ISSN 2149-2263 | E-ISSN 2149-2271
The Anatolian Journal of Cardiology - Anatol J Cardiol: 5 (1)
Volume: 5  Issue: 1 - March 2005
EDITORIAL
1.With gratitude to our referees, three Murat's and internet visitors

PMID: 15755692  Pages 1 - 2
Abstract |Full Text PDF

ORIGINAL INVESTIGATION
2.Is slow coronary flow related with inflammation and procoagulant state
Mustafa Yazıcı, Emre Aksakal, Sabri Demircan, Mahmut Şahin, Olcay Sağkan
PMID: 15755693  Pages 3 - 7
Objective: To investigate the pathogenesis of coronary slow flow (CSF), C-reactive protein (CRP) levels as indicator of inflammation and procoagulant activity were studied in patients with CSF. Methods: Fifty-one patients (22 female, mean age; 53±10 years) who were admitted to our clinic with chest pain and had the diagnosis of CSF established by TIMI frame count method and coronary angiography, and 44 healthy subjects (18 female, mean age; 54±6 years) with normal coronary flow (NCF) were included in the study. Subjects with any infectious and systemic immune disease were excluded from the study. The CRP levels were measured from venous blood samples during admission, at 24th hour and after 3 months in all subjects. Additionally; fibrinogen, plasminogen, plasminogen activator inhibitor (PAI-1), tissue plasminogen activator (t-PA) and von Willebrand factor (vWF) levels were measured to determine the procoagulant activity. Results: There was no significant difference between CRP levels of patients with CSF and healthy subjects during admission (7.26±4.2 ng/dl vs. 6.43±2.8 ng/dl, p>0.05), at 24th hour (7.84±1.3 ng/dl vs. 6.32±2.5 ng/dl, p>0.05) and after 3 months (6.37±2.4 ng/dl vs. 6.18±3.3 ng/dl, p>0.05). There were no differences between levels of CRP when compared according to the TIMI frame count, number of vessels with CSF and artery in which CSF was dominant. Additionally; procoagulant activity assessed by fibrinogen, plasminogen, PAI-1, t-PA and vWF levels was similar in both groups. Conclusion: Our findings on normal levels of CRP and procoagulant activity, and lack of relation with TIMI frame count made us to think that inflammatory and procoagulant activity did not play a role in the pathogenesis of CSF.

3.The serial changes in plasma homocysteine levels and it’s relationship with acute phase reactants in early postmyocardial infarction period
Murat Sucu, Abdulaziz Karadede, Gülten Toprak, Nizamettin Toprak
PMID: 15755694  Pages 8 - 12
Objective: We aimed to study the change in the plasma homocysteine concentration in the early stage of acute myocardial infarction and its relationship with the acute phase reactants. Methods: We included into the study 33 patients who were admitted to the hospital with acute myocardial infarction within the first three hours after the onset of symptoms. The plasma samples were obtained on admission (within 3 hours onset of symptom) and at 6, 12, 24 hours and 2, 4, 7, 30 and 90th day after admission. Results: The serial homocysteine measurements were as following: 11.87±0.71 µmol/L, 11.89±0.62 µmol/L, 11.37±0.83 µmol/L, 10.96±0.93 µmol/L, 11.37 ±0.89 µmol/L, 11.24±0.66 µmol/L, 13.09±0.64 µmol/L, 12.85±0.71 µmol/L and 12.19±0.91 µmol/L respectively (p=0.05). Statistically significant difference was found only between the hour 24 and the day 7 (p=0.04). However, there was no statistically significant difference between the admission level and none of the other time points. No correlation was identified between acute phase reactants and lipid parameters that were measured serially at the same time periods and homocysteine levels. Conclusion: Although homocysteine plasma values obtained during the sixth and twelfth hours of acute myocardial infarction provide reliable results as a risk markers, timing of blood sampling during the myocardial infarction does not have significant role since plasma values of homocysteine did not affect acute phase reactants.

4.Analytical performance of a direct assay for LDL-cholesterol: a comparative assessment versus Friedewald’s formula
Işık Türkalp, Zafer Çil, Didem Özkazanç
PMID: 15755695  Pages 13 - 17
Objective: Because low density lipoprotein-cholesterol (LDL-C) is a modifiable risk factor for coronary artery disease (CAD), its routine measurement is recommended in the evaluation and management of hypercholesterolemia. Concentrations of LDL-C are commonly monitored by means of the Friedewald formula (FF), which provides a relative estimation of LDL-C concentration when the triglyceride (TGs) concentration is <200 mgr/dl and there are no abnormal lipids. Because of the limitations of the Friedewald calculation, direct methods for an accurate quantification of LDL-C are needed. Methods: We critically examined an immunoseparation method for direct assay of LDL-C in a comparison with FF. 1) We measured intraassay and interassay precision using quality-control sera and patient serum pools. Accuracy was evaluated from total error analyses. Sample stability was examined over 2 months. 2) The LDL-C levels obtained with direct assay were compared with those calculated by the FF in 47 randomly chosen patient samples. The samples were classified as group 1 (patients with TGs 60-308 mg/dl n=25) and group 2 (patients with TGs 320-695 mg/dl, n=22). Results: The direct immunoseparation assay displayed an excellent precision (total coefficient of variance (CV) <2.5%, intraassay CV<1.5% and interassay CV<1.5%). Mean total error was 4.34%. The direct assay met the current National Cholesterol Education Program (NCEP) requirements for LDL-C testing for precision and accuracy. The results of direct method (x) and the FF (y) were highly correlated (r=0.9908, y=1.030x-0.289, n=25) in group 1, but the results of two methods disagreed (r=0.716, y=0.956x-24.869, n=22) in group 2 (patients with TGs 320 -695 mg/dl). Conclusion: The direct immunoseparation assay meets the currently established analytical performance goals and may be useful for the diagnosis and management of hyperlipidemic patients.

5.Effect of octreotide in the prevention of doxorubicin cardiotoxicity
Cem Barçın, Hürkan Kurşaklıoğlu, Mükerrem Safalı, Atilla İyisoy, Sedat Köse, Nadir Barındık, Ersoy Işık
PMID: 15755696  Pages 18 - 23
Original Article Effect of octreotide in the prevention of doxorubicin cardiotoxicity Cem Barçın 1, Hürkan Kurşaklıoğlu 2, Mükerrem Safalı 3, Atilla İyisoy 4, Sedat Köse 1, Nadir Barındık 5, Ersoy Işık 6 1 Department of Cardiology, Gülhane Military Medical Academy, Ankara, Turkey 2 Department of Cardiology, School of Medicine, Gülhane Military Medical Academy, Ankara, Turkey 3 Department of Pathology, Gulhane Military Medical Academy, Ankara, Turkey 4 Department of Aerospace Medicine, Gulhane Military Academy, Eskişehir 5 Department of Cardiology, Gulhane Military Medical Academy, Ankara, Turkey 6 Department of Cardiology School of Medicine, Gülhane Military Medical Academy, Etlik, Ankara Anatol J Cardiol 2005; 5: 18-23 This article was viewed 145 times, downloaded 128 times Key Words: Doxorubicin, cardiotoxicity, prevention, octreotide Full Text (PDF) Related Articles Send a comment Share Abstract Objective: A precise method for prevention from doxorubicin cardiotoxicity is not known. We examined whether octreotide has a protective effect against doxorubicin cardiotoxicity. Methods: New Zealand rabbits (n=44) were divided into 4 groups according to drugs given: Group A (n=12) doxorubicin and octreotide, Group B (n=12) only doxorubicin, Group C (n=10) only octreotide and Group D (n=10) only saline. Effects of the drugs were evaluated in terms of histopathological score, fractional shortening (FS) and prolongation of the QTc interval. Results: Mean pathological score for cardiotoxicity (Group A: 3.7±0.5, Group B: 3.9±0.3), prolongation of QTc (Group A: from 244.5±21.2ms to 282.9±25.9ms, p<0.0001; Group B: from 248.5±17.7ms to 298.3±13.7ms, p<0.00001) and the rate of decrease in FS (Group A: from 34.4 ± 2.0 to 28.0 ± 2.0, p<0.05; Group B: from 35.1 ± 1.9 to 24.8 ± 1.3, p<0.05) were higher in Group B when compared to Group A, but only difference in the rate of decrease in FS was statistically significant (p<0.001). None of these variables changed significantly in groups C and D. Conclusion: In this preliminary study, octreotide seems not to reduce doxorubicin cardiotoxicity. On the other hand, a consistent tendency of decreased cardiotoxicity in octreotide+doxorubicin group was observed, although only the difference in FS decrease was significant. Further investigations are needed to address the issue of the extent and the mechanisms of this effect.

6.Comparison of multiple prediction models for hypertension (Neural network, logistic regression and flexible discriminant analyses)
Mevlüt Türe, İmran Kurt, Ebru Yavuz, Turhan Kürüm
PMID: 15755697  Pages 24 - 28
Objective: In this study, we compared performances of logistic regression analysis (LR), flexible discriminant analysis (EAA) and neural networks (SA) in prediction of primary hypertension. Methods: Predictor variables were family history, lipoprotein A, triglyceride, smoking and body mass index. The data were collected from Cardiology Clinic of Trakya University Medical Faculty in Turkey, 2001. Logistic regression analysis, flexible discriminant analysis and neural networks were used for prediction of control and hypertension groups. Comparison of the performance of all models was done using receiver operating characteristic (ROC) curve analysis. Results: All models had areas under the ROC curve in the range of 0.793-0.984 and SA had sensitivity, specificity, and accuracy greater than 90% at ideal threshold. ROC curve areas of SA and LR, and SA and EAA were statistically different (p<0.001 and p<0.001 respectively), while ROC curve areas of EAA and LR did not differ (p>0.05). Conclusion: We concluded that family history, lipoprotein A, triglyceride, smoking and body mass index variables can be used for prediction of control and hypertension groups with statistically better performance of SA over LR and EAA.

EDITORIAL COMMENT
7.Predictive models and hypertension
Kazım Özdamar
PMID: 15755698  Page 29
Abstract |Full Text PDF

ORIGINAL INVESTIGATION
8.Hemodynamic performance of mechanical aortic valves in narrow aortic annulus cases
Aytül Belgi, Seyhan Çetin, Emre Altekin, Bekir Kalaycı, Selim Yalçınkaya, Mehmet Kabukçu, Oktay Sancaktar, Filiz Ersel Tüzüner
PMID: 15755699  Pages 30 - 33
Objective: Small-sized prosthetic valves used in aortic valve position usually cause a high transvalvular gradient. This situation, especially in people with a high body surface area, causes a patient-prosthetic valve mismatch. In this study, hemodynamic performances of the two new generation, bileaflet, small size mechanical valves were evaluated during rest and stress conditions. Methods: Eighteen patients with implanted 21-mm St. Jude HP (11 cases) and Sorin Bicarbon (7 cases) prosthetic valves in aortic position were evaluated at rest and during dobutamine infusion, 16.3±5.5 months after the operation. Dobutamine infusion was started at a dose of 5 mg/kg/min. The infusion rate was increased every 15 minutes up to 10-20-30 mg/kg/min. Maximum gradient, mean gradient, effective valve area (EVA), effective valve area index (EVAI) and performance index (PI) were calculated during rest and maximum dobutamine infusion rate. Results: When the rest and dobutamine infusion measurements were compared, the maximum and mean gradients were found to be increased moderately, but EVA, EVAI, PI values did not change with increasing heart rates. For St. Jude valve; maximum gradient increased from 30.5±6.5 mmHg to 74.7±33.6 mmHg (p=0.03) and mean gradient increased from 17.9±3.8 to 40.8±23.8 mmHg (p=0.03). For Sorin Bicarbon valve; maximum gradient increased from 31.7±13.3 mmHg to 52.0±11.2 mmHg (p=0.01), mean gradient increased from 16.1±6.4 mmHg to 28.8±1.0 mmHg (p=0.01). The difference was not significant between the two valves with respect to measured parameters during rest and maximum dobutamine infusion. Conclusion: According to our findings, 21-mm Sorin Bicarbon and St. Jude HP mechanical bileaflet valves have good hemodynamic performance during exercise and these types of valves seem to be appropriate for patients with small aortic annulus.

9.Effects of topical applications of aprotinin and tranexamic acid on blood loss after open heart surgery
Alptekin Yasım, Ramazan Aşık, Erhan Atahan
PMID: 15755701  Pages 36 - 40
Objective: We sought to investigate the effects of topical applications of aprotinin and tranexamic acid in preventing postoperative bleeding during open heart surgery. Methods: Thirty patients undergoing open heart surgery with cardiopulmonary bypass were randomized to three different groups. Group 1 ( n = 10 ) received 1000000 KIU aprotinin, Group 2 (n= 10) received 1 gr tranexamic acid and Group 3 ( n = 10) received placebo before closure of the sternotomy. During the first three hours and 24 hours total postoperative blood loss and amount of transfused blood products were recorded. Results: In Group 1, postoperative bleeding rates were 122 ml during first 3 hours, 302 ml during 24 hours and 384 ml total. In Group 2, postoperative bleeding rates were 108 ml during first 3 hours, 305 ml during 24 hours and 393 ml total. In control group, bleeding rates were- 162, 347 and 502 ml, respectively. Needs for transfusion were 4.7 U in the aprotinin group, 5.4 U in the tranexamic acid group and 6.0 U in the control group. Conclusion: Topical application of aprotinin and tranexamic acid reduced postoperative bleeding, but this was not statistically significant. The differences were insignificant for effectiveness between aprotinin and tranexamic acid and for transfusion requirements. Keywords: Open heart surgery, postoperative bleeding, aprotinin, tranexamic acid

REVIEW
10.The effects of obstructive sleep apnea hypopnea syndrome on cardiovascular system
Dursun oğlu, Neşe Dursunoğlu
PMID: 15755702  Pages 41 - 45
Obstructive sleep apnea hypopnea syndrome (OSAHS) is characterized by repetitive upper airway obstruction during sleep and it is commonly seen in the adult population, 4% in the men, 2% in the women. The most common nocturnal symptom is snoring while the most common daytime symptom is excessive daytime sleepiness. The gold standard in the diagnosis is polysomnography. Nasal continuous positive airway pressure is the most efficient therapy in the treatment and prevention of the disease. The OSAHS may cause cardiovascular complications in long-term, including systemic hypertension, pulmonary hypertension, congestive heart failure, arrhythmias, stroke and myocardial infarction. All these complications increase the morbidity and mortality of OSAHS.

11.Cardiovascular manifestations and treatment in Marfan syndrome
Vedat Erentuğ, Adil Polat, Kaan Kırali, Esat Akıncı, Cevat Yakut
PMID: 15755703  Pages 46 - 52
Marfan syndrome is a dominantly inherited connective tissue disease characterized by cardiovascular, skeletal and ocular manifestations which was firstly described by Antoine Marfan in 1896. The underlying disorder is a mutation, which impairs fibrillin synthesis and is associated with the FBN-1 gene on the 15th chromosome. Ghent Nosology is used for diagnosis. The progressive dilatation of the proximal aorta leading to dissection and rupture is the typical feature of the disease. Aortic aneurysm and aortic rupture are the lethal complications of the disorder. Increased life expectancy depends on the control and the prevention of the cardiovascular complications. The most frequent cardiovascular manifestation is the mitral valve involvement. The principal pathologic findings on the mitral valve are annular dilatation, fibromyxomatous changes of the leaflets and chordae, elongation and rupture of chordae and deposition of calcium. Prolapsus occurs in 80% of the cases. Elective surgery with optimal timing is associated with increased survival. In the follow-up of patients after surgery for aortic aneurysm and dissection, serial imaging studies in order to detect a new onset aneurysm or dissection on different sites of the aorta are essential.

MISCELLANEOUS
12.Conditions when coronary angiography should not/is not necessarily be performed
Yılmaz Nişancı
PMID: 15755704  Pages 53 - 55
Abstract |Full Text PDF

CASE REPORT
13.Left circumflex artery to the right bronchial artery coronary artery fistula
Özgür Avşar, İbrahim Demir, Özgür Ekin, Hüseyin Yılmaz
PMID: 15755705  Pages 56 - 58
Abstract |Full Text PDF

14.A combined surgical and endovascular procedure for thoracic aortic aneurysm in a high risk patient
Vural Özcan, Sabit Sarıkaya, Mustafa Zengin, Fürüzan Numan
PMID: 15755706  Pages 59 - 61
Abstract |Full Text PDF

15.A case of less invasive closed mitral commissurotomy with aid of transesophageal echocardiography
Soner Sanioğlu, Onur Sokullu, Ali Tabakan, Fuat Bilgen, Günseli Abay, Oral Hastaoğlu
PMID: 15755707  Pages 62 - 63
Abstract |Full Text PDF

SCIENTIFIC LETTER
16.Peak pulse pressure during exercise and left ventricular hypertrophy in athletes
Erdem Kaşıkçıoğlu, Hüseyin Oflaz, Hülya Akhan, Abidin Kayserilioğlu, Sabahattin Umman
PMID: 15755708  Pages 64 - 65
Abstract |Full Text PDF

17.Coronary artery system in a dog
İlker Alat, Gülnur Erdem, Mehmet Beşir Akpınar
PMID: 15755709  Pages 66 - 67
Abstract |Full Text PDF

LETTER TO THE EDITOR
18.The organ effects of systemic inflammation response activated during open heart surgery and current treatment methods
Birkan Akbulut
PMID: 15755710  Pages 68 - 69
Abstract |Full Text PDF

EDITORIAL COMMENT
19.Hypertrophic cardiomyopathy: the pathological features and the molecular pathogenesis
Vedat Davutoğlu
PMID: 15755711  Pages 70 - 71
Abstract |Full Text PDF

LETTER TO THE EDITOR
20.On cardiology education
Ayhan Olcay
PMID: 15755712  Page 72
Abstract |Full Text PDF

21.Distribution of risk factors according to socioeconomic status in male and female cases with coronary artery disease
Meltem Sömez
PMID: 15755713  Pages 73 - 74
Abstract |Full Text PDF

22.Evaluation of diastolic function by transmitral color M-mode flow propagation velocity in hypertensive patients
Cihangir Kaymaz
PMID: 15755714  Pages 75 - 76
Abstract |Full Text PDF

E-PAGE ORIGINAL IMAGES
23.Surgical treatment of congenital right coronary artery aneurysm and fistula in a patient with previous aortic dissection repair
Ersin Erek, Yusuf Kenan Yalçınbas, Ece Salihoğlu, Tayyar Sarıoğlu
PMID: 15755715  Pages 77 - 78
Abstract |Full Text PDF

24.Giant left main coronary aneurysm with coronary artery ectasia
Ahmet Altınbaş, Gürkan Acar, Süleyman Murat Aslan
PMID: 15755716  Pages 79 - 80
Abstract |Full Text PDF

25.Chest pain, dynamic electrocardiography changes and ventricular arrhythmia in a patient with thoracic disc hernia
Nezihi Barış, Özgür Aslan, Bahri Akdeniz, Özer Badak, Önder Kırımlı, Özhan Göldeli, Sema Güneri
PMID: 15755717  Pages 81 - 82
Abstract |Full Text PDF

26.Pulmonary valve endocarditis
Tekin Yıldırım, Selim Yalçınkaya, Sinan Arslan
PMID: 15755718  Page 83
Abstract |Full Text PDF

27.Chronic dissective aortic aneurysm as a result of cannulation performed 20 years ago
Muzaffer Bahçıvan, Ferşat Kolbakır, Hacı Akar
PMID: 15755719  Page 84
Abstract |Full Text PDF

28.Isolated left ventricular diverticulum in an adult: dynamic contrast-enhanced MRI findings
Cihan Duran, Mecit Kantarcı, Kutlay Karaman
PMID: 15755720  Pages 85 - 86
Abstract |Full Text PDF

29.A rare case of traumatic dissection and rupture of the distal thoracic aorta
Bayer Çınar, Hakkı Aydoğan, Onur Göksel, Şebnem Çetemen, Uğur Filizcan, Ergin Eren
PMID: 15755721  Page 87
Abstract |Full Text PDF

MISCELLANEOUS
30.Relationship between myocardial fibrosis and repolarization abnormalities in patients with systemic right ventricle
Ömer Göktekin
Page 88
Abstract |Full Text PDF



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