1. | Türklerde HDL-kolesterol Düzeyleri, Çevresel Etkenler ve Metabolik Sendrom Kriterleri Altan ONAT, Vedat SANSOY, Hüseyin UYAREL, İbrahim KELEŞ, Gülay HERGENÇPages 273 - 278 Abstract | |
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2. | Doxorubicin-Induced Experimental Cardiotoxicity and Effect of Pentoxphylline on Cardiotoxicity Figen NARİN, Ferunda DEMİR, Hülya AKGÜN, Ali BAYKAN, Kazım ÜZÜM, Sibel KUZUGÜDEN, Esat KÖKLÜ Pages 279 - 287 Doxorubicin, a widely used antineoplastic agent in clinical practice, has a serious side effect, as cardiotoxicity. Due to the risk of life-threatening cardiotoxicity which limits doxorubicin's therapeutic potential, diagnosis and prevention of doxorubicin-induced cardiotoxicity becomes essential. Free radicals, lipid peroxidation and antioxidant enzymes are suggested to be involved mainly in doxorubicin-induced cardiotoxicity pathogenesis. Aim of this study was the investigation of pathogenesis of doxorubicine induced cardiotoxicity and the effect of the pentoxphylline on this subject. The study was designed on three groups: the first group (n=10 young rabbit) who took 6 daily doses of intraperitoneal doxorubicine (cumulative dose 15mg/kg) for 15 days. The second group (n=10 young rabbit) who received pentoxifylline (40 mg/kg/day intraperitoneal) 24 hours before intraperitoneal doxorubicine and continued 7 days after the last dose of doxorubicine. The third group was a control group (n=7). We measured myocardial and plasma glutathione peroxidase (GSH-Px), superoxide dismutase (SOD), and malondialdehyte (MDA) activities and myocardial nitric oxide (NO) activity in our rabbit model. Serum troponin I (Tn I) and creatine kinase MB (CKMB) values were tested for the assessment of cardiotoxicity. Our results suggested that doxorubicin formed severe cardiotoxicity in young rabbits with 15 mg/kg cumulative doses with markedly decreased myocardial GSH-Px (2.4 mU/µg) and increased MDA (0.056nmol/µg) and NO (0.13 µmol-3/µg) values. Pentoxphylline reduced doxorubicin-induced cardiotoxicity by increasing myocardial GSH-Px (5.6 mU/µg), SOD (5.56 U/µg) activities and decreasing myocardial NO (0.08 µmol-3/µg) activities. Although serum Tn I (2.4 ngr/mL in the first group) and CKMB (4123 U/mL in the first group) levels had diagnostic values, any change in plasma GSH-Px, SOD and MDA activities was determined in assessing doxorubicin-induced cardiotoxicity. In conclusion, decreased antioxidant enzyme levels, increased free radicals and lipid peroxidation play major role in the pathogenesis of doxorubicin-induced cardiotoxicity and pentoxphylline is an effective antioxidant in reducing doxorubicin-induced cardiotoxicity. (Türk Kardiyol Dern Arş 2004; 32: 279-287) |
3. | Early Atherosclerosis Following Heart Transplantation: An Intravascular Ultrasonography Study Mehdi ZOGHİ, Sanem NALBANTGİL, Tahir YAĞDI, Deniz NART, Oğuz YAVUZGİL, Azem AKILLI, Mustafa AKIN, Mustafa ÖZBARAN Pages 288 - 294 There are several invasive and noninvasive techniques investigating the development of coronary artey disease following heart transplantation (TxCAD). This study attempts to investigate the extent of vasculopathy in heart transplant recipients by using intravascular ultrasonography (IVUS) compared to coronary angiography and to define the relationship between the rate of cellular rejection and intimal coronary thickness which is measured by IVUS. Our study is the first experience in Turkey. To investigate the extent of TxCAD, 18 heart transplant recipients were studied for 22±12 months after transplantation with intravascular ultrasound (IVUS). Dobutamine stress echocardiography (DES) and coronary angiography were performed in all patients. Coronary angiographically narrowing of more than 50% and intimal wall thickness >0.5mm detected by IVUS were defined as TxCAD. Biopsy score was considered as the average numerical value assigned to each grade of rejection divided by the total number of biopsies. According to the IVUS findings the patients were evaluated in two groups. There were 8 patients with TxCAD in group I, and group II consisted of 10 patients without TxCAD. The TxCAD was shown in 5.5% patients angiographically whereas this rate was 44% by IVUS. The results of DES were normal in all patients. The extent of coronary vessel wall alterations on ultrasound correlated with donor age (r=0.42, p=0.02), but not with perioperative ischemia time and other coronary artery risk factors (p>0.05). The intimal thickening was more pronounced in segments of the LAD than the other arteries (p<0.001). The value of biopsy score (the mean grade of rejection) demonstrated a correlation with the mean intimal thickening (r = 0.82, p = 0.01). Conclusion: 1) The rate of cellular rejection is an important factor for developing TxCAD. 2) IVUS is a more sensitive method for detection of TxCAD than coronary angiography. (Türk Kardiyol Dern Arş 2004; 32: 288-294) |
4. | Angiotensin-Converting Enzyme, Angiotensin II Receptor, Apolipoprotein E and Endothelial Constitutive Nitric Oxide Synthase Gene Polymorphisms in Dilated Cardiomyopathy Hakan ÖZHAN, Mustafa ZUNGUR, Mehmet YAZICI, Ramazan AKDEMİR, Hüseyin GÜNDÜZ, Enver ERBİLEN, Sinan ALBAYRAK, Haşim MUTLU, Cihangir UYAN, İhsan KARA, Güler KAYA Pages 295 - 301 Genetic factors are hypothesized to contribute to the dilated cardiomyopathy (DCM) susceptibility, even in sporadic cases. Abundant reports have investigated the association between various gene polymorphisms and the phenotypic expression of DCM. The aim of the present study is to assess the effect of four candidate gene polymorphisms (1166 A/C polymorphism of the angiotensin II type 1 receptor (AGTR1) gene, I/D polymorphism of angiotensin converting enzyme (ACE) gene, endothelial nitric oxide synthase (ec-NOS) and apolipoprotein E (APOE genes) on the pathogenesis of dilated cardiomyopathy. We studied 76 consecutive patients (mean age 58±12) with DCM and 88 healthy age- and sex-matched control subjects (mean age 59±12). All patients were assessed by 2-dimensional echocardiography and all had left ventricular dilatation (end diastolic diameter >55 mm) and impaired systolic function (ejection fraction <40%). All patients were catheterized. Patients having normal coronary arteries were classified as 'idiopathic' and the remaining group as 'ischemic' DCM. Patients with specific heart muscle disease, isolated right ventricular dilatation and valvular or pericardial disease were excluded. Deoxyribonucleic acid (DNA) was isolated from blood samples, and genotypes were determined by specific polymerase chain reaction (PCR) and separation of amplified fragments by agarose gel electrophoresis. We compared genotypes and allele frequencies, echocardiographic measurements, biochemical variables in our patients and control group. Age, sex, body mass index differences were statistically non-significant. APO E genotypes and allele frequencies were significantly different in patients with DCM. Multiple regression analyses demonstrated lack of independent association. Subgroup analysis revealed that the four candidate gene polymorphisms were not associated with ischemic or idiopathic DCM. Conclusions: No significant association exists between dilated cardiomyopathy and polymorphism of the AGTR1, ACE, ecNOS and APOE gene polymorphisms. (Türk Kardiyol Dern Arş 2004; 32: 295-301) |
5. | Effect of Reperfusion on P-Wave Duration and P-Wave Dispersion in Acute Myocardial Infarction: Primary Angioplasty Versus Thrombolytic Therapy Ramazan AKDEMİR, Hakan ÖZHAN, Hüseyin GÜNDÜZ, Ali TAMER, Mehmet YAZICI, Enver ERBİLEN, Sinan ALBAYRAK, Serkan BULUR, Cihangir UYAN Pages 302 - 308 Atrial fibrillation is a common arrhythmia occurring in about 10-20% of patients with acute myocardial infarction. P-wave dispersion and P-wave duration have been used to evaluate the discontinuous propagation of sinus impulse and the prolongation of atrial conduction time respectively. This study was conducted to compare the effects of reperfusion either by thrombolytic therapy or primary angioplasty on P wave duration and dispersion in patients with acute anterior wall myocardial infarction. We have retrospectively evaluated 72 consecutive patients (24 women, 48 men; aged 58 ±12 years) experiencing a first acute anterior wall myocardial infarction (AMI). Patients were grouped according to the reperfusion therapy received (primary angioplasty (PTCA) versus thrombolytic therapy). Left atrial diameter and left ventricular ejection fraction (LVEF) were determined by echocardiography in all patients. Electrocardiography was recorded from all patients on admission and on pach day of hospitalization. Maximum (P max) and minimum (P min) P wave durations and P wave dispersions (PWd) were calculated before and after treatment. There were no significant differences between the groups regarding age, gender, left ventricular ejection fraction (LVEF), left atrial diameter and volume, cardiovascular risk factors and duration from symptom onset to treatment. PWd and P wave durations were significantly reduced after PTCA (mean P max was 113±11 ms before and 95±17ms after the treatment [p=0.007]. Mean PWd was 46±12 ms before and 29±10 ms after the treatment (p=0.001). Also, P max and PWd were significantly lower in PTCA group (for P max 97±22 ms versus 114±16 ms and for PWd 31±13 ms versus 55±5 ms, respectively). Primary angioplasty reduces P max and P wave dispersion. (Türk Kardiyol Dern Arş 2004; 32: 302-308) |
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6. | Enhanced External Counterpulsation (EECP): Historical Background in the Treatment of Coronary Artery Disease and Its Emerging Role in Chronic Heart Özlem SORAN Pages 309 - 317 An epidemic of heart failure worldwide continues unabated. Recent developments in diagnostic and therapeutic techniques offer initial promise, but additional advances are needed to significantly alter this trend. Enhanced External Counterpulsation (EECP), which increases perfusion in the myocardium and other vascular beds, is known to decrease symptoms, increase functional capacity, and improve quality of life in patients with angina. Currently it is being investigated for the treatment of heart failure and, among potential new therapies, is unique in its noninvasive nature. This paper describes the current status of EECP for the treatment of heart failure and reviews its background in the treatment of coronary artery disease. (Türk Kardiyol Dern Arş 2004; 32: 309-317) |
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7. | Fasciculoventricular Preexcitation - A Case Report Ata KIRILMAZ, Fethi KILIÇASLAN, Eralp ULUSOY, Kürşad ERİNÇ, Ergün DEMİRALP Pages 318 - 321 Fasciculoventricular accessory pathway is a rare preexcitation and connects the His bundle to the adjacent ventricular myocardium. Although its inherent rheological and electrophysiologic properties do not cause any tachycardia, its presence as a bystander during other tachyarrhythmias may be challenging for electrophysiologists in differential diagnosis. We present a patient with an atrioventricular nodal reentrant tachycardia and a bystander fasciculoventricular accessory pathway. The slow pathway was ablated successfully and some diagnostic criteria have been proposed with the review of the related literature. Although the diagnosis of the fasciculoventricular accessory connection is relatively easy and it does not cause any tachycardia, electrophysiologists should be able to recognize the preexcitation. (Türk Kardiyol Dern Arş 2004; 32: 318-321) |
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8. | Single Coronary Artery: A Very Rare Form of Congenital Coronary Artery Anomaly (Report of 2 Cases) Barış ÖKÇÜN, Lütfü ORHAN, Erhan BABALIK Pages 322 - 325 Single coronary artery is defined as a rare congenital anomaly of the coronary arteries that only one coronary artery arises from the aortic root by a single coronary ostium, supplying the entire heart. It should be recognized as potentially dangerous and may present hazards such as sudden death. Also, it should be taken into consideration to avoid probable complications during coronary interventions and surgery and for making correct diagnosis and therapeutic approaches. We aimed to disscuss clinical significance of single coronary artery by presentation of 2 cases that are examples of 2 distinct types of this anomaly. (Türk Kardiyol Dern Arş 2004; 32: 322-325) |
9. | Radiofrequency Catheter Ablation in Members of a Family with Atrioventricular Nodal Reentry Tachycardia Ahmet VURAL, Ayşen AĞAÇDİKEN, Dilek URAL, Güliz KOZDAĞ, Göksel KAHRAMAN, Ertan URAL, Baki KOMSUOĞLU Pages 326 - 330 Paroxysmal supraventricular tachycardia (PSVT) due to familial preexcitation syndromes has been published. Although the most common cause of PSVT is atrioventricular nodal reentry, familial atrioventricular nodal reentry tachycardia has not been reported. In this report, we describe electrophysiological properties and radio-frequency catheter ablation of a family whose four members developed atrioventricular nodal reentry tachycardia. The father, a 74-year-old man, had intermittent episodes of palpitation accompanied by chest pain for years. During exercise stress testing, PSVT with left bundle branch block and presyncope developed. His coronary arteries were normal. An electrophysiological study (EPS) confirmed his clinical tachycardia was atrioventricular nodal reentrant tachycardia (AVNRT). Slow pathway of the nodal reentrant circus was successfully ablated. The son of the family, a 48-year-old man, had a 12-year history of the paroxysmal palpitation despite medical therapy. During his EPS, atrio-His (AH) jump was detected and common AVNRT was induced on the AV nod2 Wenkebach testing. After EPS, slow pathway was successfully ablated. The sister, 50-year old, had episodes of palpitation which suddenly started and ended for 10 years. During the EPS, common AVNRT subsequent AH jump was induced by atrial S1S2S3 stimulations at isoproterenol infusion, and then slow pathway ablation was performed. The other 44-year-old sister, had a 7-year history of paroxysmal palpitation. Common AVNRT had been diagnosed and ablated at another hospital. All patients remained asymptomatic following the successful ablation procedures. (Türk Kardiyol Dern Arş 2004; 32: 326-330) |
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10. | Supravalvular Aortic Stenosis and Coronary Ostial Stenosis in Familial Hypercholesterolemia: Case Report Burcu Demirkan, Yeşim Güray, Serkan Toppaloğlu, Şule Korkmaz Pages 331 - 334 Supravalvular A01·tic Stenosis and Coronary Ostial Stenosis in Familial Hyperclıolesterolemia: Case Report Fanıilial hyperclıolesterolemia is an inherited nıetabolic elisorder caused by a low-density-lipopotein (LDL) receptor abnornıality that results in severe hypercholesterolenıia which /eads to the accun/1/lation of LDL-derived cholestero/ in s kin, tendans and arterial wal/s. In fanıilia/ lıypercho/estero/emia, especially the atheromatous p/aquing on the aortic root is significant and results in supravalvular aortic stenosis and ostial stenosis of the coronary artery. These conıplications are fatal and occur in youth. Tlıey can be prevented by early diagnosis and accurate lipid-lowering treatment. W e present a patie111 with familial hypercholesterolemia at the age of twenty one. He had xanthelasmas, arcus limbus and tendinous xanthomas. In addition to tlıese lesions he also had valvular, supravalvular aortic stenosis and ostia/ coronary artery stenosis . Besides cholesterol towering treatment, he underwent coronary artery bypass surgery and had an aortic valve replacement. |
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