The Turkish Adult Risk Factor Study was initiated in 1990 on a randoru sample of 3687 adults (20 years of age or over) residing in 59 communities scattered in all regions of Turkey. After a first follow-up in I 995, a second follow-up survey was performed in the Marmara region in I 997 and in the remaining regions in the summer of 1998. This paper reports the findings on the prevalence of coronary and allcause mortality as well as of new coronary events in the last 3 years of follow-up. Data based on the Syear follow-up are also presented. Cardiovascular history and physical examination were obtained, and a 12-lead ECG was recorded at rest. New coronary events were defined to include fatal and nonfatal myocardiaı infarction, newly developed stable angina with or without associated myocardiaı ischemia. Though the last survey involved ı370 men and women, of whom 34 men and ı7 women had died, 8-year cumulative data based on a follow-up of 21160 person-years are deseribed below. Overall annual death rate was 10.2 per 1000 men and 7.1 per ıOOO womenina relatively young cohort the mean age of which moved from 37 to 49 years over the follow-up period. In the age bracket of 45-74 years, overall mortality per 1000 was 20.1 in men and 13.9 in women representing in women- together with those of Ukraine - the highest mortality levels in Europe. Coronary heart disease (CHD) mortality w as found 4.ı per ı 000 men and 3.4 per 1000 women which rose in the age bracket of 45-74 years to 7.6 in men and 6.0 in women. Rates in men correspond to those of the non-Balkanic East European countries while rates in women far exceed even those of Ukraine women. Annual prev~lence of new coronary events which comprise fatal coronary events w as estimated as 8.4 per 1 000 men and 6.2 per I 000 women - ra tes which al so appear high. These observations necessitate much more effective implementation of cardiovascular preventive measures among Turkish adults.

Previous studies regarding the elinical utility of radionuclide myocardial perfusion scintigraphy in the noninvasive detection of coronary artery disease (CAD) and identification of high risk patients with three-vessel CAD have been performed predominantly in men and also with inclusion of patients with abnormal rest ECG that might have biased the results in favor of exercise perfusion imaging. Thus, we studied ıss women with normal baseline ECG who underwent exercise SPECT thallium imaging and coronary angiography. 45 patients had no CAD; 62 had one-vessel disease; 39 had two-vessel disease; and 42 had three-vessel CAD (3V CAD). Sensitivity of SPECT and exercise ECG w as 82% and 52%, respectively (p

Abstract |Full Text PDF

This study sought to evaluate the potential prognostie usefulness of QT dispersion (Qtd) in patients hospitalized with a presumed diagnosis of uns table ang ina. QTd was ealculated at the admission ECG of 62 patients presenting to the emergency department with chest pain at rest. Blood sample w as collected for troponin-T (TnT) measurement and all patients had 25-30 mCi of Tc- 99m sestamibi injeetion. SPECT acquisition was performed within 1-6 hours after the injection. SPECT images were scored using 20 segments on a 5-point seale (O=normal, 4=no uptake) and a segment with a seore ~2 was eonsidered to have a perfusion defect. The cut-off value of ~0.1 ng/ml was used to definc an elevated TnT. All patients had one month follow-up in order to assess cardiac events. Cardiae events oeeurred in 41 patients (no death, 1 ı myocardial infarction, 4 urgent and 26 planned revaseularization dittering follow-up. The mean QTd in patients with eardiae events was signifieantly higher than in those without eardiae events (68±28 vs. 54± 1.14 m s; p=O.O ı ). When patients were divided into subgroups according to the cardiae events, the mean QTd in myoeardial infaretion and in revascularization were 90±25 ms and 60±25 ms, respeetively. QTd in patients with myoeardial infaretion was higher than in patients without eardiae events (p=O.OO 1 ). There w as no s ignifieant differenee in QTd between revaseularization subgroup and patients without eardiac events. ı 9 patients w ith elevated TnT indicaling high risk in unstable angina had greater QTd eompared to patients with normal TnT (74±29 vs. 56±20 ms; p=0.008). Additionally, the mean QTd in 46 patients with perfusion defects was slightly higher than in patients without those (66±27 vs. 53±ı7 ms; p=0.03). There was also a moderate eorrelation between QTd and the number of perfusion defects (r=0.3 ı , p=O.O 1 ). On the other hand, most of the high-risk patients who had myocardial infaretion or urgent revaseularization had QTd greater than the value of 75 ms. In eonclusion, the measurement of QTd in patients w ith unstable angina may be of heıp in the stratifieation of patients at high risk for adverse eardiae vents, in partieular myoeardial infaretion.

In this study, we have determined lipoprotein(a) [Lp(a)] and malondialdehyde (MDA) (a marker of lipid peroxides) levels in patients with eoronary artery disease (CAD) and sought to find an association between CAD and these parameters. The study group was composed of 86 phatients (3 I women, 55 man, mean age 57 ± ıo years) who underwent eoronary angiography. The latter revealed CAD in 62 patients (CAD +) while 24 patients were found to have normal eoronary arteries (CAD-). There were no s ignifieant differenees between the two groups with regard to total eholesterol, triglyceride, HDL-and LDL-eholesterol levels. Lp(a) (37.9 ± 29.5 mg/d! vs 22.3 ± 21.3 mg/di, p=0.008) and MDA (1.58 ± 0.47 mmol/ml vs 1.26 ± 0.38 mmol/ml, p=0.002) levels were signifıeantly higher in patients with CAD. However, we failed to demonstrate a good eorrelation betwecn Lp(a) and MDA levels both in patients with and without CAD (r=0.219, p=0.09). Total e hoıestero ı and MDA levels of patients with diabetes mellitus were significantly higher than those of patients without diabetes (233 ± 47 mg/d! vs 205 ± 55 mg/di, p=0.03; ı .85 ± 0.51 mmol/ml vs ı .37 ± 0.37 mmol/ml, p=0.006; respeetively). Lp(a) levels were also higher in diabetie patients but the difference did not reach signifıcanee. A eorrelation betwecn Lp(a) and· MDA levels did not exist in patients with diabetes (r=0.08, p=0.34). LP(a) levels of diabetic patients with CAD were signifieantly higher than those of diabetie patients with normal coronary arteries (47.9 ± 32.4 mg/di vs 16±3.1 mg/di, p=0.0009). However MDA levels of diabetic patients were not significantly increased in the presence of CAD. Lp(a) and MDA levels were also poorly correlated in diabetic patients with CAD (r=0.02, p=0.29). In conclusion, Lp(a) and MDA levels were shown to be higher in patients with CAD than the patients with normal coronary arteries. Atherogenic characteristics of LP(a) seem to be more important than MDA in diabetic patients with CAD.

QT dispersion may serve as a measure of variability in ventricular repolarization time and may be a means of identifying patients at risk of arrhythmias and sudden death after different elinical settings. The acute responses of QTc dispersion were assessed in 47 American Society of Anesthesiology (ASA) class 1 or 2 patients receiving volatile anaesthetic agenls. Anaesthes ia was induced with sevoflurane (n= l6), halothane (n=17), or isoflurane (n=l4), and the inspired concentration increased to reach an end-tidal concentration of 1% to 6%. Recordings of ECG, heart rate, blood pressures were obtained at the following times: prior to induction of anaesthesia, 1 min and 3 min after stable end-tidal concentration, 1 min and 3 min later vecuronium administration, and 1 min and 3 min after tracheal intubation. Al l the patients studied had normal values of QTc interval and QTc dispersion at rest. All anaesthetic agents significantly increased QTc dispersion compared with baseline values. Both isoflurane and sevoflurane increased QTc interval compared with baseline in contrast to halothane which did not change it s ignificantly. Thus, anaesthetic agents cause myocardial repolarization abnormalities in man in terms of increased QTc dispersion. This may be relevant in the aetiology of arrhythmias in patients receiving anaesthesia without cardiovascular disease.

Low levels of high-density lipoprote in cholesterol (HDL-C) are ın ore coınınon in Turkey than in any other population that has been studied. These low HDL-C levels occur irrespective of regional differences in dietary fat consumption, which s ignificantly alter low-density lipoprote in cholesterol levels. About 50% of Turk ish men and about 25% of Turkish women have undesirably low HDL-C levels of <35 mg/di. Increased hepatic lipase activ ity (25-30% higher levels coın pare d with American controls and presumably of genetic origin) appears to account for the generalized low HDL-C. In association with high Jevels of hepatic lipase, secondary e nvironınen ta l and metabolic factors, such as sın ok ing, physical inactivity, obesity, and diets that raise Lriglyceride levels, could further tower HDL-C. Although ınany Turks have low total cholesterol levels, the very low HDL-C causes the total cholesterol/HDL-C ratio to be dangerously high. Even at a "normal" total cholesterol level of 200 mg/di, an HDL-C !eve! of 35 mg/dl results in a ratio of 5.7. In every country studied, this ratio is clearly associated with a high risk of coronary heart disease. Thus, it is necessary to define what is a normal cholesterol !eve! in the context of low HDLC. Recent data from elinical trials now indicate thal treating patients who have low HDL-C and decreasing their total cholesterol/HDL-C ratio are beneficial in both priınary and secondary prevention of heart disease.

Although the probabil ity of restenosis following successful coronary balloon angioplasty reduced Tiirk Kardiyol Dem Arş 1999:27: 4-7 after stent implantation, it is stili an ongoing problem. The results of some drug trials (coumadine, heparin, low molecular weight heparin, hirudin, aspirin, dipyridamole, t ic lopidine, plate let glycoprotein Ilb/IIIa inhibitors, lovastatin, pravastat in, fluvastatin) are disappointing, and positive studies (probucol, trapidil) were not confirmed by randomized trials. The local application of heparin or urokinase are ine ffective in the decreasing the restenesis rate, but local delivery of enoxaparin prior to stent placement reduced restenosis in ;ı study. Gene therapies were not effective in preventing restenosis in humans. The results of the some methods (balloon angioplasty, rotablation, laser angioplasty) for the treatment of in-stent restenesis is unsatisfactory. In o ne study, stent implantation after coronary atherectomy significantly reduced the restenesis rate. Intracoronary radiation therapy may reduce restenosis. As a result, it may be concluded that none of the above mentioneel methods except stent implantation is seen to be e ffective in preve nting restenosis, but radiation therapy may be promising in the near future.

A 50-year-old feına le patient suffering from an intravenous leiomyoma invading the right atrium was reported. Echocardiographically ılıere was an ellipsoid, smooth-edged mass in the right atrium extending inside the infcrior vena cava (IVC). The tricuspid valve w as normal. During surgery, the intracardiac mass and its extensions to the IVC and the right atrium were partially resected. Because of tight attachments to the vascular wall, extensions in the right renal vein and the second mass inside the distal portion of the IVC could only parıially be excised. Bleeding from the lumbal veins and IVC was serious and she died in the early postope rative period because of hemorrhagic el i a tlı esis and myocardial fai lure. T he excised mass was patho logically reporteel as an intravascular Jeiomyoma.

Noonan syndrome is an autosomal dominant condit ion, which is frequently associated with congenital heart diseases. In one fou rth of these patie nts hype rtrophic cardiomyopathy was recognised. In this report, wc present a newbom with Noonan syndrome who was diagnosed as hypertrophic cardiomyopathy, and wc discuss the diagnosis, differential diagnosis and treatment of this highly mortal association.