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Objective Although numerous studies have shown the protective effects of the well-developed coronary collaterals on left ventricular functions, the relationship between collateral grade and left ventricular end diastolic pressure has not been studied in chronic total occlusion patients. Also, there are conflicting data on the effect of collaterals on NT-proBNP levels. The aim of our study was to evaluate the relationship between coronary collateral circulation and left ventricular end diastolic pressure and NT-proBNP levels in chronic total occlusion patients. Methods Study group was retrospectively selected from the patients who had undergone coronary angiography at our hospital between June 2011 and March 2013. Clinical, biochemical, angiographic and hemodynamic data of 199 consecutive patients having at least one totally occluded major epicardial coronary artery were evaluated. Coronary collateral circulation was graded according to Rentrop classification. While Rentrop grade 3 was defined as well-developed, all the remaining collateral grades were regarded as poor collaterals. Results Overall 87 patients were found to have good collaterals and 112 patients had poor collaterals. There was no significant difference between the patients with well- or poorly developed coronary collaterals with regard to left ventricular end diastolic pressure (16.84 ± 5.40 mmHg vs 16.10 ± 6.09, respectively, p = 0,632) and log NT-proBNP (2.46 ± 0.58 vs 2.59 ± 0.76, respectively, p = 0,335). Conclusion In patients with coronary chronic total occlusion even well-developed coronary collaterals are not capable of protecting the rise of left ventricular end diastolic pressure and NT-proBNP levels which are reliable markers of the left ventricular dysfunction.

A double-chambered right ventricle (DCRV) is a heart defect, typically congenital, in which the right ventricle is separated into a proximal high-pressure (anatomically lower) chamber and distal low-pressure (anatomically higher) chamber. Commonly ventricular septal defect is found concomitantly in patients with DRCV. In this case report, we present a 20-year- -old female patient who was found to have a DRCV without any concomitant congenital heart disorder.

Our aim was to evaluate left ventricular (LV) systolic and diastolic functions of primary hyperparathyroidism (pHPT) patients with detailed echocardiographic analysis and investigate the effect of parathyroidectomy on echocardiographic parameters. A total of 22 eligible consecutive patients with pHPT who underwent parathyroidectomy operation were recruited to the study. Another 22 subjects with similar age, gender and frequency of cardiovascular risk factors compared to patients were used as a control group. Echocardiographic parameters of patients scheduled for parathyroidectomy were compared to healthy matched controls. Echocardiographic parameters measured 6 months after the operation were also compared with preoperative values for each patient. Patients had higher LV mass index compared with controls. There were no significant differences between groups regarding 2D echocardiographic parameters reflecting LV systolic function and tissue Doppler velocities; however, 2D echocardiographic parameters demonstrated impairment in LV diastolic functions compared with controls. Speckle tracking echocardiography (STE) demonstrated similar LV global longitudinal systolic strain; however, left atrial conduit and reservoir functions were significantly reduced in patients with pHPT. In general, there were no significant differences between baseline and postoperative state regarding parameters reflecting LV systolic and diastolic functions; however, STE demonstrated significantly increased LV global longitudinal strain after surgery (22.3 ± 3.3% vs 20.3 ± 2.9%, p = 0.026). Patients with pHPT displayed higher LV mass and impairment in LV diastolic function compared with controls. Parathyroidectomy did not lead to significant improvements in LV mass or LV diastolic function; however, subtle but not apparent increases in LV systolic function were observed 6 months after surgery.

Variant angina (VA) is a clinical syndrome caused by spontaneous vasospasm of the epicardial coronary artery which is characterized by episodes of angina. Endothelial dysfunction and neurohormonal hyperactivity are important factors in pathogenesis of VA. Although patient prognosis is good, VA may be one of the reasons of sudden cardiac death (SCD) in case of persistent ST segment elevation and malignant arrhythmias. Therefore, early treatment of VA is crucial for prevention of malignant arrhythmias and SCD. In this case report we describe a case of VA presented with cardiogenic shock and malignant ventricular arrhythmia.

Takotsubo cardiomyopathy (TC) is a rare and usually physical or emotional stress-induced clinical disorder characterized by transient left ventricular dysfunction and apical segment ballooning. Much is still unknown regarding risk factors and clinical relationships. Recently, an association between TC and malignancies has been proposed. We present a case of lung adenocarcinoma whose initial hospital admission was due to TC. We contribute this case report to the growing set of literature on the association between TC and malignancies.

Background: The ratio of early transmitral flow velocity to mitral annulus early diastolic velocity (E/Ea) is a widely used noninvasive tool to estimate left ventricular end diastolic pressure (LVEDP). The aim of this study was to explore whether E/Ea ratio was a reliable index for the estimation of LVEDP in patients with mitral regurgitation (MR). Methods: Sixteen patients with nonischemic MR (primary MR group; 6 male, 58 ± 12 years) 51 patients with ischemic MR (secondary MR group; 29 male, 63 ± 9 years) and 29 patients without MR (control group; 19 male, 53 ± 10 years) were consecutively included. The peak transmitral flow and mitral annular velocities during early diastole were measured. LVEDP was determined invasively by left heart catheterization. Results: Primary and secondary MR groups had significantly higher E/Ea ratios and LVEDP than control group. LVEDP significantly correlated with E/Ea ratio in patients with primary MR, but not in patients with secondary MR. Multiple regression analysis revealed that E/Ea ratio was an independent predictor of LVEDP in patients with primary MR. Ten patients with primary MR had LVEDP ≥15 mmHg. ROC analysis demonstrated cutoff values for E/Ea ratios as >10.5 for lateral mitral annulus (sensitivity: 80%, specificity: 66%, PPV: 80%, NPV: 66%) and as >14 for medial mitral annulus (sensitivity: 90%, specificity: 83%, PPV: 90%, NPV: 83%) to predict primary MR patients with LVEDP ≥15 mmHg. Conclusion: E/Ea ratio is still reliable in estimation of LVEDP in primary MR patients while it is not predictive for LVEDP in secondary MR patients. (Echocardiography 2011;28:633-640)

Background: The purpose of this study is to investigate the effect of standard heart failure treatment on the C-reactive protein (CRP) level. Method: During this study, 60 patients with heart failure were admitted to the Department of Cardiology at Ondokuz Mayis University Hospital for a period of over six months (November 2001-April 2002). Each patient was classified according to the New York Heart Association functional class at admission and at discharge. We determined the CRP levels in patients with heart failure at admission and compared them to the CRP levels at discharge. Results: As a result, we observed a decrease in the levels of CRP after treatment compared to the levels before treatment (before treatment, 40.37 ± 48.75 ng/mL; after treatment, 27.60 ± 39.50 ng/mL). This decrease was found to be statistically significant (p < 0.03). In parallel to the significant improvement in the left ventricular ejection fraction (LVEF) capacity and systolic function (LVEF before treatment, 28.7 ± 7.9%; after treatment, 32.2 ± 8.6%, p < 0.001), we also observed a decrease in the white blood cell count (WBCc) after treatment (before treatment, 9450 ± 5412/mm3, after treatment, 7976 ± 2455/mm3, p < 0.006). Conclusions: We can conclude that the CRP levels in patients with heart failure measured several times during hospitalization may predict, in an independent way, a response to standard medical treatment of heart failure, and we may use the CRP level as a criterion for follow-up and decision to discharge patients.

Activation of the renin–angiotensin system (RAS) is associated with atrial fibrillation (AF). The aim of this study was to investigate the relation between AF and polymorphisms in RAS. One hundred and fifty patients with AF, 100 patients with no documented episode of AF and 100 healthy subjects were consecutively recruited into the study. The angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism, and the M235T, A-20C, and G-6A polymorphisms of the angiotensinogen gene were genotyped. Patients with AF had significantly lower frequency of II genotype of ACE I/D and higher frequency of angiotensinogen M235T polymorphism T allele and TT genotype and G-6A polymorphism G allele and GG genotype compared with the controls. AF patients had significantly larger left atrium, higher left ventricular mass index (LVMI) and higher frequency of significant valvular pathology. ACE I/D polymorphism II genotype, angiotensinogen M235T polymorphism TT genotype and G allele and GG genotype of angiotensinogen G-6A polymorphism were still independently associated with AF when adjusted for left atrium, LVMI and presence of significant valvular pathology. Genetic predisposition might be underlying the prevalence of acquired AF. Patients with a specific genetic variation in the RAS genes may be more liable to develop AF.

WOS: 000241578500014 PubMed: 17117761 Randomized clinical trials of glycoprotein IIb/IIIa inhibition during percutaneous coronary intervention have shown significant clinical efficacy and safety in reducing the morbidity and mortality. In Turkey, only tirofiban is available. Tirofiban is a safe and effective agent in combination with heparin and aspirin in the setting of an acute coronary syndrome. In previous studies involving tirofiban, the incidence of bleeding complications was more frequent than heparin alone but major bleeding complications were seen in 5.3% of patients receiving tirofiban and not significantly different from the heparin-only treated patients. The incidence of thrombocytopenia, defined as an absolute platelet count of < 90,000/mm(3), was 0.4% in the PRISM, 1.9% in PRISM-PLUS and 1.1% in RESTORE trials. We reported a case of acute profound thrombocytopenia 48 hours after the administration of tirofiban in the treatment of a patient with an acute coronary syndrome and tirofiban discontinuation was sufficient in the management of this condition.

WOS: 000236450100015 PubMed: 16457936 Honey intoxication, a kind of food poisoning, can be seen in the Black Sea region of Turkey and in various other parts of the world as well. In this study, 66 patients were hospitalized with a variety of symptoms including nausea, vomiting, salivation, dizziness, weakness, hypotension, bradycardia and syncope several hours after the ingestion of small amounts of honey. All patients had hypotension, and majority had bradycardia. These features resolved completely in 24 h with i.v. fluids and atropine, and none died. In conclusion, honey poisoning should be taken into consideration in the differential diagnosis of acute myocardial infarction and in the patients with vomiting, hypotension and bradycardia (c) 2005 Elsevier Ireland Ltd. All rights reserved.

WOS: 000179279000014 PubMed: 12397470 Oxygen (O-2) inhalation after acute myocardial ischaemia has long been a part of standard therapy in cardiology. It has also been demonstrated that therapeutic hyperoxia diminishes myocardial stunning. The aim of this pilot study was to investigate whether the uptake kinetics of the myocardial perfusion agent technetium-99m sestamibi (MIBI) during O-2-enriched breathing is modified in comparison with the kinetics observed under conventional rest imaging performed after injection during inhalation of room air. Nine patients scheduled for coronary intervention (CI) with a documented significant stenosis (greater than or equal to50%) of at least one epicardial coronary vessel and one patient with slow flow on coronary angiography were investigated. First, rest MIBI electrocardiogram-gated single-photon emission tomography (G-SPET) with 740 MBq was performed. Two days later, the tracer was injected following a 5-min period of 100% O-2-supported (nasal catheter) breathing at rest (6 1/min) and a second G-SPET acquisition (O-2+MIBI G-SPET) was carried out. Patients' medication was not withdrawn and was matched throughout the study. The mean elevation of arterial oxygen saturation achieved was 2.95%. No significant changes in arterial blood pressure or heart rate could be detected at any time during the procedure. Compared with the results of baseline G-SPET, on O-2+MIBI G-SPET five patients scheduled for CI and the patient with slow flow showed increased tracer uptake in initially ischaemic regions without any alterations in other myocardial regions. In three of these five patients, post-CI imaging could be performed and showed increased tracer uptake in all additional areas detected previously by O-2+MIBI imaging. In three patients, besides improvement in ischaemic regions, a mild reduction in tracer uptake was observed in myocardium that initially appeared normal. In one of these patients, thallium-201 rest-redistribution SPET was performed and showed an uptake pattern more similar to that seen on O-2+MIBI images than that on baseline MIBI G-SPET.In one patient, no difference in tracer uptake was observed in pre- and post-CI studies. Improvement was detected in the wall thickening images of the O-2+MIBI study in seven of the ten patients. Four of these patients showed improvement in the same regions after CI. In this pilot study, it was demonstrated that MIBI injection during O-2-enriched breathing can be a useful technique for enhancing the detection of viable myocardial tissue. The possible mechanisms of altered tracer kinetics are discussed.

Dursun, Ihsan/0000-0001-7503-7949 WOS: 000240910100007 PubMed: 16897147 …

Kearn sayre syndrome (KSS) is a rare disease with a typical onset before 20 years and charactarized by triad of chronic progressive external ophthalmoplegia, retinitis pigmentosa and progressive cardiac conduction abnormalities. The most important prognostic factor in KSS patients is the involvement of heart characterized by progressive degeneration of the conduction system. In patients with KSS, early diagnosis of cardiac involvement is very important because complete atrioventricular (AV) block may develop and it can be cause of sudden cardiac death. Herein we report a patients with KSS who presented with syncope due to complete AV block . [Med-Science 2016; 5(4.000): 1005-7]

Many types of coronary artery anomalies have been detected, and most of them occur in the left circumflex artery. In this report a unique circumflex artery anomaly is presented. The left circumflex artery arose as a terminal extension of the right coronary artery. The main stem and obtuse marginal branches of the circumflex artery were normal and well developed.

The ratio of early transmitral flow velocity to mitral annulus early diastolic velocity (E/Ea) is a widely used noninvasive tool to estimate left ventricular end diastolic pressure (LVEDP). The aim of this study was to explore whether E/Ea ratio was a reliable index for the estimation of LVEDP in patients with mitral regurgitation (MR).Sixteen patients with nonischemic MR (primary MR group; 6 male, 58 ± 12 years) 51 patients with ischemic MR (secondary MR group; 29 male, 63 ± 9 years) and 29 patients without MR (control group; 19 male, 53 ± 10 years) were consecutively included. The peak transmitral flow and mitral annular velocities during early diastole were measured. LVEDP was determined invasively by left heart catheterization.Primary and secondary MR groups had significantly higher E/Ea ratios and LVEDP than control group. LVEDP significantly correlated with E/Ea ratio in patients with primary MR, but not in patients with secondary MR. Multiple regression analysis revealed that E/Ea ratio was an independent predictor of LVEDP in patients with primary MR. Ten patients with primary MR had LVEDP ≥15 mmHg. ROC analysis demonstrated cutoff values for E/Ea ratios as10.5 for lateral mitral annulus (sensitivity: 80%, specificity: 66%, PPV: 80%, NPV: 66%) and as14 for medial mitral annulus (sensitivity: 90%, specificity: 83%, PPV: 90%, NPV: 83%) to predict primary MR patients with LVEDP ≥15 mmHg.E/Ea ratio is still reliable in estimation of LVEDP in primary MR patients while it is not predictive for LVEDP in secondary MR patients.

WOS: 000251886600206 …

In this study, we investigated the association of two genetic variants of the endothelial nitric oxide synthase (eNOS), T786C and G894T, with CAD. Polymerase chain reaction and restriction fragment length polymorphism analyses were performed to detect the variants of eNOS gene in 102 patients with coronary artery disease and 103 healthy controls under the age 55. The statistical analysis was done by Chi square. The genotype and allele frequencies of CAD patients and controls were compared for the T786C genetic variant of eNOS. No evidence of significant difference was found between the two groups in the frequencies of the genotype [p = 0.810, OR = 0.77(0.25-2.15)] and allele [p = 0.173, OR = 0.72(0.47-1.11)]. In addition, the genotype and allele frequencies of CAD patients and controls were compared for the G894T genetic variant of eNOS. Similarly, no evidence of significant difference were found between the frequencies of genotype [p = 0.627, OR = 0.69 (0.25-1.88)] and allele [p = 0.610, OR = 0.87 (0.56-1.36)]. The present study provides evidence that the T786C and G894T polymorphism of the eNOS gene are not associated with the early-onset coronary artery disease in our population. © 2007 Asian Network for Scientific Information.

WOS: 000251886600231 …

Besides causing a hypertrophy in the left ventricle, hypertension results in a change in the geometry of the left ventricle. The blood pressure, which does not decrease enough during the night, leads to structural changes in the left ventricle. In this study, the influence of 24-hour blood pressure profile on the left ventricular geometry was examined. Ambulatory blood pressure monitoring was applied to 60 patients with mild to moderate hypertension who had never been treated and standard echocardiographic evaluation was conducted thereafter. The patients were divided into two groups with respect to the ambulatory blood pressure profiles: the patients whose night blood pressure levels decreased by more than 10% compared to their daytime blood pressure levels (dipper) and those whose levels did not decrease that much (nondipper). The left ventricle mass index and the relative wall thickness of the patients were calculated. With respect to the left ventricle geometry, mass index and relative wall thickness of the patients were determined as: having normal geometry, concentric remodeling, eccentric hypertrophy, and concentric hypertrophy. Age, gender, systolic, and diastolic blood pressure were similar within the dipper and nondipper groups. Normal geometry, concentric remodeling, and concentric hypertrophy ratios were similar in both groups. Eccentric hypertrophy was higher in the nondipper group compared to the dipper group (42.9% vs 6.3%, P < 0.03). Patients with mild to moderate hypertension, whose blood pressure does not decrease enough, develop eccentric hypertrophy. (ECHOCARDIOGRAPHY, Volume 21, January 2004)

WOS: 000186794500012 PubMed: 14636910 The tombstoning electrocardiographic pattern of a particular kind of ST-segment change, as observed in some patients during the early stages of acute myocardial infarction, is well known to be of prognostic value. However, little is understood of the causes and the relations of these changes. This study of 106 patients showed that in patients with tombstoning electrocardiographic patterns, infarction size is larger; left ventricular ejection fraction and preinfact angina are lower, and in-hospital complications are higher. (C) 2003 by Excerpta Medica, Inc.

Purpose: The myocardial performance index (Tei index) reflects both systolic and diastolic function of the heart and it's easily applied in the practice. In this study; we aimed to determine the relationship between Tei index and invasive hemodynamic parameters in heart failure patients. Methods: 126 patients (pts) with heart failure were selected for the study. Diagnostic cardiac catheterizations were performed in all patients. The pts were divided into 2 groups. Group I consisted of 59 pts (32 men, mean age 61±10, Functional capacity NYHA Class I and LVEDP0.05).Group II pts had longer IVCT and ET (p

19th Annual Scientific Meeting of the American-Society-of-Hypertension -- MAY 18-22, 2004 -- New York, NY WOS: 000221281400433 … Amer Soc Hyperters

PP-265 Numerous investigations have shown that well-developed coronary collaterals exert protective effect on left ventricular functions. But, relationship between collateral grade and left ventricular end diastolic pressure has not been studied in chronic total occlusion patients. Also, there are

PP-400 Mitral valve repair is considered to be the ideal treatment for both ischemic and degenerative diseases. All 58 patients who had mitral valve repair for mitral regurgitation from 2010 to 2012 were prospectively followed for up to 24 months (mean 16.3±6.4, range 6-24). Mean age was 62.46±