ISSN 2149-2263 | E-ISSN 2149-2271
The Anatolian Journal of Cardiology - Anatol J Cardiol: 9 (1)
Volume: 9  Issue: 1 - February 2009
1.Our Country, Science and AKD in new year
Bilgin Timuralp
PMID: 19196565  Pages 1 - 2
Abstract |Full Text PDF

2.Prevalence of risk factors of ST segment elevation myocardial infarction in Turkish patients living in Central Anatolia
Nazif Aygül, Kurtuluş Özdemir, Adnan Abacı, Meryem Ülkü Aygül, Mehmet Akif Düzenli, Mehmet Akif Vatankulu, Hüseyin Uğur Yazıcı, İbrahim Özdoğru, Ekrem Karakaya
PMID: 19196566  Pages 3 - 8
Objective: There is not enough available data in our country about the prevalence of risk factors for ST-elevation myocardial infarction (STEMI), which has the highest in-hospital mortality rate within subtypes of acute coronary syndromes. Therefore, in this study, we aimed to evaluate the prevalence of risk factors for STEMI in Central Anatolia, one of the regions with high risk for coronary heart disease (CHD). Methods: This cross-sectional observational study included 1210 patients (962 men, 248 women) with the diagnosis of STEMI in 3 tertiary-medical centers in 3 cities in Central-Anatolia (Ankara, Konya, and Kayseri). Demographic characteristics (age, gender) and risk factors known to be traditional risk factors for CHD (history of hypertension (HT), diabetes mellitus (DM), smoking, and family history) were inquired and fasting blood samples within 24 hours from onset of STEMI were taken to analyze lipid levels. Patients were divided into 3 groups based on their ages: Group A - age ≤44 years; Group B - age 45-64 years; and Group C - age≥65 years. Prevalence of risk factors and differences within age-groups and genders were evaluated. Results: The mean age was 58±11 years (range 24-96 years). Although the percentage of female patients increased in relation to increasing age, 80% of the total patients were male. While prevalence of smoking and family history was observed to decrease with aging, there was a statistically significant increase in prevalence of HT and DM (p<0.001). Prevalence of smoking was the highest in young patients and males (p<0.001). Prevalence of HT and DM, on the other hand, was significantly higher in women than in men (p<0.001). Although the number of modifiable risk factors was found to be significantly smaller in men, male patients with STEMI were 8 years younger than females on average. Conclusions: The results of our study, in which modifiable risk factors and especially smoking were found to have a high prevalence in patients with STEMI living in Central Anatolia, suggested that most STEMI cases especially at younger ages might be prevented by the modification of these risk factors.

3.Relation between angiotensin-converting enzyme I/D gene polymorphism and pulse pressure in patients with a first anterior acute myocardial infarction
Önder Öztürk, Ufuk Yetkin
PMID: 19196567  Pages 9 - 14
Objective: Evidence shows that an elevated pulse pressure (PP) may lead to an increased risk of cardiovascular morbidity and mortality. The aim of the present study was to determine the effects of polymorphism of the angiotensin-converting enzyme (ACE) gene on the PP after a first anterior acute myocardial infarction (AMI). Methods: Overall 116 patients with a first anterior AMI were included in this cross-sectional study. DNA was isolated from peripheral leukocytes. The ID status was determined by polymerase chain reaction by a laboratory staff member who was unaware of the clinical details. Based on the polymorphism of the ACE gene, they were classified into 3 groups: Deletion/Deletion (DD) genotype (Group 1, n=45), Insertion/Deletion (ID) genotype (Group 2, n=58), Insertion/Insertion (II) genotype (Group 3, n=13). Blood pressure measurements were performed in all patients within 10 minutes admitted to coronary care unit. The PP was calculated by subtraction of diastolic blood pressure (DBP) from systolic blood pressure (SBP). Echocardiographic examinations were performed using the parasternal longitudinal axis and apical 4-chamber windows in accordance with the recommendations of the American Echocardiography Committee. One-way analysis of variance (ANOVA) and Chi-square analyses were used to compare differences among subjects with different genotypes. Results: There were no significant differences among clinical parameters of patients. Pulse pressure was significantly higher in patients who have ACE DD and ID genotypes than in patients who have ACE II genotype (47±16, 47±14 and 39±12, F=3.4, p<0.05). But SBP, DBP and heart rate were not significantly different among ACE DD, ACE ID and ACE II genotypes. Conclusion: Our results suggested that, ACE Gene I/D polymorphism D allele may affect PP in patients with a first anterior AMI.

4.QT interval and dispersion differences between normal and prehypertensive patients: effects of autonomic and left ventricular functional and structural changes
Mehmet Tolga Doğru, Mahmut Güneri, Emine Tireli, Atila İyisoy, Ömer Şahin, Turgay Çelik
PMID: 19196568  Pages 15 - 22
Objective: We aimed to investigate the effects of autonomic and left ventricular functional and structural changes on QT interval and dispersion differences between normal and prehypertensive patients. Methods: A total of 291 normotensive patients (<140/90 mmHg) (135 males, age range: 16-75 years, mean age: 45±11 years; 156 females, age range: 17-71 years, mean age 38±10 years) were enrolled into this cross-sectional case-controlled study. Patients were categorized into two groups according to their blood pressure (BP) levels as Group 1 - patients with normal BP (<120/80 mmHg) or Group 2 - patients with prehypertensive BP (120-139/80-89 mmHg). We evaluated autonomic states by using heart rate variability measurements. Left ventricular structure and functions were evaluated by using Doppler echocardiography in both normal and prehypertensive BP groups regarding their effect on QT intervals and QT dispersion. Statistical analyses (Student’s t and Mann-Whitney U tests) were used to evaluate the differences in QT intervals and QT dispersion between the BP groups. Results: There were statistically significant differences between the two BP groups with respect to QT intervals and QT dispersion (for QT min, p<0.001, QTc min, p<0.001 and QT dispersion, p<0.001). We also detected that prehypertensive patients had increased sympathetic activity and slightly impaired left ventricular systolic and diastolic function (for low frequency power / high frequency power ratio -p=0.029, left ventricular ejection fraction - p=0.054, and transmitral peak A wave velocity - p<0.001). Conclusion: QT interval and dispersion differences are present in prehypertension. Moreover, these differences are independent of left ventricular mass. Autonomic changes can be effective on these differences between the patient groups.

5.Insulin resistance is related with oxidative stress in systemic lupus erythematosus
Süleyman Serdar Koca, Ilgın Karaca, Mustafa Ferzeyn Yavuzkır, Necati Dağlı, Metin Özgen, Bilal Üstündağ, Ahmet Işık
PMID: 19196569  Pages 23 - 28
Objective: Systemic lupus erythematosus (SLE) patients have increased risk of coronary heart disease (CHD) that cannot be fully explained by the traditional risk factors. Metabolic alterations like oxidative stress and insulin resistance may be additional risk factors to contribute early and accelerated atherosclerosis in SLE. Our aim was to evaluate malondialdehyde (MDA) level, oxidative stress indicator, and homeostasis model assessment of insulin resistance (HOMA-IR), and possible relationship between oxidative stress and insulin resistance, in SLE. Methods: This cross-sectional controlled study included 30 SLE patients (SLE group) and 15 age- and sex-matched healthy controls (HC group). The SLE patients were classified into subgroups based on the disease activity index as active or inactive. Serum MDA, insulin, C-peptide, fasting blood glucose, lipid profile, acute phase reactants, tumor necrosis factor (TNF)-a, interleukin (IL)-6 and HOMA-IR were determined. Statistical analyses were performed using Kruskal-Wallis, Mann-Whitney U and Pearson tests. Results: In the SLE group, TNF-a (7.9 [0.5-57.8] vs. 3.9 [0.3-6.3] pg/ml, p<0.01), IL-6 (9.2 [0.1-33.9] vs. 2.2 [0.1-4.8] pg/ml, p<0.01), MDA (2.3 [0.1-6.7] vs. 0.95 [0.5-2.96] nmol/ml, p<0.01) and C-peptide (1.9 [0.9-3.5] vs. 1.5 [1.1-2.4] ng/ml, p<0.01) levels were higher than in the HC group, while HOMA-IR index (1.7 [0.5-6.5] vs. 1.2 [0.8-2.9], p>0.05) was nonsignificantly higher. In the SLE group, MDA levels were correlated with insulin (r=0.614, p<0.05) and HOMA-IR (r=0.601, p<0.05). Conclusion: In inflammatory diseases, relations between oxidative stress and insulin resistance, each of them triggers or enhances the other one, come to an impasse. In conclusion, this modifiable impasse might be important to prevent the development of atherosclerosis in SLE.

6.The ratio of congenital heart disease and innocent murmur in children in Van city, the Eastern Turkey
Abdurrahman Üner, Murat Doğan, Ali Bay, Caner Çakın, Avni Kaya, Ertan Sal
PMID: 19196570  Pages 29 - 34
Objective: We tried to determine the prevalence of and expose the significance of clinical evaluation of innocent and pathological murmurs due to underlying disorders and to determine the indication of echocardiographic examination in innocent murmurs’ evaluation and the frequency of congenital heart diseases (CHD) in childhood. Methods: This study was performed on 6035 children between 6-15 ages (3306 boys and 2729 girls) who attended six different elementary schools reflecting various economic groups in Van city in the Eastern of Turkey, which is a developing country. Results: We detected murmurs of different intensities in 243 patients (4%). The results showed that 209 children’s (3.5%) murmurs were accepted as innocent. The regurgitation was detected in single or two valves in 27% (56 cases) of cases with innocent murmurs. Additionally no valve insufficiency or regurgitation was determined in children who had innocent murmurs except these 56 cases. Of patients who had murmurs, 27 children (0.4%) had congenital heart disease and 7 (0.1%) had rheumatic heart disease. In patients who had CHD, mitral valve prolapsus and tricuspid valve prolapsus were found in 48% and 37% of the cases, respectively. Conclusion: Congenital heart disease was found in similar frequency with the literature. Innocent murmurs were found lower than in the literature, but higher than in other studies done in our country. Our study showed that, especially valve prolapsus, other CHD and less frequently rheumatic carditis can be seen in children who look like otherwise healthy. We emphasize that all children especially attending primary education, should be examined by a cardiologist even they have no complaints.

7.The cardiac examination and the cardiac murmurs
Semra Çetinkaya
PMID: 19196571  Pages 35 - 36
Abstract |Full Text PDF

8.Investigation of the embolic foci through echocardiographic evaluation in patients undergoing urgent femoral embolectomy
Ufuk Yetkin, Burçin Abud, Orhan Gökalp, Berkan Özpak, Aykut Şahin, Tayfun Göktoğan, Ali Gürbüz
PMID: 19196572  Pages 37 - 40
Objective: The determination of the source of embolism in patients with lower extremity arterial emboli is a major clinical problem. A review of the literature focusing on large patient series showed that the heart is the embolic source in 78% of these patients. The aim of this study was to determine the role of early postoperative echocardiographic investigations in the determination of embolic origin. Methods: This retrospective study group consisted of 57 patients in whom we performed 63 unilateral and bilateral urgent femoral embolectomies. Bilateral urgent femoral embolectomy was performed in 6 of the 57 patients included in the study and unilateral intervention was performed in the rest. Besides the features regarding age and sex, the cardiac rhythms of the patients during their application to our clinic were evaluated. In order to determine the origin of the acute peripheral arterial occlusion, transthoracic echocardiography was performed in all patients in the first 24 hours after the embolectomy. Results: In 6 patients who underwent bilateral femoral embolectomy, distinct heart valve pathologies were determined. As for the 51 patients who underwent urgent unilateral femoral embolectomy, it was determined that 28 (55%) had serious cardiac pathologies. Among these 28 patients, 14 (50%) underwent the required open-heart surgery interventions after the completion of further examinations. It was determined that, in our series, 14 (64%) of the 22 patients with serious mitral valve pathologies had a history of acute joint rheumatism. Conclusion: Regardless of whether the interventions are bilateral or unilateral, we believe that echocardiographic investigation should be performed in all patients during the early postoperative period in order to prevent recurrence by the determination of the thromboemboli source. Thus, accompanying serious intracardiac pathologies can be treated and the development of additional peripheral emboli can be prevented.

9.Aortic valve replacement in isolated severe aortic stenosis with left ventricular dysfunction: long-term survival and ventricular recovery
Murat Bülent Rabus, Kaan Kırali, Nihan Kayalar, Eylem Yayla- Tuncer, Mehmet Erdem Toker, Cevat Yakut
PMID: 19196573  Pages 41 - 46
Objective: The aim of this study was to assess the effects of aortic valve replacement (AVR) on the recovery of left ventricular function and the predictors for long-term survival in patients suffering from isolated severe aortic stenosis (AS) with a significant left ventricular dysfunction (LVD). Methods: This retrospective study was conducted on 46 patients with isolated severe AS and LVD [left ventricular ejection fraction (LVEF) ≤ 40%] who underwent AVR in our clinic between January 1993 and March 2006. Patients with coronary artery disease, with more than moderate aortic regurgitation (>2), with previous valve replacement or repair, and with other valve pathologies were excluded. The mean aortic valve area was 0.7±0.09 cm2. The following fourteen variables were analyzed: etiology, age (≥70 years), sex, preoperative New York Heart Association (NYHA) functional class, chronic obstructive pulmonary disease, hypertension, diabetes, peripheral arterial disease, chronic renal insufficiency, need for concomitant procedures for the ascending aorta, cardiopulmonary bypass time ≥120 min, aortic cross-clamp time ≥90 min, intraaortic balloon pump support and inotropic support. Statistical analysis for comparison of pre- and postoperative changes in clinical and functional variables was performed using Wilcoxon rank test. The predictors of early mortality after AVR were analyzed using logistic regression analysis and late survival was studied using Cox proportional regression and Kaplan Meier survival analyses. Results: Operative mortality was 8.6% with four patients. As the result of univariate logistic regression analysis, preoperative NYHA functional class ≥3 was found to be predictive of early mortality. Patients with NYHA class ≥3 had 12.6 times (OR: 12.6; 95%CI: 1.2-131.3; p=0.035) higher probability of early mortality than those with a lower NYHA class. However, multivariate logistic regression analysis demonstrated no predictor for early mortality. A positive change was observed in the LVEF in 79.3% of survivors and the mean LVEF increased from 34.5%±3.9% to 44.7%±10.4% (p<0.001). There were eight (19%) late deaths. Actuarial survival was 83.1% ± 5.9% at 5 years and 59.6%±10.9% at 10 years. Cox proportional hazards regression analysis demonstrated diabetes mellitus (p=0.031; HR: 6.6; 95% CI: 1.19-36.9) and intraaortic balloon pump use (p<0.001; HR: 10.7; 95% CI: 2.9-39.7) as significant predictors for late mortality. Conclusion: Left ventricular ejection fraction and symptoms improve after AVR in patients with isolated severe AS and LVD with an acceptable operative mortality and satisfactory long-term survival.

10.Mid-segment harvesting of right internal thoracic artery decreases sternal ischemia
Kaan Kaya, Doğan Kahraman, Raif Cavolli, Ozan Emiroğlu, Sadık Eryılmaz, Refik Tasoz, Ümit Özyurda
PMID: 19196574  Pages 47 - 53
Objective: We aimed to preserve sternal vascularity better by harvesting only midsegment of the right internal thoracic artery (RITA) than using conventional bilateral internal thoracic artery (BITA) harvesting method, and we evaluated the sternal vascularity with single photon emission computed tomography (SPECT). Methods: In this prospective clinical randomized investigation, 135 patients undergoing coronary artery bypass surgery (CABG) were divided into three groups: Full-RITA group who had a full length of both ITA as a graft for CABG (n=45); mid-RITA group - a midsegment of RITA and left internal thoracic artery (LITA) (n=45); and non-RITA group who had only LITA (n=45). Before and after surgery, all patients underwent a bone scan with single photon emission computed tomography (SPECT) to evaluate the sternal vascular activity. Comparisons of variables were performed by Chi-square, ANOVA, Tukey HSD and paired t test as appropriate. The Bonferroni correction was applied for multiple comparisons. Results: Postoperative early scans (6.9±0.9 days) showed a reduction of blood flow in the both sides of the sternum compared with the preoperative scans (p<0.001). In full-RITA group, there was no significant difference between left and right hemi-sternum (0.56±0.04 and 0.55±0.02 respectively). However, in mid-RITA and non-RITA groups, right hemi-sternum showed significantly better vascularity than left hemi-sternum in the early postoperative period (p<0.001). Three patients (6.6%) with diabetes mellitus in full-RITA group had sternal infection; one of them was deep sternal infection with dehiscence. In mid-RITA group, there was only two patients who had superficial infection (4.4%) and in non-RITA group there was no infection (p=0.234). Conclusion: Mid-RITA harvesting technique can be preferred to preserve sternal vascularity better than conventional technique. By improving new techniques and methods, more acceptable sternal complications could be achieved than full-RITA technique.

11.Epidural anesthesia versus general anesthesia in patients undergoing minimally invasive direct coronary artery bypass surgery
Murat Kurtoğlu, Şanser Ateş, Beyhan Bakkaloğlu, Selmin Beşbaş, İbrahim Duvan, Hatice Akdaş, Tayfun Aybek, Haldun Karagöz
PMID: 19196575  Pages 54 - 58
Objective: Minimally invasive direct coronary artery bypass (MIDCAB) surgery in the awake patient with epidural anesthesia had been previously reported. However, there is no prospective randomized study comparing MIDCAB surgery with epidural anesthesia versus general anesthesia. Methods: The study was conducted as a prospective and randomized study. Between January 2002 and May 2003, 76 patients were randomly assigned into either MIDCAB under general anesthesia (GA Group) or MIDCAB under epidural anesthesia (EA Group). The EA Group patients did not receive concomitant general anesthesia and they were conscious throughout the procedure. All patients had a left internal thoracic artery to left anterior descending coronary artery bypass using the same MIDCAB techniques. There were 42 patients in the GA Group and 34 patients in the EA Group. For statistical analysis, unpaired t-test for independent samples was used for comparison of continuous variables, and Pearson Chi-Square test was used for comparison of discrete variables. Results: The demographic characteristics of the groups were similar. There was no mortality or major morbidity in both groups. The EA Group patients had lower arterial oxygen saturations (93.3±3.2% versus 97.4±1.3%, p<0.001) and higher partial carbon dioxide pressures (45.8±3.6 mmHg versus 41.5±2.5 mmHg, p<0.001), but these were not clinically significant. The EA Group patients had significantly less intensive care unit (ICU) (5.5±6.5 hours versus 18.2±4.8 hours, p<0.001) and hospital stay periods (31.4±20.7 hours versus 58.6±17.9 hours, p<0.001), as well as significantly less postoperative pain (visual analog score 1.06±.6 versus 2.3±.6, p<0.001) and blood loss (184.2±169 ml versus 371.7±315.3 ml, p<0.001). There was no any difference in regard to patient satisfaction after the procedure between the two groups. Long -term results were equally satisfactory in both groups. Conclusions: It can be concluded that, similar surgical results can be achieved by MIDCAB surgery with general or epidural anesthesia. Although epidural anesthesia has no impact on the degree of patient satisfaction after the procedure, it yields significantly shorter ICU and hospital stay periods, which may result in more efficient use of hospital resources.

12.Kounis syndrome: first series in Turkish patients
Murat Biteker, Nilüfer Ekşi Duran, Funda Biteker, Hasret Ayyıldız Civan, Sabahattin Gündüz, Tayyar Gökdeniz, Hasan Kaya, Mehmet Özkan
PMID: 19196576  Pages 59 - 60
Abstract |Full Text PDF

13.Vasovagal syncope in monozygotic twins
Erdinç Arıkan, Murat Yeşil, Zeynep Apali, Nursen Postacı, Serdar Bayata
PMID: 19196577  Pages 61 - 62
Abstract |Full Text PDF

14.Ventricular septal diverticule and ventricular septal defect after penetrating cardiac trauma
F. Ayşenur Paç, Deniz N. Çağdaş
PMID: 19196578  Pages 62 - 63
Abstract |Full Text PDF

15.Necklace fistula for complicated dialysis access patients
Mustafa Şırlak, Sadık Eryılmaz, Mehmet Çakıcı, Bahadır İnan, Bülent Kaya, Ümit Özyurda
PMID: 19196579  Pages 64 - 65
Abstract |Full Text PDF

16.Arrhythmogenic right ventricular dysplasia /cardiomyopathy with coronary artery fistula: an uncommon occurrence
Hasan Kocatürk, Ednan Bayram, Mehmet Cengiz Çolak
PMID: 19196580  Pages 66 - 67
Abstract |Full Text PDF

17.Hyperthyroidism as a rare cause of complete AV block
Can Yoldaş Karakaş, Caner Topaloğlu, Elif Canbolant, Ergun Seyfeli, Ferit Akgül
PMID: 19196581  Pages 67 - 68
Abstract |Full Text PDF

18.A case of acute rheumatic fever presenting with syncope due to complete atrioventricular block
Nilüfer Ekşi Duran, Kenan Sönmez, Murat Biteker, Mehmet Özkan
PMID: 19196582  Pages 68 - 69
Abstract |Full Text PDF

19.Coronary artery anomalies in patients with syndrome X
Çağdaş Akgüllü, Yusuf Yılmaz, Enver Yücel, Aysel Aydın Kaderli, Ethem Kumbay, Ali Aydınlar
PMID: 19196584  Page 69
Abstract |Full Text PDF

20.Effects of metoprolol and diltiazem on plasma homocysteine levels in patients with isolated coronary artery ectasia
Mehmet Demir, Mehmet Özaydın, Ercan Varol, Abdullah Doğan, Ahmet Altınbaş
PMID: 19196583  Pages 69 - 70
Abstract |Full Text PDF

21.A case with Wolf-Parkinson-White syndrome first presented with a devastating event: aborted sudden cardiac death
Zülal Ülger, Bülent Karapınar, Bedir Akyol, Mehmet Tayyip Arslan, Ertürk Levent, Arif Ruhi Özyürek
PMID: 19196585  Pages 70 - 71
Abstract |Full Text PDF

22.Ruptured abdominal aortic aneurysms: a five-year experience
Ömer Tetik, Ufuk Yetkin, Gökhan İlhan, Kazım Ergüneş, Serdar Bayrak, Tevfik Güneş, Ali Gürbüz
PMID: 19196586  Pages 71 - 72
Abstract |Full Text PDF

23.Valve sparing ascending and transverse aorta aneurysm repair with mild hypothermia in Takayasu arteritis
Şanser Ateş, İbrahim Duvan, Murat Kurtoğlu, Beyhan Bakkaloğlu, Selmin Beşbaş, Tayfun Aybek
PMID: 19196587  Page 73
Abstract |Full Text PDF

24.The longest documented left main coronary artery
Ersan Tatlı, Meryem Aktoz, Ahmet Barutçu
PMID: 19196561  Page E1
Abstract |Full Text PDF

25.Development of atherosclerosis and in-stent restenosis in an unusual case of dual left anterior descending coronary artery
Ayşe Saatci Yaşar, Emine Bilen, Mehmet Bilge, Hatice Tolunay, Göktürk İpek
PMID: 19196560  Page E1
Abstract |Full Text PDF

26.Demonstration of double aortic arch with multislice computed tomography
Hatice Nursun Özcan, Fırat Özcan, Deniz Adıgüzel, Selim Ardıç
PMID: 19196563  Page E2
Abstract |Full Text PDF

27.Spontaneous dissection of the left main coronary artery regressed with thrombolytic therapy: evaluation with multislice computed tomography angiography
Tansu Karaahmet, Kürşat Tigen, Emre Gürel, Cihan Çevik, Bülent Mutlu, Yelda Başaran
PMID: 19196562  Pages E2 - E3
Abstract |Full Text PDF

28.Giant aneurysmal dilation of a native pericardial patch used for reconstruction of the right ventricular outflow tract
Ali Gürbüz, Banu Lafçı, Ufuk Yetkin, Timur Meşe, Vedide Tavlı
PMID: 19196564  Pages E3 - E4
Abstract |Full Text PDF

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