ISSN 2149-2263 | E-ISSN 2149-2271
The Anatolian Journal of Cardiology - Anatol J Cardiol: 4 (3)
Volume: 4  Issue: 3 - September 2004
EDITORIAL
1.Why This Journal Is Read? New Printing Order of the AKD?
Bilgin Timuralp
PMID: 15355816  Page 197
Abstract |Full Text PDF

INVITED EDITORIAL
2.Some Aspects of Cardiology Practice in Lebanon
Charles Jazra
PMID: 15355817  Page 198
Abstract |Full Text PDF

ORIGINAL INVESTIGATION
3.The Relationship Between Serum C-Reactive Protein Levels and Coronary Artery Disease in Patients with Stable Angina Pectoris and Positive Exercise Stress Tes
E. İpek Türkoğlu, Cemil Gürgün, Mehdi Zoghi
PMID: 15355818  Pages 199 - 202
Objective: In this study we aimed to investigate whether serum C- reactive protein (CRP) levels are related with the incidence of coronary artery disease (CAD) and selection of management approaches in stable angina pectoris (SAP). Methods: Overall 134 patients (pts) with SAP and positive exercise stress test were investigated. All pts were divided into two groups according to the baseline levels of CRP. In group 1 (mean age 57.8±10.3 years) there were 41 pts with the level of CRP >0.50mg/dl (high levels of CRP) and group 2 consisted of 93 pts (mean age 56.0±11.7 years) with the CRP levels <0.50mg/dl (normal levels of CRP). We investigated the relationship between CRP levels with coronary artery disease and treatment strategies. Results: There were no significant differences in age, sex, hypertension and hyperlipidemia between groups. In group 1 (n=41 pts) 36 pts, and in group 2 (n=93) 58 pts had CAD (p= 0.004). We found statistically significant relationship between high levels of CRP and smoking and diabetes mellitus. After adjustment of these risk factors by multivariate regression analyses the CRP association with CAD become attenuated but was still statistically significant (p=0.03). Conclusion: In this study we found that high level CRP is an independent strong marker of CAD in middle-aged patients with stable angina and positive treadmill exercise test. There was no correlation between CRP levels and interventional procedures.

EDITORIAL COMMENT
4.C-Reactive Protein and Coronary Artery Disease
Esmeray Acartürk
PMID: 15355819  Pages 203 - 204
Abstract |Full Text PDF

ORIGINAL INVESTIGATION
5.Triple Valve Surgery: A 25-Year Experience
Mustafa Yılmaz, Murat Özkan, Erkmen Böke
PMID: 15355820  Pages 205 - 208
Objective: Surgical treatment of rheumatic valvular disease still constitutes a significant number of cardiac operations in developing countries. Despite improvements in myocardial protection and cardiopulmonary bypass techniques, triple valve operations (aortic, mitral and tricuspid valves) are still challenging because of longer duration of cardiopulmonary bypass and higher degree of myocardial decompensation. This study was instituted in order to assess results of triple valve surgery. Methods: Between 1977 and 2002, 34 patients underwent triple valve surgery in our clinic by the same surgeon (EB). Eleven patients underwent triple valve replacement (32.4%) and 23 underwent tricuspid valve annuloplasty with aortic and mitral valve replacements (67.6%). Results: There was no significant difference between the two groups of patients who underwent triple valve replacement and aortic and mitral valve replacement with tricuspid valve annuloplasty. There were 4 hospital deaths (11.8%) occurring within 30 days. The duration of follow-up for 30 survivors ranged from 6 to 202 months (mean 97 months). The actuarial survival rates were 85%, 72%, and 48% at 5, 10, and 15 years respectively. Actuarial freedom from reoperation rates at 5, 10, and 15 years was 86.3%, 71.9%, and 51.2%, respectively. Freedom from cerebral thromboembolism and anticoagulation-related hemorrhage rates, expressed in actuarial terms was 75.9% and 62.9% at 5 and 10 years. Major cerebral complications occurred in 10 of the 30 patients. Conclusions: We prefer replacing, if repairing is not possible, the tricuspid valve with a bileaflet mechanical prosthesis in a patient with valve replacement of the left heart who will be anticoagulated in order to avoid unfavorable properties of bioprosthesis like degeneration and of old generation mechanical prosthesis like thrombosis and poor hemodynamic function. In recent years, results of triple valve surgery either with tricuspid valve conservation or valve replacement in suitable cases have become encouraging with improvements in surgical techniques and myocardial preservation methods.

6.Serum Levels of Insulin-Like Growth Factor-1 and Insulin-Like Growth Factor Binding Protein-3 in Acute Coronary Syndromes and Relationship with Prognosis
Cevad Şekuri, Ece Onur, Ozan Ütük, Özgür Bayturan, Özlem Arslan, Uğur Kemal Tezcan
PMID: 15355821  Pages 209 - 212
Objective: The aim of the present study was to examine the levels of insulin-like growth factor (IGF-I) and binding protein-3 (IGFBP-3) in acute coronary syndrome (ACS) and their relationship with prognosis. Methods: Thirty patients with ACS (22 male, 8 female) were included in our study. Patient’s population included 20 patients with ST elevation myocardial infarction (STEMI) and 10 with non-ST-elevation ACS. Death, re-infarction, revascularization and malignant arrhythmia were monitored during 3 months. Study group was compared with 20 healthy subjects (Controls). Blood samples were collected in the first 24 hours and at the end of third month. Serum IGF-I and IGFBP-3 levels were determined by radioimmunoassay method. Results: We found decreased level of IGF-I only in the STEMI group (105±84 ng/ml vs. 715±150 ng/ml, p<0.0001). There were no significant differences in IGFBP-3 levels between two groups. Serum IGF-I levels were significantly increased after 3rd month in the STEMI group (356±72 ng/ml vs. 105±84 ng/ml, p=0.025). There was no relationship between IGF-I, IGFBP-3 levels and cardiovascular events occurred during 90 days of follow-up. Conclusion: These data allows to suggest that significantly decreased level of IGF-I in STEMI group of ACSs can be used as a marker of myocardial necrosis. There was no relationship between IGF-I level and cardiovascular events occurred in 90 days, so this parameter can not be used as a negative prognostic factor.

7.The Effects of Clarithromycin Treatment on Cardiac Events in Acute Coronary Syndrome Patients
Ozan Ütük, Cevad Şekuri, Özgür Bayturan, Ali Rıza Bilge, Hakan Tıkız, Talat Tavlı, Uğur Kemal Tezcan
PMID: 15355822  Pages 213 - 216
Objective: The assessment of short duration early clarithromycin treatment on major cardiac events in acute coronary syndrome patients Methods: One hundred and thirteen patients with acute coronary syndrome had been enrolled in the study in a prospective manner. Fifty-seven of 113 patients received peroral clarithromycin 1g/day for 14 days in addition to standard therapy. The remaining 56 patients were considered as control group. The treatment and control groups had similar major cardiac risk factors such as diabetes, hypertension, dyslipidemia and smoking habits. The occurrence of unstable angina pectoris, non-ST elevation myocardial infarction and ST elevation myocardial infarction was comparable in both groups. The use of thrombolytic therapy and glycoprotein IIb/IIIa receptor blockers administration was also similar in both groups. The patients were followed for major cardiac events for 6 months. Results: During the follow-up, no difference was observed between groups in the occurrence of unstable angina pectoris, myocardial infarction, the need for revascularization with percutaneous coronary intervention or cardiac surgery and cardiac death. We observed a reduction of myocardial infarction and cardiac death occurrence and an increase in the necessity of percutaneous interventions in the treatment group even though this difference did not reach statistical significance. Conclusion: No benefit of short duration early clarithromycin therapy was observed in the occurrence of major cardiac events in acute coronary syndromes. Studies with longer treatment and follow-up period using different antibiotics are necessary to elucidate the possible effect of antibiotics on major cardiac events in patients with acute coronary syndrome.

8.The Effect of Left Ventricular Geometry on Myocardial Performance Index in Hypertensive Patients
Remzi Yılmaz, Tünzale Seydaliyeva, Abdullah Uluçay
PMID: 15355823  Pages 217 - 222
Objective: The aim of this study was to investigate the relationship between the myocardial performance index (MPI) and left ventricular (LV) geometry in hypertensive patients. Methods: The MPI, which is a marker of systolic and diastolic ventricular function, was measured in 64 hypertensive patients and in 15 healthy persons (Control). According to the value of relative wall thickness (RWT) and LV mass index (LVMI), hypertensive patients were subdivided into four groups: normal (N), 17 patients (26.6%); concentric remodeling (CR), 21 patients (32.8%); concentric hypertrophy (CH), 16 patients (25%); and eccentric hypertrophy (EH), 10 patients (15.6%). Results: A higher MPI was found in all patient groups (N, 0.56 ± 0.11; CR, 0.59 ± 0.11; CH, 0.68 ± 0.19; EH, 0.57 ± 0.10) compared with the controls (0.44 ± 0.09) (p = 0.004, p < 0.001, p < 0.001 and p = 0.002, respectively). In the CH group, the MPI was also higher than in N, CR and EH groups (p = 0.006, p < 0.03 and p = 0.009, respectively). No significant difference was found among N, CR and EH groups. The MPI was correlated with LVMI (r = 0.28, p = 0.014), RWT (r = 0.24, p = 0.035) and interventricular septum diastolic thickness (r = 0.32, p = 0.004). Conclusion: The systolic and diastolic LV functions are impaired in all subgroups of hypertensive patients according to their LV geometry compared to control group. This impairment is more advanced in patients with concentric hypertrophy than in those with the other LV geometric patterns.

9.Prevalence of Coronary Artery Disease in Patients Undergoing Valvular Operation Due to Rheumatic Involvement
Hüseyin Bozbaş, Aylin Yıldırır, Mehmet Alparslan Küçük, Aliseydi Özgül, İlyas Atar, Atilla Sezgin, Sait Aşlamacı, Mehmet Emin Korkmaz, Bülent Özin
PMID: 15355824  Pages 223 - 226
Objective: Rheumatic heart disease is still a major health problem in developing countries. The impact of coronary artery disease (CAD) on or its relation to rheumatic fever is not well established. We aimed to evaluate the prevalence of CAD and atherosclerotic risk factors in patients who underwent valvular surgery due to rheumatic heart disease. Methods: The records of 346 patients who had undergone rheumatic valvular surgery in a university hospital between 1996 and 2002 were evaluated. Results: Coronary angiography was performed in 218 (63%) patients, of whom 41 (18.8%) had CAD. The mean age of the patients having CAD and normal coronary arteries were 57.3 and 50.5 years respectively (p<0.001). In the study population patients with CAD had significantly increased prevalence of diabetes mellitus (14.6% vs. 4.5%; p=0.02), hypertension (36.6% vs. 16.4%; p=0.003), smoking (51.2% vs. 23.2%; p=0.001) and family history of CAD (39.5% vs. 20.0%; p=0.01) compared to patients with normal coronary arteries. However, the prevalence of dyslipidemia was similar in both groups (45.9% vs. 36.4%; p=0.1). Conclusion: These findings suggest that coronary artery disease prevalence in rheumatic valvular disease patients is similar to the normal population of same age. In cases where invasive assessment of valvular lesions is not indicated we suggest coronary angiography to be performed only in patients having clinical suspicion of CAD or multiple risk factors.

10.Assessing the Effect of Low Dose Dobutamine on Various Diastolic Function Indexes
Şevket Görgülü, Mehmet Eren, Bülent Uzunlar, Hüseyin Uyarel, Tuna Tezel
PMID: 15355825  Pages 227 - 230
Objective: The aim of this study was to evaluate the effect of low dose dobutamine (LDD) on various diastolic function parameters in patients without wall motion abnormality. Methods: Thirty-one volunteer patients who had no regional wall motion abnormality were included in the study. Echocardiographic measurements were taken both at pre-dobutamine and during LDD infusion. The peak E velocity, A velocity, the E/A ratio, deceleration time (DT), isovolumetric relaxation time (IVRT), myocardial performance index (MPI) and flow propagation velocity (FPV) were assessed as left ventricular diastolic function parameters. Tissue Doppler velocities were also obtained in order to calculate the E/Em and Em/Am ratios. Results: No significant changes were observed in heart rate, E velocity, A velocity, E/A ratio, E/Em ratio, Em/Am ratio, systolic and diastolic blood pressure with LDD. With LDD, DT (239±40 msec vs. 201±31 msec, p<0.001), IVRT (109±12 msec vs. 94±11 msec, p<0.001) and MPI (0.57±0.15 vs. 0.44±0.22 p<0.001) were found to be decreased, while there was an increase in FPV (45±8 cm/s vs. 59±10 cm/s, p<0.001) and ejection fraction (64±6% vs. 66±7%, p<0.05). Conclusion: Low dose dobutamine (5mcg/kg of body weight) improves left ventricular relaxation in patients with normal wall motion, while it has no effect on left ventricular filling pressure index.

REVIEW
11.The Organ Effects of Systemic Inflammation Response Activated During Open heart Surgery and Current Treatment Methods
Erkan İriz
PMID: 15355826  Pages 231 - 235
Multi-organ failure may occur due to activation of systemic inflammatory process with many other factors in open-heart procedures when cardiopulmonary bypass is used. Activation of systemic inflammatory process may cause postoperative complications. Surgical trauma, contact of blood with foreign surface, endotoxemia and ischemia-reperfusion injury are major factors that contribute to activation of inflammatory response. In this review we purposed to investigate the factors which contribute to the systemic inflammatory process, multiorgan dysfunction and the therapeutic modalities during open heart surgery.

12.Lipids, Lipoproteins and Apolipoproteins Among Turks, and Impact on Coronary Heart Disease
Altan Onat
PMID: 15355827  Pages 236 - 245
Serum concentrations of lipids, lipoproteins, and apolipoproteins (apo) among Turkish adults have been reviewed in this paper whereby stratification by gender and age groups was provided, together with a description of differences by geographic regions and urban-rural areas. Most of the knowledge was derived from the prospective population-based Turkish Adult Risk Factor (TEKHARF) Study, having already a 13 years’ follow-up, but data contributed by the Turkish Heart Study were also outlined. In the setting of a prevalence of metabolic syndrome in 3 out of 8 Turkish adults, Turks have low levels of total cholesterol (mean 185 mg/dl), LDL-cholesterol (mean 116 mg/dl), and HDL-cholesterol (mean 37 and 45 mg/dl in men and women). The latter is associated with comparatively high concentrations of triglycerides (mean 143 mg/dl) and of apo B (mean 115 mg/dl). This suggests that small, dense LDL particles (pattern B) prevail in this population though studies are missing in this regard. In line with this notion are the high levels of total/HDLcholesterol ratio (mean 5.3 in men, 4.5 in women). It is remarkable that women exhibit identical LDL-cholesterol levels as men. The lipid parameter that has changed strikingly since 1990 are the rising triglycerides, accompanying a similar trend in (abdominal) obesity. On multivariate analysis, the best independent lipid predictor of coronary heart disease (CHD) risk among Turks is the TC/HDL-C ratio. A 2-unit increment of TC/HDL-C adds an excess of 68% to both the nonfatal and fatal CHD event risk. When ratios of ≥5.5 in men and ≥5 in women are considered as high risk, slightly more than one-third of Turkish adults, corresponding to 12 million adults, are included by these criteria into high-risk group. A major portion of Turkish adults harbouring total cholesterol concentrations in the 180-200 mg/dl range are at high risk, and we stress the opinion that the upper normal limit of total cholesterol be reduced to 180 mg/dl in Turks, at least in men.

MISCELLANEOUS
13.General Approach to Ventricular Arrhythmias
Nihal Akar Bayram, Sinan Aydoğdu, Erdem Diker
PMID: 15355828  Pages 246 - 252
Abstract |Full Text PDF

CASE REPORT
14.Perivalvular Pseudoaneurysm, Abscess and Vegetation Along with Coronary Embolism in Aortic Prosthetic Valve
Bülent Mutlu, Atilla Bitigen, Fatih Bayrak, Yelda Başaran
PMID: 15355829  Pages 253 - 255
Abstract |Full Text PDF

15.Cardiac Decompression Sickness After Hypobaric Chamber Training: Case Report of A Coronary Gas Embolism
Cengiz Öztürk, Ahmet Şen, Ahmet Akın, Atilla İyisoy
PMID: 15355830  Pages 256 - 258
Abstract |Full Text PDF

EDITORIAL COMMENT
16.Cardiac Decompression Sickness
Muzaffer Çetingüç
PMID: 15355831  Page 259
Abstract |Full Text PDF

CASE REPORT
17.Two Cases with Suspected Permanent Pacemaker Allergy
Mehmet Kanadaşı, Murat Çaylı, Esmeray Acartürk
PMID: 15355832  Pages 260 - 261
Abstract |Full Text PDF

18.Stent Implantation to Left Pulmonary Artery Stenosis in Children: A Case Report
Arda Saygılı, Berna Canter, Serdar Kula, Fatma Sedef Tunaoğlu, Rana Olguntürk
PMID: 15355833  Pages 262 - 263
Abstract |Full Text PDF

19.Double Orifice Mitral Valve and Spontaneous Echo Contrast in the Descending Aorta
Ceyhun Ceyhan, Tarkan Tekten, O. Alper Onbaşılı, Ayvaz Aydoğdu
PMID: 15355834  Pages 264 - 265
Abstract |Full Text PDF

SCIENTIFIC LETTER
20.Surgical Treatment of the Atrial Septal Aneurysms with Concomitant Cardiovascular Abnormalities
Gökhan İpek, Denyan Mansuroğlu, Mesut Şişmanoğlu, Suat Nail Ömeroğlu, İlker Mataracı, Hakan Akbayrak
PMID: 15355835  Pages 266 - 267
Abstract |Full Text PDF

21.Endovascular Treatment of Thoracic Aortic Aneurysms
Cengiz Köksal, Vural Özcan, Sabit Sarıkaya, Burhan Meydan, Mustafa Zengin, Fürüzan Numan
PMID: 15355836  Pages 268 - 269
Abstract |Full Text PDF

LETTER TO THE EDITOR
22.The Role of Aerobic Exercise After Myocardial Infarction
Erdem Kaşıkçıoğlu
PMID: 15355837  Pages 270 - 271
Abstract |Full Text PDF

23.The Effect of Glutamate and Aspartate on Myocardial Protection at Cardiopulmonary Bypass
Tamer Türk, Yusuf Ata, Hakan Vural
PMID: 15355838  Page 272
Abstract |Full Text PDF

24.The 8th World Congress of Echocardiography and Vascular Ultrasound, Antalya, Turkey, May 6th-9th, 2004
Kul Aggarwal
PMID: 15355839  Page 273
Abstract |Full Text PDF

E-PAGE ORIGINAL IMAGES
25.A Case of Left Main Coronary Artery Aneurysm Associated with Severe Stenosis of Left Anterior Descending Artery
Yeşim Hoşcan, Abdullah Doğan, Ahmet Altınbaş
PMID: 15355840  Page 274
Abstract |Full Text PDF

26.Catheter-Induced Left Anterior Descending Coronary Artery Spasm Mimicking Atherosclerotic Lesion
Mesut Demir, Mahir Avkaroğulları, Abdi Bozkurt, Esmeray Acartürk
PMID: 15355841  Page 275
Abstract |Full Text PDF

27.From Treatment to Diagnosis: A Huge Left Ventricular Thrombus in A Patient with Heart Failure
Sümeyye Güllülü, Aysel Aydın Kaderli, Bülent Özdemir, İbrahim Baran, Ali Aydınlar, Jale Jordan
PMID: 15355842  Page 276
Abstract |Full Text PDF

28.Severe Myocardial Ischemia Caused by Muscular Bridge of the Diagonal Branch of the Left Anterior Descending Coronary Artery
Ahmet Altınbaş, Mehmet Özaydın, Abdullah Doğan, Ömer Gedikli
PMID: 15355843  Pages 277 - 278
Abstract |Full Text PDF

29.Right Atrial Mobile Thrombus Leading to Pulmonary Embolism
Serpil Eroğlu, Aylin Yıldırır, Vahide Şimşek
PMID: 15355844  Pages 279 - 280
Abstract |Full Text PDF

30.Renal Cell Carcinoma with Right Atrial Invasion
Mehmet Melek, Celal Kilit
PMID: 15355845  Page 281
Abstract |Full Text PDF

MISCELLANEOUS
31.Conversation with Prof.Dr. Remzi Özcan. Interview by Prof.Dr. Yılmaz Nişancı
Remzi Özcan, Yılmaz Nişancı
PMID: 15355846  Pages 282 - 284
Abstract |Full Text PDF



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