This study sought to evaluate the relation of myocardial perfusion abnormalities to increased QT dispersion (QTd) and the relationship between QTd and scintigraphic high-risk parameters providing prognostic information in patients with coronary artery disease (CAD). 1ı2 consecutive patients (52±9 yrs) referred to exercise Tl-20 ı scintigraphy were studied, using reinjection protocol. SPECT images were divided into 20 segments; each segment was classified as normal, reversible defect, viable or nonviable fixed defect. Accordingly, cases were divided into 4 groups as normal subjects (n=45), patients with only reversible defects (n=28), patients with only nonviable fixed defects (n=22) and patients w ith reversible, viable and nonviable defects (n= ı7). Involvement of 5 or more segments, increased lung Tl-201 uptake and transient left ventricular dilatation were considered as scintigraphic high-risk parameters. QTd was defined as the difference between maximal and minimal QT intervals in at least 8 leads of the surface ECG. Mean QTd was 39±9 msec in normal subjects, 62±20 msec in patients with only reversible defects, 65±22 msec in patients with only nonviable fixed defects and 67± ı9 m see in the remaining patients. There was a significant difference between normal subjects and patient groups (p

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Epidemiologic studies have shown that serum iron can be a risk factor for coronary artery disease (CAD). The relation of serum ferritin !eve! and transferrio saturation with CAD was investigatcd in this study. Four-hundred male patients (mean age 56±4) who were hospitalized for coronary angiography in our clinic were included in this study. Paı ients were divided into two groups: control group n=ı 49 (coronary angiography normal), case group n=25ı (CAD prescnt). Transferrio saturat ion was categorized as :5:10% and > 10%. Serum ferri tin !eve! was grouped as <200ng/ml and 2!200ng/ml. A nonsignificant weak negative relation (p=0.5) was idcntified between serum ferrit in level and CAD by multivariate logistic regression analysis. No significanı relation (P=0.4) was noted between serum transferrio saturation and CAD. The results did not gain statistical significance for both transferrio saturation and ferritin !eve! when patients with high LDL-choJesterol !eve! were included in the model. Thus, our results do not support the hypothesis on a relation between serum iron stoı·es and CAD.

This study investigates the significance of dobutamine 99ınTc-tetrofosmin myocardial perfusion SPECT in the detection of coronary artery disease (CAD). Among those referred to the Nuclear medicine department of the Istanbul University , fstanbul Medical Faculty, 26 patients with CAD were incİuded in the study. Dobutamine infusion was init iated ata dose of 5 j.lg/kg/min and gradually increased to 1 O, 20, 30 and to a maximum dose of 40 j.lg/kg/min every 3 minutes. Following cessation of the planned dobuta mine perfusion, 8-1 O m Ci 99ınTc-tetrofosmin w as injected and stres SPECT images were obtained. After 3 hours, resting SPECT images were taken following 14-22 mCi 99mTc-tetrofosmin injection. With doses of and above 10 pg/kg/min dobutamine perfusion, increases in heart rate and systolic blood pressure were found to be statistically significant (p

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Although ST segment depression, during exercise stress test (EST) is the most commonly used electrocardiographic (ECG) criterion for myocardial ischemia, its diagnostic value is limited because of low sensitivity and specificity. It was shown that not only ST depression, but also Q, R and S wave changes occur during EST, but these changes also have limited value in the diagnosis of myocardial ischemia when evaluated individually. However, it was hypothesized that incorporation of these individual changes with exercise, into a composite index (QRS score) might improve sensitivity and specificity. In this study, the diagnostic value of this new exercise index in detecting myocardial ischemia was investigated and its sensitivity and specificity was compared with the conventional ST segment criterion. For this purpose, ı 7 ı patients were enrolled in the study and divided into 3 groups as group 1: normal coronary artery group (n=55), group 2: patients with one-vessel disease (n=73), group 3: patients with multi-vessel disease (n=43). All patients underwent maximal EST with standard Bruce protocol and coronary angiography. Using a cut-off point of ~O as normal, QRS score had a higher sensitivity than ST segment criterion in all patients (79% and 65%, respectively, p<0.005), however, no difference existed in specificity and positive predictive value. In one-vessel disease group (group 2), QRS score had a sensitivity of 77%, whereas conventional ST segment criterion had a sensitivity of 56% (p

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The efficacy and safety of radiofrequency cathcter ablation to eliminate atrioventricular nodal reentrant tachycardia (A VNRT) was evaluated in 53 consecutive patients with typi cal A VNRT. Primarily, slow pathway ablation was performed in 52 patients, and fast pathway ablation in 1 patient. Success was achieved in the patient in whom fast pathway abıa tion was attempted. Slow pathway ablation was successful in 47 patients out of 52 (% 90). In 3 of the remaining 5 patients. fast pathway ablation was attempted after unsuccessful slow pathway ablation. Success was achieved in one of them, atrioventricular (AV) block occurred in one and ablation was unsuccessful in the third one. There was no statistically significant change in the atriaHis interval (79 ± 19.2 msec before and 77.9 ± 13.7 msec after ablation) or effective refractory period of the fast pathway (289.5 ± 51.3 msec before, 271.7 ± 40.6 msec after ablation) after selective ablation of the slow pathway. However AV Wenckebach rate (294± 35.2 msec before, 315.7 ± 78.9 msec after ablation, p=0.05) and AV nodal refractory period (217.6 ± 37.4 msec before, 259.4 ± 52.4 msec after ablation, p=0.003) increased after slow pathway ablation. Retrograde conduction remained intact in 45 of 47 patients after slow pathway ablation, while there was an increase in the maximum ı: ı ventricuıoatrial conduction rate in two patients. Over a mean follow-up period of ıı.2 ± ı 0.5 months, A VNRT recurred in two patients, who were successfully treated in a second sıow pathway ablation session. Conclusion: These data suggest that, radiofrequency catheter ablation, especialıy slow pathway ablation technique, is safe and highly effective for the treatment of A VNRT.

The rate of reperfusion with thrombolytic therapy is higher in patients with acute myocardial infaretion (AMI) and previous angina pectoris than in patients with unheralded AMI. The effectiveness of primary PTCA and thrombolytic therapy have not been compared yet in patients with unheralded AMI. In this multicenter study, we prospectively compared these two strategies in patients with unheralded AMI presenting within 6 hours after the onset of chest pain. Patients with diabetes mellitus were excluded. Seventy-three patients were enrolled and thirty-eight patients underwent direct (primary) PTCA. Time to thrombolytic therapy and PTCA were 2.4± 1. 1 and 3.0±2.2 hours after onset of chest pain, respectively. Two patients in each group died during the hospital period. Baseline characteristics of both groups were not statistically different. Coronary angiography was performed 7±3 days after the infaretion in all patients. In the direct PTCA group, ra te of TIMI III flow (88.9% vs 69.7%; p<0.005) and left venıricular ejection fraction (63±9% vs 54±11% p<0.005) were higher. Rate of reintervention during the hospital period in the thrombolytic group was statistically higher (75.8% vs 16.7%, p

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Necrosis will be the eventual fate of myocardial ischemia which occurs after acute coronary occlusion. As antegrade reperfusion will be time consuming, a retrograde circulation will decreasc the intensity of necrosis and the infarered area will be reduced after the blood flow is rearranged. In our study, we performed retroinfusion of Lcarnıtıne, which activates the pyruvate dehydrogenase enzyme and by this way inercasing the aerobic utilisation of glucose, in our simplified retroperfusion system. There were ten mongrcl dogs, divided equally into carnitine and control groups. After taking the basa! values, the left anterior descending artery was occludcd. At the fiftccnth minute, in the carnitine group, 0.15 ının ol/kg of carnitine retroinfusion was perform ed . Thcn, hemodynamic and biochemical measuremcnts were made till the end of 120 minutes. The control group had no retroinfusion or medical therapy. The occlusion was ended in 60 minutes in both groups. In the carnitine group, there was stat istically significant difference for cardiac output ( 1375±50 ml/dk in control, 1625±75 ml/dk in carnitine group, p<0.05), cardiac index (62.5±2.3 ml/ kg/min in control, 81.25±3.7 ml/kg/min in carnitine group, p<0.05), m ean arteri al press u re (7 1 ±6 mmHg in control, 89±5 mmHg in carnitine, p<0.05). mcan pulmonary artery pressure (33±6 mmHg in control, 25±4 mmHg in carnitine, p<0.05), myocardial oxygen extraction (59±3 % in control, 50±2 % in carnitine, p<0.05) and myocardial lactate extraction ( -0.1 9±0.05 mmol/L in control, -0.09±0.03 mmoi/L in carnitine, p<0.05). Administration of L -carniıinc combined with simplified rctrograde coronary infusion has protective effects oh ischcınic myocardial metabolism and fu rther investigations are needed for the elinical trials.

Type A patients with coronary artery disease (CAD) tend to ignore symptoms or underreport angina during challenging tasks such as the treadmill exercise test. This study sought to evaluate whether type A patients with CAD might be more likely than type B patients to have silent ischemia during exercise and also greater ischemic burden by TI-201 scintigraphy. 112 patients with angiographically defined CAD and a positive treadınili exercise test were studied. All patients underwent exercise TI-201 SPECT imaging and a psychologica1 test (SCL-90) to asses type A personality. Scintigraphic images were divided into 20 segments and the number of redistribution and fixed defects were calculated in each patient. 78 patients were of type A and 34 patients were of type B according to psychological testing. 40 type A patients (51%) and 25 type B (73%) patients report ed typical angina during exercise. Type A patients were more likely to have silent ischemia than type B patients (p<0.05). However, when patients were classified as type A plus symptomatic ischemia, type A plus silent ischemia, type B plus symptomatic ischemia and type B plus silent ischemia into four subgroups, the number of redistribution defects as an indicator of myocardial ischemic burden were 3.64±2.4, 3.42±2.2, 3.28±1.9, 3.46±2.6, respectively. There were no significant differences among them. In conclusion, although type A patients were more likely to have silent ischemia than type B patients during exercise, there was no significant difference with regard to ischemic burden among CAD patients classified according to their personality types and presence of symptoms during exercise.

Aorticopulmonary window (APP) is an uncommon cardiac anomaly in which there is a communication between the ascending aorta and pulmonary trunc. Because of its large left-to-right shunt, it needs early diagnosis and surgical treatment to avoid irreversible pulmonary lesion. In this report, two cases with aorticopulmonary window were presented. One of them, APP type I, could not be operated because of the coexisting Eisenmenger syndrome. The other one having APP type 2 and a ventricular septal defect, underwent surgical correction.

Primary lymphoma of the heart is an extremely rare condition which is usually diagnosed postmortem. We report the case of a 26-year-old man who presented with congestive heart failure and complete heart block. Transthoracic echocardiography demonstrated right atrial mass and increased interventricular and posterior wall thickness. Transesophageal echocardiography and magnetic resonance imaging confirmed the right atrial mass and increased wall thickness. Operative myocardial biopsy revealed high-grade giant cell malignant lmyphoma. S ince further diagnostic studies failed to demonstrate extracardiac lymphoma involvement, diagnosis of primary lymphoma of the heart was considered.

Harvey studied medicine at Caius College, Cambridge and Padoa, Italy. He is famous with his book with detailed description of the movement of heart and circulation: "Exercitatio Anatomica De Motu Cordis Et Sanguinis In Animalibus" (1628). He also has cxperimentally proven that the valves of the veins exist to forward the directian of blood flow towards the heart and toprevent the backward flow, in contrast to the views of his teaeber Girolamo Fabricio. Seven stamps and 4 postal cancellations on Harvey and Fabricio are presented.