previous AF attacks, increased left atrial dimension, P maximum value of 120 ms, and a PWD value of 40 ms were associated with a significantly increased risk of persistent AF. These patients must further be managed with other treatment modalities to prevent the development of persistent AF.

Platelets play a key role in the pathogenesis of atherosclerosis and acute coronary syndromes and antiplatelet therapy offers a clinical benefit. Although aspirin is the most widely used agent, there are several conditions in which aspirin may fail to provide a full antithrombotic benefit. Furthermore, data concerning the relationship between platelet function, aspirin, and the associated risk factors are limited. In the present study, ADP and collagen-induced platelet aggregation of 200 consecutive patients with suspected coronary artery disease (CAD) who underwent coronary angiography were evaluated. The patients were classified into three groups according to the number of stenotic vessels. One hundred and eight patients were using 300 mg/day of aspirin. The associated cardiovascular risk factors were also considered. The collagen-induced platelet aggregation of smokers was significantly higher than non-smokers (P

The aim of this study was to investigate QT dispersion during atrial pacing in patients with coronary artery disease (CAD) without clinical ischemia, such as angina pectoris and ST segment depression. Thirteen patients with normal coronary arteries and 42 patients with CAD (12 with single-vessel, 16 with two-vessel and 14 with three-vessel disease) having no angina pectoris or ST segment depression during atrial pacing with maximum rate of 120/minute were enrolled in the study. Twelve-lead surface ECGs were recorded at 100 mm/second paper speed before pacing, at maximum pacing rate, and during the recovery period for measurement of QT interval parameters. Corrected QTd (QTcd) increased from 43.4 ±8.1 to 49.3 ±9.5 ms (p

Inflammation-induced procoagulant changes and endothelial cell activation appear to play an important role in thromboembolic complications of infective endocarditis. Hence, the aim of this study was to compare the plasma levels of soluble adhesion molecules E- and P-selectin in infective endocarditis patients with and without embolic events, and healthy subjects.The study group consisted of 76 consecutive patients (mean age=26 years old, range from 8 to 64 years) with definite infective endocarditis according to the Duke criteria. Thirteen of the patients (17.1%) had embolic events. Transoesophageal echocardiographic examinations were performed on all patients within 3 days of initiation of antimicrobial therapy. Although there was a trend towards a higher rate of vegetations detected in those with embolic events than in those without, this did not reach statistical significance (84.6% vs 80.9%, P0.05). Significantly larger vegetations were observed in patients with embolic events as compared to those without embolic events (1.4 cm vs 1.0 cm, P=0.03). The mean plasma concentrations of P-selectin were elevated in patients with embolic events as compared to both patients without embolic events and control subjects (58.69+/-7.49 ng x ml(-1)vs 29.65+/-5.69 ng x ml(-1), P=0.001 and 58.69+/- 7.49 ng x ml(-1) vs 25.82+/-5.38 ng x ml(-1), P0.001). Similarly, the patients with embolic events had increased plasma levels of E-selectin compared to those without embolic events and the control group (73.15+/-11.47 ng x ml(-1) vs 42.84+/-8.77 ng x ml(-1), P0.001 and 73.15+/- 11.47 ng x ml(-1) vs 34.23+/-5.92 ng x ml(-1), P0.001).Determination of these membrane activation molecules may provide useful markers with which to identify patients at high thromboembolic risk from infective endocarditis.

Cardiac involvement of the hydatid disease is uncommon. In this report a case of 54-year-old patient with a hydatid cyst in the interventricular septum was presented. The cyst was detected incidentally by cardiac multislice computed tomography and transthoracic echocardiographic appearances of the cyst raised the suspicion of cardiac echinococcosis. The patient was referred to surgery immediately for the removal of the cyst in order to prevent the potentially life threatening complications. The postoperative period was uneventful and she was discharged on albendazole therapy.

Swyer–James (MacLeod's) syndrome is a rare entity that is characterized by the hyperlucent appearance of one or more lobes of one lung, diminished ipsilateral hilar shadow and hardly visible arterial structure on chest radiography. Ventricular septal defect is the most common childhood congenital heart defect and, if left untreated, this will result to irreversible pulmonary hypertension, reversing of the shunt and Eisenmenger's syndrome. In this case report, we describe a 19-year-old female patient who had diagnosis of VSD and Swyer–James syndrome at the same time.

In this report, we describe a case of sustained ventricular tachycardia of right ventricular outflow tract origin, induced by dobutamine infusion in a patient with symptomatic, frequent ventricular premature depolarizations but no documented clinical ventricular tachycardia. Radiofrequency catheter ablation abolished not only the ventricular tachycardia itself, but also the frequent ventricular premature depolarizations responsible for all the symptomatology. In conclusion, provocation by catecholamine infusion may have a place in the search for an alternative to antiarrhythmic therapy in patients with isolated, frequent and symptomatic ventricular premature depolarizations.

In this study, we tried to disclose certain electrocardiogram (ECG) criteria that might be useful in the classification of posteroseptal accessory atrioventricular pathways as right and left in patien

Patent ductus arteriosus is a rare adult congenital heart disease, especially asymptomatic cases are uncommon in older ages. We report here the case of a 41-year-old woman, who was incidentally found to have a patent ductus arteriosus. The patient also was asymptomatic. For anatomical demonstration, computerized tomography angiography was performed and then surgical intervention was applied.

Objectives: The aim of this study was to assess the relationship between mean platelet volume (MPV) and the presence and extent of coronary artery disease (CAD) in patients who underwent coronary angiography for stable chest pain. Study design: A total of 540 patients (350 male, 190 female; mean age: 59.6+-11.4 years) were consecutively included in the study. The patients were divided into four groups according to the presence and extent of their CAD as follows: Group 1 - patients with no significant CAD, group 2 - one vessel disease, group 3 - two vessel diseases, and group 4 - three vessel disease. Also, the Gensini score of each coronary angiogram was calculated. Results: There were 159 patients in group 1, 169 in group 2, 110 in group 3, and 102 in group 4. As expected, we found significant differences among the groups regarding mean age and other coronary risk factors including gender, hypertension, diabetes mellitus, hyperlipidemia, smoking, and family history of ischemic heart disease. However, there were no significant differences among the groups regarding platelet counts and MPV values (8.5+-0.1 fl, 8.5+-1.2 fl, 8.6+-0.9 fl and 8.6+-0.9 fl, MPV values of groups 1-4, respectively). Although the Gensini score was found to be significantly correlated with age, plasma uric acid level, white blood cell count, hemoglobin level, fasting blood glucose, and high density lipoprotein level, no significant association was detected between MPV and Gensini score values. Conclusion: This study is one of the largest studies assessing the relationship between MPV and the extent of coronary atherosclerosis in patients with stable CAD to date. However, we found no association between MPV and the presence and extent of coronary atherosclerosis.

Left persistent superior vena cava occurs in f0.3% of the general population and 4.3% in patients with congenital heart disease. Left-sided inferior vena cava has been welldescribed and occurs in f0.2–0.5% of the general population. In most cases left inferior vena cava crosses over to the right via the left renal vein or more inferiorly and crossover is usually anterior but rarely posterior to the aorta [1]. Entire transposition of the inferior vena cava to the left with hemiazygos continuation is extremely rare although it has been previously described [2]. We report a case of a leftsided (transposed) inferior vena cava communicating with the hemiazygos vein which is draining into the dilated coronary sinus via persistent left superior vena cava.

Atrial myxomas are rare tumors. They occur in less clinical history. In her neurological examination, no than 0.05% of the population, but they constitute persisting deficit was noticed. She was, then, conapproximately 50% of primary cardiac neoplasms [1]. sulted to the neurology department for differential They are true neoplasms thought to be derived from diagnosis of severe headache. At her contrast-enpluripotential subendocardial mesenchymal cells [2]. hanced computerized tomographic examination of the These tumors present with systemic embolization in cranium, she was noticed to have many commaup to 45% of cases [3,4], with the cerebral circulation shaped enhancing lesions one of which was a giant being involved in one-half of these instances [5]. aneurysm on the left side. She was, then, referred to Cerebral ischemia resulting from direct tumor emthe neurosurgery department on an urgent basis. bolization is the most common neurological preFollowing her hospitalisation in the neurosurgery sentation [6]. Other rare neurological manifestations department, she underwent cerebral angiography in include parenchymal brain metastasis [7], intracerebrwhich there were multiple fusiform aneurysms on al hemorrhage [5] and oncotic aneurysm formation both carotid artery territories, one of which was a [1,8]. With rare exceptions, neurological symptoms giant aneurysm on the left middle cerebral artery related to atrial myxomas occur before or at the time artery locus (Fig. 1) of primary tumor diagnosis. We describe a patient Treatment with coil embolization of the aneurysm who presented with transient neurological symptoms was decided due to localisation of the giant 25 years after complete resection of left atrial myxaneurysm. Before the procedure, since she was oma as initial finding of late recurrence. known to have resection of myxoma, an echocardiogA 38-year-old woman was admitted to our raphy was performed and a mass lesion originating emergency department with chief complaints of from the posterior wall of the left atrium with severe headache and episodes of right sided weakmultiple, mobile, papillary extensions towards mitral ness. She was normotensive having 115/75 mmHg valve was noted (Fig. 2). Following coil embolization systolic /diastolic blood pressures and known to have of the giant aneurysm, she was referred to our left atrial myxoma resection 25 years ago in her department and operated successfully for the mass lesion. Pathology confirmed our diagnosis and the diagnosis for the late recurrence of the myxoma at the first site was established. She has been followed up *Corresponding author. SSK Bloklari 70 /7 06170, Yenimahalle /Anby our clinic uneventfully for both recurrence and kara, Turkey. Tel.: 190-312-346-9401. E-mail address: cardioceptor@ttnet.net.tr (M.B. Yilmaz). progression or regression of cerebral aneurysms.

Left atrial compression by the esophagus, the stomach, or both is an uncommon but important cause of hemodynamic compromise. Achalasia is a disease of the esophagus with dilatation of the distal part and constriction of the lower oesophageal sphincter. Dilated esophagus is a rare cause of left atrial compression. Timely and precise diagnosis is of paramount importance in cases of left atrial compression and echocardiography enables clinicians to make a differential diagnosis successfully in most cases. Correction of primary pathology will usually lead to the return of normal hemodynamic function. We describe a case of extrinsic left atrial compression caused by the dilated esophagus due to achalasia that caused paroxysms of atrial tachycardia and hemodynamic compromise. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.

There is no doubt that appropriate use of thrombolytic drugs improves survival in patients with acute myocardial infarction. Streptokinase, one of the most commonly used thrombolytic drugs in large clinical trials, is not fibrin-specific and brings about a lytic state with potential for bleeding. We report a case of spontaneous rectus muscle hematoma following streptokinase therapy for acute myocardial infarction and review the relevant literature. To our knowledge, this is the first case reported in the literature. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.

During percutaneous mitral balloon valvuloplasty, the Inoue method leaves patients with an iatrogenic atrial septal defect. In this study, we evaluated the factors affecting the development of iatrogenic atrial septal defect and searched for the possible influence of this defect on long-term outcomes.We reviewed the medical records of 267 patients who had undergone successful percutaneous mitral balloon valvuloplasty for symptomatic moderate or severe mitral stenosis from January 2000 through March 2004. Sixty-three of the 267 patients were enrolled in a face-to-face follow-up study. We noted their clinical and demographic characteristics. All included patients were asked for the endpoints of repeat percutaneous mitral balloon valvuloplasty or mitral valve surgery, cerebrovascular accident or transient ischemic attack, and the need of intervention for the iatrogenic atrial septal defect. They underwent standard 2-dimensional and Doppler echocardiographic examination. The presence of iatrogenic atrial septal defect was evaluated via the color-Doppler technique in the subcostal view and via contrast echocardiography.Patients were subclassified in accordance with the presence (n = 15) or absence (n = 48) of echocardiographically proven persistent iatrogenic atrial septal defect. When we compared the 2 groups, there were no significant differences in baseline demographic characteristics or in pre- and postprocedural echocardiographic data.We conclude that the presence of persistent iatrogenic atrial septal defects might not be predicted from echocardiographic or demographic data in patients undergoing percutaneous mitral balloon valvuloplasty. Fortunately, these defects are small in size and low in shunt ratio. They appear not to be associated with serious long-term outcomes.

Objective Coronary artery ectasia (CAE) is defined as local or generalized aneurysmal dilatation of the coronary arteries. We aimed to determine the frequency of CAE at our center and to compare clinical and angiographic characteristics between patients with isolated CAE and CAE with coronary artery disease (CAD). Methods From February 2004 to December 2005, 12.514 patients were retrospectively analyzed by two independent operators who underwent coronary angiography. Coronary artery diameters were measured using qualitative computed angiography. CAD risk factors were recorded for all patients. Unpaired Student's t-test and Chi-square test were used for statistical analysis. Results CAE was diagnosed in 201 patients (1.59%). The majority (78%) were male. The mean age was 61±10.8 years (range, 25 to 82 years). The cases were divided into 2 groups as isolated CAE (Group 1) (14.9%) and CAE with CAD (Group 2) (85.1%). The risk factors of CAD were similar between two groups. The frequency of arterial involvement was: the right coronary artery (RCA) 54.3%; circumflex artery (Cx), 48.3%; the left anterior descending artery (LAD), 40.4%. CAE affected only one major vessel in 64.2% of cases and all 3 vessels in 9%. Isolated CAE was most commonly detected in Cx (47%). The type of CAE was determined according to Markis and Harikrishnan classification. The most prevalent involvement was Markis type 4 and Harikrishnan type 4a. Although atypical angina was the most common clinical presentation in both groups, acute coronary syndrome was more frequent in Group 2 (p=0.018). Conclusion The risk factors of CAD and the manner of clinical presentation were considerably similar in both groups and this situation was consistent with similar etiopathogenesis of two diseases.

WOS: 000290468600005, PubMed ID: 21421510, Objective: Admission hyperglycemia is associated with poor prognosis in patients with acute myocardial infarction. Final Thrombolysis in Myocardial Infarction (TIMI) frame counts of culprit coronary arteries may show significant variability despite successful coronary reperfusion after primary percutaneous coronary intervention (PCI). In this prospective observational study, relationship between final TIMI frame counts of the culprit coronary artery and admission glucose values was investigated in patients who underwent successful primary PCI due to acute ST-elevation myocardial infarction (STEMI). Methods: During a 6- month period of time, 73 non-diabetic patients presented with acute STEMI who have undergone primary PCI with final TIMI 3 flow were consecutively included in the study. Patients were divided into two groups according to final TIMI frame counts. Group 1 (n=53) consisted of patients with final TIMI frame counts of the culprit coronary artery within the two standard deviation of predefined values and Group 2 (n=20) consisted of those with higher TIMI frame counts. Statistical analysis was performed using Chi-square, Mann-Whitney U tests and multiple linear regression analysis. Results: Despite similar fasting glucose values, admission glucose levels were significantly higher in Group 2 as compared to Group 1 (138 [114-165] vs. 123 [97-143] mg/dl, p=0.03). In whole group, admission glucose values were significantly correlated with corrected TIMI frame counts of culprit coronary arteries (r=0.30, p=0.01). In addition, there were significant association between admission glucose values and peak creatine kinase-MB (r=0.36, p=0.007) values as well as left ventricular ejection fraction (r=-0.43, p=0.009). In multiple linear regression analysis, only admission glucose value was found to be significantly related to the final TIMI frame count of the culprit artery (beta=0.04, 95% Cl: 0.02-0.085, p=0.04). Conclusion: High admission glucose values were significantly associated with impaired coronary flow even after successful primary PCI in non-diabetic patients with STEMI. (Anadolu Kardiyol Derg 2011; 11:213-7)

Serum gamma-glutamyltransferase (GGT) activity has been shown to be associated with progression of atherosclerosis. We evaluated the relationship between serum GGT levels and saphenous vein bypass graft disease at least one year after coronary artery bypass graft (CABG) surgery.The study included 125 consecutive patients who had undergone CABG surgery with at least one saphenous vein graft (SVG) and were referred to cardiac catheterization for stable anginal symptoms or positive stress test results at least one year after CABG surgery. Laboratory parameters including serum GGT levels were measured before angiography. Occluded grafts were defined as a luminal stenosis of ≥70% or absence of distal TIMI 3 flow. Thus, SVGs were found to be patent in 53 patients (42.4%; 40 males, 13 females; mean age 65±8 years) and occluded in 72 patients (57.6%; 62 males, 10 females; mean age 64±9 years).The two groups were similar with regard to age, gender, hypertension, diabetes mellitus, family history of coronary artery disease, smoking, and alcohol consumption. The mean time from CABG to angiography was similar in patients with a patent and occluded SVG (6.8±4.3 vs. 8.1±3.7 years; p0.05). Waist circumference was greater (p=0.02) and serum levels of total cholesterol (p=0.001), triglyceride (p=0.02), uric acid (p0.001), hs-CRP (p0.001), GGT (p0.001) and fibrinogen (p0.001) were significantly higher in patients with occluded veins. Serum GGT level was moderately but significantly correlated with waist circumference (r=0.2, p=0.04), uric acid (r=0.3, p=0.008), and hs-CRP (r=0.3, p=0.002). In logistic regression analysis, total cholesterol (OR=1.012, 95% CI 1.002-1.023, p=0.03), hs-CRP (OR=1.968, 95% CI 1.17-3.311, 0.01), uric acid (OR=1.57, 95% CI 1.1-2.208, p=0.01), and GGT (OR=1.047, 95% CI 1.002-1.1, p=0.04) were found to be significant predictors of SVG occlusion.Our results suggest that serum GGT activity is associated with higher occlusion rates of venous bypass grafts.

WOS: 000294311800008, PubMed ID: 21821502, Objective: Percutaneous mitral balloon valvuloplasty (PMBV) is the method of choice in treatment of patients with hemodynamically significant mitral stenosis. We aimed to analyze acute and long-term clinical and echocardiographic consequences of PMBV. Methods: In this retrospective cohort study; 311 patients who underwent PMBV in our Cardiology Clinic at Turkiye Yuksek Ihtisas Education and Research Hospital between January 2000 and March 2004 were evaluated for acute procedural outcomes and primary endpoints (death, rePMBV, mitral valve replacement (MVR)). All 311 patients were contacted by phone call or letter at least five years after the procedure. Of the 311 patients, 87 who defined NYHA class II-IV symptoms were invited for a control visit and detailed echocardiographic evaluation. Sixty-three patients out of 87 who completed follow-up were enrolled for long-term consequences. Those 63 patients were subclassified into two groups as those without any negative event (n=26) (Group 1) and those with mitral valve area (MVA) (< 1.5 cm(2)), rePMBV or referral to MVR (n=37) (Group 2) on follow up to 6.4 +/- 1.6 years. Results: In the analysis of 311 patients, acute post procedural success, which was defined as mitral valve area (MVA) cm2 without severe mitral regurgitation, was 94% and was only associated with preprocedural MVA (p=0.008). In the logistic regression analysis, preprocedural MVA was the only independent parameter, associated with acute procedural success (Exp beta=0.004, 95%CI 0.0001-0.234, p=0.008). In the long-term follow up of 63 patients, the patients with uneventful course (Group 1) had significantly higher MVA (p < 0.001), lower mean (p=0.001) and peak (p < 0.001) transmitral gradients immediately after the procedure when we compared to the patients in Group 2. It was also noticed that patients with at least 60% improvement in MVA experienced composite end point much less frequently compared to those with less than 60% improvement in MVA (5% vs. 30.4%, p=0.009). Kaplan-Meier analysis yielded significantly diverging cumulative survival curves for those with and without at least 60% improvement in MVA (p=0.003). Conclusion: Concerning long-term follow up data of patients undergoing PMBV in a single center, it seems only acute postprocedural MVA was significantly associated with long-term consequences. (Anadolu Kardiyol Derg 2011; 11:515-20)

Background: There is a growing body of evidence from animal and in vitro studies for the existence of reperfusion injury after thrombolytic therapy for acute myocardial infarction (AMI), but the patient data are limited. Hypothesis: We aimed to examine the plasma thrombomodulin (TM) levels as a marker of endothelial injury and to investigate the effect of successful reperfusion on these levels. Methods: The study included 32 patients who had a first episode of acute myocardial infarction (AMI) and received intravenous streptokinase therapy. Results: Thrombomodulin levels increased significantly at 60 min after thrombolysis compared with the levels before thrombolytic therapy (0 min) in 21 (66%) patients who had successful reperfusion (49.09 ± 10.51 vs. 25.76 ± 5.55 ng/ml, p < 0.001). There was no difference between the TM levels at 0 and at 60 min of thrombolysis in the remaining 11 (34%) patients who could not achieve reperfusion (27.81 ± 6.32 vs. 28.72 ± 7.28 ng/ml, p = 0.35). Conclusion: There was a significant increase in TM levels at 60 min after thrombolysis in a group of patients with AMI who achieved successful reperfusion; this increase may have been caused by the activation/injury of endothelial cells. Data also suggest that the increment in TM levels may be predictive of the potential success of thrombolytic therapy.