Prospective Assessment of Influences of Alcohol Consumption on Risk Parameters, Metabolic Syndrome and Coronary Risk in Turkish Adults We evaluated in a prospective manner the effects of alcohol consumption on coronary heart disease (CHD) risk, overall mortality, metabolic syndrome (MS) and relevant risk variables based on the baseline data of the original cohort of the Turkish Adult Risk Factor Study. Alcohol status was assessed in two ways: a) abstinents and 5 increasing categories of alcohol intake, b) abstinents, moderate and severe alcohol intake brackets. In addition to smoking as a confounding factor, 4 components of the MS, as well as total cholesterol and C-reactive protein were evaluated. Criteria of ascertainment of cause of death and of CHD had been previously published. The 2714 men and women included in 1990 in the study and followed up for a mean of 10.0 (5 to 12) years had a mean age of 41.7 (±15) years. Consumers of alcoholic beverages were limited to 17.9% of adults (32.5% of men and 3.6% of women). Consistency of alcohol consumption data obtained 12 years apart and HDL-cholesterol values obtained 4 years apart showed a good correlation (r = 0.6) with each other. In logistic regression analysis adjusted for age and smoking status, alcohol status -despite failing to attain level of significance- showed a trend towards predicting fatal and nonfatal CHD: raising in men and lowering in women. Alcohol intake was not significantly associated with overall mortality but was an independent predictor of subsequent MS 10 years later, when adjusted for age and smoking status, raising this risk in men (p=0.002), lowering it among women (p=0.05). By linear regression, alcohol status was found to be a determinant, independent of age and smoking status, of plasma HDL-cholesterol concentrations 10 and 12 years later, significantly in men (by 4 mg/dl [2 to 6]), showing only a trend in women. It was also associated with a significantly elevated (5.3 mmHg) systolic and diastolic (by 3.7 mmHg) blood pressure in men, while being associated with a trend to diminution of levels in women. Again, when age and smoking status was controlled for, alcohol status was correlated significantly with waist circumference, systolic and diastolic blood pressures, total cholesterol (and triglycerides at borderline significance) among men, whereas women showed no correlation or a reverse trend. We concluded that alcohol intake raised the risk for MS, abdominal obesity and elevated blood pressure in Turkish men, diminished the risk for MS in women while raising HDL-cholesterol levels in both genders. In contrast to a trend to an inverse association with CHD risk in women, men disclosed a trend towards rising CHD events even with moderate consumption, presumably consequent to their alcohol drinking pattern.

Pulmonary Venous Flow Characteristics in Ostium Secundum Type Atrial Septal Defect The pulmonary venous flow characteristics in ostium secundum atrial septal defect (ASD) have not been previously studied in detail. ASD dramatically alters cardiac hemodynamics during both ventricular systole and diastole. This study investigated the pulmonary venous flow pattern in patients with ostium secundum ASD. Fourteen patients who had a shunt ratio of pulmonary to systemic flow (Qp/Qs) <1.5 (group I), seventeen patients who had shunt ratio Qp/Qs <1.5 (grupII) and fifteen healthy subjects (grup III) were included in the study. The left upper pulmonary venous flow of all subjects was analysed by transesophageal echocardiography. We showed a single continuous antegrade wave extending from the beginning of systole to the onset of atrial contraction in 88% of patients who had a shunt ratio of Qp/Qs >1.5. The pulmonary venous flow was biphasic (systolic and diastolic waves) in only two patients (12%) in group II. The atrial reversal flow wave was significantly lower in group II than in group I (p<0.001) and in group III (p<0.001). In patients who had a shunt ratio <1.5, pulmonary venous flow was biphasic. There was no difference regarding pulmonary venous systolic and diastolic waves between group I and group III. Atrial reversal wave velocity was lower in group I than in group III (p<0.001). Pulmonary venous flow comprises a single continuous antegrade wave and a diminished atrial reversal wave in patients who have a shunt ratio < 1.5, whereas biphasic pulmonary venous flow and diminished atrial reversal wave are present in patients who have a shunt ratio <1.5. Investigating the pulmonary venous flow in patients with atrial septal defect may provide information on the size of the shunt in the atrial septum.

Recent studies have focused upon the significance of ST segment elevation (STE) in lead V1 in acute anterior myocardial infarctions (AAMI). Our study investigated whether STE in V1 is associated with alterations in regional and global left ventricular functions determined by tissue Doppler (TD) imaging mitral annulus corners. Standard echocardiography and TD imaging of four sites of mitral annulus were performed to 47 consecutive patients with AAMI within 36 hours of hospital admission. Correlations between the maximum STE amplitude in V1 and TD velocities were analyzed. The amplitude of STE in V1 significantly correlates with early diastolic TD velocities of septal (r= -0.49), anterior (r= -0.47) and inferior mitral annulus (r= -0.51), early to late diastolic TD velocity ratio of inferior mitral annulus (r= -0.48), and mean early diastolic TD velocity (r= -0.52). A subgroup analysis revealed that patients with STE of 2 mm in V1 (32%) had significantly lower peak systolic and late diastolic TD velocity at septal annulus (5.9 ±1.8 cm/s vs. 6.8 ±1.3 cm/s; p=0.03 and 9.1 ±2.5 cm/s vs. 10.6 ±1.8 cm/s; p=0.02, respectively), early diastolic velocity at lateral mitral annulus (6.1 ±1.7 cm/s vs. 8.1 ±2.6 cm/s; p=0.02), and mean systolic TD velocity (6.2 ±1.2 cm/s vs. 6.8 ±0.9 cm/s; p=0.04). In patients with AAMI, a pronounced STE in V1 is associated with high degree of functional impairment involving both infarct-related and apparently best functioning portions of the left ventricle as determined by TD analysis of different mitral annulus corners.

Since apolipoprotein C-III (apoC-III) has been proposed to indicate coronary risk in healthy subjects, we studied cross-sectionally in a population sample representative of Turkish adults whether serum levels of total apoC-III or its components were independent markers of prevalent coronary heart disease (CHD) or were related to the metabolic syndrome (MS). In 857 unselected participants of the Turkish Adult Risk Factor Survey in 2001, apoC-III and other risk variables were evaluated. CHD was diagnosed on the basis of clinical findings and Minnesota coding of resting ECGs. The sample consisted of middle-aged and elderly adults, 42% of whom had MS identified by criteria of the ATP III. ApoC-III values were measured by turbidimetric immunoassay. Mean concentrations for nonHDL apoC-III in men and women were 6.4 and 6.2 mg/dl, respectively, and for apoC-III in HDL were 6.2 and 6.3 mg/dl, respectively. Both fractions of apoC-III were significantly correlated with lipids, lipoproteins, apo B, anthropometric measures and blood pressures in both sexes. Correlations of both were high with serum triglycerides (rs = around 0.70) and apo B (rp = around 0.37). Total apoC-III as well as both fractions were significantly correlated in women also with C-reactive protein (rs = around 0.20, p<0.001). High (>7.0 mg/dl) as opposed to lower levels of nonHDL apoC-III indicated the presence of hypertriglyceridemic hyperapo B with an age-adjusted OR of 13.8; it indicated the presence of metabolic syndrome with 4.66-fold likelihood. Total apoC-III and nonHDL apoC-III proved to be significantly (p trend <0.05 and 0.002) and strongly associated with prevalent CHD in men even when adjusted for age, LDL- and HDL-cholesterol; namely, the OR across upper and lower quartiles was 3.9 (CI 1.3;11.4), and 8.8-fold (CI 2.6;29.8), respectively. We concluded that total and nonHDL apoC-III are each a determinant in Turkish men and women of the metabolic syndrome and of hypertriglyceridemic hyperapoB. They are also significant markers of prevalent CHD in men independent of LDL- and HDL-cholesterol levels.

Although the correlation between upper limit of vulnerability (ULV) and defibrillation threshold (DFT) has been well described, there has been no uniform DFT testing protocol taking the advantage of ULV after defibrillator (ICD) implantation. This study was designed to test DFT with the least number of fibrillation inductions using the ULV and to describe the most practical set of ICD during DFT following implantation. A total of 13 patients undergoing a new ICD implantation had a DFT induced with scanned T wave shock. The hypothesis that VF could be defibrillated with 5 J higher than the highest T-wave shock needed to induce VF or with 10 J if the T wave shock needed to induce VF was less than 5 J, was tested. The common features of five patients who did not fulfill the hypothesis were that T wave shock needed to induce VF was either under 5 J (4 patients) or high (1 patient). We propose the first T wave and rescue shock set at 10 J and 15 J, respectively. If any of the scanned T wave shocks could not induce VF, then the T wave and the first rescue shock should be set at 5 J and 10 J, respectively. If the induction of VF has been unsuccessful with T wave shock at 5 J, then a high DFT should be expected.

B-type natriuretic peptide (BNP) is a cadiac neurohormone specifically synthesised in and secreted from the ventricles in response to elevations of end-diastolic pressure and volume. It represents a favorable side of neurohormonal activation with its diuretic, natriuretic and vasodilator properties. Concentrations of BNP are increased in chronic heart failure and correlate with the severity and functional capacity of the patient. Measurement of BNP may be useful in distinguishing between cardiac and noncardiac causes of acute dyspnea. It is also suggested as a screening method for left ventricular systolic dysfunction in groups at high risk such as those with coronary heart disease, hypertension, diabetes or other vascular diseases. In patients with congestive heart failure, BNP is an independent predictor of long-term morbidity and mortality. On the other hand, repeated measurements of BNP might be used to evaluate the efficacy of therapy for heart failure. Nesiritide, a recombinant human BNP, may have an important role in the management of heart failure, especially in patients with acute decompensated heart failure. In this article, we reviewed the studies evaluating the diagnostic, prognostic and thearapeutic role of BNP in patients with heart failure.

Lyme disease is a systemic disease, which is caused by a spirochete, called Borrelia burgdeorferi and transmitted by the Ixodes ticks. The disease has three stages; early localized disease (stage 1), early disseminated disease (stage 2) and late or persistent infection (stage 3). Lyme carditis is usually seen in the second stage together with the findings of other systemic involvement, for example neurological complications and musculoskeletal pain. The principal manifestation of cardiac involvement is usually self-limited conduction abnormalities. These conduction abnormalities rarely require permanent pacing. Here, we present a patient with temporary complete atrioventricular block caused by Lyme carditis.