ISSN 2149-2263 | E-ISSN 2149-2271
The Anatolian Journal of Cardiology - Anatol J Cardiol: 5 (2)
Volume: 5  Issue: 2 - June 2005
EDITORIAL
1.Changes and renovations in AKD with some current surprise
Bilgin Timuralp
PMID: 15939680  Page 89
Abstract |Full Text PDF

ORIGINAL INVESTIGATION
2.Effects of glucose-insulin-potassium solution added to reperfusion treatment in acute myocardial infarction
Baybars Türel, Kani Gemici, İbrahim Baran, Dilek Yeşilbursa, Sümeyye Güllülü, Ali Aydınlar, Akın Serdar, Ali Rıza Kazazoğlu, Ethem Kumbay, Jale Cordan
PMID: 15939681  Pages 90 - 94
Objective: Reperfusion treatment modalities used in the routine treatment protocols of acute myocardial infarction (AMI) were found to be ineffective in establishing the nutritional cellular reperfusion in the microvascular environment even they succeed to open the infarct related artery. Glucose-insulin-potassium (GIK) solution, which is presumed to stimulate the glycolytic pathway, is experimentally proven to be the most efficacious substrate for the preservation of energy production and therefore the myocardial viability, in the setting of acute ischemia. Methods: We compared, 54 patients who suffered AMI and received GIK solution (300 g glucose+50 IU crystallized insulin+80 mEq potassium chloride in one liter solution) in addition to conventional treatment (GIK group) with 27 patients who were traditionally treated (control group) for in-hospital and early-term (1 month) cardiac morbidity. We also compared the two groups in terms of heart rate variability (HRV). Results: Eight patients in the control group, developed new-onset symptomatic congestive heart failure whereas only 5 patients in GIK group were found to have such a cardiac morbidity (p=0.01). Reduced HRV (<50 ms) was found in 3 patients of control group whereas no patient in GIK group had abnormal HRV (p=0.01). Conclusion: The GIK solution decreased the incidence of new-onset symptomatic congestive heart failure and low HRV after myocardial infarction. Larger multicenter trials need to resolve the questions on the efficiency of metabolic intervention with GIK solution in acute myocardial infarction.

3.Thrombotic, fibrinolytic and proliferative activities of pulmonary vascular bed in secondary pulmonary hypertension
Kumral Ergün Çağlı, Yücel Balbay, Gökhan Cihan, Dursun Aras, Kerim Çağlı, Selime Ayaz, Filiz Bilgiç, Öner A. Balbay, Hatice Şaşmaz, Şule Korkmaz
PMID: 15939682  Pages 95 - 100
Objective: To determine whether pulmonary vascular bed contributes to the development of in situ thrombosis and vascular remodelling in secondary pulmonary hypertension (SPH) via changes in its local secretory activities. Methods: Seventy-one patients with the diagnosis of secondary pulmonary hypertension (38 females, mean age 40.36± 1.05 years) were included in the study. Selective right and left heart catheterization was performed to each patient for diagnostic purposes. Blood samples obtained from left ventricle (LV) and pulmonary artery (PA) of each patient were analyzed for levels of plasminogen activator inhibitor-1 (PAI-1), platelet derived growth factor (PDGF), vascular endothelial growth factor (VEGF), D-dimer, von Willebrand factor (vWF), protein-C, antithrombin-III, fibrinogen, and plasminogen. Results were compared between LV and PA. Correlation analysis between each parameter and mean pulmonary artery pressure (MPAP) was performed. Results: Although mean level of VEGF in LV and PA were found to be in normal range, it was significantly higher in LV than in PA (p<0.001). Mean PDGF and D-dimer levels, which remained in normal range were also higher in LV (p<0.001 and p<0.001, respectively) than in PA;.vWF showed similar degree of elevation in both LV and PA. Only one parameter, PAI-1, was found to be significantly higher in PA than in LV (p=0.012). Antithrombin-III, protein C, plasminogen, and fibrinogen levels showed no significant differences between two chambers. They also remained in normal range, except for fibrinogen which was slightly elevated in both LV and PA. Correlation analysis revealed strong positive correlation between D-dimer level in both LV and PA and MPAP (r=0.775, p<0.001 and r=0.649, p<0.001, respectively). Conclusion: In SPH, pulmonary vascular bed shows increased thrombotic, hypofibrinolytic, and proliferative activities which are partially related to the severity of illness.

4.Has the mortality rate from acute myocardial infarction fallen substantially in recent years? Single center data on elderly patient population
Nurcan Arat, Nesligül Gülel, İrfan Sabah
PMID: 15939683  Pages 101 - 107
Objective: We aimed to compare the trend in clinical approach and interventions, in-hospital mortality rate in elderly patients with acute myocardial infarction (AMI) in a single reference center within subsequent years, 2000-2002. Methods: In our retrospective analysis within years 2000 and 2003 we could reach 160 eligible patients’ data files, who were hospitalized for of AMI and aged above 70 years. Results: Within three years we evaluated data of 105 male and 55 female eligible patients (mean age: 74±3.3 years). In-hospital mortality was observed in 39 (24%) patients with a median admission-to-mortality time of 24 hours. In 33 (20%) of the cases AMI involved more than one myocardial wall. Sixty-one percent of the whole population and 80% of the patients with early in-hospital mortality had reduced left ventricular ejection fraction. The comparison of treatment approaches within three years revealed a growing tendency for application of percutaneous transluminal coronary angioplasty (PTCA), surgical interventions and for the use of beta-blockers, angiotenzin converting enzyme inhibitors and lipid lowering agents (p<0.05). We did not observe any difference in mortality rates at subsequent years. Conclusion: In our single center analysis we observed changes in treatment policy in elderly AMI population, which was in concordance with the trends in international arena. But we were not able to show any reduction in mortality rate. Beyond the diverse ethnicity of our patient population, the relative delayed time to hospital admission, more extensive infarct area, lower administration of interventional procedures and primary PTCA, and most importantly the relative short time interval we analyzed may be contributing factors for still high in-hospital mortality in elderly population.

5.The myocardial performance index in children with isolated left-to-right shunt lesions
Tamer Baysal, Bülent Oran, Mustafa Doğan, Derya Çimen, Sevim Karaaslan
PMID: 15939684  Pages 108 - 111
Objective: The myocardial performance index (MPI) measures the ratio of isovolumic time intervals to ventricular ejection time. The effects of altered ventricular preload or afterload on MPI have yet to be determined. This study was designed to determine the impact of altered preload on left and right ventricular myocardial performance index in the clinical setting of left-to-right lesions. Methods: The left and right ventricular myocardial performance indexes were measured in 17 patients with atrial septal defect (ages 6 to 148 months), 23 patients with ventricular septal defect (ages 2 to 160 months), and 24 healthy children (ages 3 to 160 months). A complete 2- dimensional and Doppler echocardiographic examination was performed in all study groups. Results: In patients with atrial septal defect, ventricular septal defect, and control group subjects, the left ventricular MPI was 0.38, 0.37 and 0.32, respectively, and the right ventricular MPI was 0.24, 0.21, and 0.20, respectively. No significant differences in the left and right ventricular myocardial performance indexes were seen between patients with left-to-right shunt lesions and control subjects. Conclusion: This study documents that the myocardial performance index is a quantitative measure of ventricular function that appears to be relatively independent of changes in preload.

6.Cardiac troponin I elevation in paediatric cardiac catheterization
Tamer Baysal, Bülent Oran, Osman Başpınar, Mustafa Doğan, Sevim Karaaslan
PMID: 15939685  Pages 112 - 115
Objective: The aim of this study is to investigate prospectively whether intracardiac catheterization produces myocardial damage in paediatric heart. Methods: The study was performed in all patients undergoing diagnostic cardiac catheterization at our institute. A baseline serum sample was drawn before the procedure. The second serum sample was obtained 4-6 hours after the procedure. Cardiac troponin-I and creatine kinase isoenzyme MB fraction levels were determined quantitatively. Results: Diagnostic cardiac catheterization was performed in 30 patients. There were 17 males and 13 females in the study group. The median age was 12 months (range 1 to 204 months); the median body weight was 8 kilograms (range 2.1 to 45 kilograms). The increase in cardiac troponin I (0.21±0.04 ng/ml to 1.16±1.40 ng/ml, p<0.05) and creatine kinase isoenzyme MB (26.68±7.53 U/L to 41.65±22.12 U/L, p< 0.05) levels after the procedure was significant. Conclusion: This study shows that serum elevations of cardiac troponin I and creatine kinase isoenzyme MB occur after the most of paediatric diagnostic cardiac catheterization procedures.

7.The effects of phase II cardiac rehabilitation programme on patients undergone coronary bypass surgery
Çavlan Çiftçi, Belgin Süsleyici Duman, Pembe Çağatay, Cemşid Demiroğlu, Vedat Aytekin
PMID: 15939686  Pages 116 - 121
Objective: To investigate the effects of phase II cardiac rehabilitation in 52 patients undergone coronary artery bypass surgery. Methods: Gradual walking tests, cardio-pulmonary capacity tests and lipid profile were administered to patients selected for phase II cardiac rehabilitation before and after the programme. Training was started on 12-channel electrocardiogram controlled running bands 3 times a week for 20 min periods for 12 weeks fitting the programme. Low or intermediate level exercise programme was applied to patients. Cleveland Clinic Chronotropic Assessment exercise protocol was used during rehabilitation. Results: As a result of phase II cardiac rehabilitation administered to 52 patients undergone coronary bypass operation, exercise capacity, oxygen consumption, anaerobic threshold, cardiac output mean values (p£0.001) and mean HDL cholesterol level (p£0.05) were found to increase, whereas body mass index, total cholesterol, LDL cholesterol and triglyceride mean levels reduced (p£0.001) significantly. Conclusion: In patients who have undergone coronary bypass surgery, phase II cardiac rehabilitation is a very useful programme in improvement of life quality and secondary prevention.

EDITORIAL COMMENT
8.Cardiac rehabilitation in our country
H. Nilgün Gürses
PMID: 15939687  Pages 122 - 123
Abstract |Full Text PDF

REVIEW
9.Contrast media-induced nephropathy: clinical burden and current attempts for prevention
Muhammed Habeb, Mustafa Tarık Ağaç, Farid Aliyev, Seçkin Pehlivanoğlu, Zeki Öngen
PMID: 15939688  Pages 124 - 129
Contrast media-induced nephropathy is the third most common cause of hospital acquired acute renal failure. With the increasing use of contrast media in diagnostic and interventional procedures it has become one of the major challenges encountered during routine cardiology practice. Despite clinical importance it is an under-recognized event with major morbidity and mortality. Risk of developing contrast media-induced nephropathy depends mainly on patients preexisting characteristics and physicochemical properties of the contrast agent. Primary attempts for the prevention of contrast media-induced nephropathy should include systematic review of patients characteristics and risk stratification. Patients at the greatest risk for contrast media-induced nephropathy can be defined as those having preexisting impaired renal function, diabetes mellitus, and congestive heart failure. Other risk factors include; age above seventy years, female gender, dehydration and use of high volume contrast media. The more expeditious use of iso-osmolar non-ionic contrast media reduced the incidence of contrast media related renal dysfunction. Currently, the only widely proven method of reducing the risk of contrast induced nephropathy is adequate pre and postprocedural hydration. In addition, prophylactic use of free radical scavenger N-acetylcysteine has been shown to prevent contrast media-induced nephropathy in some moderate-scale clinical trials and a meta-analysis. Despite the attempts to reduce the risk of contrast nephropathy, this clinical event affects over 25% of high risk patients and mortality remains to be high.

MISCELLANEOUS
10.What we should not do in the catheterization laboratory
Tuğrul Okay
PMID: 15939689  Pages 130 - 132
Abstract |Full Text PDF

SCIENTIFIC LETTER
11.Blood pressure control rates in hypertensive patients and their determining factors in two urban regions of İzmir
Bahri Akdeniz, Özhan Göldeli, Nezihi Barış
PMID: 15939690  Pages 133 - 134
Abstract |Full Text PDF

CASE REPORT
12.Cardiac thrombus due to protein C deficiency
Meral Kayıkçıoğlu, Müge Ildızlı, Cemil Gürgün, İnan Soydan
PMID: 15939691  Pages 135 - 137
Abstract |Full Text PDF

13.Left ventricular “noncompaction” with hypothyroidism and sensorineural hearing loss
Garip Şahin, Mehmet Soydan, Ahmet Ünalır
PMID: 15939692  Pages 138 - 139
Abstract |Full Text PDF

14.Non-cardiac Tl-201 uptake on myocardial perfusion SPECT study
Doğangün Yüksel, Olga Yaylalı, Turgut Serdaş, F.Suna Kıraç, Mustafa Kılıç
PMID: 15939693  Pages 140 - 141
Abstract |Full Text PDF

15.Annular insertion levels of atrioventricular valves along the interventricular septum alone can lead to misdiagnosis of ventricular morphology
Funda Öztunç, Güler Eroğlu, Tevfik Demir
PMID: 15939694  Pages 142 - 144
Abstract |Full Text PDF

16.Surgical removal of fractured guidewire with ministernotomy
Ergun Demirsoy, Hakan Alp Bodur, Harun Arbatlı, Naci Yağan, Oğuz Yılmaz, Faruk Tükenmez, Servet Öztürk, Bingür Sönmez
PMID: 15939695  Pages 145 - 147
Abstract |Full Text PDF

LETTER TO THE EDITOR
17.Anabolic-androgenic steroids: a bad tenor for cardiovascular orchestra (Myocardial infarction with intracoronary thrombus induced by anabolic steroids)
Erdem Kaşıkçıoğlu
PMID: 15939696  Pages 148 - 149
Abstract |Full Text PDF

18.A new philosophy on stem cell trials in cardiovascular diseases: to collect pollen or to be a beekeeper
İlker Alat
PMID: 15939697  Page 150
Abstract |Full Text PDF

E-PAGE ORIGINAL IMAGES
19.Fetal echocardiography and postnatal electrocardiographies of omphalopagus twins
Naci Ceviz, Haşim Olgun, Rahmi Örs
PMID: 15939698  Page 151
Abstract |Full Text PDF

20.Isolated noncompaction of left ventricular myocardium in an elderly man
Sait Mesut Doğan, Mustafa Aydın, Metin Gürsürer, Aydın Dursun, Fatih Çam, Hediye Madak
PMID: 15939699  Page 152
Abstract |Full Text PDF

21.Isolated left ventricular noncompaction: magnetic resonance imaging findings
Mecit Kantarcı, Cihan Duran, Onur Sıldıroğlu, Levent Ulusoy, Hakan Mutlu, Bülent Karaman
PMID: 15939700  Page 153
Abstract |Full Text PDF

22.Multiple vascular aneurysms in Behçet’s disease
Abdurrahman Oğuzhan, Ali Gül, Ramazan Aşık, Tuğrul İnanç, İbrahim Özdoğru, Ramazan Topsakal, Namık Kemal Eryol
PMID: 15939701  Page 154
Abstract |Full Text PDF

23.A huge left atrial myxoma with angiographic tumour vascularity
Hatice Selçuk, M. Timur Selçuk, Cemal Özbakır, Vedat Çaldır, Neslihan İnci Zengin, Şule Korkmaz
PMID: 15939702  Pages 155 - 156
Abstract |Full Text PDF



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