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Amaç; Bu çalışmanın amacı; Obstrüktif uyku apne sendromu (OUAS) olan hastalarda, 2-boyutlu ve pulse dalga doppler (PDD) ekokardiyografi teknikleri kullanılarak SV fonksiyonlarının değerlendirilmesidir. Yöntem; Çalışmaya polisomnografi ile OUAS tanısı konulan ve henüz tedavi uygulanmamış 40 hasta ve 28 sağlıklı birey kontrol grubu olarak alındı. Hastalara M-mod, 2- boyutlu ve PDD ekokardiyografi incelemeleri yapıldı. Bulgular; Gruplar arasında M-mode ölçümleri ile elde edilen SV sistolik ve diyastolik çapları, ejeksiyon fraksiyonları açısından fark saptanmadı. OUAS’ li grupta SV kitle ve kitle indeksi ve SV diyastolik duvar kalınlıkları, kontrol grubuna göre anlamlı olarak daha fazla tespit edildi. Transmitral diyastolik doluş parametrelerinin PDD ekokardiyografi ile yapılan incelemesinde; OUAS grupta erken diyastolik doluma ait E dalga hızında, E/A oranlarında anlamlı azalma izlendi. E dalga deselerasyon zamanı ve izovolümetrik gevşeme zamanının OUAS’ lı grupta anlamlı olarak daha uzun saptandı. Apne-hipopne indeksi ile SV diyastolik parametreler arasında ilişki saptanmadı. Sonuç; OUAS, altta yatan herhangi bir kalp hastalığı olmasa da SV kitlesini etkileyen ve hastalığın şiddetinden bağımsız olarak SV diyastolik fonksiyonlarını bozan bir durumdur. Bu nedenle OSAS hastaları kardiyak açıdan da mutlaka değerlendirilmelidir.

Background: Insulin-like growth factor(IGF) is the primary mediator of growth hormone. IGF-1 may have an importantrole in protecting the myocardial functions following an acute myocardialinfarction (AMI). Literature reveals only a limited number of studiesinvestigating the relationship between the serum IGF-1/IGF binding protein-3 (IGFBP-3)levels and the left ventricular functions post AMI. We aimed to determineIGF-1 and IGFBP-3 levels and evaluate their effect on cardiac functions postAMI.Material and Method: Sixty five patients who were includedin the study and the control group had 26 patients. Blood samples of thepatients were obtained on the second day of their admission. The patientsunderwent echocardiographic examination on the 7th day of theirhospitalization.Results: The serum IGF-1 and IGFBP-3 levels of the patient group werehigher than those of the control group; however only IGF-1 levels werestatistically significant (243,2±87,9 ng/mL versus 177,2±81,8 ng/mL p=0,001).The increase in the wall thickness and LV chamber size did not correlate withthe decrease in LVEF and IGF-1/IGFBP-3 levels. The patients who had minorcardiac events had lower IGF-1 levels but this was not statisticallysignificant (210.5±88.5 versus 253.1±86.1 p>0.05). Conclusion: IGF-1 and IGFBP-3 levels elevatedfollowing an the early AMI, but these markers were not correlated with theechocardiographical measurements in early post MI period., Giriş; İnsülin benzeri büyüme faktörü (İGF), büyüme hormonunun primer mediatördür. İGF-1 akut miyokard infarktüsü (AMİ) sonrası miyokard fonksiyonlarının korunmasında önemli olabilir. Literatürde AMI sonrası İGF-1/İGF binding protein-3 (IGFBP-3) ​​düzeyleri ile sol ventrikül fonksiyonları arasındaki ilişkiyi araştıran sınırlı sayıda çalışma vardır. Bizim amacımız, AMİ sonrası serum İGF-1 ve İGFBP-3 düzeylerini belirlemek ve kardiyak fonksiyonlar üzerindeki etkisini değerlendirmektir.Çalışma planı; Çalışamaya koroner yoğun bakım ünitesine yatırılan ve kabul edilme kriterlerine sahip olan 65 hasta alındı. Kontrol grubu daha önce koroner arter hastalığı olmayan ve dışlanma kriterlerine sahip olmayan 26 kişiden oluşturuldu. Hastaların kan örnekleri aç olarak yatışının ikinci gününde alındı. Serum İGF-1 ve İGFBP-3 düzeyleri ölçüldü. Hastaların ekokardiyografik değerlendirmesi ortalama yatışının 7. gününde yapıldı.Bulgular; Hasta grubunun serum İGF-1 ve İGFBP-3 düzeyleri kontrol grubuna göre daha yüksek tespit edildi. Ancak sadece IGF-1 düzeyleri (243,2 ± 87,9 ng / ml ve 177,2 ± 81,8 ng / ml p = 0.001) istatistiksel olarak anlamlı idi. Sol ventrikül (SV) duvar kalınlığı ve boşluk boyutlarındaki artış veya SV ejeksiyon fraksiyonlarındaki azalma ile İGF-1/İGFBP-3 düzeyleri arasında ilişki saptanmadı. Hasta grubunda minör kardiyak olaylar ile düşük İGF-1 düzeyleri arasında istatiksel olarak anlamlı olmayan bir ilişki tespit edildi. (253,1 ± 86,1 ve 210,5 ± 88,5 p> 0.05).Sonuç; Daha önceki benzer çalışma sonuçlarından farklı olarak AMİ sonrası serum İGF-1 düzeylerinde yükselme tespit ettik. Ancak İGF-1 düzeyleri ile hastane içi kardiyak olaylar ve ekokardiyografik parametreler arasında ilişki bulamadık. AMİ ile İGF / İGFBP düzeyleri arasındaki bağlantılar karmaşık gibi görünmektedir ve bu ilişkiyi açıklamak için daha ileri çalışmalar gereklidir.

Objectives: Coronary atherosclerosis is a progressive degenerative disease and is associated with significant myocardial damage and thus with increased mortality and morbidity. Trace elements are essential for sustained metabolism in healthy individuals, and a delicate balance is achieved in the body. In this study, we aimed to investigate the relationship between serum essential elements, including copper (Cu), zinc (Zn), and chromium (Cr) levels, and angiographic progression of atherosclerosis in patients with coronary artery disease. Materials and methods: This was a single-center, observational study. Among all patients, 80 patients who had more than a 2-month time interval between two coronary angiographies due to clinical indications were included in the study. Venous blood was obtained for the evaluation of the Zn, Cu, and Cr levels before coronary angiographic study. Results: The mean serum levels of Cr were significantly lower in the progression group than in the nonprogression group (0.0797 +/- 0.0287 mg/L vs. 0.0937 +/- 0.0325 mg/L, p = 0.045). Additionally, the mean serum levels of copper were significantly higher in the progression group than in the nonprogression group (1.287 +/- 0.369 mg/L vs. 1.074 +/- 0.374 mg/L, p = 0.013). There were no significant differences in serum levels of Zn between the two groups (0.241 +/- 0.205 vs. 0.230 +/- 0.138, p = 0.796). Conclusion: Plasma heavy metal levels are associated with progression of atherosclerosis. The levels of these trace elements may be an early indicator of an atherosclerotic progression that may potentially occur later on in the disease process.

Amac; Obstruktif uyku apne sendromu (OUAS) olan hastalarda, pulmoner ven diyastolik akim Doppler (PVDD) teknigi ve doku Doppler ekokardiyografi (DDE) teknigi kullanilarak sol ventrikul (SV) diyastolik fonksiyonlarinin degerlendirilmesidir. Gerec ve Yontem: Calismaya polisomnografi ile OUAS tanisi konulan ve henuz tedavi uygulanmamis 40 hasta ve 28 saglikli birey kontrol grubu olarak alindi. Hastalara PVDD ve DDE incelemesi yapildi. Bulgular: Gruplar arasinda M-mode olcumleri ile elde edilen SV sistolik ve diyastolik caplari, ejeksiyon fraksiyonlari acisindan fark saptanmadi. OUAS’ li olgularda SV’ de incelenen septal ve lateral anulusa ait erken diyastolik Ea-m dalga hizlarinda ve Ea-m/Aa-m oranlarinda azalma (sirasiyla p 0,05). PVs/PVd orani her iki grupta da 1’den buyuk olmakla birlikte, OUAS’ li hastalarda daha dusuk bulundu(p

Amaç: Akut miyokard infarktüslü (AMİ) hastalarda insülin benzeri büyüme faktörü-1 (İGF-1) düzeylerini araştırdık ve IGF-1’de bir azalmanın uzun vadeli prognozu etkileyip etkilemeyeceğini belirlemeyi amaçladık.Yöntemler: AMİ nedeniyle hastanemize başvuran 65 hasta ve 25 sağlıklı kontrol birey çalışmaya dahil edildi. İGF-1 ve insülin benzeri büyüme faktörü bağlayıcı protein-3 (IGFBP-3) seviyelerini belirlemek için AMİ’ den sonra en erken zamanda ve 10 ay sonra tüm hastalardan ve kontrol grubundan kan örnekleri alındı. Hastalar AMİ’ den 10 ay sonra kardiyak olayları açısından değerlendirildi.Bulgular: İGF-1 düzeyleri, AMI hastalarında sağlıklı kontrollerden daha yüksekti (p = 0,002); 10 ay sonra, hem İGFBP-3 hem de İGF-1 seviyeleri daha yüksekti. Düşük ve yüksek İGF-1 ve IGFBP-3 düzeyleri olan hastalarda kardiyak olay oluşumunda anlamlı fark bulunmadı (hem başlangıç ​​hem de 10 aylık değerler için).Sonuç: Serum total İGF-1 ve İGFBP-3 düzeyleri, AMİ hastalarında kontrol hastalarına göre daha yüksekti; ancak, İGF-1 ve iGFBP-3 seviyeleri ile AMİ sonrası 10 aylık dönemde kardiyak olaylar arasında korelasyon bulunamadı. AMİ sonrası İGF-1 ve İGFBP-3 düzey normalleşmesi için gereken süreyi netleştirmek ve AMİ sonrası hastaların uzun dönem prognozu üzerindeki etkilerini belirlemek için ilave çalışmalara ihtiyaç vardır., Background: We investigated the levels of insulin-like growth factor-1 (IGF-1) in acute myocardial infarction (AMI) patients, and we determined whether a decrease in IGF-1 could influence long-term prognosis.Methods: In total, 65 patients who were admitted to our hospital for AMI and 25 healthy controls were included in this study. Fasting blood samples were obtained from all patients immediately after AMI and 10 months later to determine their IGF-1 and insulin-like growth factor binding protein-3 (IGFBP-3) levels. Fasting blood samples were obtained from the control group. The patients were also evaluated for cardiac events 10 months after AMI.Results: The IGF-1 levels were higher in the AMI patients than in the healthy controls (p=0.002); after 10 months, both the IGFBP-3 and IGF-1 levels were higher. No differences were found in cardiac event occurrence between patients with low and high IGF-1 and IGFBP-3 levels (for both the baseline and 10-month values).Conclusions: The serum total IGF-1 and IGFBP-3 levels were higher in the AMI patients compared to the control patients; however, there was no correlation between the IGF-1 and IGFBP-3 levels and cardiac events during the 10-month period after AMI. Additional studies are needed to clarify the time required for IGF-1 and IGFBP-3 level normalization after AMI, and to determine the effects of IGF-1 and IGFBP-3 on the long-term prognosis of patients after AMI.

Objectives: Several studies have evaluated a relationship between increased red cell distribution width (RDW) and morbidity and mortality of acute coronary syndrome (ACS). In this study, we aimed to investigate the association of serum RDW levels and development of coronary collateral vessel (CCV) in patients with ACS. Study design: We evaluated 226 patients with ACS in this prospective and cross-sectional study. Traditional laboratory and clinical parameters and serum RDW levels were measured on admission. All patients underwent coronary angiography on the first day after admission and patients with >80% stenosis were included in the study. The CCV was graded according to the Rentrop scoring system, and a Rentrop grade 0 was accepted as no CCV development (Group 1), while Rentrop grades 1-2-3 were accepted as presence of CCV development (Group 2). Results: Only levels of RDW were significantly higher in Group 1 than in Group 2 (Group 1 RDW 14.6+-1.9, Group 2 RDW 14.1+-1.4, p=0.02). The predictive value of serum RDW level for absence of collaterals (sensitivity of 58% and specificity of 54%, area under the receiver operating characteristic (ROC) curve = 0.573) was 13.90. Conclusion: We found that high levels of RDW were associated with absence of CCV in patients with ACS.

Objectives The role of Helicobacter pylori (HP) in the progression of atherosclerosis is controversial. We investigated the relation between HP IgG antibody titres and severity and intensity of coronary atherosclerosis and also clinical presentation of coronary artery disease (CAD). Methods The patient group consisted of 353 patients with angiographically proven CAD, which contains 3 different subgroups: 163 patients with myocardial infarction (MI), 106 patients with unstable angina (USAP) and 84 patients with stable angina (SAP). Control group included 163 subjects with angiographically proven normal coronary arteries. Helicobacter pylori IgG antibody titres were measured by an enzyme immunoassay method in all patients. Gensini and Extent scores were used to evaluate the angiographic severity and extent of atherosclerosis. C-reactive protein levels were measured by Behring nephelometry system kits. Results Seropositivity rates for HP were similar between groups (82.7% in the patient group and 86.6% in the control group (P > 0.05)). Also HP-IgG levels were similar among the MI, USAP and SAP groups. No significant correlation was observed between CRP levels and HP-LgG level titres. There was no significant correlation between HP-IgG level (r = 0.086, P = 0.2) and Gensini score but a significant poor correlation was observed between HP-IgG level and Extent score (r = + 0.156, P = 0.03). Conclusions Helicobacter pylori IgG titres do not play an important role in the presentation of CAD and do not increase systemic inflammatory response. However, Helicobacter pylori IgG antibody titres may be correlated with the extent of CAD.

Migraine is a common type of primary headache predominantly seen in women. This study aimed to evaluate endothelial function in patients with migraine using pulse wave velocity (PWV).The study included 73 patients with newly diagnosed migraine and 80 healthy subjects. All patients and controls underwent baseline transthoracic echocardiography and PWV measurements. Patients were randomized to three groups to receive propranolol, flunarizine or topiramate, and the measurements were repeated at the end of 1 month.The newly diagnosed migraine patients and the control group exhibited no differences in baseline clinical characteristics, and the measurements showed that PWV was 7.4 ± 1.0 m/s in the patient group and 6.0 ± 1.0 m/s in the control group (p0.001). The same measurements were repeated during a control visit at the end of 1 month. Following treatment, a significant decrease was observed in PWV in all patient groups compared to baseline (p0.001). Subgroup analysis showed significantly decreased PWV in all drug groups, with the most prominent decrease in the topiramate group.The increased PWV demonstrated in migraine patients in this study stands out as an additional parameter elucidating endothelial dysfunction in these patients. Decreasing the number of migraine attacks with prophylactic treatment may reduce PWV and decrease cardiovascular risk in long-term follow-up.

Coronary collateral vessels can provide a perfusion reserve in case of increased myocardial oxygen demand. Development of coronary collateral vessels (CCV) is triggered by the pressure gradient between the coronary bed of arteries caused by an obstruction and myocardial ischemia. Myocardial hypoxia can facilitate development of CCVs. There is a chronic hypoxemia in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to evaluate the effect of COPD on CCVs. The study included 98 patients with COPD who underwent coronary angiography. Those patients in whom coronary angiography is normal or severity of coronary artery stenosis in thought not to be sufficient for the development of CCVs (

Doppler tissue imaging (DTI) has been proposed as a tool for the evaluation of diastolic function. Controversy exists regarding whether DTI measurements are influenced by preload. Changes in the circulating volume associated with hemodialysis result in preload reduction. To determine the influence of preload reduction on DTI and standard pulsed-Doppler transmitral diastolic velocities, 30 patients (mean age 41 +/- 14) with chronic renal insufficiency without overt heart disease were studied by DTI and standard pulsed Doppler before and after hemodialysis. From the apical window, DTI sample volume was placed at the lateral and septal mitral annulus and at the midsegment of lateral and septal myocardial wall of the left ventricle. Peak early diastolic annular and myocardial, and peak late diastolic annular and myocardial velocities were measured. Transmitral peak early and late diastolic velocities were also recorded by standard pulsed Doppler. The peak velocity of early diastolic mitral flow decreased from 100 +/- 30 to 85 +/- 34 cm/s (P < 0.001) after hemodialysis. Hemodialysis elicited marked reduction in early diastolic lateral mitral annular and midlateral myocardial velocities (6.9 +/- 3.2 to 6.3 +/- 2.9 cm/s, P < 0.04 and 6.7 +/- 0.3 to 5.5 +/- 2 cm/s, P < 0.001, respectively). Early diastolic, septal mitral annular, and midseptal myocardial velocities were also significantly decreased (5.8 +/- 2.8 to 4.6 +/- 2 cm/s, P < 0.006 and 6.2 +/- 2 to 5.1 +/- 1 cm/s, P < 0.008, respectively). Late diastolic mitral annular and myocardial velocities did not change. It is concluded that early diastolic mitral annular and myocardial velocities are affected by acute preload reduction. It is necessary to consider preload when diastolic function is assessed by DTI.

Growth hormone deficiency (GHD) is a risk factor for increased cardiovascular disease, and it has been recently demonstrated that abnormalities in coagulation system might contribute to the increased cardiovascular morbidity and mortality. However, there is not enough data related to the major thrombotic events in GH-deficient patients. We describe the case of a 62-year-old woman with Sheehan's syndrome who developed massive cardiac thrombosis. She was hospitalized with acute pulmonary edema. ECG revealed high ventricular responsive atrial fibrillation (AF) and T-wave inversion on precordial leads. The ejection fraction of left ventricle (LVEF) was measured as 60% by transthoracic echocardiography (TTE) and there was 2nd degree mitral regurgitation with concentric hypertrophic LV walls. Transesophagial echocardiography (TEE) established thrombi both at right atrium and left atrial appendix. Before anticoagulant therapy several hemostatic and fibrinolytic markers were measured. Except increased D-dimer concentration (763.14 mu g/L (0-325)) we did not observe any pathological finding in these parameters. After 14 days of discharge, the patient was admitted to the intensive care unit with upper gastrointestinal bleeding. The warfarin and salicilate were stopped for two months. At the end of two months, the patient was again hospitalized with congestive heart failure and there was a high ventricular responsive AF on ECG. TEE was performed and three thrombi were demonstrated at right atrium (RA), left atrium (LA) and left ventricle (LV). There was no active bleeding on upper GIS endoscopy and anticoagulant therapy was restarted. In this particular case massive cardiac thrombi involving three chambers (LA, RA, LV) were more extensive than expected in AF. Moreover, there was a 2nd degree mitral regurgitation in the patient, and based on previous Studies mitral regurgitation has been associated with less prevalent LA spontaneous echo contrast and fewer thromboembolic events. Therefore we hypothesized that severe GHD in the present case might be the major contributing factor in massive cardiac thrombosis. In summary, based on previous data there is increased risk of thromboembolic events in GHD although the mechanism is unclear yet. Our case is the first case showing massive cardiac thrombosis in a severe GH-deficient patient with Sheehan's syndrome. Therefore, patients with GHD should be screened carefully for thrombus in clinical practice, and further studies need to be done to understand the relation between GHD and coagulation system.

The aims of this study were to evaluate the diagnostic value of intracoronary electrocardiogram (ECG) and presence of angina pectoris during percutaneous coronary interventions in the prediction of myocardial viability assessed by low-dose dobutamine echocardiography (LDDE). Seventy-one patients (60 men; mean age, 54 +/- 11 years) with recent Q-wave MI and angiographically documented regional wall motion abnormality in the presence of a significant (>/= 70%) nonocclusive stenosis of the infarct-related vessel who were referred for angioplasty were prospectively included in the study. The intracoronary ECG was recorded using coronary angioplasty guidewire. Significant ST segment elevation was defined as a new or worsening ST segment elevation of >/= 0.1 mV at 80 msec after the J-point. Angina pectoris was noted as present or absent during balloon inflation. All patients underwent LDDE for viability assessment. Significant ST segment elevation in the intracoronary ECG and chest pain were observed in 56 (78.9%) and 49 (69%) of the 71 patients. Viability was present on LDDE in 52 (92.9%) of 56 patients with and 3 (20%) of 15 without ST segment elevation. Viability was detected in 45 (91.8%) of 49 patients with and 10 (45.4%) of 22 without angina pectoris during balloon occlusion. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of ST segment elevation for viability were 94.5%, 75%, 92.9%, 80%, and 90.1%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of angina pectoris for viability were 81.8%, 75%, 91.8%, 54.5%, and 80.3%, respectively. The present study demonstrated that a simple assessment of ST segment elevation in the intracoronary ECG or angina pectoris during coronary angioplasty can be used to assess myocardial viability identified by LDDE in patients with previous MI.

Electrocardiographically, the QT interval is shortened, ST segment is depressed, and T wave becomes negative in hypercalcemia. The use of diuretics in cases with hyperparathyroidism decreases the excretion of calcium, causes changes in bone-calcium turnover and parathyroid hormone activity, and forms hypercalcemia. A 67 year-old Turkish female patient in whom we electrocardiographically observed a J wave is presented as a hypercalcemic case with primary, hyperparathyroidism aggravated by the use of a thiazide diuretic.

Background: The ventricular late potential (VLP) detected using the technique of signal average electrocardiography (SAECG) interacts with several factors, primarily time. Method: In this study, we examined the interaction, over time, of VLP with the initial ischemic burden and enzyme levels in acute myocardial infarction. Patients diagnosed as having acute myocardial infarction were included in the study. On the first day, the patients underwent enzyme analysis and electrocardiography (ECG) follow-up every 6 hours. A 24-hour ambulatory ECG was performed on the seventh day in order to determine the ischemic burden. SAECG findings (TQRS, RMS, LAS were obtained on the seventh day, in the first and third months. The study was continued with the patients who did not require angioplasty as decided with angiographic evaluation in the first month. Results: The study included 30 patients with acute myocardial infarction (mean age 51 ± 12, 28 males and 2 females). The initial mean CK-MB levels and the mean ischemic burden were 98 ± 31 U/L and 44 ± 96 minutes. The TQRS (ms), LAS (ms), and RMS (μV) values (mean ± SD) obtained at day 7, month 1, and month 3 are 97 ± 12, 96 ± 9, 103 ± 11, P = 0.01; 31 ± 10, 31 ± 11, 32 ± 10, P = 0.46; 43 ± 28, 41 ± 26, 33 ± 25, P = 0.01, respectively. We observed that the TQRS and RMS values changed significantly with time, but these levels of significance disappeared when adjusted for the initial ischemic burden and CK-MB levels (P = 0.06; P = 0.53). The VLP frequency was 33% at day 7 and 23% at month 3. Unlike the CK-MB level, the initial ischemic burden was significantly different between the patients with and without VLP at month 3 (150.85 ± 149.28, 12.34 ± 26.48, P = 0.001). When tested together with age and gender, it was found that the high initial ischemic burden increased the possibility of VLP (OR: 24, Cl: 2.09–279.52, P = 0.01) at month 3. Conclusion: SAECG findings in patients with myocardial infarction changed with time; however, this change occurred depending on the initial ischemic burden and CK-MB levels. Of these, only the initial ischemic burden, especially in high levels, was a determinant for the presence of VLP in the late period of myocardial infarction. A.N.E. 2002;7(3):242–246

The cardiovascular system is involved in 5% of the cases of Behçet's disease. Thrombophlebitis. aneurysm in arteries, pericarditis, myocarditis, valvular disease, ventricular arrhythmia, and conduction system disorders may occur. A case of Behçet's disease with complete proximal atrioventricular block is presented.

We hypothesized that the change in aortic elastic properties could directly be shown with color Doppler tissue imaging (CDTI), that these findings could be related to aortic stiffness and distensibility and that, through these, coronary artery disease (CAD) could be predicted. One hundred and twenty six patients (group I: 83 with CAD, mean age 54+/-10 years, 18 female, 65 male; group II: 43 without CAD, mean age 53+/-10 years, 27 female, 16 male) having been evaluated for coronary artery disease by angiography were examined by echocardiography. Arterial pressure was measured immediately before echocardiographic evaluation. Internal aortic systolic and diastolic diameters by M-mode echocardiography and aortic upper wall tissue velocities (Aortic S, E, A, m/sec) by CDTI were measured 3 cm above the aortic valve. Lateral mitral annulus tissue velocities (Annulus S, E, A, m/sec) were also recorded. Aortic distensibility (cm2 x dynes(-1)) and aortic stiffness index were calculated using formulas. In the statistical analyses, CAD risk factors and left ventricular ejection fraction were used for adjustment. Aortic stiffness (2.79+/-3.49 vs 1.62+/-1.31, P=0.03), distensibility (1.55+/-1.46 vs 2.37+/-3.08, P=0.04), and aortic S velocity (0.057+/-0.016 vs 0.064+/-0.015, P=0.02) differed significantly between groups I and II. After adjustment, while aortic stiffness and S velocity were still statistically different (P=0.04; P=0.03 respectively), the significance of the difference in aortic distensibility disappeared (P=0.051). Aortic stiffness and aortic S velocity (0.06 m/sec

WOS: 000288462900006, PubMed ID: 20682610, Impairment of endothelial functions has been shown to occur after acute and chronic exposure to passive smoking (PS), as assessed by flow-mediated dilatation (FMD) of the brachial artery. A total of 61 participants, 30 male and 31 female, mean ages 26 (18-36) were enrolled in the study. All were clinically well and nonsmokers. All participants stayed for 30 minutes in the smoking room. Carbon monoxide (CO) level was 7.42 +/- 0.98 ppm (4.71-10.50). Mean carboxyhemoglobin (COHb) levels of participants were significantly elevated after PS. Mean FMD was 18.6% +/- 9% and decreased to 12.4% +/- 7% after PS (P < .001). In the current study, with more number of participants at lower CO concentrations (7.42 ppm) and with smaller increase in COHb (51%) significant reduction (33%, P < .001) in FMD was observed.

Background —The potential factors that introduce variability into TIMI frame count (TFC) have not been systematically investigated. The goal of this study was to determine if nitrate use, dye injection rate, catheter size, the phase of the cardiac cycle in which dye is injected, or heart rate affect the TFC and to investigate the reproducibility of the TFC. Methods and Results —The dye injection rate was increased 1 mL/s, and angiography was repeated. A coronary angiogram was taken first with an 8F catheter and then with a 6F catheter. After taking angiograms, intracoronary nitrate was given to the patient, and the second angiography was performed. Basal heart rate was increased 20 beats/min, and angiography was repeated. Dye injection was performed at the beginning of systole and diastole. The TFC was not significantly changed by increasing the dye injection rate ( P =0.467) or by changing catheter size ( P =0.693). Nitrate administration significantly increased the TFC from 26.4±11.9 to 32.8±13.3 frames ( P P P P Conclusions —Nitrate use, heart rate, and the phase of the cardiac cycle in which dye is injected had significant effects on the TFC. Therefore, studies comparing TFC need to consider these factors, and the use of nitrates should be either standardized or randomized.

Carbon monoxide (CO) poisoning is an important health problem. Cardiac abnormalities may occur in patients with CO poisoning; however, the severity and duration of cardiac abnormalities are not well known. In this study, cardiac structures and function in CO poisoning were evaluated prospectively. Twenty patients were enrolled in the study. Echocardiographic examination was performed in all patients on admission, at 24 hours, and within the first week. B-type natriuretic peptide and carboxyhemoglobin levels were measured. Patients with increased cardiac markers underwent coronary angiography. Cardiac markers were high in 6 patients. Patients with high cardiac markers had significantly higher carboxyhemoglobin levels and longer exposure to CO. Left ventricular ejection fraction (LVEF) was < 45% in 8 patients (group I) on admission and > 55% in 7 patients in group 124 hours after echocardiography. A significant negative correlation was found between B-type natriuretic peptide and LVEF on admission (r = -0.586, p < 0.01). The decrease in LVEF was also negatively correlated with carboxyhemoglobin level and CO exposure duration. All angiograms showed normal coronary arteries. In conclusion, despite normal coronary arteries, myocardial dysfunction may occur in patients with CO poisoning. LV systolic function might be normal or mildly to severely impaired. However, most of the myocardial dysfunction dissipates, at 24 hours in patients with CO poisoning. (c) 2007 Elsevier Inc. All rights reserved.

OBJECTIVE: Elevated serum gamma-glutamyl transferase (GGT) level has been proposed as a risk factor for coronary artery disease and is associated with poor clinical outcome in acute coronary syndrome (ACS). We aimed to evaluate the relationship between GGT level and presence of coronary collateral vessels (CCV) patients with ACS. METHODS: We evaluated 178 patients with ACS in this cross-sectional-observational study. Traditional laboratory and clinical parameters and serum GGT levels were measured. All patients underwent coronary angiography on the first day after admission and patients who had >80% stenosis of coronary artery were included in the study. The CCVs graded according to the Rentrop scoring system and Rentrop 0, 1, 2 and 3 were determined in respectively 76 (42.7%), 32 (18.0%), 33 (18.5%), and 37 (20.8%) patients. Rentrop grade 0 was accepted as no CCV development (Group 1), Rentrop grades 1-2-3 were accepted as presence of CCV development (Group 2). Statistical analysis was performed using independent-samples t , Mann-Whitney U and Chi-squared tests, logistic regression and receiver operator curve analyses. RESULTS: Mean age was 62 ± 10 years and 134 (75.3%) of patients were male. Group 1 consisted of 76 (42.7%) patients and Group 2 consisted of 102 (57.3%) patients. The median and minimum-maximum values of serum GGT were 33.5 (8-128) U/L for Group 1 and 23 (2-83) U/L for Group 2. Absence of CCV was significantly associated with high levels of GGT (p

Objectives: Because both high red cell distribution width (RDW) and non-dipping hypertension are closely related to adverse cardiovascular outcomes and higher inflammatory status, we aimed to investigate whether there is any relationship between RDW and dipping/non-dipping hypertension status. Methods: The present study involved 123 hypertensive patients and 65 age- and gender-matched healthy, normotensive subjects. Hypertensive patients were divided into two groups: 56 dipper patients (20 males, mean age 51.9 ± 15.3 years) and 67 non-dipper patients (27 males, mean age 55.6 ± 15.0 years). If the systolic daytime blood pressure (BP) of the patients decreased by at least 10% during the nighttime, these subjects were ‘dippers’, and all other subjects were ‘non-dippers’. Results: Both dipper patients and non-dipper patients had higher levels of RDW compared to normotensives (13.5 ± 0.89 and 14.1 ± 1.33 vs. 13.0 ± 1.42%, p = 0.027 and p Conclusion: Our study demonstrates that non-dippers have high RDW levels compared to both dippers and controls.

Background: Bosentan improves symptoms in patients with Eisenmenger syndrome (ES). This study evaluated the effect of long-term bosentan therapy on cardiac function and its relation to symptomatic benefits in ES patients. Methods and Results: Twenty-three consecutive adult ES patients (15 with ventricular septal defect, 6 with atrial septal defect, and 2 with patent ductus arteriosus) underwent standard and tissue Doppler echocardiography before and 24 6 9 months after bosentan therapy. Echocardiographic measurements included pulmonary arterial systolic pressure (PASP), myocardial performance index (MPI), tricuspid and lateral mitral annular pulsed-wave tissue Doppler systolic (Sa) and early diastolic (Ea) long-axis motions. Patients’ World Health Organization (WHO) functional class, 6-minute walk distance (6MWD), and systemic arterial oxygen saturations (SaO2) were also recorded. The PASP, WHO functional class, 6MWD, and SaO2 all improved (118 6 22 to 111 6 19 mm Hg, 3.2 6 0.4 to 2.4 6 0.5, 286 6 129 m to 395 6 120 m, and 84.6 6 6.5% to 88.8 6 3.9%, respectively; all P ! .01) after therapy. There was also significant improvement in right ventricular (RV) MPI (by 23.9%: 0.46 6 0.15 to 0.35 6 0.09) and biventricular long-axis function (tricuspid Sa and Ea: 6.7 6 1.5 to 8.8 6 1.7 cm/s and 5.7 6 1.3 to 7.0 6 1.2 cm/s, respectively; lateral Sa and Ea: 6.8 6 1.3 to 8.4 6 1.5 cm/s and 7.6 6 2.0 to 8.5 6 2.1 cm/s, respectively; all P ! .05). Posttherapy RV MPI was moderately correlated with PASP and 6MWD. Conclusions: Sustained improvement of pulmonary arterial hypertension and RV function in ES patients was evident 2 years after bosentan therapy, and this may provide insights on the symptomatic benefits gained in these patients. (J Cardiac Fail 2012;-:1e6)

We aimed to elucidate the relation between serum uric acid (SUA) level and severity of coronary artery disease (CAD) in nondiabetic, nonhypertensive patients (n = 246) with acute coronary syndrome (ACS). Severity of CAD was assessed by the Gensini score. One, 2, and 3 or more diseased vessels were identified in 87 (35.4%), 55 (22.4%), and 104 (42.2%) patients, respectively. Patients with hyperuricemia had higher Gensini score, high number of diseased vessels, critical lesions, and total occlusion. Serum uric acid level was significantly associated with number of diseased vessels. Serum uric acid was an independent risk factor for multivessel disease by univariate analysis. High levels of SUA associated with the severity of CAD in nondiabetic, nonhypertensive patients with ACS.

WOS: 000286809300010, PubMed ID: 21145704, Background: The aim of this study was to investigate the acute effects of passive smoking on left ventricular (LV) function in healthy volunteers. Methods: Sixty-one healthy nonsmoking volunteers were enrolled in this study. LV M-mode, two-dimensional, conventional Doppler, and color tissue Doppler echocardiography were performed, and carboxyhemoglobin (COHb) levels were obtained from subjects before and immediately after exposure to passive smoking for 30 min in a smoking room. The differences between baseline and post-smoke exposure measurements of transmitral E and mitral annular Em velocities, heart rate, systolic blood pressure, diastolic blood pressure, and COHb levels were assessed. Results: Mean COHb levels were statistically higher after exposure. There were no changes in LV systolic function and volumes. LV diastolic function changed significantly immediately after passive smoking. The transmitral E wave (0.89 +/- 0.12 vs 0.70 +/- 0.14 m/sec, P =.001), the pulmonary venous D wave (0.52 +/- 0.12 vs 0.49 +/- 0.13 m/sec, P = .01), and the transmitral E/A ratio 1.79 +/- 0.48 vs 1.47 +/- 0.32, P =.001) decreased, while the transmitral A wave did not change. The mitral annular Em velocity decreased (12.5 +/- 2.1 vs 11.7 +/- 1.9 cm/sec, P =.001), the Am velocity increased (6.3 +/- 2.1 vs 6.8 +/- 1.6 cm/sec, P =.001), and the Em/Am ratio decreased (2.28 +/- 0.82 vs 1.78 +/- 0.42, P =.001). Color Doppler echocardiography determined diastolic impairment in only women, whereas color tissue Doppler echocardiography demonstrated diastolic dysfunction in both genders. Acute deleterious effects of passive smoking on color Doppler echocardiographic parameters were more prominent in women. Change in E was related to changes in heart rate and systolic blood pressure and with COHb levels, while change in Em was related only to COHb levels. Conclusions: Acute exposure to passive smoking impairs LV diastolic function in healthy volunteers. The mechanism whereby passive smoking affects diastolic function is probably complex; however, carbon monoxide exposure and an increment in COHb level may be among the causes. (J Am Soc Echocardiogr 2011; 24: 185-91.)

The study aimed to investigate the intermediate-term effects of transcatheter atrial septal defect (ASD) closure on cardiac remodeling in children and adult patients. Between December 2003 and February 2009, 117 patients (48 males, 50 adults) underwent transcatheter ASD closure with the Amplatzer septal occluder (ASO). The mean age of the patients was 15 years, and the mean follow-up period was 25.9 +/- A 12.4 months. New York Heart Association (NYHA) class, electrocardiographic parameters, and transthoracic echocardiographic (TTE) examination were evaluated before the ASD closure, then 1 day, 1 month, 6 months, 12 months, and yearly afterward. Transcatheter ASD closure was successfully performed for 112 (96%) of the 117 patients. The mean ASD diameter measured by transesophageal echocardiography (TEE) was 14.0 +/- A 4.2 mm, and the mean diameter stretched with a sizing balloon was 16.6 +/- A 4.8 mm. The mean size of the implanted device was 18.6 +/- A 4.9 mm. The Qp/Qs ratio was 2.2 +/- A 0.8. The mean systolic pulmonary artery pressure was 40 +/- A 10 mmHg. At the end of the mean follow-up period of 2 years, the indexed right ventricular (RV) end-diastolic diameter had decreased from 36 +/- A 5 to 30 +/- A 5 mm/m(2) (p = 0.005), and the indexed left ventricular (LV) end-diastolic diameter had increased from 33 +/- A 5 to 37 +/- A 6 mm/m(2) (p = 0.001), resulting in an RV/LV ratio decreased from 1.1 +/- A 0.2 to 0.8 +/- A 0.2 (p = 0.001). The New York Heart Association (NYHA) functional capacity of the patients was improved significantly 24 months after ASD closure (1.9 +/- A 0.5 to 1.3 +/- A 0.5; p = 0.001). At the 2-year follow up electrocardiographic examination, the P maximum had decreased from 128 +/- A 15 to 102 +/- A 12 ms (p = 0.001), the P dispersion had decreased from 48 +/- A 11 to 36 +/- A 9 ms (p = 0.001), and the QT dispersion had decreased from 66 +/- A 11 to 54 +/- A 8 ms (p = 0.001). Five of six patients experienced resolution of their preclosure arrhythmias, whereas the remaining patient continued to have paroxysmal atrial fibrillation. A new arrhythmia (supraventricular tachycardia) developed in one patient and was well controlled medically. Transcatheter ASD closure leads to a significant improvement in clinical status and heart cavity dimensions in adults and children, as shown by intermediate-term follow-up evaluation. Transcatheter ASD closure can reverse electrical and mechanical changes in atrial myocardium, resulting in a subsequent reduction in P maximum and P dispersion times.

Aortic dissection (AD) is a disease characterized by tear of the aortic intimal layer and separation of the arterial wall. Some risk factor such as hypertension and Marfan syndrome is well known in AD. However, the role of genetic factors in AD is largely unknown. Insertion/deletion (I/D) polymorphism of the angiotensin-converting enzyme (ACE) gene is associated with cardiovascular diseases; patients with D allele have higher serum and tissue ACE levels. We investigated the relationship between the I/D polymorphism of the ACE gene and non-syndromic acute AD. Sixteen patients diagnosed with AD were included in the study (mean age: 60.1 +/- 6.2 years). The diagnosis was established by clinical evaluation and imaging techniques. The control group consisted of 22 age-matched patients without AD (60.9 +/- 7.3 years), who suffered from chest pain. Incidence of hypertension was similar in dissection and control groups (62% vs. 59%). The I/D polymorphism was investigated in both groups by PCR analysis. Dissection types according to the DeBakey classification were identified as type 1 (proximal + distal) in 7 patients (43%), type 2 (proximal) in 5 patients (31%), and type 3 (distal) in 4 patients (25%). The D/D and D/I polymorphisms are present in 13 and 3 AD patients, respectively. None of patients with AD have the II polymorphism. The frequencies of the D allele (DD + ID) are significantly higher in dissection group than control (100% vs. 68%, P < 0001). These results indicate that the D allele of ACE gene is a risk factor for AD.

A 60-year-old woman was admitted to cardiology clinic because of typical chest pain. The presenting electrocardiography (ECG) revealed sinus rhythm and T wave inversion on inferolateral wall. Her chest pain relapsed at second day of admission and electrocardiogram recorded during chest pain had ECG changes consistent with Wolf Parkinson White (WPW) syndrome. She underwent cardiac catheterization and borderline lesion was detected in proximal of left anterior descending artery and direct stent implantation was performed. This is the first case report in which acute ischemia may induce typical ECG changes of WPW in a patient with concealed WPW syndrome. We concluded that acute coronary ischemia may manifest concealed WPW syndrome. (C) 2007 Elsevier Ireland Ltd. All rights reserved.

We report perforation of a side branch of left main coronary artery during coronary angiography. We suppose that the engaging of the catheter into a small side branch caused this complication. Furthermore, we observed that the conservative approach might be successful in the restoration of such coronary artery perforations. To the best of our knowledge this is the first reported case of left main side branch coronary artery perforation during angiography. (C) 2007 Elsevier Ireland Ltd. All rights reserved.

Objective The diagnosis of coronary artery disease (CAD) is an important clinical problem. Ischemia-modified albumin (IMA) has been demonstrated to be a helpful marker in detecting myocardial ischemia. In this study, we have investigated the diagnostic importance of IMA in CAD. Method and results Fifty patients with chest pain were enrolled in the study. IMA levels were measured on admission and within 30-60 min after exercise by albumin cobalt-binding test. Coronary angiography was performed in all patients after the exercise test. The mean preexercise IMA level was 83+/-27 U/ml in the patient group. IMA levels before the exercise test were similar in both patient and control groups (P>0.05). The mean IMA level in the patient group was, however, higher than in the control group after the exercise test (P=0.001). The sensitivity, specificity and positive and negative predictive values of the postexercise IMA levels >85 in diagnosis of CAD were 78, 73, 0.81 and 0.73%; respectively. Postexercise IMA levels were higher in patients with chest pain, ST depression and downsloping and horizontal ST depression of 2 mm or more. Conclusion IMA levels after the exercise test increased in patients with CAD. Our study results indicate that postexercise IMA levels can be helpful markers in the diagnosis of stable CAD in clinical practice.

Myocardial blush grade (MBG) is used to assess myocardial perfusion in the infarcted myocardium. The purpose of this study was to determine whether the analysis of myocardial blush grade after resolution of the acute phase of myocardial infarction is useful for assessing myocardial viability. The present study is consisted of 64 patients (55 men, mean age 55 ±11 years) who had acute myocardial infarction and nonoccluded stenosis (>50%) in an infarct-related artery. All the patients had thrombolysis in myocardial infarction (TIMI)-3 flow in the infarct-related artery on coronary angiograms. Myocardial viability was determined by single-photon emission computed tomography (SPECT) within the same week after coronary angiograms. MBG 0 in 5 (8%) patients, grade 1 in 10 (16%) patients, grade 2 in 23 (36%) patients, and grade 3 in 26 (40%) patients were present. Fifty-four (84%) of 64 patients showed myocardial viability by SPECT. Myocardial viability was demonstrated in 11 of 15 patients (74%) with MBG 0/1 and 43 of 49 patients (88%) with MBG 2/3. There was a weak relation between MBG and myocardial viability by correlation analysis (r = 0.28, p = 0.025). If MBG 0 and 1 are regarded as a sign of nonviable myocardium, and if MBG 2 and 3 are regarded as a sign of viable myocardium, the sensitivity of MBG for the prediction of myocardial viability was 79%, specificity was 40%, positive predictive value was 88%, and negative predictive value was 27%. MBG has a weak correlation with myocardial viability. Although sensitivity is fairly good, specificity is very low. We concluded that the diagnostic value of MBG is limited to detect myocardial viability in the infarcted region.

B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) are both secreted primarily from the ventricle myocardium in response to the increase in volume and pressure. We aimed to investigate the relationship between the severity of mitral stenosis (MS) and the level of plasma BNP. A total of 56 patients (50 female, 6 male) were included in the study. Mitral stenosis and its related parameters were evaluated by echocardiographic methods. Patients were divided into three groups as with mild, moderate and severe MS according to their planimetric valvular area. Plasma BNP levels were measured using "Triage-B-type natriuretic peptide test" method (Biosite Diagnostics, San Diego). The relationship of BNP with mitral stenosis and other echocardiographic parameters were studied. The comparison of the 3 groups with one another revealed that the BNP level in the group with moderate MS was higher than that in the group with mild MS, however it was statistically insignificant (74.9 +/- 49.7 versus 49.9 +/- 40.5 pg/ml, p > 0.05). BNP level in the group with severe MS was significantly higher than that in the mild MS (144.3 +/- 83.9 versus 49.9 +/- 40.5 pg/ml, p < 0.001) and that in the moderate MS group (144.3 +/- 83.9 versus. 74.9 +/- 49.7 pg/ml, p < 0.05). When patients were taken together, as the area of the mitral valve decreased, the level of BNP underwent a corresponding increase (r:-0.48, p < 0.001). We have ascertained that the level of plasma BNP and the degree of MS are significantly correlated, and as MS becomes more serious, the plasma BNP level rises.

Cardiac parameters in growth hormone (GH) deficiency and the effects of GH replacement treatment (GHRT) are still controversial. We investigated 19 adult patients (mean age: 45 +/- 10 years, 7 male), with GH deficiency before and after 12 months of GHRT. Twenty age- and sex-matched healthy individuals (mean age: 44 +/- 12 years, 9 male) were taken as a control group. All participants underwent echocardiography both before and after GHRT. The patients before GHRT and control subjects had similar left ventricular sizes and ejection fraction whereas patients before GHRT had impaired diastolic indices of left ventricle. Peak systolic annular velocity, which identifies myocardial longitudinal systolic function, was lower in patients before GHRT than in the control subjects (0.08 +/- 0.01 vs 0.10 +/- 0.02, P < .05) and improved after GHRT (0.09 +/- 0.03, P < .05). Adult-onset GH deficiency is associated with normal left ventricular sizes and preserved ejection fraction whereas longitudinal systolic function obtained by Doppler tissue imaging is deteriorated, which improves with 12 months of GHRT.

Summary Objectives Growth hormone deficiency (GHD) in adults is associated with a cluster of cardiovascular risk factors. Some abnormalities of cardiac structure and function have been reported in adult patients with GHD, but there are few data related to cardiac autonomic tone. Non-invasive assessment of cardiac autonomic status can be achieved by heart rate variability (HRV), which can be measured by using time-domain or frequency-domain variables. To our knowledge, short-term (6 months) effects of GH replacement therapy (GHRT) on HRV in a limited number of patients have been evaluated prospectively in only two previous studies. The present study was therefore designed to investigate the effects of GHD and 12 months of GHRT on cardiac autonomic tone in a larger number of adult patients with severe GHD. Patients and methods HRV measurement, by using time-domain variables, was performed in 22 patients with GHD (eight men, 14 women; mean age 45·4 ± 2·4 years) and 22 healthy controls (nine men, 13 women; mean age 40·8 ± 1·8 years) at baseline. The time-domain variables (sympathetically influenced parameters SDNN and SDANN and parasympathetically influenced parameters RMSSD and PNN50) were derived from 24-h electrocardiogram (ECG) recordings. In the patient group, cardiac autonomic tone was re-evaluated after 6 and 12 months of GHRT. Results Mean baseline values of SDNN and SDANN were significantly higher (higher values mean lower sympathetic activity) in GHD patients than in healthy controls (P

Two-dimensional color Doppler tissue imaging (CDTI) has so far been used, in general, to evaluate ventricular function. In this study, the left atrial appendage (LAA) tissue velocity was measured by CDTI. LAA function in 38 patients with mitral stenosis in sinus rhythm (SR) and 19 healthy subjects undergoing transesophageal echocardiography were examined by CDTI. Systolic tissue appendage velocity (SaV, m/s) was measured at the tip of the LAA in the basal short-axis view. LAA emptying (LAAEV) and filling (LAAFV) velocities (m/s) were also recorded 1 cm below the orifice of the appendage. LAA ejection fraction was also measured. In addition, two-dimensional imaging was used to determine the presence of thrombus and/or spontaneous echo contrast (SEC). Patients with mitral stenosis in SR had significantly decreased LAAEV, LAAFV, SaV, and LAA ejection fraction compared to controls (0.34 +/- 0.15 vs 0.72 +/- 0.17, 0.37 +/- 0.13 vs 0.63 +/- 0.19, 0.050 +/- 0.015 vs 0.071 +/- 0.093, and 39 +/- 14% vs 69 +/- 13%, respectively, P < 0.001, P < 0.001, P < 0.001, and P < 0.001). Among the patients with mitral stenosis in SR, 10 patients had SEC and one had LAA thrombus. Compared with patients without SEC, patients with SEC had decreased LAAEV, LAAFV, SaV, and LAA ejection fraction (0.24 +/- 0.05 vs 0.37 +/- 0.16, 0.29 +/- 0.05 vs 0.39 +/- 0.14, 0.039 +/- 0.087 vs 0.055 +/- 0.015, and 28 +/- 14% vs 43 +/- 12%, respectively, P = 0.01, P = 0.02, P = 0.01, and P = 0.006). In conclusion, these results suggest that the LAA dysfunction may occur in patients with mitral stenosis in SR and CDTI can successfully be used for the quantification of contraction at the tip of the LAA.

blood control: implications for the pathophysiology of neurocardiogenic syncope. PACE 1997;20:764–774. 7. Wallin BG, Sundlof G. Sympathetic outflow in muscles during vasovagal syncope. J Autonom Nerv Syst 1982;6:287–291. 8. Wallin BG, Westerberg C-E, Sundlof G. Syncope induced by glossopharyngeal neuralgia: sympathetic outflow to muscle. Neurology 1984;34:522– 524. 9. Ellenbogen KA, Morillo CA, Wood MA, Gilligan DM, Eckberg DL, Smith ML. Neural monitoring of vasovagal syncope. PACE 1997;20:788–794.

Background: Growth hormone (GH) deficiency is associated with increased cardiovascular morbidity and mortality. Abnormalities in heart rate variability (HRV) (such as decreased cardiac sympathetic activity), which is a marker of cardiac autonomic tone, have been found in patients with GH deficiency. Objective: The purpose of this study was to investigate the effects of GH therapy on HRV in adults with GH deficiency. Methods: Adult patients with GH deficiency were eligible. HRV measurements were obtained by 24-hour measurements from Holter electrocardiography before and after 6 months of GH therapy in adult patients with GH deficiency. The following time domain parameters of HRV were calculated: the SD of the normal-to-normal (NN) interval (SDNN), the SD of the average NN interval (SDANN), the square root of the mean squared differences (RMSSD), and the proportion derived by dividing the number of interval differences of successive NN intervals >50 ms (NN50) by the total number of NN intervals (PNN50). Results: A total of 21 patients (7 men, 14 women; mean age, 46.0 ± 11.2 years) were enrolled. Thirteen patients had panhypopituitarism and 8 had normal adrenocorticotropic hormone secretion. At the end of 6 months of GH therapy, the mean values of the sympathetically influenced parameters SDNN (before GH treatment, 134.5 ± 6.0 ms; after GH treatment, 118.5 ± 8.0 ms) and SDANN (before GH treatment, 121.2 ± 6.0 ms; after GH treatment, 96.2 ± 9.1 ms) decreased significantly ( P Conclusions: In this patient population, cardiac sympathetic tone was increased, without an obvious arrhythmogenic effect, after 6 months of GH therapy.

Background —Although myocardial ischemia is known to be significantly related to the development of coronary collateral vessels (CCVs), there is considerable variation between patients with ischemic heart disease in the presence of collateral development. The nature of this variability is not well known. Likewise, it remains unclear whether diabetes mellitus (DM) has any effect on CCVs. The aim of this study was to evaluate the effect of DM on CCVs. Methods and Results —Of the patients who underwent coronary angiography during the interval between March 1, 1993, and June 20, 1998, in our institution, 306 were diabetic. Those patients in whom coronary angiography is normal or severity of coronary artery stenosis is thought not to be sufficient for the development of CCVs (75% stenosis were included in the control group. The CCVs were graded according to the Rentrop scoring system, and the collateral score was calculated by summing the Rentrop numbers of every patient. There was no statistical difference between patients with and without DM in clinical baseline characteristics. The mean number of diseased vessels in the DM group (1.58±0.68) was higher than that in the nondiabetic group (1.42±0.65, P =0.005). The mean collateral score was 2.41±2.20 in the DM group and 2.60±2.39 in the control group. After confounding variables were controlled for, the collateral score in the diabetic group was significantly different from that in the nondiabetic group ( P =0.034). Conclusions —Our findings suggest that CCV development is poorer in patients with than in patients without DM. Thus, we can speculate that DM is an important factor affecting CCV development.

Aim : The purpose of this study was to document treatment profiles in 850 patients surviving acute myocardial infarction at 17 academic hospitals in Turkey. Methods and results : Pharmacological management data of acute myocardial infarction survivors were collected and divided into three categories: drugs which patients received before hospitalization, during the hospitalization, and at hospital discharge. Data regarding medical history, complications during hospitalization, MI extent (Q wave or non-Q wave), infarct location and diagnostic and revascularization procedures were also recorded. This study is based on the 850 patients who met the diagnostic criteria for initial acute MI in the period examined. Among 850 patients with myocardial infarction enrolled 408 (48%) received thrombolytic therapy. The median time interval from symptom onset to initiation of thrombolytic therapy was 196 min. The most commonly used thrombolytic agent was streptokinase (93%). Thrombolytic recipients were younger, and presented sooner after onset of symptoms. Among patients receiving thrombolytic therapy, concomitant pharmacotherapy included aspirin (95%), intravenous heparin (93%), intravenous nitroglycerin (91%), oral beta-blockers (44%), calcium channel antagonists (13%), and angiotensin converting enzyme inhibitors (41%). The lipid lowering therapy was only used in 4% of all patients, and was given to 18% of patients with hyperlipidemia. Conclusion : Current usage rates of thrombolytic therapy in Turkey are lower than expected, but when compared with previous reports it increased. Although adjunctive treatment with intravenous heparin and intravenous nitroglycerin is usually used, beta-blockers appear to be underused and calcium channel blockers appear to be overused. The lipid reducing therapies were infrequently prescribed.

OBJECTIVES The aim of this study was to determine the protective effect of carvedilol in anthracycline (ANT)-induced cardiomyopathy (CMP). BACKGROUND Despite its broad effectiveness, ANT therapy is associated with ANT-induced CMP. Recent animal studies and experimental observations showed that carvedilol prevented development of CMP due to chemotherapeutics. However, there is no placebo-controlled clinical trial concerning prophylactic carvedilol use in preventing ANT-induced CMP. METHODS Patients in whom ANT therapy was planned were randomized to administration of carvedilol or placebo. We enrolled 25 patients in carvedilol and control groups. In the carvedilol group, 12.5 mg once-daily oral carvedilol was given during 6 months. The patients were evaluated with echocardiography before and after chemotherapy. Left ventricular ejection fraction (EF) and systolic and diastolic diameters were calculated. RESULTS At the end of 6 months of follow-up, 1 patient in the carvedilol group and 4 in the control group had died. Control EF was below 50% in 1 patient in the carvedilol group and in 5 in the control group. The mean EF of the carvedilol group was similar at baseline and control echocardiography (70.5 vs. 69.7, respectively; p = 0.3), but in the control group the mean EF at control echocardiography was significantly lower (68.9 vs. 52.3; p < 0.001). Both systolic and diastolic diameters were significantly increased compared with basal measures in the control group. In Doppler study, whereas E velocities in the carvedilol group decreased, E velocities and E/A ratios were significantly reduced in the control group. CONCLUSIONS Prophylactic use of carvedilol in patients receiving ANT may protect both systolic and diastolic functions of the left ventricle.

Objective Elevated mean platelet volume (MPV) has been proposed as a risk factor for coronary artery disease (CAD) and is associated with poor clinical outcome in acute coronary syndrome (ACS). We aimed to evaluate the association of MPV with presence of coronary collateral vessel (CCV) in patients with ACS. Methods A total of 417 patients with ACS were included in the study. All patients underwent coronary angiography on the first day after admission and patients with a greater than or equal to 80% obstruction in at least one epicardial coronary artery were included in the study. The CCVs are graded according to the Rentrop scoring system and a Rentrop grade 0 was accepted as no CCV development (Group 1), Rentrop Grade 1–2–3 were accepted as presence of CCV development (Group 2). Results The median of MPV was 9.1 ± 1.4 fl. Mean age was 60 ± 12 year. Group 1 consisted of 233 (55.9%) patients and Group 2 consisted of 184 (44.1%) patients. Presence of CCV was significantly associated with high levels of MPV (p = 0.005). Presence of CCV was also associated with presence of diabetes and systolic blood pressure. Conclusion High MPV on admission was associated with presence of CCV in patients with ACS.