Objective: Epidemiological studies demonstrate that the high-density lipoprotein (HDL) cholesterol levels in Turkish people are lower compared to other populations. In the present study, the HDL cholesterol levels in subjects with or without angiographically documented coronary artery disease (CAD) were compared to assess whether HDL cholesterol levels were as low as expected. Methods: A total of 420 consecutive patients with age of ≥40 years (160 female, 260 male) undergoing coronary angiography were included in the study. Patients receiving fibric acid derivatives or niacin were excluded. Coronary artery disease group consisted of those patients with any atherosclerotic lesions in coronary angiography, and non-CAD group consisted of patients with no such lesions. Results: Average HDL cholesterol levels were 45.0±10.5 mg/dl (44.4±10.9 mg/dl in men, 46.5±9.6 mg/dl in women) in CAD group, and 47.7±9.0 mg/dl (45.5±8.4 mg/dl in men, 48.9±9.2 mg/dl in women) in non-CAD group (p<0.05). Conclusion: Compared to non-CAD patients, patients with CAD had lower HDL cholesterol levels, but in general HDL cholesterol levels were not as low as to be expected from epidemiological studies.

Objective: Serum lipoprotein(a) [Lp(a)] concentrations, determined in 665 persons in the 2003/04 survey of the Turkish Adult Risk Factor Study, were investigated in regard to distribution, determinants and relationship to cardiovascular risk factors, metabolic syndrome (MS) and coronary heart disease (CHD). Methods: Diagnosis of MS was based on Adult Treatment Panel III criteria, that of CHD on the presence of clinical findings and Minnesota coding of resting electrocardiograms. Metabolic syndrome was observed in 44%, CHD in 14% of the study sample. Behring nephelometry was used for Lp(a) values measurements which were log-transformed for analyses because of skewing. Results: Geometric mean values of Lp(a) in 286 men and 379 women, aged 55.5 ±12.0 years, were 9.46 ±2.90 mg/dL and 10.46 ±3.00 mg/dL (p>0.2), respectively. Apart from a slight correlation with age, Lp(a) exhibited significant positive correlations with apolipoproteins A-I and B, low density lipoprotein-cholesterol (LDL-C) (r =0.15), total cholesterol, high density lipoprotein-cholesterol (HDL-C), systolic blood pressure and log C-reactive protein, and inverse ones with thyroid stimulating hormone (r =-0.25) in men, and log gamma glutamyltransferase in women. Further 10 variables were not significantly correlated in either gender. In linear regression analyses for independent covariates of Lp(a), positive associations were noted with serum total cholesterol and systolic blood pressure, and inverse ones with waist circumference, triglycerides and (only in women) with gamma glutamyltransferase. Logistic regression analyses revealed in men no association with either MS or CHD likelihood. Among women, age-adjusted Lp(a) was associated inversely at a borderline significance with MS, as did levels of Lp(a) >30 mg/dl vs. the remaining sample, controlled for age and MS, display an odds ratio (OR) of 1.62 for prevalent CHD (p=0.20). An OR of 1.92 (p<0.19). was noted in all adults for the coexistence of Lp(a) >30 mg/dl and LDL-C >150 mg/dl, after controlling for age, MS, smoking status and LDL-C categories. Conclusion: Lipoprotein(a), the variance of which is known to be overwhelmingly due to the apo(a) isoforms, proved to have a significant inverse independent association with a measure of abdominal obesity. Lipoprotein(a) levels appeared not to be associated with risk for MS or CHD among men. In women, however, high Lp(a) levels were accompanied with an environment less prone to MS, and – without attaining significance - tended to be associated with CHD likelihood, independent of age and MS. Further studies are warranted in this area.

Objective: Low threshold characteristics and mechanical stability are important features of an ideal pacing lead, especially for children. We report our experience and medium-term results with a steroid-eluting, active-fixation ventricular lead in children. Methods: Telectronics Accufix II DEC model 033-212 ventricular leads were implanted in 21 patients. Eighteen patients (11 male / 7 female; 10.6 ± 4.0 years), who were followed for a mean period of 6.47 ± 1.13 years were included in the study. Results: Pacemaker mode was DDDR in three patients, and VVIR in the remaining 15 patients. Mean threshold value was 0.5 volts at implant, which increased to 0.7 volts in the first month (p>0.05). It remained stable (0.62-0.78 V) until 5.5 years (p>0.05), increased significantly at 5.5 years (0.99 ± 0.63 V at 5.5 years, p<0.05) and remained significantly high after this time (p<0.05). Pacing lead impedance did not differ significantly throughout the study (p>0.05). Thirteen pulse generators reached end-of-life at ≥ 4 years. In all the patients whose generators were replaced (11 patients), the leads were kept in place. Conclusion: Steroid-eluting active-fixation ventricular leads have long service lives and low chronic stimulation threshold values, allowing lower outputs. These features may have advantages in pacing therapy of children

Objective: Metabolic syndrome (MS) is a condition, which is recognized as raising the risk of cardiovascular disease. The aim of our study is to estimate the left ventricular functions by atrioventricular plane displacement (AVPD), myocardial performance index (MPI) and conventional methods in patients with MS who were diagnosed according to NCEP (ATP III) criteria. Methods: Fifty-three female patients with MS (mean age 53.1±6.9 years) and 30 healthy female subjects (mean age 52.8±6.3 years, p>0.05) underwent complete echocardiographic assessment. All of the subjects had no heart and pulmonary diseases. The systolic mitral AVPD was recorded at 4 sites (septal, lateral, anterior, and posterior) by M-mode echocardiography and left ventricle ejection fraction (LVEF) was calculated from the AVPD-mean (EF-AVPD). The LVEF was also established by biplane Simpson’s (EF-2D) and Teichholz’s methods (EF-T). Left ventricular MPI was calculated as (isovolumic contraction time + isovolumic relaxation time) / aortic ejection time by Doppler echocardiography. Results: Patients with MS showed mild left ventricular diastolic dysfunction (DD) in comparison to healthy subjects. The EF-2D and EF-T in patients with MS and healthy subjects were not different significantly and were within normal limits. Patients with MS showed LV global dysfunctions compared to healthy subjects (MPI: 0.56±0.12 and 0.46±0.11 respectively, p<0.01). Both the septal, anterior, lateral and posterior part of the atrioventricular plane values and also AVPD-mean during systole were statistically lower in patients with MS (12.85±1.76 mm) as compared with controls (14.65±2.19 mm, p<0.05). EF-AVPD in patients with MS was statistically lower (65.58 ±11.95%) as compared with healthy subjects (74.45±11.07 %, p<0.01). Conclusion: Female patients with MS had both left ventricular DD and a global dysfunction with an increased MPI. The EF-2D and EF-T were not different significantly between patients and controls, but patients with MS had a relatively reduced EF-AVPD. The AVPD method may indicate a systolic dysfunction with a relatively lower AVPD-mean and relatively lower EF-AVPD. The presence of global dysfunction in patients with MS may lead to heart failure

Objective: P-wave dispersion (Pd), defined as the difference between the maximum and the minimum P-wave duration (Pmin), and maximum P-wave duration (Pmax) are electrocardiographic (ECG) markers that have been used to evaluate the discontinuous propagation of sinus impulses and the prolongation of atrial conduction time, respectively. The incidence of cardiac arrhythmias, particularly atrial fibrillation (AF), following acute alcohol intake has been previously reported. Prolonged P-wave duration and Pd have been reported to represent an increased risk for AF. However, the association between Pd and acute alcohol intake has not been studied previously in normal subjects. Methods: In a randomized crossover study, 10 healthy male volunteers, aged 30.0 ± 2.1 years (range 25-33) received either ethanol and/or placebo (juice). Alcohol group drank moderate dose ethanol; 0.97 ± 0.12 g/kg body weight (range 0.80-1.25 g/kg), and the other group consumed same amount of juice in one-hour period. After 48-hours washout period, alcohol group took juice and juice group drank alcohol. Pmax, Pmin and Pd were measured as milliseconds (ms) on baseline ECG, after alcohol period (AP) and after juice period (JP). Results: In comparison with baseline, Pmax values were significantly prolonged after AP but not after JP (baseline: 95.3 ± 5.3 ms, after AP: 103.7 ± 9.5 ms, after JP: 94 ± 7 ms, p=0.027, p=0.102, respectively). Pmin values did not change significantly. And also, in comparison with baseline, Pd values were significantly prolonged after AP but not after JP (baseline: 27.0 ± 7.6 ms, after AP: 42.7 ± 12.8 ms, after JP: 27.0 ± 6.7 ms, p=0.021, p=0.891, respectively). Conclusion: Acute moderate dose of alcohol intake in short time is associated with an increase in Pmax and Pd

Objective: Life-threatening arrhythmias and sudden death remain to be serious late complications after correction of tetralogy of Fallot. The aim of this study was to detect ventricular arrhythmia incidence and to find out the relationship between ventricular arrhythmia and the transannular and infundibular patch repair techniques to correct tetralogy of Fallot. That is still unpredictable exactly. Methods: Thirty-nine patients with mean age of 12.1+3.1 years were studied prospectively for 7.1+2.1 years after operation. They were all investigated with electrocardiography, echocardiography, treadmill and Holter monitorization. Right ventricular functions, exercise capacity and arrhythmia patterns were assessed. Lown criteria were used for grading the arrhythmia patterns. QRS duration, QT dispersion and QT dispersion indexes were calculated. Results: Follow up time was 5 to 13 years in both groups. All QT dispersion times and indexes were within normal ranges and there were no differences between two groups. Holter and treadmill studies did not reveal during any ventricular arrhythmia risk in the study and control groups. Conclusion: Seven years of follow-up after correction of tetralogy of Fallot revealed that transannular patch reconstruction is not a cause of tendency for ventricular arrhythmia according to Lown criteria, QT dispersion, QT dispersion indexes and QRS duration do support the results of previous studies.

Objective: Acute rheumatic fever can follow throat infections with group A streptococci. Certain serotypes of group A streptococci such as M1, M3, M5, M6, M14, M18, M19, M24 are associated with this disorder. Immunity to streptococci and to rheumatic fever depends on antibodies to the M proteins. Due to current scarcity of M-typing sera, many laboratories use T typing and opacity factor production for serotype identification of group A streptococci. In order to, investigate the most common serotypes of group A streptococci in our country in recent years we studied T-agglutination typing and opacity factor of 120 group A streptococci strains isolated from throat cultures of 930 children. Methods: Diffuse, stable suspensions of group A streptococci were tested with polyvalent antisera (T,U,W,X,Y) by slide agglutination. Microplate method was used for opacity factor detection. Results: T-protein -agglutination patterns U ( 2,4,6,28 ) were the most common among typeable strains. The rate of T-protein -agglutination patterns T ( 1,3,13, B3264 ) and X ( 8,14,25,Imp.19 ) were 20 % and 18 % respectively. Opacity factor production rate of isolated group A streptococci strains was 65 %. Conclusion: To profit global assessment of rheumatic fever and rheumatic heart disease, more epidemiologic and serotyping research is required in our country.

Natriuretic peptide type B (brain natriuretic peptide, BNP) is a neurohormone released by cardiac ventricles in response to volume and pressure load. Recent studies have demonstrated that BNP level measured in the plasma plays an important role in cardiovascular diseases especially in the diagnosis and treatment of heart failure and acute coronary syndrome. This article summarizes the physiology of the brain natriuretic peptide, diagnosis of heart failure and acute coronary syndrome and use of BNP in the treatment and determining the prognosis of cardiovascular diseases.

Heart rate (HR) compensation of electrocardiographic (ECG) parameters is not an unique concept. However, in the detection of coronary artery disease (CAD) ST-segment plotted as a function HR has been studied extensively during the last 20 years. In clinical practice quantitative methods are evolved for the exercise phase of the exercise test and post-exercise recovery phase has not been studied as extensively. Quantitative parameters, as ST/HR hysteresis, which represents the average difference in ST depressions between the exercise and recovery phases at an identical HR up to three minutes of recovery, has been shown to improve the detection of CAD. Furthermore, the ST/HR parameters have been demonstrated to be very competent in a prediction of mortality.