Objective: The study investigated whether preinfarction angina influences left ventricular functions assessed by using Tei index, which is an independent predictor for left ventricular dysfunction in acute myocardial infarction. Methods: We studied 96 patients with acute myocardial infarction with ST segment elevation (80 men, 16 women; mean age 57.5±9.9 years) who were assigned into 2 groups: with and without preinfarction angina. All patients were serially evaluated by 2-dimensional and Doppler echocar- diography on the days 1, 6, and 30, and were followed up for 30 days for incidence of complications. Results: We observed that Tei indexes was lower on the days 1, 6 and 30 (0.49±0.20 vs. 0.59±0.20, p=0.003, 0.46±0.20 vs. 0.56±0.20, p=0.001, 0.44±0.20 vs. 0.53±0.10, p=0.01) in patients with preinfarction angina as compared with those without angina. Tei index significantly decreased during follow-up (0.49±0.20, 0.46±0.20, 0.44±0.20; p=0.02) in patients with preinfarction angina, while it did not change significantly in patients without preinfarction angina (p=0.2). Echocardiographically significant improvements were observed in E deceleration time, isovolumic relax- ation time and ejection time in all patients, whereas significant improvements in ejection fraction, wall motion score index and isovolumic con- traction time were observed only in patients with preinfarction angina during follow-up. Mortality, Killip class ≥2, pericarditis, atrial fibrillation, and left ventricular thrombus were lower in patients with preinfarction angina. Conclusion: These data indicated that the patients with preinfarction angina had better preserved systolic left ventricular function and Tei index values. Also, it was observed that preinfarction angina may cause earlier and more prominent myocardial functional recovery and confer protection against complications on short-term after first acute myocardial infarction.

Objective: Muscle fibers overlying the intramyocardial segment of an epicardial coronary artery are termed myocardial bridging. Variable prevalence has been described at autopsy and angiographic series with small and large sample sizes. The aim of the study was to inves- tigate the angiographic prevalence of myocardial bridging in 25982 patients from Turkey. Methods: We performed a retrospective study, evaluated the cases with myocardial bridging among patients undergone selective coro- nary angiography, and searched the angiographic prevalence of myocardial bridging in a very large sample size. We studied also the cor- relation between the severity of the bridging and risk factors for coronary artery disease. Results: Among 25982 patients we found 316 cases of myocardial bridging in a retrospective manner. The total prevalence was 1.22%. Although, 96.52% of patients with myocardial bridging had the lesion in the left anterior descending coronary artery (LAD) as expected, distribution of bridges between mid- and distal segments were almost equal (52.79% and 47.21%, respectively). We sub classified patients in two groups, Group A (<50% of systolic compression) and Group B (≥50% of systolic compression), according to the amount of systolic compression of LAD and studied relationship of risk factors for coronary artery disease between groups. Another subclassifica- tion was also made for patients having myocardial bridging without coronary or valvular heart disease and hypertrophic obstructive car- diomyopathy; Group 1 (<50% of systolic compression) and Group 2 (≥50% of systolic compression). In these patients we studied corre- lation between the severity of the myocardial bridging and risk factors for coronary artery disease. The prevalence of bridges in circum- flex and right coronary arteries individually and in all arteries as combination was also studied. Conclusion: In a very large group of patients from Turkey undergone selective coronary artery angiography, the angiographic prevalence of myocardial bridging was slightly higher than expected. Only diabetes mellitus as a risk factor for coronary artery disease was higher in groups representing <50% of systolic compression (Group A and 1) than in groups representing ≥50% of systolic compression (Group B and 2) but the importance of this result is not known.

Objectives: The aim of this study is to compare lipoprotein (a) [Lp(a)] levels in patients with low and high risk unstable angina pectoris which is defined according to the cardiac troponin-I (Tn-I) levels and to investigate their relation with myocardial damage. Methods: From patients with chest pain; venous blood samples were collected for measuring serum Lp(a) and CRP (C-reactive protein) levels on admission and serum cTn-I levels 12 and 24 hours after admission. Fifty-nine patients with serum cTn-I levels <1.0 ng/ml were assigned as negative unstable angina group and 53 patients with serum cTn-I levels ≥1.0 ng/ml were assigned as positive unstable angi- na groups, respectively. Severity of coronary artery disease was determined by angiography in all patients. Results: Compared with cTn-I negative group, Lp(a) levels were significantly higher in cTn-I positive group (52.9±6.0 mg/dl vs 15.7±2.5 mg/dl, p<0.0001). There was a significant correlation between Lp(a) and cTn-I levels (r=0.870, p=0,0001). We could not establish any cor- relation between Lp(a) levels and Gensini score or between multiple vessel disease and LDL cholesterol levels (p>0.05). Also, there was no significant difference between cTn-I positive and negative groups with respect to Gensini score (p>0.05). Conclusion: Increased Lp(a) levels and significant relation between Lp(a) and cTn-I levels support that Lp(a) can be a risk factor for plaque destabilization and thrombosis rather than severity of coronary artery disease in patients with high risk unstable angina. Further- more, high levels of Lp(a) may be related with myocardial injury in patients with unstable angina.

Objective: In our study we aimed to investigate the effects of paclitaxel-eluting stent on restenosis. Methods: Sixteen porcine were randomly assigned to two groups (n=8 per group): control group animals received conventional stent imp- lantation and study group animals -paclitaxel-eluting stent implantation. Both groups were treated with 300 mg acetylsalicylic acid and 75 mg clopidogrel daily. The degree of neointimal proliferation and effect of drug-eluting stent on restenosis were evaluated 6 weeks af- ter by angiography and intravascular ultrasound (IVUS). Results: Angiographic in-stent restenosis was lower in paclitaxel-eluting stent group (12.50 ± 7.07% versus 41.25 ± 28.50%, p=0.001). The IVUS data demonstrated that paclitaxel group animals had larger minimal lumen area (8.76 ± 1.09 mm2 versus 6.23 ± 3.10 mm2, p=0.028), smaller mean neointimal proliferation area (1.03 ± 0.75 mm2 versus 3.55 ± 2.86 mm2, p=0.01) and mean percent stenosis (10.71 ± 8.10% ver- sus 36.85 ± 30.93%, p=0.01). Conclusion: This study suggests that drug-eluting stents may also have a preventive effect for the in-stent restenosis.

Objective: The aim of this study was to find the association between stroke, acute myocardial infarction (AMI) and assess related risk factors such as diabetes, hypertension and atrial fibrillation. Methods: This is a cohort study with prospective and retrospective outcomes. All patients who were hospitalised in Hamad General Hospital, Hamad Medical Corporation with stroke from January 1999 to December 2003 were included. The diagnostic classification of stroke and associated risk factors were made in accordance with the International Classification of Disease 9th revision. Results: Total 377 stroke patients were treated during the five years period. The average annual incidence of stroke for 5 years was 11.7 per 100,000 population. The incidence of AMI was higher in males than in females (73.5% vs 26.5%). There was a significant difference in stroke patients with AMI in respect of their gender (P<0.001). Conclusion: The present study supports the hypothesis that there is a strong association between stroke, AMI and related risk factors such as diabetes, hypertension and other cardiovascular disease risk factors. Furthermore, present study showed that 60% of stroke patients had AMI and nearly 46.4% of stroke patients had diabetes mellitus.

Objective: To evaluate the incidence of symptomatic patent ductus arteriosus (PDA) in preterm infants, and the results of the intraveno- us indomethacine treatment and surgery. Methods: Among 394 preterm infants (<37 weeks), symptomatic PDA was diagnosed by echocardiography in 51 babies and they were examined retrospectively. All infants were managed conservatively and then IV indomethacine was given to non-responders (n=30). Sur- gical closure was performed in 12 babies. Results: The incidence of symptomatic PDA in preterm infants was 12.9%: median age: 3 days, mean birth weight: 1434±540 g (540-2900g) and mean gestational ages (GA) 30.9±3.3 weeks (23-37 weeks). With indomethacine, ductal closure was achieved in 70% infants. Early clinical improvement was observed in all cases that underwent surgery and most of them had a low birth weight (< 1500 g) and an early gestational age (< 32 weeks). None of them died due to operation. Conclusion: The incidence of symptomatic PDA is high in preterm infants. Treatment with indomethacine improves ductal closure and as- sociated with few reversible adverse effects. In the other hand, early clinical improvement and high success rate was achieved after surgery. If indomethacine fails to achieve ductal closure, decision of surgery must be made immediately.

Objective: In this study, the effect of agmatine was studied on sympathetic neurotransmission in the frog isolated ventricular strips. Methods: Ventricular strips were prepared from the heart of the pitched frog. Each strip was mounted vertically in an organ bath. Musc- le contractions were recorded isometrically by a force displacement transducer and displayed on a polygraph. Results: Concentration-response relationships to noradrenaline were obtained on contractility of frog ventricular strips evoked by elect- rical stimulation. The responses of noradrenaline were re-obtained in presence of agmatine (3X10-4 M). Agmatine was found to be inef- fective on contractile responses of noradrenaline in electrically driven ventricular strips of frog heart. Transient additional stimulations (TAS) induced contractions. The contractions induced by TAS were re-obtained in presence of agmatine, idazoxan + agmatine and yo- himbine + agmatine. Agmatine significantly increased the positive inotropic responses of TAS. The effect of agmatine on contractile res- ponses of TAS was not changed by idazoxan, indicating that imidazoline receptors have not functions in this response. The effect of ag- matine on the contractile responses to TAS was reversed by yohimbine, indicating involvement of α2 adrenoceptors in this response. Ag- matine did not change the contractile responses of ventricular strips to exogenous noradrenaline, indicating that agmatine does not af- fect postjunctional adrenoceptors. Conclusion: These results suggest that agmatine facilitates sympathetic neurotransmission in frog myocardium via an action on prejunc- tional α2 adrenergic receptors located on sympathetic nerve terminals.

Objective: The aim of the study is to find out the efficacy of radiofrequency catheter atrial ablation (RF) simultaneously done with mitral valve replacement (MVR) surgery in patients having rheumatic mitral valve disease with chronic atrial fibrillation and to evaluate the short-term postoperative results. Methods: Seventeen patients underwent MVR surgery and intraoperative RFA were done simultaneously to eight of these patients whe- reas remaining nine of them were assigned to control group. Patients were assessed preoperatively, at time of discharge, and 1th, 6th and 12th months controls. Atrial and ventricular functions were evaluated with echocardiography, serum atrial natriuretic peptide (ANP) levels were investigated and electrocardiograms were recorded in all patients. Results: Demographically there were no significant differences between two groups. Radiofrequency ablation group had longer aortic cross-clamping and cardiopulmonary bypass times. Sinus rhythm was established in seven patients of RF group at postoperative 12th month. However, all patients of this group experienced sinus rhythm at postoperative sixth month whereas 'atrial kick' was detected in five of them. Significantly increased ejection fraction, decreased pulmonary artery pressure and decreased left atrial diameter were ob- served in RF group compared to control group. Serum ANP levels were found to be significantly decreased as compared to preoperative periods in both groups. Conclusion: Although RF ablation has higher costs, this technique is efficient and useful to restore the sinus rhythm and to recover the atrial functions back in patients having rheumatic mitral valve disease.

Heart failure is a leading cause of cardiovascular mortality and morbidity. It has been shown that inflammatory markers may play a role in the pathogenesis of heart failure. Therefore, inflammatory markers and anticytokine therapy in heart failure have become the attractive sub- jects in the literature. There are new studies regarding this issue in the literature. In this article, we reviewed inflammatory markers in heart failure and their prognostic significance based on the literature data.

Psychological factors effect the development and course of coronary heart disease (CHD). Hypothalamic-pituitary-adrenal dysregulation, reduced heart rate variability, diminished baroreflex sensitivity, impaired immune function and altered platelet function are proposed as significant psychophysiologic mechanisms to explain this association. Because psychological factors may influence several different stages of long atherosclerosis period, interventional studies aiming to alter negative psychological factors by behavioral and medical ways, expecting to prevent or improve CHD, have been discussed. Complementary to the traditional treatment, this new treatment strat- egy could be a different perspective and a nice promise for CHD patients.

Low levels of high density lipoprotein cholesterol (HDL-C) are an independent risk factor for coronary heart disease. The Turkish Heart Study revealed very low levels of plasma HDL-C in the Turkish population, a fact confirmed by the Heart Disease and Risk Factors in Tur- kish Adults study. Low HDL-C levels have also been observed in Turks living in the United States, Germany, and the Netherlands. Dietary habits do not explain the low HDL-C levels, which were found in Turkish Heart Study participants from six regions of Turkey with signifi- cant differences in typical diets. Among newborns and pre-pubescent children, plasma HDL-C levels were similar in Turks and western Eu- ropeans. After puberty, however, HDL-C levels declined significantly in Turkish boys and girls. These results suggest a genetic basis for the low HDL-C levels. In fact, hepatic lipase activity modulated by sex hormones was 25-30% higher in the Turkish population than in other populations. Elevated hepatic lipase activity is clearly associated with low plasma HDL-C in many studies. Results of a recent genome-wi- de scan for plasma HDL-C in Turks revealed a linkage on chromosome 15q22 where the hepatic lipase gene is located and that low HDL- C was 80% heritable. In addition, evidence for an interaction between HDL-C levels and modifiable environmental factors, particularly smo- king and obesity, came from the study of cholesterol ester transfer protein TaqIB polymorphism. This polymorphism was associated with plasma HDL-C levels in Turks. Subjects with the B2B2 genotype-both smokers and nonsmokers-had higher plasma HDL-C levels. Interes- tingly, B2B2 subjects were protected from the HDL-C-lowering effect of smoking, whereas B1B1 subjects who smoked had significantly lo- wer HDL-C levels. A similar interaction was observed between TaqIB polymorphism and obesity. In conclusion, low HDL-C levels in Turks were modulated by genetic factors and their interaction with modifiable environmental factors, such as smoking and obesity.

Recent development in our understanding of atrial fibrillation (AF) have focused on the key role of pulmonary vein initiators of multiple wa- velet reentry in the atria. Percutaneous catheter ablation of atrial fibrillation is commonly performed by electrical disconnection of pulmonary vein myocardium from the left atrium. As a result, pulmonary vein foci can no longer drive the atria into fibrillation. At present, the procedure is offered to patients with paroxysmal atrial fibrillation refractory to multiple antiarrhythmic agents. For patients with persistent atrial fibrillation, supplementary linear lesions in the left atrium may be necessary. Success rates (AF elimination) are 90% without drugs in case of paroxysmal atrial fibrillation and 80% for persistent atrial fibrillation. Complications including pulmonary vein ste- nosis are uncommon.