A multicenter study comprising 26 medical units was carried out in Turkey with the purpose of assessing the feasibility and extent of risk reduction in cardiovascular events upon implementation of the Turkish Guidelines on Prevention of Coronary Heart Disease, based on those of NCEP and the European Society of Cardiology (ESC), in patients with coronary heart disease (CHD) or those at high risk for it in the setting of elinical practice. Results obtained in 2021 enrolled volunteers over a total follow-up of 1245 patients-years among whom 970 individuals w ere followed up for 12 months are herein reported. Inclusion criteria postulated a minimum of 20-40% cardiovascular event risk in the subsequent 1 O years as estimated from the risk tab le of the ESC Guidelines. Allowance was made for the presence of symptomatic CHD, family history of premature coronary disease, diabetes, low HDLcholesterol (HDL-C) and high triglyceride levels. The number of individuals involved in primary and secondary prevention as well as of men and women were, by coincidence, virtually identical. Laboratory tests were performed at each center. The estimated CHD risk reduction as evaluated from the risk tables of the ESC Guidelines constituted the primary endpoint, and its determinants were analyzed. In the statistical evaluation, Wilcoxon and Mann-Whitney U tests were used to test the significance of the difference in the distribution of risk categories at baseline and at the end of 12 months. In addition, Framingham risk scores, computed from the data of each individual, served to assess the mean reduction in coronary risk. Mean global risk burden, 25.4% at baseline, diminished in absolute terms by 6.5% at 3 months, by 9.4% at six months and by ı 1.7% at 12 months; the tatter represents a relative risk reduction by 44% which exceeds by half as much the mean relative risk reduction obtained in 5 randomized lipid lowering trials - an achievement that seems plausible by the multilaterality of the preventive measures. The risk reduction was accompanied by a fall in the !eve! of risk factors persisring into the second 6- month period. Independent variables determining the ( enhanced) reduction in risk Jevel at the en d of ı 2 months w ere: 1) (high) level of baseline risk, 2) (high) degree of compliance with the treatment, 3) absence of a) CHD, b) diabetes and c) lipid lowering treatment, 4) younger age, 5) female gender, and 6) presence of smoking or of hypertension, 7) (high) level of baseline HDL-C. At the end of the study, women exhibited a higher reduction in cardiovascular risk than men, and while the reduction in patients with CHD amounted to 10.1% and 43.7% in absolute and relative terms, respectively, a reduction by 13.2% (p <0.001) and 46% (p <0.00 1) was obtained in the setting of primary prevention. The risk reduction was more prominent in smokers than in nonsmokers. Diabetes emerged as a factor modestly limiting the extent of risk reduction. Whereas subjects without hypertension, the most prevalent risk factor in this cohort, revealed a decline of coronary risk by merely 8.7%, those with hypertension showed a decline by 12.7% (p <0.001). No significant difference in global risk reduction was elicited between those not requiring lipid lowering treatment, as compared to persons subjected to such a treatment. These risk reductionsat the end of the study were accompanied by a diminution of mean LDL-C !eve! by 25.4%, a rise in mean HDL-C level by 16%, a fall in mean systolic blood pressure by 26 mmHg. Half of all smokers succeded in discontinuing the habit. In conclusion, by implementing standard prevention guidelines in the Turkish population, among each 1000 individuals comprising equal numbers of highrisk men and women and patients with CHD, prevention of cardiovascular events could be expected in 117 persons in the following ten years.

In patients with rheumatic mitral valve disease presence of thrombus (THR) and spontaneous echo centrast (SEC) in left atrium (LA) and LA appendage (LAA) have been considered to be predictors for embolic events. However impact of morphologic characteristics of LA THR in relation to embolic events has not been investigated. This study aims to evaluate whether morphologic characteristics of LATHR is associated with embolic events, and to assess the grade of LASEC in relation to morphologic characteristics of LA THR in patients with rheumatic mitral valve disease. Study population comprised 474 patients of rheumatic mitral valve disease (F 320, M 154, mean age 40±16) in whom transesophageal echocardiography was performed prior to mitral valve surgery. Pure or predominant mitral stenosis and mitral regurgitation were detected in 333 and 141 of patients, respectively. Rhythm was atrial fibrillation in 267 patients. Embolic event (n=26) was defined as presence of documented sytemic arterial embolism recently, 30 day s prior to transesophageal echocardiography. Thrombus w as detected in lül(LA 13, LAA 62 and LA+LAA 26) and SEC in 212 of patients. Morphology of THR was defined as the ir age (organ i sed vs non organised;54 vs 47), surface characteristics (smooth vs irregular; 69 vs 32), diameter (cm) and thickness of THR measured by transesophageal echocardiography and intraatrial extension score of THR (from 1 to 5). Overall, mean age (p

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The purpose of this study is to evaluate and to compare the subvalvular thickening in patients with rheumatic mitral valve disease by Abaseat seering determined both by transthoracic and transesophageal echocardiography (TTE, TEE). Our study also aimed to investigate the quantitative basis of this semiquantitative scoring corresponding as transmitral gradient, valve area, chordal length, calcification and mitral regurgitation and to compare subvalvular thickening of patients who underwent mitral valve replacement and reconstruction. Study population comprised 364 patients with rheumatic mitral valve disease (F 241, M ı 23, mean age 4ı +22.6 yrs) subjected to preoperative TTE and TEE, 2 ı O and 154 of them underwent mitral va! ve replacement and mitral reconstruction, respectively. Abascal seering of subvalvular thickening of mitral valve and calcification were determined by TTE. Anterelateral and postemmedial chordal length (cm) was measured by TEE. Morphologic assessment for subvalvular thickening, by means of measurement of chordal length was also performed in excised mitral valves. Grade I, II, III and IV subvalvular thickening was detected in 177(48.6%), 107(29.4%), 65(17.8%) and 15 ( 4.1%) of patients by TTE. Mean transmitral gradient and mitral valve area were not found to be different (p>0.05) between grade I and II subvalvular thickening, but were significantly different between grade I and III (p<0.0004 and p=O.OOOI), grade II and III (p=0.02 and p

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The purpose of this study is to investigate and to compare elinical and echocardiographic characteristics and hemodynamic consequences secondary to chordal rupture (CR) associated with rheumatic mitral valve disease (RMVD) and primary mitral valve prolapse (MVP). Study group comprised 224 pts (M 118, F 106, mean age 46.3±15.3) with severe mitral regurgitation associated w ith RMVD(n= 141) and with MVP(n=83) evaluated by transthoracic and transesophageal echocardiography. Chordal rupture was detected in 58 (25.9 %) of the pts, ard CR found to be associated with RMVD in 25 pts (M ll, F 14, mean age 44.3±13) and with MVP in 33 pts (M 26, F 7, m ean age 55.4±1 1.4). Mitralleaflet(s) associated with CR, left atrium diameter, mitral regurgitation jet area, mitral annulus circumference, posteromedial and anterolateral chordal length, infective endocarditis, functional class (NYHA), frequency of acute decompensation, estimated pulmonary artery systolic pressure by Doppler, need to mitral valve surgery in the following 3 months in both groups with CR were compared. Chordal rupture was found to be associated with anterior, posterior and both mitral leaflets in 20 (80%), 4 (16%) and 1 (4%) of pts with RMVD, and in 6 (18.2%), 24 (72.7%) and 3(9%) of pts with MVP, respectively (p<0.05). In pts with CR secondary to MVP, frequency of male gender (p<0.05), mean age (p0.05), functional class (p < 0.05), pulmonary artery systolic pressure (p< 0.05), frequency of acute decompensation (p< 0.05), infective endocarditis (p<0.05) and mitral valve surgery (p<0.05) were found to be lower in group with CR secondary to MVP than in pts with CR due to RMVD. In pts with MVP mean age(p<0.05), frequency of male gender (p<0.05), anterolateral (p<0.05) and postemmedial chordal length (p<0.05) were higher in pts with CR than in patients without. However in pts with rheumatic mitral regurgitation, mean age and gender were not different (p>0.05),but anterolateral (p

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Objective of our study was to find whether the stent length affects the outcomes after coronary stenting. Ninety-five patients with 100 GFX coronary stents who were performed a six-month angiography were individually matched into a short-stent group (SS group, (18 mm, 53 stents in 5 ı patients) and a longstent group (LS group, (18 mm, 47 stents in 44 patients). Study groups were comparable in regard to the most of the possible predictors of adverse outcomes of coronary stenting, except lesion type and stent Jength. Results: Early outcomes in SS and LS group, respectively; acute Q-wave MI was seen in 1 and 2 patients, an operation for CABG was required in 1 patient in both groups, stent thrombosis occurred in 1 and 2 patients (P>0.05 for all). There were no deaths during follow-up. At six month angiography binary restenosis ra te (50%) w as significantly higher in LS group (n=l4, 34%) than in SS group (n=7, 13%, P(0.05). Percent diameter stenosis of the target lesion at six month was significantly different between the groups (23 ± 27 o/o vs 44 ± 28 mm in SS and LS group, respectively, P

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Coronary artery injuries occurred during interventional revascularization procedures may lead to acute occlusion and restenosis. Cytokines and adhesion molecules are major elements for the adhesion of the cells to the vasecular endothelium and regulation w ith the vessel walls. The aim of this study is to determine the alterations in the levels of vascular adhesion molecule (VCAM-1), interleukin- 6 (IL-6), interleukin-2 receptor (IL-2R), fibrinogen and leukocytes following stent implantations. The study consists of 29 patients. Blood samples were taken before the proedure (BP), at the third hour of the procedure (AP-3), and 24th hour (AP-24). Restenosis was determined by coronary angiograph performed at the ı 16±5 days. In the ovarall patient population, we observed a significant increase in the VCAM - I levels at the 24th ho ur. (p

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Pulsed Doppler indexes of diastolic filling have been used as measures of left ventricular diastolic function. However, various hemodynamic factors and Ioading conditions influence the pattem of LV filling. Doppler tissue imaging (DTI) is a new technique for assessment of regional systolic and diastolic left ventricular function. The aim of the present study has been to evaluate whether the diastolic mitral annular velocities by Doppler tissue imaging are affected by changes in preload conditions. Pulsed Doppler transmitral inflow velocities (E, A), diastolic mitral annular velocities at the lateral (LatE, LatA) and septal (SepE, SepA,) side of the mitral annulus by pulsed DTI, and the ratio of peak early to peak atrial filling velocities (E/A, LatE/A, SepE/A) were assessed in 38 subjects (age 56 ± 9 years) with coronary artery disease at baseline and after nitroglycerine administration. All measures were performed at end expiration and averaged over three cardiac cycles. Heart rate increased from 68 ± I O to 77 ± 12 beats/ min (p<0.001). The E, LatE, and Sep E velocities (cm/see) decreased from 68.7 ± 25.6 to 54.2 ± 18.7 (p<0.0001), from 9.2 ± 3.2 to 8.1 ± 2.6 (p<0.001), and from 7.4 ± 2.8 to 6.6 ± 2.6 (p=0.001), respectively. The A, LatA, and SepA velocities were not significantly changed (68.6 ± 21.2 vs. 71.3 ± 21.4; p=0.518, 9.4 ± 2.4 vs. 9.5 ± 2.5; p=0.721 , 8.8 ± 2.0 vs. 8.7 ± 2.0; P=0.521, respectively). The E/A, LatE/ A, and SepE/A decreased from 0.98 ± 0.33 to 0.87 ± 0.36 (p=0.0001), from 1.07 ± 0.59 to 0.92 ± 0.44 (p=0.0002), and from 0.87 ± 4.2 to 0.78 ± 3.2 (p=0.0049), respectively. Conclusions: Alterations in preload significantly altered the pattem of diastolic filling as assessed by DTI of mitral ann u lar velocities in a similar manner to the pulsed Doppler transmitral flow velocity profile.

With the purpose of assessing the progress of the output of medical publications originating from Turkey, the se w ere identified from the Science Citation Index compact disk SCI CD-ROM 1998. A weighted credit system was utilized for items published jointly with a foreign or a nonmedical Turkish institution. A total of 1736 publications were traced which comprised 1078 articles, reviews and editorials. These figures represented increases by 15% and 8.4%, respectively, over the previous year. A rise to 5.5 per mille of Turkey's share of world medical publication output was noted. The number of full-text articles were evaluated with respect to distribution to the fields of medicine, the cities and institutions. Medical basic sciences as a group slightly declined over the preceding year, whereas publications among the surgical branches and in neurosciences rose substantially. The share of institutions in Ankara (45%) and in Istanbul (18.5%) were slowly on decline, whereas that of the sınaller cities in Anatolia (27%) rose as might be expected. A total of 60 full-text articles were published in the field of cardiovascular medicine in 1998, which was estimated to represent a world share of 4.8 per mille.