Objective: There are controversies about the relation between infarction localizaton and late potentials (LP) following acute myocardial infarction (AMI). To evaluate this issue 124 consecutive patients with first Q- wave AMI fulfilling the inclusion criteria were enrolled in this signal - averaged ECG (SAECG) study. Methods: The patients were divided into three groups according to infarction localization: anterior (Group I n=62; 50%), inferior (Grop II: n=42; 34%) and both inferior and right ventricular (RV) involvement (Group III n=20; 16%). SAECG records were performed during the second week. LP results were evaluated as positive when at least two of the major criteria (QRS > 114 ms, LAS 40>38 ms, RMS < 20v) were obtained. Tukey - Cramer multivariate analysis was performed. Results: Positive LP results were obtained in 29% of group I, 35.7 % of group II and 55 % of group III patients. Patients with both inferior and RV involvement had a significantly higher positive LP results independent from left ventricular ejection fraction. Conclusion: Therefore, increased risk of arrhythmia in those patients with both inferior MI localization and RV involvement should be taken into consideration.

Objective: Genetic predisposition and chrnoic inflammation play the leading role in the early stages and in the development of atherosclerosis. Previous studies have shown that substantial amounts of T-lymphocytes are present in both early fatty lesions and advanced fibrous lesions in humans. This observation suggests that HLA antigens may be used as genetic markers for the tendency to coronary artery disease. The aim of our study was to investigate the relation of atherosclerosis and HLA antigens in patients with acute myocardial infarction. Methods: Thirty consecutive patients with acute myocardial infarction (15 male, 15 female, aged 548 years) and 30 subjects (15 male, 15 female, aged 527 years) without evidence of coronary artery disease-according to physical, fundoscopic, electrocardiographic and radiological examination-were enrolled to the study. Histocompatibility antigens (HLA-AB, -DR, -DQ) were studied with lymphocytotoxicity method. Results: Age, gender, smoking, alcohol consumption, frequency of obesity and diabetes mellitus were similar between the two groups. In patients with myocardial infarction frequency of hypertension, family history and hyperlipidemia were significantly higher than the controls (p<0.0003, p<0.0001, p<0.01 respectively). Frequency of HLA antigens in patients and in controls was 50% and 23% for HLA-A2, 63% and 20% for HLA-DQ4 and 90% and 50% for HA-DQ7. Logistic regression anlysis revealed a significant relation with the disease and the presence of these antigens (p=0.02, p=0.02 and p=0.03 respectively). Conclusion: It is concluded that in the Turkish population presence of HLA-A2, HLA-DQ4 ve HLA-DQ7 (3) may be used as genetic markers for the tendency to coronary artery disease.

Objective: Since there is a difficulty in the assesment of right ventricular systolic function by 2D echocardiogrphy, a noninvasive, practical and, cost effective method is desirable. Tisse Doppler technique enables to visualize systolic and diastolic velocities of the tissue through sample volume replacement. In this study, we aimed to evaluate the relationship between tricuspid annular tissue Doppler velocities and right ventricular systolic functional. Methods: For this purpose, tricuspid annular systolic (S), early diastolic (E) and, late diastolic (A) velocities were obtained from 38 patients (23 with dilated cardiomyopathy, 15 with mitral stenosis, all of them in sinus rhythm) and 15 healthy control subjects by placing the pulsed wave sample volume at the junction of right ventricular free wall and tricuspid annulus. The time velocity integral (TVI) of S, peak velocity of S and isovolumic contraction time (IVCT) were compared with right peak velocity of tricuspid regurgitation and dP/dt calculated from the spectral tracce of this regurgitation. Results: A significant correlation was determined between RVEF and peak S velocity, S TVI and IVCT (r: 0.76, p<0.001, r: 0.82, p<0.0001 and r: -0.85, p<0.0001 respectively). The peak S velocity <12 cm/sec, S TVI < 2 cm and IVCT>75 msec yielded 76%, 84%, 92% sensitivity and 84%, 84%, 80% specificity for predicting the patients with right ventricular ejection fraction <40%, respectively. A significant and powerful correlation was determined between the peak S velocities and dP/dt in 19 patients whose tricuspid regurgitation could be clearly recorded (r: 0.88, p<0.0001). Conclusions: The analysis of tricuspid annular velocities obbtained by tissue Doppler technique is a practical method of the assessment of right ventricular systolic functions.

Objective: This stduy was planned to assess the vena contracta (VC), flow convergence area (PISA) and jet area (JA) methods in evaluating the severity of mitral regurgitation 5MR) and to test the accuracy of a proposed algorithm using these methods. Methods: Eighty-seven patients with chronic MR were enrolled in the study. VC of < 0.3 cm, maximal MR flow rate calculated by PISA (Qmax) of < 72 cm3/sn and JA of < 4 cm2 were classified as mild MR. VC of > 0.5 cm, Qmax of > 240 cm3/sn and JA of > 8 cm2 were classified as severe MR. Whereas the values between these ranges were called to be moderate MR. The algorithm was planned as follows.: In the first step, VC width was measured. If a patient has VC = 0.3-0.5 cm, it was used Qmax in the eccentric jets and JA in the central jets in the second step. The severity of MR were considered as severe, moderate and mild for >50%, 21-49% and 20% of the regurgitant fraction calculated by the reference method (the quantitative Doppler method dopending on aortic and mitral stroke volumes), respectively. Results: The sensitivity of VC was low in difeeratiating between moderate and severe MR (63%). In eccentric jets, the regurgitant volume calculated by PISA was higher than that of reference method (70±49 vs. 59±29 cm3) and the JA was found to be less than that of cntral jets despite similar regurgitant fraction (6.8±3.2 vs. 8.5±3.3 cm2). The algorithm agreed well with the reference method and it was better than those of each three methods (Cappa coefficients 0.89 vs. 0.65, 0.63 and 0.45 for VC, Qmax and JA; respectively). The accuracies of the algorithm in discriminating between mild and moderate MR or severe and non-severe MR were high 598% and 95% respectively). Conclusions: The severity of MR can be determined accurately and simply by using VC, PISA and JA methods logether.

Objective: Although chronic myocardial inflammatory process mediated by viral and autoimmune factors has been postulated in the pathogenesis of idiopathic dilated cardiomyopathy (IDC), the role of autoimmune mechanisms still remains unclear. The aim of the present study was to investigate the rates of various T cell subsets and natural killer (NK) cells in peripheral blood in order to see whether they had a role in the immunoregulation of IDC. Methods: The surface markers of peripheral T and B lymphocytes were detected and percentages of pan T and B cells as well as helper (CD4+) and suppressor (CD8+) T lymphocytes subsets in the peripheral blood and their ratio (CD4+/CD8+) were determined in 27 patients with IDC and in 20 healthy controls. NK cell percentage was also studied. Results: There were no significant differences between IDC and control groups with respect to T and B cell percentages. The percentages of CD4+ T cell subsets were similar in both groups (48.7±8.7 % vs. 43.5±9.7 % respectively; p=0.107). CD8+ T cell percentage was significantly decreased in patients with IDC than in controls (22.6±7.7 % vs. 28.2±8.2 %, respectively; p=0.044). CD4+/CD8+ ratio was markedly higher in patients with IDC than controls (2.6±1.8 vs. 1.6±0.6, respectively; p=0.006). There was no significant difference in the NK cell percentage between groups. Conclusion: Decreased CD8+ T cell subset is the cause of increased CD4+/CD8+ ratio, which may imply decreased self-tolerance and an immunoregulatory defect in the pathogenesis of IDC.