Objective: Oxidative stress is one of the major factors involved in the pathogenesis of adriamycin (ADR)-induced cardiac dysfunction. The present study examined the antioxidant protective effects of carnosine (CAR) on adriamycin-induced cardiac damage in rats. Methods: Female Sprague Dawley rats were divided into four groups. Control (CONT, n=8, saline only i.v.); carnosine (CAR, n=8.10 mg/kg/day, i.v.); adriamycin (ADR, n=10.4 mg/kg four times every 2 days for 8 days, i.v.) alone and carnosine with adriamycin (CAR+ADR, n=10). Carnosine was given one week before adriamycin treatment and following one week with adriamycin treatment. After measurement of physiological functions, blood samples were collected for biochemical assays. The hearts were excised for hemodynamic study. Comparisons between different groups were made using ANOVA and posthoc Tukey test. Results: Adriamycin produced evident cardiac damage revealed by; hemodynamic changes - decreased left ventricular developed pressure (p<0.01), the maximum-minimum rates of change in left ventricular pressure (±dP/dt, p<0.01), electrocardiogram (ECG) changes (elevated ST, decreased R-wave, p<0.001), cardiac injury marker changes (increased creatine kinase, lactate dehydrogenase, aspartate aminotransferase and alanine aminotransferase), plasma antioxidant enzymes activity changes (decreased superoxide dismutase, glutathione peroxidase, catalase activities, p<0.03) and lipid peroxidation (elevated malondialdehyde, p<0.05) to the control and carnosine groups. Carnosine treatment caused significant attenuation (p<0.05) of cardiac dysfunction induced by adriamycin (CAR+ADR), revealed by normalization of the ventricular function, ECG and biochemical variables. Conclusion: An increase in oxidative stress, superoxide dismutase, glutathione peroxidase levels, catalase inactivation and cardiac dysfunction induced by adriamycin were prevented by carnosine.

Objective: Rheumatoid arthritis (RA) is a chronic systemic disease. The risk of cardiovascular morbidity and mortality is high in patients with RA. Heart rate turbulence (HRT) expresses ventriculophasic sinus arrhythmia and has been considered to reflect cardiac autonomic activity. It has been shown that HRT is an independent and powerful predictor of mortality. The aim of this study is to determine if HRT changes in patients with RA in comparison with the healthy controls. Methods: The study was performed as a cross-sectional study. Twenty-six patients with RA (mean age 56±10 years, 18 women) and 26 healthy controls (mean age 55±9 years, 18 women) were enrolled in this study. All participants underwent 24 hours Holter electrocardiogram monitoring. HRT measurements, turbulence onset (TO) and turbulence slope (TS), were calculated in patients and healthy controls that have at least one ventricular premature complex (VPC) in their Holter recordings. TO is a measure of the early sinus acceleration and TS is the measure of the rate of sinus deceleration that follows the sinus acceleration after a VPC. Mann-Whitney U test was used for comparison of continuous variables and the Chi-square test for comparison of categorical variables. Results: There were no statistically significant differences in TO and TS between the RA and control groups (TO: -2.2±3.1% vs -2.8±2.5%, p=0.25; TS: 11.5±9.7 ms/RR vs 15.5±10.9 ms/RR, p=0.10). Conclusion: HRT parameters, which determine the autonomic dysfunction, did not seem to be altered in patients with RA.

Objective: Emerging evidence assumes that statins have a benefit to influence the myocardial remodeling and ischemia in patients with coronary artery disease (CAD). Our aim was to investigate the possible and direct favorable effects of lovastatin on left ventricular (LV) systolic, diastolic function and myocardial ischemia in patients with CAD. Methods: This randomized prospective study consisted of 83 patients (46 males; mean age 54.3±6.5 years) with CAD and dyslipidemia. All patients were randomized to following groups: the 1st group (n=44) received lovastatin (20-60 mg/day), hypolipidemic diet and physical training; the 2nd group (n=39) - hypolipidemic diet and physical training. Lipid spectrum, Doppler-echocardiography, bicycle exercise test and 24-hour ambulatory electrocardiographic monitoring were done at baseline and were repeated after 12 months of treatment. The data were analyzed by using the paired and unpaired Student's t-tests. Results: In the 1st group there was an improvement of lipid spectrum (p<0.05) without significant changes of liver transaminases and other side effects. After treatment LV ejection fraction increased from 59.8±8.04 to 62.9±4.43% in lovastatin alone group (p=0.01). Unlike 2nd group, the 1st group’s patients had also reduction of myocardial ischemia: increased exercise time (5.21±1.81 vs. 5.96±1.76 min; p<0.05), METS (4.42±0.6 vs. 4.78±0.7; p<0.05), magnitude (1.12±0.34 vs. 0.81±0.19 mm; p<0.05) and duration (2.16±0.67 vs. 1.04±0.46 min, p<0.01) of ST segment depression, as well as number of leads with ST segment depression (2.18±0.72 vs. 1.31±0.67; p<0.05). Conclusion: Lipid-lowering therapy with lovastatin improved the LV systolic function and decreased myocardial ischemia.

Objective: Recent studies suggest that statins have anti-arrhythmic effects. The aim of this study was to evaluate the effects of statins on sustained ventricular tachycardia or ventricular fibrillation (S-VT or VF) in patients presenting with acute coronary syndrome (ACS). Methods: The population of this study consisted of consecutive patients admitted to coronary care unit. It was an observational case-controlled retrospective analysis performed on prospective cohort. From a total of 1000 patients presenting with ACS, 241 were on and 759 were not on statin. Patient demographics, clinical characteristics and previous medical treatment including statins were recorded. A S-VT or VF episode during hospitalization was accepted as endpoint. Multiple logistic regression model was performed which considered the occurrence of S-VT or VF as the response variable. Results: Sustained VT or VF occurred in 3.3% of patients in statin group and in 9% of patients in non-statin group. Univariate positive predictors of S-VT or VF were ST elevation myocardial infarction as clinical presentation, smoking and thrombolysis; univariate negative predictors of S-VT or VF were ejection fraction, use of acetylsalicylic acid before hospitalization, use of statin before hospitalization, initiation of clopidogrel at the hospital and normal coronary arteries. In the multiple logistic regression analysis, the only independent predictor of S-VT or VF was ejection fraction (OR 0.96; 95% CI 0.93 to 0.99; p=0.005). Conclusion: Our results indicate that, although the incidence of S-VT/VF was significantly lower in patients with ACS and previous statin use; statin use is not an independent predictor of the occurrence of S-VT or VF in patients presenting with ACS.

Objective: There have been numerous investigations demonstrating protective effects of awell- grown coronary collateral circulation (CCC) on left ventricular systolic function. N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) is released by ventricular myocardium as a result of increased myocardial wall stress. The aim of the study was to evaluate the relationship between CCC and plasma NT-pro-BNP levels. Methods: Study group was retrospectively selected from patients who had a coronary angiography at our center between January 2008 and December 2009. One hundred and thirty patients having at least one totally occluded main coronary artery were included in this study. Collateral circulation was graded according to Rentrop score. Grade 0 and 1 are regarded as poor, and grade 2 and 3 - good CCC. Plasma NT-pro-BNP levels were measured by electrochemiluminescence immunoassay method and left ventricular ejection fraction (LVEF) were measured by modified Simpson method. We used Chi-square, Student t and Mann-Whitney-U tests for statistical analysis. Results: Overall 57 patients were found to have poor CCC and 73 patients have good CCC. Plasma NT-pro-BNP levels (pg/ml)-median (minimum-maximum)- were 1319 (48-9753) in poor CCC group and 847 (16-5529) in good CCC group (p=0.004). LVEF was found to be -median (minimum-maximum)- 45% (30-55%) in poor CCC group and 50% (30-60%) in good CCC group (p=0.003). Correlation analysis demonstrated that collateral grade was negatively correlated with NT-pro-BNP levels (r=-0.252, p=0.004). Conclusion: We found that plasma NT-pro-BNP levels were more elevated in patients with poor CCC than in patients with good CCC. This finding may be explained with the protective effect of good CCC on LVEF.

Objective: P-wave dispersion (PWD) is an electrocardiographic measurement, which reflects a disparity in an atrial conduction. In this study, we aim to demonstrate the diagnostic accuracy of PWD in predicting recurrence of atrial fibrillation (AF) in patients with sinus rhythm restoration after external cardioversion. Methods: This prospective, observational study consists of 26 patients, who underwent external cardioversion for non-valvular persistent AF and successfully cardioverted to sinus rhythm (13 men, mean age 58.1±11 years). Twelve-lead surface electrocardiogram of each patient was recorded immediately after the external cardioversion process to measure the P-wave duration. Recurrent AF was assessed for each patient during the 12-month follow-up after restoring the sinus rhythm. Patients were divided into the 2 groups with respect to the AF recurrence (recurrent AF group, (n=19), and sinus rhythm group, (n=7)) and variables that can affect AF development were compared between the two groups. Stepwise logistic regression analysis was used to identify the independent predictors of AF recurrence and ROC curve analysis was performed to determine the cut-off value of independent factors. Results: The two groups have similar demographic, clinical and echocardiographic features. Patients with recurrent AF had significantly higher PWD than those who continued to have a sinus rhythm (80±21 msec vs 53±11 msec, p=0.001, respectively). There is a positive correlation observed between the increase in PWD and the risk of AF recurrence (r=0.643; p<0.001). In logistic regression analysis, PWD was found to be an independent predictor of AF recurrence (OR 1.192 (95% CI 1.032-1.375), p= 0.013). Receiver operating characteristic analysis revealed that the best cut-off value of PWD for maintenance of sinus rhythm was 58 msec (sensitivity: 86%, specificity: 95%, AUC=0.917, 95% CI=0.785-1.05, p=0.001). Conclusion: This study suggests that PWD analysis after successful external cardioversion has diagnostic accuracy to predict the recurrence of AF.

Objective: Chronic atrial fibrillation (AF) is a frequent arrhythmia in patients undergoing open-heart surgery. In this study, we compared the results of irrigated monopolar and bipolar radiofrequency (RF) ablation in the surgical treatment of AF. Methods: Sixty-three patients with chronic AF, who underwent open cardiac surgery and concomitant irrigated RF ablation between October 2004 and January 2006, were retrospectively studied in two groups. Group 1 included 31 patients (22 female, 9 male), who underwent monopolar RF ablation, and Group 2 included 32 patients (18 female, 14 male), who underwent bipolar RF ablation. All patients received amiodarone during the first 6 months after surgery. Rhythm status of patients after RF ablation was followed-up postoperatively in the intensive care unit, on the day of discharge, and at their follow-ups with electrocardiography. In patients with a documented sinus rhythm (SR) at follow-up, the presence of atrial transport function was assessed with transthoracic echocardiography. Statistical analyses were performed by using t-test for independent samples, Chi-square test and McNemar's test. Complication-free survival during follow-up was evaluated using Kaplan-Meier analysis. Results: There was no hospital mortality in both groups. One patient from Group 1 had non-cardiac mortality (colon carcinoma). While in monopolar ablation group SR was documented in 83.3% of patients at a mean follow-up period of 11.5±4.0 months (between 4-18 months), 68.8% of patients from bipolar ablation group was in SR at a mean follow-up period of 9.3±3.0 months (between 4-15 months). In patients with documented SR during follow-up visits, atrial transport function was 76.6% in cases undergoing monopolar ablation, whereas it was 72.7% in cases undergoing bipolar ablation (p=0.797). Pacemaker implantation was performed in one (3.4%) patient from Group 1 after hospital discharge and in one (3.1%) patient from Group 2 during hospital stay. Conclusion: Irrigated monopolar and bipolar RF ablation are both safe and effective in terms of restoring SR and atrial transport function in patients with chronic AF, who underwent open cardiac surgery.

Objective: The aim of our study was to investigate atrial conduction and ventricular repolarization inhomogeneities using P-wave dispersion (Pwd) and QT dispersion (QTd) analyses in acute carbon monoxide (CO) poisoning. Methods: Sixty patients were retrospectively included in this case-controlled study. Thirty acute CO poisoning patients were assigned to the Group with acute CO poisoning (ACOP). Patients who did not have acute CO poisoning were assigned to the control group (Group C, n=30). Anthropometric measurement, body mass index, electrocardiogram (ECG) and serum electrolyte levels were recorded in all patients. Also, carboxyhemoglobin (COHb) levels were recorded in Group ACOP. Pwd, QT interval and QTd durations were measured. Corrected QT (QTc) and QTc dispersion (QTcd) intervals were determined with the Bazett formula. Independent samples t and Chi-square tests were used for statistical analysis. Results: No statistically significant difference was found between the age, gender distribution, anthropometric measurement, serum electrolytes, PR and QT durations between the groups. The Pwd (56.33±17.11 msec vs 28.33±11.16 msec, p<0.001) and QTd (63.33±26.69 msec vs 42.16±7.84 msec, p<0.001) were significantly longer in Group ACOP than in Group C. In addition, QTc and QTcd durations of Group ACOP were also found to be significantly longer than in Group C (p<0.001). Conclusion: In our study, we found in ECG analyses of patients with acute CO poisoning that the Pwd, QTc and QTcd durations were significantly prolonged when compared with control group. For this reason, patients with acute CO poisoning need close attention because of arrhythmias, which can be related to increased QTcd and Pwd durations.

Objective: Risk factors for hemorrhage due to gastric and/or duodenal ulcer in patients diagnosed by upper gastrointestinal (GI) endoscopy were investigated in the present study. Methods: Medical records of 350 patients (226 males, 124 females) diagnosed as duodenal or gastric ulcers by GI endoscopy in the gastroenterology clinic were scanned retrospectively. Upper GI hemorrhage was detected in 92 patients by upper endoscopic examination. The medical history of non-steroidal anti-inflammatory drugs (NSAIDs) or acetylsalicylic acid (ASA) usage and the presence of coronary artery disease (CAD) were investigated in all patients with or without hemorrhage. Results were evaluated by Chi-square test and logistic regression analysis. Results: The mean age of the patients was 50.4±15.7 years (range: 25 to 82 years). Hemorrhage due to gastric or duodenal ulcer was identified in 92 patients (26%). Mean age was 64.6±11.4 years in patients with hemorrhage and 45.7±13.9 years in patients without hemorrhage. ASA usage was more common than NSAID in patients with ulcer hemorrhage (NSAID usage n=35 (40%); ASA usage n=51 (60%); p=0.035). Hemorrhage was reported in 20% of the females and in 28% of the males who have ulcer (p=0.055). Risk factors for hemorrhage were CAD (OR: 24.75, 95% CI=1.6-96.7, p=0.001), ASA usage (OR: 9.76, 95% CI=2.1-37.5, p=0.021), NSAID usage (OR: 4.72, 95%CI=1.1-16.5, p=0.032), age (OR: 11.59, 95% CI= 2.7-12.1, p=0.001), and male gender (OR: 2.56, 95% CI= 0.8, 9.6, p=0.052). Conclusion: Advanced age, atherosclerosis, male gender and NSAID administration (particularly aspirin) are the major risk factors of upper GI hemorrhage in patients with gastric and/or duodenal ulcer.

Objective: The nocturnal blood pressure (NBP) reduction is less than normal in the patients with type 2 diabetes mellitus (type 2 DM). L-carnitine deficiency may cause changes of NBP by leading to hyperglycemia, insulin resistance and endothelial dysfunction in patients with type-2 DM. The purpose of the study was to investigate whether there is a difference in levels of L-carnitine in dipper and nondippers patients with type 2 DM. Methods: This is a cross-sectional observational cohort study. We compared the 50 (33 females, 17 males) patients with type 2 DM and the 35 healthy persons (18 females, 17 males) as a control group. In all cases, ambulatory blood pressure monitoring (ABPM) was performed and L-carnitine was measured. The independent samples t test, Chi-square test, Mann-Whitney U test and Pearson correlation analysis were used in the statistical evaluation of data. Results: We found that the percentage of nondipper pattern was 72% in patients with type 2 DM. L-carnitine levels were lower in patients with type 2 DM (52.77±12.34 μmol/L) than those of control group (79.18±10.59 μmol/L), and these differences were statistically significant (p<0.05). L-carnitine levels were lower in nondipper cases (50.02±16.30 μmol/L) than those of dipper cases (53.83±10.50 μmol/L), but these differences were not statistically significant (p=0.125). Conclusion: Nondipper pattern is common in patients with type 2 DM. Nondipper pattern is associated with damage of target organ. Therefore, determination of nondipper pattern by ABPM is very important. L-carnitine levels were found to be lower in nondipper patients than in dipper patients with type 2 DM. Although, these differences were statistically nonsignificant, more detailed studies should be performed to determine the frequencies and relationship between nondipper pattern and L-carnitine levels in patients with type-2 DM.

Objective: The anatomic changes of the patent ductus arteriosus (PDA) in adult patients can complicate its transcatheter occlusion. The aim of the study was to determine procedural approaches to facilitate transcatheter closure of PDA in adult patients using the Amplatzer duct occluder (ADO). Methods: In this prospective study, 33 consecutive adult patients with a moderate to large-sized PDA underwent transcatheter closure. Conventional antegrade approach was used in 14 patients, while retrograde wire-guided assisted approach in remaining 18 patients to access the PDA antegrade. If the initial procedure failed, snare-assisted technique was used to pass through the ductus antegradely. For comparative statistics, the Student’s t-test, Mann-Whitney U test and Chi-square test were used as appropriate. Results: Thirty-two patients had successful PDA occlusion. PDA ostium could be engaged in 10 of 14 patients by conventional approach, while 17 of remaining 18 patients by retrograde wire-guided assisted approach (p=0.07). PDAs could be passed antegradely using the snare-assisted technique in those five patients in whom the initial procedure failed. The mean size of implanted devices was 3.76 mm larger than the narrowest size of the PDA. Spontaneous embolization occurred in one patient in whom smaller device implanted due to his short ductus. All patients attained complete occlusion and there were no complications encountered during follow-up. Conclusion: The retrograde wire-guided technique is an effective approach and offers an alternative to access the PDA antegradely in adult patients. Larger than recommended size ADO device can be used safely in all adult patients with feasible ductal ampulla and may prevent device migration.