ISSN 1016-5169 | E-ISSN 1308-4488
Archives of the Turkish Society of Cardiology - Turk Kardiyol Dern Ars: 27 (3)
Volume: 27  Issue: 3 - April 1999
1. Summaries of Articles

Pages 132 - 135
Abstract | English Full Text

2. Investigations Blood Pressure Levels in Turkish Adults: 8-year Trends, Rate of Treatment, Relationship to Other Risk Factors and to Coronary Disease
Altan ONAT, Vedat SANSOY, Beytullah YILDIRIM, İbrahim KELEŞ, Ali ÇETİNKAYA, Hüseyin AKSU, Nevzat USLU, Necmettin GÜRBÜZ
Pages 136 - 143
During an 8-year follow-up of the original cohort of the Turkish Adult Risk Factor Study, blood pressure was measured appropriately in 1838 subjects (mean age 48.6 ±14), and trends were studied after stratifying for sex and age groups. In order to assess the overaJI change at constant age, based on the previously obtained age-related pressure curve of Turkish adults, an aJlowance for 8 years of aging in systolic and diastolic pressures by +4.5/+2.2 mmHg in men, and +7.2/+3.4 mmHg in women was made. Overall net mean blood pressure of the sample population rose by 3.2/1.9 mmHg in men over 8 years; and while the systolic measurement revealed no significant difference among women, the diastolic value increased by 1.5 mmHg. Based on 2575 adults comprising the new as well as the original cohort, the prevalence of mild and higher grades of hypertension (~ 140 and/or ~90 mmHg) was 36.3% and 43.1% for men and women, respectively, suggesting the existence of 5 million Turkish men and 6 million women. Thirty-seven % of hypertensive individuals were estimated to be under drug treatment and that hypertension control was achieved only in one-third of them as defined by keeping blood pressures at normal or mildly hypertensive levels. Univariale analysis disclosed the waist circumference to have the strongest correlation between systolic or diastolic pressure among men as well as women (r= 0.29-0.41). Good correlation existed in both genders also between either pressure values and body mass index (r= 0.28-0.36). A significant association was noted between systolic pressure and coronary heart disease in both genders and between the latter and diastolic pressure in men. Multivariate analysis, however, did not reveal systolic and diastolic blood pressure to be significant independent markers of coronary heart disease.

3. A New Electrocardiographic Algorithm to Localize the Accessory Pathway in Patients with Wolff-Parkinson-White Syndrome and Prospective Study of Three Electrocardiographic Algorithms Proposed for the Same Purpose
Alpay SEZER, Kâmil ADALET, Fehmi MERCANOĞLU, Ercüment YILMAZ, Zehra BUĞRA, Kemalettin BÜYÜKÖZTÜRK, Güngör ERTEM
Pages 144 - 155
The aims of this study were to form a new algorithm under the guidance of radiofrequency catheter ablation (RFA) to localize the accessory pathway (AP) in patients w ith the Wolff-Parkinson-White (WPW) syndrome using the surface ECG during sinus rhythm, and to test other algorithms, which have been proposed for the same purpose. Sixty-five patients with WPW syndrome, who had only one atrioventricular AP and mani fest or intermittent preexcitation on the surface ECG were included in the study. The exclusion criteria were inadequate preexcitation (QRS duration $ 100 ın s ) and an ultirnately unsuccessful RFA procedure. The AP was Iocalized to one of the eight predetermined anatoın ical zones around the mitral and tricuspid annuli. The ECGs were analyzed for QRS complex polarity, delta wave polarity and QRS complex amplitude. Cri teria that could distinguish different AP zones were identified. The criteria with highest success were used to form the algorithm. The new algorithm correctly localized the AP in 92% of the patients to one of the seven AP zones. A differentiation between right and left posteroseptal pathways could not be achieved. Three different algorithms proposed by other investigators were tested prospectively with the same ECGs. Although the reported success rates for correct localization of the AP were 87%, 92% and 93%, these algorithms showed lower success rates in our study group (72%, 74% and 62%, respectively). W e concluded that our new ECG algorithm is a useful noninvasive tool to guide the RFA procedure; but a prospective study is needed to verify its high success rate. A drop in the accuracy of our algorithm should be expected in a different group of patients, as we have observed for the other algorithms.

4. Changes in QT Dispersion Magnitude During Respiratory Phases: Role of Maximum Inspiration and Expiration
Ertan YETKİN, Ahmet YANIK, Makbule KUTLU, Mehmet İLERİ, Sengül ÇEHRELİ
Pages 156 - 158
There is stili controversy about the reliability and prognostic value of QT interval dispersion because of inter- and intra-ohserver variability. The present study hypothesizes that QT interval duration and QT interval dispers ion are affected by the respiratory phases in healthy subjects. Sixty healthy volunteers (38 men, 22 women, mean age=25 ± 3 years) f rom the medical staff comprised the study group. Electrocardiograms were recorded by the same technician at a rate of 50 mm/s during normal breathing, maximum inspiration and expiration. QT dispersion was defined as the difference between the maximal and minimal QT interval measurement occurring among any of the 12 leads. Corrected QT (QTc) interval was calculated according to Bazzet's formula. There was no significant difference between QTc max interval during maximum inspiration and expiration compared to that during normal breatlıing (409±22ms vs 4 17±26 ms, p>0.05 and 4ı2± 18ms vs 4 I 7± 26ms, p>0.05 respectively). QTc dispersion during maximum inspiration and maximum expiration were significantly lower than that during normal breatlıing (36±8 ms vs 44± 9 ms, p

5. Aortic Valve Replacement with a Stentless Bioprosthesis: A Report of 21 Cases
Belhhan AKPINAR, Mustafa GÜDEN, Bülent POLAT, Ertan SAĞBAŞ, İlhan SANİSOĞLU, Bingür SÖNMEZ, Cemi DEMİROĞLU
Pages 159 - 162
The ideal substitute for the diseased aortic valve is yet to be found . We documented the effects of the Freestyle stentless valve (Medtronic Tnc . Minneapolis Minn.) on elinical outcome and ı eft ventricular mcchanics. The valve was implanted in 2 ı patients, age ranging from 62 - 88 years (mean 71 ± 3.2) 1 6 were mal e and 5 female. In 14 patients the modified subcoronary technique was used for vaıve implantation and the other 7 patients received a total root replacement. The mean ischemic time was 90 ± ı 3 mi nu tes. There were no in-hospital deaths or major complications. Mean stay in the intensive care w as I .3 day s and m ean hospita ı s tay w as 7±2 day s. At discharge, 2 patients had triviaı aortic insufficiency, and all other patients had perfectly functioning aortic valves. Follow-up period ranged between 4- ı 8 months (mean ı ı months). During th is period, hemodynamic function improved, gradients dropped slightl y (p=ns), and there were no valverelated complications. During the follow-up period, trivial aortic insuffiency seen in two patients at discharge, remained the same. Corsequently, we advocate the use of this tyse of valve in patients requiring biological valves.

6. Prognostic Significance of Maximal Exercise Testing After Uncomplicated Myocardial Infarction
Zerrin YİĞİT, Deniz GÜZELSOY, Vedat SANSOY
Pages 163 - 169
To investigate the prognostic s ignificance of maximal exerc ise tes ting two months after uncomplicated myocardial infaretion (Ml). 506 patients (462 men, 44 women, mean age 5 ı .7±9.4, 246 anterior and 242 inferior Ml) were followed up for one year. The exercise test criteria for ischemia were typical angina pectoris and or ST depression of 1 mm. Exercise time less than 6 minules and exercise-induced systolic blood pressure (SBP) increase Jess than 30 mmHg were other parameters for high risk. Cardiac events (CE) were defined as cardiac death, reinfarction, unstable angina pectoris, a coronary angioplasty or aorto-coronary by-pass surgery. During follow-up 9 patients (1.8 %) died and 92 (18.2 %) had a cardiac event. The positive predictive va1ues of ECG ischemia, exercise duration, and ASBP for death were found to be 2% 4% and 3%, respectively for coronary events, the positive predictive value of ECG ischemia, exercise duration and ~SBP were 27%, 34% and 23%, respectively. The negative predictive values of the same parameters were found to be 99% and 89%, 99% and 87%, and 99% and 87%, respectively. When all of the parameters were considered together, the positive and negative predictive values for death and coronary events were found to be 10% and 81%,99% and 98%, respectively. It is concluded that, after an uncomplicated myocardia1 infarction, patients without ischemia and with a good exercise capacity and systolic blood pressure response to exercise need not undergo routine coronary angiography. Key words: Myocardial infarction, exercise test, prognosisTo investigate the prognostic s ignificance of maximal exerc ise tes ting two months after uncomplicated myocardial infaretion (Ml). 506 patients (462 men, 44 women, mean age 5 ı .7±9.4, 246 anterior and 242 inferior Ml) were followed up for one year. The exercise test criteria for ischemia were typical angina pectoris and or ST depression of 1 mm. Exercise time less than 6 minules and exercise-induced systolic blood pressure (SBP) increase Jess than 30 mmHg were other parameters for high risk. Cardiac events (CE) were defined as cardiac death, reinfarction, unstable angina pectoris, a coronary angioplasty or aorto-coronary by-pass 133 Türk Kardiyol Dem Arş 1999:27: 132-135 surgery. During follow-up 9 patients (1.8 %) died and 92 (18.2 %) had a cardiac event. The positive predictive va1ues of ECG ischemia, exercise duration, and ASBP for death were found to be 2% 4% and 3%, respectively for coronary events, the positive predictive value of ECG ischemia, exercise duration and ~SBP were 27%, 34% and 23%, respectively. The negative predictive values of the same parameters were found to be 99% and 89%, 99% and 87%, and 99% and 87%, respectively. When all of the parameters were considered together, the positive and negative predictive values for death and coronary events were found to be 10% and 81%,99% and 98%, respectively. It is concluded that, after an uncomplicated myocardia1 infarction, patients without ischemia and with a good exercise capacity and systolic blood pressure response to exercise need not undergo routine coronary angiography.

7. Effect of Coronary Angiography on Fasting Plasma Lipid Values
Abdurrahman OĞUZHAN, Tahir DÖNMEZ, Ercan VAROL, Kurtuluş ÖZDEMİR, Adnan ABACI, H. L. KISACIK, Siber GÖKSEL
Pages 170 - 172
The effect of coronary angiography on plasına lipid concentrations were investigated in 196 patients who underwent elective coronary angiography. After a 12-hour fasting period, peripheral venous blood samples were taken on the day of coronary angiography before the initiation of procedure and 24±1 hours after coronary angiography. All patients underwent coronary angiography and ventriculography by the Judkins technique. Heparin at 5000 IV was adıninistrated intraarterially after arterial cannulation and 120±20 cc contrast agent was used during the procedure. Post-angiography levels of plasma total cholesterol [199±3.7 before angiography (BA), 185.4±3.4 after angiography (AA), p

8. Value of Troponin-T in Assessment of Early Prognosis of Unstable Angina
Mehmet EREN, Mehmet AKSOY, Ayşe EMRE, Mustafa POLAT, Metin GÜRSÜRER, Birsen ERSEK
Pages 173 - 178
Patients with unstable angina are at either low or high risk with regard to cardiac death, myocardial infaretion and revascularization procedures. Patients at high risk have poor early prognosis due to syınptomatic or silent myocardial ischeınia in spite of maximal medical therapy. Cardiac troponin-T is a contractile protein norınally absenı in circulation. When present in circulation, it is a specific and sensitive sign for myocyte daınage. This study sought to evaluate whether troponin-T is a deterın i nant of early prognosis in unstable angina. Fourty-five patients of Braunwald class-III unstable angina were included in the study. Troponin-T was ıneasured at admission, and 0.2 ng/mL was taken as the upper limit. Patients were followed up for 3 weeksfor the development of cardiac events defined as cardiac deaıh, myocardial infarction, recurrent angina and revascularization. Cardiac troponin-T w as elevated in 18 of 45 patients ( 40% ). All patients had normal creatine kinase-MB values. In 17 patients with high troponin-T levels (94%), 6 (33%) developed MI, 10 (56%) had recurrent angina and 6 (33%) underwent revascularization. In 27 patients with low troponin-T 1evels, only 4 (15%) had a cardiac event. Patients with high cardiac troponin-T levels were signifıcant1y different from patients with low cardiac troponin-T levels in terrns of cardiac events during a 3-week follow-up (p<0.0001). In conclusion, cardiac troponin T measurement is a reliable, simple, inexpensive and noninvasive test which identifies high-risk patients with unstable angina who require early coronary arteriography.

DERLEME
9. Review Treatment of Ventricular Arrhythmias- New Perspectives
Erdem DİKER
Pages 179 - 187
Prevent ion of sudden death, reduction in total mortality, or at least improvement in symptoms should be the benefits of therapy. Within the last decade, a number of İnıpo rtant multicenter, randomized studies have been conducted, which had dramatic outcome to the arrhythmia management. Some trials have changed our concepts about the benefits of supsression of ventricular ectopy. Some trials with amiodarone have provided some evidence about the wide use of this durg. ICD devices have been extensively evaluated in prospective elinical trials. This review tries to highlight the design and results of soıne of these trials (CAST, ESVEM, GESICA, SWORD, STAT-CHF, CAMIAT, EMIAT, MADIT, CABG-PATCH, AVID, CIDS, CASH). Hence, we will be able to delineate the risks and benefits of arrhythmia therapy more accurately. Key words:

OLGU
10. Case Report Functional and Anatomical Pulmonary Atresia Associated with Ebstein's Anomaly Appearing in the Neonate
Ahmet ÇELEBİ, Gülhis BATMAZ, Gülay AHUNBAY, Mehmet VURAL, Teoman ONAT
Pages 188 - 191
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