Objective: The index of myocardial performance (IMP) is a global cardiac function index with prognostic utility in patients with myocar- dial infarction and dilated cardiomyopathy but is preload dependent. We hypothesized that a volume overload lesion prolonging LV ejec- tion time (LVET) may reduce IMP despite LV dysfunction (LVD). Methods: The study groups consisted of 35 normals, 26 with LV dysfunction, and 60 with aortic regurgitation (AR): 40 with ejection fracti- on (EF) >50% (AR+Normal EF) and 20 with ejection fraction ≥50% (AR+Reduced EF). We evaluated consecutive patients in each group with technically adequate 2D and Doppler echocardiography. Results: When compared to normal subjects (0.357±0.122), IMP was increased with LVD (0.604±0.278 p<0.001) but was similar in AR+Nor- mal EF patients due to isovolumic relaxation time (IRT) and LVET prolongation. The IMP was lower in AR+Reduced EF group (0.346±0.172, p<0.001) as compared to the LVD group due to a prolonged LVET and a reduced IRT and isovolumic contraction time (ICT). Conclusions: The IMP in AR+Normal EF patients was similar to normals due to IRT and LVET prolongation. The IMP was reduced in AR+Reduced EF patients compared to LVD patients due to IRT and ICT shortening and LVET prolongation. The index of myocardial per- formance in AR patients should be applied with caution.

Objective: The aim of the study was to determine the relation between some parameters, which can be obtained from cardiac catheteriza- tion pressure records, and coronary artery disease. Methods: The study included 65 patients, in whom coronary angiography was performed by the cardiologists of the study. The parameters could be obtained in 40 patients (59±6 years; 28 male), and statistical analysis included the data of these patients. From the pressure record- ings, myocardial performance index (MPI), isovolumetric relaxation time (IVRT), isovolumetric contraction time (IVCT), ejection time (ET), augmentation wave amplitude (AW), augmentation wave time (AWT) and augmentation index (AI) were measured manually. Coronary artery disease was defined as the presence of any lesion, without regarding the degree of narrowing. The parameters were evaluated with respect to relation with presence of coronary artery disease (Mann-Whitney U test), relation with risk factors for atherosclerosis (Mann-Whitney U test and Chi square test) and capability of predicting coronary artery disease (area under ROC curve, AUC). Statistical significance was set at 0.05. Results: The presence of coronary artery was significantly related to AI, AWT, AW, IVCT and MPI (p<0.001 for all). The most sensitive para- meters for coronary artery disease were AI (sensitivity 94%, AUC -0.846, p<0.001) and AW (sensitivity 94%, AUC -0.848, p<0.001), while the most specific one was AWT (specificity 82%, AUC -0.833, p<0.001). The MPI and IVCT were weakly related with risk factors, while IVRT had stronger relation. The parameters of augmentation wave were significantly related with high density lipoprotein cholesterol, whereas the relation with low density lipoprotein cholesterol was weak. Conclusion: The parameters, which are obtained from cardiac catheterization pressure recordings, are related with coronary artery disease. They may be useful for predicting future coronary artery disease especially in patients with normal coronary angiogram. It is useful to add these parameters into the reports of coronary angiograms.

Objective: Increased QTc dispersion is a predictor for ventricular arrhythmias. The aim of this study was to investigate whether QTc dis- persion decreases after weight loss program with diet and medical treatment. Methods: Total 30 (24 women and 6 men, mean age: 44±8 years) obese subjects who lost at least 10% of their original weight after 12 week weight loss program were included in present study. Obesity was defined as ≥30 kg/m2 of body mass index (BMI). Normal weight was defined as ≤ 25 kg/m2 of BMI. Results: After 12 week weight loss program, BMI decreased from 42±5 kg/m2 to 36±4 kg/m2 (p<0.001) and mean weight of obese subjects decreased from 110±17 kg to 95±15 kg (p<0.001). The mean amount of weight loss was 14.5±5.0 kg (range 9-32 kg). The average percent of weight loss was 13% (10.0%-20.3%). Maximum QTc interval (from 446±19 ms to 433±27 ms, p=0.024) and QTc dispersion (from 66±18 ms to 52±25 ms, p=0.024) significantly decreased after weight loss program. A statistically significant correlation was found between decrease in level of QTc dispersion and amount of weight loss (r=0.487, p=0.007). Conclusion: Substantial weight loss in obese subjects is accompanied by significantly decreased QTc dispersion. The degree of QTc dis- persion reduction is associated with amount of weight loss.

Objective: Platelet-activating factor (PAF) is a phospholipid with multiple actions that is involved in inflammatory diseases as well as in athero- genesis. It is inactivated by a plasma enzyme, PAF-acetylhydrolase (PAF-AH). Deficiency of this enzyme in plasma is caused by a missense mutation in the gene (G994T). The aim of this study was to investigate association of this mutation with premature coronary artery disease (CAD). Methods: One hundred and fifteen unrelated Turkish patients with a diagnosis of premature CAD and 128 unrelated healthy subjects were enrolled in this study. Genotyping was performed by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP). Results: The prevalence of the G994T mutation in the patients was 2.60 % (heterozygote), and 0 % in the controls. There was no significant difference in allele frequency and genotype distribution among the study groups. Conclusion: The G9943T mutation in the plasma PAF acetylhydrolase gene is not associated with premature CAD in Turkish subjects.

Objective: We investigated the acute effects of treadmill exercise test (TET) on total peroxide, total antioxidant capacity (TAC), oxidative stress index (OSI) and DNA damage levels in voluntary and untrained healthy subjects. Methods: A total of 113 untrained healthy subjects were included in the study. All subjects maintained a similar diet and physical activi- ty for a week before the test. Blood samples were obtained before and after TET. Total peroxide, TAC, vitamin C and DNA damage were measured. The DNA damage was analyzed by using the Comet assay and OSI was calculated using total peroxide and TAC values. Results: Treadmill exercise test leads to the increase of total peroxide (12 ± 3 μmol H2O2/L to 14 ± 3 μmol H2O2/L, p<0.001), OSI (0.72 ± 0.18 AU to 0.81 ± 0.22 AU, p<0.001), and to the decrease of TAC (1.78 ± 0.16 mmol Trolox Eq./L to 1.72 ± 0.15 mmol Trolox Eq./L, p<0.001) and vit- amin C levels (98 ± 4.2 μmol/L to 95 ± 3.4 μmol/L, p<0.001). There was not significant difference in DNA damage. Conclusion: Our findings demonstrate that TET increases oxidants, decreases TAC and vitamin C namely, the balance shift towards oxida- tive side, but this stress is not enough to produce DNA damage.

Objective: This study investigates whether the combination of thiazides with an aldosterone antagonist can decrease their negative effects on the fibrinolytic activity. Methods: Twenty-eight hypertensive patients (20 men, 8 women) visiting our hypertension unit were included in the study. The control group consisted of age- and gender-matched 9 normotensive healthy individuals. The patients in the 1st group (7 men, 2 women, mean age 48.55±6.14 years) were given 50 mg hydrochlorothiazide (HCT), whereas patients in the 2nd group (7 men, 2 women, mean age 48±6.3 years) received a combination of 50 mg HCT and 5 mg amyloride and the 3rd group (7 men, 3 women, mean age 48.2±7.25 years) took 50 mg HCT and 50 mg spironolactone for a period of 2 weeks. The plasminogen activator inhibitor (PAI)-I, tissue plasminogen activator (t- PA) and PAI-I/t-PA ratio were assessed before and after treatment. Results: Treatment with HCT-spironolactone caused an increase in PAI-I (p<0.001) and t-PA ( p<0.001), while no changes were observed in PAI-I/t-PA (P>0.05). In patients treated with HCT-spironolactone, PAI-I increase rate was lower than in those treated with HCT and HCT- amyloride (p<0.001). Hydrochlorothiazide, HCT-amyloride and HCT-spironolactone treatments caused a significant decrease in the base- line blood pressure values (p<0.001). Uric acid levels had increased after treatment with HCT (p<0.01) and HCT-amyloride (p<0.001), but no changes were observed in individuals receiving HCT-spironolactone (p>0.05). Conclusion: Thiazides have a negative effect on the endogenous fibrinolytic activity, which is already impaired in the hypertensive patients. Their use in combination with an aldosterone antagonist such as spironolactone can decrease their hypofibrinolytic effects and metabolic side effects.

Objective: The number of percutaneous coronary interventions (PCI) is increasing. There is limited outcome data on patients with a his- tory of PCI and subsequently required surgical revascularization. Methods: Overall 611 patients who survived 30 days after coronary artery bypass graft surgery (CABG) between 2001 and 2005 were eva- luated. Mean follow-up was 29.4 ± 11.3 months and 45% were female. The effect of preoperative PCI as a risk factor for symptom recur- rence and adverse cardiovascular events and mortality was determined. Results: Preoperative PCI was an independent risk factor for symptom recurrence (p<0.0001), combined adverse cardiac events (p<0.0001) and slightly increased overall mortality (p<0.04). Comparison of patients with and without a prior PCI showed that former had significantly worse outcomes compared to the latter. Patients with history of at least one restenosis following a PCI developed sig- nificantly more adverse end points (p<0.0001). Conclusion: In this study, patients with previous PCI were more likely to develop symptom recurrence and adverse cardiovascular events following CABG. This difference was more pronounced in patients who had at least one recurrent stenosis after a PCI.

The effect of coronary artery bypass grafting (CABG) lasts as long as the grafts are patent. The internal mammary artery has been con- sidered the “golden” graft due to the superb long-term patency, exceeding 90% at 10 years. The saphenous vein grafts, unfortunately, tend to occlude with a rate of 10-15% within a year after surgery, and eventually, at 10 years after the operation, as much as 60-70% of these vein grafts are either occluded or have angiographic evidence of atherosclerosis. The search for another “arterial conduit”, the ra- dial artery, has intensified through the last 15 years in hope to provide a better graft than the saphenous vein for CABG. This article revi- ews the current knowledge for the radial artery as a conduit in CABG.

It is believed that myocardial ischemia-reperfusion injury is related to increased free radical generated and intracellular calcium overlo- ad especially during the period of reperfusion. The pineal secretory product, melatonin, is known to be a potent free radical scavenger, antioxidant and can inhibit the intracellular calcium overload. In this review, we have summarized the fundamental of cardiac ischemia- reperfusion injury and the effects of melatonin on myocardial damage that related to cardiac ischemia-reperfusion injury. The total anti- oxidant capacity of human serum is related to melatonin levels. Incidence of sudden cardiac death is high in the morning hours. It has been shown that melatonin levels are significantly low at these times and patients with coronary heart disease have lower than normal individuals. These findings thought that melatonin would be valuable to test in clinical trials for prevention of possible ischemia-reper- fusion-induced injury, especially life threatening arrhythmias and infarct size, effecting life quality, associated with thrombolysis, angiop- lasty, coronary artery spasm or coronary bypass surgery.

Beyond evaluating physiologic alterations encountered during pregnancy quantitative pulsed- and continuous Doppler and qualitative co- lor Doppler technology can be used for cardiovascular assessment of the pregnant woman with heart disease or suspected cardiac ab- normality. Echocardiography provides information about disease etiology, leads to accurate and non- invasive assessment of disease se- verity and is a powerful means of monitoring progression. Only with echocardiography it has been clearly demonstrated that during preg- nancy congenital heart disease is the first leading abnormality followed by rheumatic heart disease. Doppler and qualitative color Dopp- ler are useful to illuminate the pathophysiology of the hemodynamic consequences of fixed valve stenosis during pregnancy with respect to the labile nature of gradients resulting from variable loading conditions of pregnancy. Accurate cardiac diagnosis leads to accurate es- timation of prognosis, illuminates the necessity of noninvasive monitoring throughout pregnancy and labor, and leads to determine whet- her surgical or medical intervention should be performed. Need for Fetal echocardiography should also be considered after maternal ec- hocardiography is undertaken. Although there are no strictly defined limits established for the use of Doppler ultrasound in the early preg- nancy there is an unequivocal demand for carefulness that is best expressed by the ALARA principle,-as low as reasonably achievable.