ISSN 2149-2263 | E-ISSN 2149-2271
The Anatolian Journal of Cardiology - Anatol J Cardiol: 10 (1)
Volume: 10  Issue: 1 - February 2010
1.Preparation of AKD for the second decade
Bilgin Timuralp
PMID: 20149995  Pages 1 - 2
Abstract |Full Text PDF

2.Anatomic variability of the coronary arterial orifices
Figen Govsa, Servet Çelik, Ekin Özgür Aktaş, Bahar Boydak
PMID: 20149996  doi: 10.5152/akd.2010.002  Pages 3 - 8
Objective: Anatomical differences in coronary orifices (CO) are important as they are associated with myocardial ischemia and sudden death. The location of coronary orifices to the aortic valve has been studied since it is a determining point in surgical and radiological attempts. Methods: The number, position, and shape of the CO, and their relation to the sinotubular junction (SJ), were studied in 100 normal adult hearts. Student-t test, one- and two-way ANOVA with posthoc Tukey’s HSD tests were applied for statistical analysis. Results: The mean height of the right, non- and left coronary sinuses were 18.75±1.71, 17.86±1.55 and 16.41±1.21 mm, respectively. The mean height of the right, non- and left coronary cusps were measured as 16.2±1.2, 15.9±1.1 and 12.3±2.1 mm, respectively. The left coronary artery (LCA) was observed to arise from the lower part of the SJ in 58% of the patients, while in 29% of them it originated from the SJ, and in 13% of the cases it arose from the upper part of the SJ. The right coronary artery (RCA) arising from the lower part of the SJ was seen in 78% of the patients, while it originated from the SJ in 13% of the patients, and it was observed to arise from the upper part of the SJ in 9 specimens. The diameters of the LCA and RCA were measured as 4.22±0.72 and 3.32±0.82 mm, respectively. An accessory orifice was found on the left in 47 specimens, while it was seen on the right in 54 of them. Conclusions: The location of the CO should be identified according to the vertical and horizontal surfaces of the sinus. In this study, the frequency of the coronary artery orifices with different locations was provided. Such data will increase the success of coronary interventions and decrease complication rate.

3.Importance of anatomic variability of the coronary arterial orifices
Burak Onan
PMID: 20149997  Pages 9 - 10
Abstract |Full Text PDF

4.Inhibitory effects of ticlopidine and clopidogrel on the intimal hyperplastic response after arterial injury
Tuğrul Göncü, Osman Tiryakioğlu, Ayhan Özcan, Hasan Arı, Mustafa Sezen, Hakan Vural, Ahmet Bayer, Serhat Yalçınkaya, Şenol Yavuz, Ahmet Özyazıcıoğlu
PMID: 20149998  Pages 11 - 16
Objective: The purpose of this study was to compare the effects of ticlopidine and clopidogrel on the development of neointimal hyperplasia after experimental arterial injury. Methods: This experimental, prospective, randomized controlled study was performed on twenty-seven rabbits, which were divided into three groups, each of which contained nine subjects. Following the development of a balloon catheter injury in the iliac artery, no drugs were administered to Group 1 (control). Group 2 was given ticlopidine, while Group 3 was given clopidogrel. At the end of the 21-day experimental period, arterial sections were evaluated histomorphologically and immunohistochemically with staining using antibodies against platelet derived growth factor β and basic fibroblast growth factor. Statistical analyses were performed using Chi-Square, Mann Whitney U and one-way ANOVA tests. Results: At the end of study period, ticlopidine and clopidogrel strongly reduced the development of intimal hyperplasia after arterial injury (54.1%, p<0.001, 53.2%, p<0.001, respectively). No significant difference was observed in terms of intimal and medial areas between the drug-treated groups. Expressions of the basic fibroblast growth factor and platelet derived growth factor β were significantly lower in the intima of drug treated groups with respect to the control group (p<0.05). Conclusion: The results of our study suggest that ticlopidine and clopidogrel, which are widely used in antiplatelet treatment in clinics, can similarly prevent the development of intimal hyperplasia after experimental arterial injury.

5.Antiplatelet therapy with clopidogrel or ticlopidine reduces intimal hyperplasia in an animal model of experimental arterial injury
Geoffrey Kloppenburg
PMID: 20149999  Page 17
Abstract |Full Text PDF

6.Nebivolol prevents remodeling in a rat myocardial infarction model: an echocardiographic study
Güldem Olguner Mercanoğlu, Burak Pamukçu, Nurhas Safran, Fehmi Mercanoğlu, Francesco Fici, Mehmet Güngör
PMID: 20150000  Pages 18 - 27
Ob jec ti ve: Ventricular remodeling (VR) which develops after myocardial infarction (MI) plays an important role in progressive left ventricular dysfunction. We aimed to investigate the role of nebivolol treatment on VR after a MI in a rat ischemia-reperfusion model. Methods: Rats were divided into 3 groups of 12 each: sham operated (sham-control), MI-induced (MI-control) and nebivolol treated (MI-nebivolol). Left ventricular (LV) diameters, volumes, and diastolic filling parameters were evaluated by echocardiography. On the 28th day, after recording the systemic and LV pressures and determining the plasma nitric oxide (NO) and peroxynitrite (ONOO-) levels, animals were sacrificed and heart, body and LV weights (HW, BW, LVW) were measured and infarct sizes were determined. Results were evaluated statistically by ANOVA for repeated measurements 3x3 factorial design with post-hoc Bonferroni test. Results: After MI, while VR (an increase in LV diameters and volumes associated with a decrease in EF, FS and posterior wall thickness change (LWPc) was significant in MI-control rats (p<0.05 for; all comparisons) these changes were significantly less in MI-nebivolol group (p=0.08 and p=0.06 for EF and FS respectively). LV end diastolic pres-sure (LVEDP) was lower (p<0.005) and Δ±dp/dt’s (p<0.05) were higher in MI-nebivolol group compared to MI-control animals. Although infarct sizes were similar in MI-induced groups (p=0.79); LVW/HW and HW/BW’s were significantly greater in the MI-control group compared to sham-control (p<0.01 for all comparisons), these changes were not statistically significant in MI-nebivolol group. The increase in plasma NO and ONOO- levels were also prevented with nebivolol. Conclusion: Nebivolol therapy reduced the effects of VR in rats after MI. These beneficial effects were not related to its heart rate and blood pressure reducing effects. Nitric oxide regulatory action of this compound may contribute these beneficial effects on VR developed after MI.

7.Hazelnut consumption decreases the susceptibility of LDL to oxidation, plasma oxidized LDL level and increases the ratio of large/small LDL in normolipidemic healthy subjects
Fulya Balaban Yücesan, Asım Örem, Birgül Vanizor Kural, Cihan Örem, İbrahim Turan
PMID: 20150001  Pages 28 - 35
Objective: Nut consumption has beneficial effects on protection for development of atherosclerotic process. Methods: Single intervention study design was used to determine the effects of hazelnut-enriched diet (1 g/kg/day) during 4 weeks period on atherogenic tendency of low-density lipoprotein (LDL) by evaluating susceptibility of LDL to oxidation, α-tocopherol content of LDL, LDL subfractions, plasma oxidized (ox) LDL, lipid and lipoprotein levels in normolipidemic healthy subjects (n=21). Statistical analysis was performed using paired t test, ANOVA for repeated measurements test, Pearson’s and Spearman correlation analyses. Results: Lag time for oxidation (baseline 54.6±12.3 min, 15th day 59.3±13.4 min, 30th day 65.2±17.8 min, p=0.001) and α-tocopherol content of LDL (baseline 4.82±1.2 μg/mg LDL protein, 15th day 4.88±1.4 μg/mg LDL protein, 30th day 5.35±1.7 μg/mg LDL protein, p=0.02) were found to be increased while ox-LDL levels (baseline 57.2±16.2 U/L, 15th day 51.2±13.6 U/L, 30th day 48.2±14.2 U/L, p=0.001) decreased during the study period. Total cholesterol, LDL-cholesterol, apolipoprotein (apo) B and apo B/apo AI ratio were found to be significantly lower while apo AI was higher (p<0.05). In respect to LDL subfraction, ratio of large/small LDL was significantly increased at the end of the study (baseline 3.79±1.35, 15th day 3.41±1.60, 30th day 4.28±2.44, p= 0.046). Conclusion: Hazelnut-enriched diet may play important role in decrease in atherogenic tendency of LDL by lowering the susceptibility of LDL to oxidation and plasma ox-LDL levels, and increasing the ratio of large/small LDL beyond its beneficial effect on lipid and lipoprotein levels.

8.Management and comorbidities of atrial fibrillation in patients admitted in cardiology service in Kosovo-a single-center study
Shpend Elezi, Gazmend Qerkini, Liridon Bujupi, Driton Shabani, Gani Bajraktari
PMID: 20150002  Pages 36 - 40
Objective: Atrial fibrillation (AF) is the most important risk factor for ischemic stroke. Anticoagulation therapy can substantially decrease the risk of stroke in patients with AF. The aim of our study was to investigate the patient’s comorbidities and management of patients with AF on the discharge. Methods: From 5382 consecutive patients admitted in our institution between January 2005 and March 2008, 525 (mean age 66.4±11.4 years, 53.3% male) had AF upon discharge, who were included in this retrospective study. Patients were divided in two groups according to prescription of anticoagulation therapy at discharge. Continuous data were compared between groups using a two-tailed unpaired Student t test. Discrete variables were compared using Chi-square test or Fisher’s exact probability test as appropriate. Logistic regression analysis was used to identify the independent clinical and echocardiographic predictors of prescribing oral anticoagulation therapy. Results: Associated comorbidities of AF in our patients were: ischemic heart disease (21.4%), hypertensive heart disease (27.44%), valvular heart disease (17.4%), congestive heart failure (47%), chronic obstructive pulmonary disease (6.7%), and diabetes 14.3%). Of 525 patients 76% were discharged on beta-blockers, 67% on angiotensin converting enzyme inhibitors, 23% on digoxin, 16% on calcium antagonists, 67% on diuretics, 72% on aspirin, and 27% on oral anticoagulant (OAC) therapy, 11% were with both antithrombotics. Multivariate analysis showed that the under-prescription of OAC therapy in patients with AF was independently associated with elder age (OR=0.916, 95%CI 0.891-0.942, p<0.001), non-enlarged left atrium (OR=1.148, 95%CI 1.100-1.198, p<0.001) and good left ventricular ejection fraction (OR=0.970, 95%CI 0.948-0.993, p=0.011). Conclusions: Patients with atrial fibrillation were mainly with ischemic, hypertensive heart disease and congestive heart failure. Our study, suggests underuse of anticoagulation therapy. The independent predictors of under prescription of anticoagulants in patients with atrial fibrillation were elder age, non-enlarged left atrium, and good left ventricular ejection fraction. Medical treatment with other groups of drugs for atrial fibrillation and comorbidities seems to be according to current guidelines.

9.Oral anticoagulation in atrial fibrillation: are the problems solved?
Umuttan Doğan
PMID: 20150003  Pages 41 - 42
Abstract |Full Text PDF

10.Comparative effects of losartan and nifedipine therapy on exercise capacity, Doppler echocardiographic parameters and endothelin levels in patients with secondary pulmonary hypertension
Şerife Savaş Bozbaş, Hüseyin Bozbaş, Aslı Atar, Gaye Ulubay, Füsun Öner Eyüboğlu
PMID: 20150004  Pages 43 - 49
Objective: Pulmonary hypertension (PHT) is associated with high mortality and morbidity. Interest has increased in the use of drugs that, because of their neurohumoral inhibitory effects, inhibit the renin angiotensin system. In this study, we sought to examine whether losartan therapy is non-inferior to nifedipine in the treatment of secondary PHT. Methods: This prospective randomized study consisted of 63 patients (mean age, 63.7±9.1 years) with PHT who underwent Doppler echocardiographic examination. A baseline 6-minute walk test (6MWT) and cardiopulmonary exercise test (CPET) were performed, and the endothelin-1 level of each patient was measured. Patients were assigned to two groups receiving treatment with nifedipine (n=30) and losartan (n=33). After 2 months of treatment, those measurements were repeated. The groups were compared with regard to effectiveness for the studied parameters using 2*2 factorial ANOVA design for repeated measurements. Results: When posttreatment values were compared with baseline values in both groups, the following statistically significant changes were noted: the mean values of both mean and systolic pulmonary artery pressures (PAPs) were reduced (p<0.05) on Doppler echocardiography; exercise duration, work rate, and end-tidal carbon dioxide pressure (PETCO2) were higher (p<0.05 for all); and the minute ventilation (VE) and ventilatory equivalents for carbon dioxide (VE/VCO2) were lower (p<0.05 for both) according to the results of a CPET. No statistically significant change was noted in the mean levels of serum endothelin-1. With regard to the results cited above, no statistically significant difference was detected between the losartan and nifedipine groups (p > 0.05). Conclusion: The findings of this study indicate that losartan is non-inferior to nifedipine for reducing PAP and improving exercise capacity. However, the short-term use of losartan or nifedipine had no statistically significant effect on endothelin-1 levels in patients with secondary PHT.

11.Losartan and nifedipine therapy in patients with secondary pulmonary hypertension
Remzi Yılmaz
PMID: 20150005  Pages 50 - 51
Abstract |Full Text PDF

12.Carotid intima-media thickness and its relations with the complications in patients with type 1 diabetes mellitus
Kamile Gül, İhsan Üstün, Yusuf Aydın, Dilek Berker, Kutlu Erol, Mustafa Ünal, Ayşe Özden Barazi, Tuncay Delibaşı, Serdar Güler
PMID: 20150006  Pages 52 - 58
Objective: Atherosclerosis is the major cause of the morbidity and mortality in type 1 diabetes mellitus (DM). Carotid intima-media thickness (CIMT) is the early sign of atherosclerosis and thereby, also the sign of macrovascular diseases. In this study, we aimed to evaluate the CIMT in patients with type 1 DM, and its association with diabetic microvascular complications (nephropathy-retinopathy). Methods: One hundred and thirteen consecutive patients with type 1 DM without macrovascular disease were enrolled into this cross-sectional study. Age, gender, and body mass index matched 59 healthy subjects, were taken as the control group. Microvascular complications in diabetic patients were scanned. Ultrasonographic analysis of the carotid artery was performed with a high-resolution ultrasound scanner. Student’s t, Mann Whitney U, Chi-square and Kruskal-Wallis tests, as well as multiple linear regression analysis were used for the statistical analysis. Results: Patients with type 1 DM had significantly higher CIMT compared to control group (p<0001). The CIMT of the patients with microvascular complications (nephropathy and/or retinopathy) was significantly increased (0.70±0.11 mm) compared with the patients without complications (0.63 ± 0.09 mm) (p=0.001). The increase in CIMT in type 1 DM in multiple regression analysis was dependent on the presence of proliferative retinopathy (beta=0.037, 95%CI 0.010-0.065, p=0.008), macroalbuminuria (beta=0.043, 95%CI 0.019-0.068, p=0.001), increased urinary albumin excretion (beta=0.00003, 95%CI 0.00001-0.00005, p=0.005) and duration of diabetes (beta=0.002, 95%CI 0.001-0.003, p=0.009). Conclusions: Increment of CIMT in type 1 diabetic patients was associated with microvascular complications, suggesting that diabetic microangiopathy is related with macroangiopathy. Therefore, there is a need for prospective studies to show the effect of increased CIMT on prognosis of type 1 DM.

13.Carotid intima-media thickness in type 1 diabetes mellitus
Cem Köz
PMID: 20150007  Pages 59 - 60
Abstract |Full Text PDF

14.Percutaneous renal artery stenting reduces arterial blood pressure, but what about renal function? A single-center experience
Erkan Dervişoğlu, Ercüment Çiftçi, Alev Selek, Hasan Tahsin Sarısoy, Betül Kalender, Ahmet Yılmaz
PMID: 20150008  Pages 61 - 65
Objective: To assess the effects of percutaneous transluminal angioplasty and stenting (PTRA/S) on arterial blood pressure and renal function. Methods: A retrospective chart review of patients undergoing PTRA/S at our institution between December 2003 and September 2006 was done. Follow-up data were derived from hospital records. Estimated glomerular filtration rate (EGFR) was used as the marker of renal function. To evaluate the pre- and post-procedure values in individual patients the paired t test and Wilcoxon signed-rank tests were used. Results: Thirty-six patients (16 women, 30 men; mean age 59±15 years, range: 25-83 years) underwent 43 PTRA/S interventions at our institution. The mean duration of follow-up was 9.3±8.6 (range 2-28) months. We observed no significant change in EGFR from pre-procedure to that obtained at follow-up (71.4±40.2 mL/min vs.73.3±39.0 mL/min; p=0.483). Mean arterial blood pressure (MABP), however, was reduced significantly: pre-procedure MABP-123±22 mmHg; post-procedure follow-up value of 101±14 mmHg (p <0.001). The mean number of antihypertensive medications used at the time of intervention was 2.1±1.0 (range: 0-4), whereas at follow-up, this number had decreased to 1.3±1.0 (range: 0-4; p<0.001). In patients with renal impairment (EGFR ≤59 mL/min), 41% showed improvement, 29% showed no change and 29% demonstrated deterioration in EGFR. Conclusion: PTRA/S may preserve renal function, especially in patients with pre-procedural impaired renal function.

15.Renal stenting: still alive after ASTRAL and STAR publications?
Carlo Trani, Antonella Tommasino
PMID: 20150009  Pages 66 - 68
Abstract |Full Text PDF

16.Assessment of cardiac masses: magnetic resonance imaging versus transthoracic echocardiography
Burcu Narin, Alper Arman, Deniz Arslan, Masum Şimşek, Ahmet Narin
PMID: 20150010  Pages 69 - 74
Objective: The purpose of this study is to compare the role of magnetic resonance imaging (MRI) with transthoracic echocardiography (TTE) for characterization of cardiac masses. Methods: Twenty-three patients were examined with a 1.5T MRI Scanner and TTE for the evaluation of suspected intracardiac masses. MRI examinations were performed with a protocol of steady cine imaging, HASTE and 3D IR-FLASH sequence after administration of gadolinium chelate. All patients were examined with MRI within a period of 1-2 weeks after TTE. Results: According to the results of MRI, 15 patients underwent cardiac surgery. All of the operated patients were proven to have cardiac tumors with no false positive diagnosis on MRI. In 3 of 8 unoperated patients who were diagnosed to have cardiac tumors on TTE, cardiac thrombi were identified on MRI. Two patients with Eustachian valve in the right atrium on MRI were misinterpreted as having cardiac masses on TTE. In one patient with known renal cancer, metastases were diagnosed within the myocardium on MRI. TTE demonstrated a mass in the left atrium in one patient with a history of myxoma operation, whereas MRI was able to show the paracardiac extension of the mass into pulmonary veins and lung metastases, which are indicators of malignant transformation. In one patient, a mediastinal mass compressing the left atrium on MRI was misinterpreted as an intracavitary lesion with TTE. Conclusion: Contrast enhanced MRI is a noninvasive method superior to TTE in diagnosis, differentiation, and detection of extension of cardiac masses.

17.Cardiovascular consequences of sleep apnea: I -Epidemiology
Yelda Turgut Çelen, Yüksel Peker
PMID: 20150011  Pages 75 - 80
Obstructive sleep apnea (OSA) is common in general population. There is an accumulating research evidence for an independent relationship between OSA and cardiovascular morbidity and mortality. This relationship is stronger in clinical cohorts compared with the general population, which suggests that concomitant OSA in subjects with traditionally recognized risk factors such as obesity, hypertension, smoking, and hyperlipidemia may provide an additive risk factor for the cardiovascular consequences. In the current article, the clinic-and population-based epidemiologic data will be reviewed in this context.

18.Echocardiographic longitudinal, radial, circumferential and rotational synchronization disturbance in predicting response to cardiac resynchronization therapy
Leyla Elif Sade
PMID: 20150012  Pages 81 - 87
Several echocardiographic methods have been proposed to assist patient selection for cardiac resynchronization therapy. Color-coded tissue Doppler is one of the most promising methods to quantify mechanical dyssynchrony. However, tissue Doppler data are affected by Doppler angle of incidence and tethering or translational motion. Furthermore tissue Doppler based modalities are good for longitudinal motion analysis but limited in other directions of wall motion such as radial, circumferential, and rotational. Speckle tracking is a more recent technique that allows accurate calculation of regional radial and circumferential strain as well as regional rotation for dyssynchrony analysis. Although no ideal echocardiographic method exists that integrates regional dyssynchrony data in all contraction directions as yet, technical refinements and advances in understanding of pathophysiology will help to improve the study of mechanical dyssynchrony.

19.Association of Gerbode-type defect and Wolff-Parkinson-White syndrome with Ebstein’s anomaly
Nermin Bayar, Alper Canbay, Özgül Uçar, Sinan Aydoğdu, Erdem Diker
PMID: 20150013  Pages 88 - 90
Abstract |Full Text PDF

20.Resistant radial artery spasm during coronary angiography via radial approach responded to local warm compress
Cem Barçın, Hürkan Kurşaklıoğlu, Sedat Köse, Basri Amasyalı, Ersoy Işık
PMID: 20150014  Pages 90 - 91
Abstract |Full Text PDF

21.Repair of a traumatic aorto-right ventricular fistula following a stab wound
Gökhan Lafçı, Mustafa Mahmut Ulaş, Adem İlkay Diken, Kemal Korkmaz, Hikmet Selçuk Gedik, Binali Mavitaş
PMID: 20150015  Pages 92 - 93
Abstract |Full Text PDF

22.Increased platelet serotonin levels in hypertensive patients already taking antihypertensive drugs
Oben Baysan, Adnan Haşimi, Mehmet Yokuşoğlu
PMID: 20150017  Page 94
Abstract |Full Text PDF

23.Acute stress-induced late drug-eluting stent thrombosis leading to hyperacute myocardial infarction
Özcan Özeke, Kenan Ömürlü, Erdoğan İlkay
doi: 10.5152/akd.2010.023  Pages 94 - 95
Abstract |Full Text PDF

24.Harvesting internal mammarian artery by using ultrasound harmonic scalpel: experience of 154 cases
Ahmet Yavuz Balcı, Pınar Alkan
PMID: 20150018  Pages 95 - 96
Abstract |Full Text PDF

25.Triple right coronary artery accompanied by an ectopic circumflex artery arising from right sinus of Valsalva
Kenan Yalta, Osman Can Yontar, Mehmet Birhan Yılmaz, Alim Erdem, Okan Onur Turgut, Ahmet Yılmaz, Şinasi Manduz, İzzet Tandoğan
PMID: 20149991  Page E1
Abstract |Full Text PDF

26.Partial anomalous pulmonary venous return associated with coarctation of the aorta
Serdar Kula, Cihat Şanlı, Ali Yusuf Öner, Rana Olguntürk
doi: 10.5152/akd.2010.026  Pages E1 - E2
Abstract |Full Text PDF

27.Takotsubo cardiomyopathy mimicking acute high lateral myocardial infarction
Murat Biteker, Nilüfer Ekşi Duran, Tayyar Gökdeniz, Sabahattin Gündüz, Ahmet Güler, Hasan Kaya, Mustafa Yıldız, Mehmet Özkan
PMID: 20149992  Pages E2 - E3
Abstract |Full Text PDF

28.Pulmonary stenosis due to metastatic malignant melanoma
Yeşim Güray, Çağatay Tuncel, Zişan Sakaoğulları, Ayça Ata Boyacı, Levent Birincioğlu
PMID: 20149994  Page E3
Abstract |Full Text PDF

29.A case of infective endocarditis presented with a giant free wall vegetation
Serhat Bahadır Sözen, Ahmet Kaya, Hakan Cinemre, Enver Sinan Albayrak, Hakan Özhan, Mehmet Yazıcı
doi: 10.5152/akd.2010.029  Page E4
Abstract |Full Text PDF

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