Hibernating myocardium that is dysfunctional due to chronic ischemia but still viable show functional improvement after revascularization. In this study, the effect of the collateral circulation to related territory of the totally occluded vessel on myocardial viability was assessed by dobutamine stress echocardiography (DSE) and functional improvement after coronary artery bypass surgery (CABG). Fifty-eight patients with coronary artery disease and left ventricular dysfunction, who had at least one totally occluded coronary artery and planned to have elective CABG were included into the study. The collateral circulation to the totally occluded vessel territory was graded from 0 to 3 according to the Rentrop classification. Before CABG, myocardial viability was evaluated by low dose DSE and left ventricular functions and functional recovery of the hibernating myocardium were assessed three months after CABG via echocardiography. Thirty cases with advanced coronary collateral circulation were compared to the twenty eight cases without collateral circulation. The groups were similar in terms of age, gender, previous myocardial infarction and the number of diseased vessels. The parameters of the cases with and without collateral circulation were as follows. The number of akinetic segments in cases with and without collateral circulation were 141 and 144, respectively (not significant). The number of preoperative DSE (+) segments were 83 (58%) and 56 (41%) in cases with and without collateral circulation (p<0.05), respectively. The preoperative wall motion score index (WMSI) were 1.88 and 1.94, respectively (p<0.05). Preoperatively, left ventricular ejection fraction (EF) were 41.1% and 40.4%, respectively. The number of segments with improvement were 66 and 47 (p < 0.05), the ratio of improvement in the segments were 69% and 68%, respectively. Postoperative WMSI's were 1.43 and 1.63 (p < 0.05) and postoperative EF was 47% and 44,4% (p < 0.05), respectively. In both groups after CABG significant improvement in DSE (+) segments, decrease in WMSI and increase in EF were noted. In cases with advanced collateral circulation myocardial viability assessed by DSE and functional improvement after CABG were significantly increased. Though basal ventricular functions are similar in cases with advanced collateral circulation they have much more viable segments and higher ratios of functional improvement after CABG. These findings underline the beneficial effects of advanced collateral circulation on myocardial viability. (Türk Kardiyol Dern Arş 2004; 32: 335-343)

The evaluation of patient profile and treatment approaches are extremely important in the treatment of hypertension. The primary aim of this study is to define the risk groups of hypertensive patients. The secondary aims are to assess the diagnostic tests that are used in the diagnosis and follow-up, to assess the severity of hypertension, target organ damage, associated clinical conditions and the frequency of microalbuminuria, and also to define the concordance of treatment to the guidelines, clinical approaches, and differences of the approaches according to the characteristics of centers, patients and medical doctors, and to establish vascular damage in cases that advanced diagnostic tests are used. In this study, a total of 11,000 patients from 220 centers; 1,000 patients from 20 tertiary centers and 10,000 patients from other 200 centers will be enrolled in this study. Study has been started in December 2003. More than 10,000 patients were enrolled into the study until now. (Türk Kardiyol Dern Arş 2004; 32: 344-349)

Structural changes in the atria play an important role in the pathogenesis of AF. Chronic inflammatory processes might cause such changes in the atria of patients with valvular heart diseases and facilitate the occurrence of AF. In this study, we tried to find out whether C-Reactive Protein (CRP), a classical marker for inflammation, is associated with a higher incidence of AF in patients with mitral stenosis. A total of 120 patients with mitral stenosis who were admitted to our institution between years 1996 and 2003 were studied, retrospectively. The rhythm at the time of CRP evaluation was noted for each patient. White blood cell count, erythrocyte sedimentation rate (ESR) and CRP values, risk factors for development of AF, electrocardiographic and echocardiographic findings were recorded as well. Fixty-four of 120 patients were in normal sinus rhythm (Group NSR) and 56 had atrial fibrillation (Group AF). Mean ages of the patients in Group AF were higher than Group NSR (53 ± 11 versus 44 ± 12 yrs, p<0.001). Compared with the Group NSR, Group AF included more men (34 women and 22 men in Group AF vs 54 women and 10 men in Group NSR, p=0.003). White blood cell count and ESR were not different between the groups, while serum CRP levels in Group AF were significantly higher than Group NSR (14.3 ± 12.1 versus 8.1 ± 12.7 mg/l, p=0.007). In multivariate logistic regression only advanced age, left atrium diameter and mitral valve area were independent predictors of AF (p < 0.05). Increased serum CRP levels in patients with AF compared to patients with sinus rhythm, appears to be mediated by age and other correlates and CRP does not seem to be on independent risk factor. (Türk Kardiyol Dern Arş 2004; 32: 350-355)

The metabolic syndrome (MS) is a public health problem which is becoming increasingly common worldwide. According to TEKHARF study database, MS was responsible for 53% of patients with established coronary heart disease (CHD) indicating its role es an important public health insure in Turkish adults. We studied prevalance, component distribution of the MS and its relationship with CHD and high-sensitivity C-reactive protein (hsCRP) in patients with unstable angina pectoris. Study population consisted of 100 hospitalized patients with unstable angina pectoris (M 77, F 23; mean age 60.33±9.48 yrs). These patients had not received lipid-lowering therapy before hospitalization. Components of the MS were screened and apoA, apoB and hsCRP levels were measured in all patients. Body mass index was calculated and all patients underwent coronary angiography. The number of coronary arteries with critical stenosis was determined. MS existed in 57% of patients. MS prevalance was 53% in men and 69% in women. Among components of the MS, most frequent three components were low HDL-cholesterol levels (81%), hypertriglyceridemia (63%) and hypertension (53%) in men and abdominal obesity (waist circumference >88 cm) (91%), low HDL-cholesterol levels (82%) and hypertension (65%) in women respectively. Between MS and non-MS groups; one, two, three vessels disease and hsCRP levels were not statistically significant (p>0.05). The geometric mean values of hsCRP increased in relation to the number of diseased coronary arteries. In conclusion, MS existed in a very high prevalence amory patients with unstable angina pectoris. The component distribution of the MS varied somew hat between male and females. Increased levels of hsCRP were measured in patients with unstable angina pectoris, but MS does not contribute to this augmentation. (Türk Kardiyol Dern Arş 2004; 32: 356-363)

The aim of this study was to determine whether there is a significant association between calcification of the aortic valve or thoracic aortic calcified plaques and coronary artery disease (CAD) in patients undergoing coronary angiography. If an association could be established between cardiovascular calcifications and CAD, their presence might be used as a marker of coronary atherosclerosis. The study group consisted of 1100 patients who underwent coronary angiography. The presence of aortic valve calcification was identified by echocardiography. Chest X-rays were used to detect calcification in the thoracic aorta. Of the 1100 patients included in the study, 812 (73.8 percent) had CAD, and 288 (26.2 percent) had normal coronary arteries. Aortic valve calcification was present in 420 (38%) and aortic calcified plaques in 180 (16%) of the entire study population. The patients with aortic valve calcification had a significantly higher prevalence of CAD (88% vs 65%, p<0.0001) and higher rates of multivessel disease (65% vs 55%, p=0.003). Also, the prevalence of CAD (86% vs 71%, p<0.0001) and multivessel disease (66% vs 57%, p=0.035) were significantly higher in patients with aortic calcified plaques compared with the patients without aortic calcified plaques. Logistic regression analysis showed that aortic valve calcification (p=0.003) and aortic calcified plaques (p=0.004) were strongly and significantly associated with CAD after adjusting for coronary risk factors. In addition, patients with aortic valve calcification had a high incidence of aortic calcified plaques (23% vs. 12%, p<0.0001). In conclusion, we found a significant association of CAD with the presence of aortic valve calcification and aortic calcified plaques. Our study further demonstrates that aortic valve calcification is significantly associated with calcified plaques in the thoracic aorta. Therefore, the presence of these calcifications should be regarded as a sign for the presence of CAD. (Türk Kardiyol Dern Arş 2004; 32: 364-370)

Cyclooxygenase-2 (Cox-2) inhibitors are widely used in the elderly population. There have been contradictory studies on the effect of this class of agents on coronary atherothrombotic events. Cox-2 specific inhibitors (rofekoksib, celekoksib, etc.) decrease synthesis of prostaglandin-I2 and therefore predisposes to a prothrombotic state. They seem to have an adverse effect on myocardial preconditioning, as well . These issues have been the main concern about the use of this class of agents. In addition, Cox-2 enzyme has an important role in the inflammatory process which is a triggering factor on atherothrombosis. By contrast, some preliminary reports indicated that antiinflammatory properties of Cox-2 inhibitors might be useful during an acute coronary syndrome. These pros and cons on the use of Cox-2 inhibitors should be clarified with a large randomized prospective study. (Türk Kardiyol Dern Arş 2004; 32: 371-375)

Cardiac resynchronization therapy (CRT) is the correction of disturbed left ventricular (LV) function due to atrioventricular, interventricular and intraventricular conduction delay by cardiac stimulation. The addition of CRT to optimal medical therapy in patients with heart failure improves symptoms, quality of life, functional capacity, and decreases rate of hospitalization and also improves LV function and structure. Furthermore, studies reporting decrease in mortality are present. However, despite appropriate application of guideline criteria, 30% to 50% of patients do not respond to therapy. The precise determination of patients that will respond to CRT is crucial and individual evaluation is required in patient selection. Currently, presence and quantity of intraventricular asynchrony is accepted as the most important predictor of hemodynamic improvement and response to therapy after CRT. Before CRT, LV segments should be mapped by such methods as tissue Doppler imaging and the LV wall that has the longest delay relative to the septum should be determined. If possible, LV electrode should be implanted to this wall. In addition, intraventricular asynchrony was detected in approximately half of the patients with narrow QRS complexes. In future, it is expected that QRS width which was until recently an important criterion in patient selection will not be taken into consideration and the presence and quantity of intraventricular asynchrony will become more important. (Türk Kardiyol Dern Arş 2004; 32: 376-389)

A 38-year-old woman was admitted to our clinic with exercise dyspnea, in whom transthoracic echocardiographic examination was done because of a systolic murmur. Isolated double-orifice mitral valve with a grade 2/4 mitral insufficiency and mild mitral stenosis was found at transthoracic echocardiography. Isolated double-orifice mitral valve is a rare congenital malformation of the mitral subvalvular apparatus. It should be considered during echocardiographic evaluation of mitral stenosis and/or mitral insufficiency. (Türk Kardiyol Dern Arş 2004; 32: 390-392)

A 21-year-old man presented with frequent episodes of palpitations. A 12-lead ECG revealed an incessant ventricular tachycardia (VT) originating from the outflow tract at a rate of 144 bpm. During electrophysiologic study, clinical sustained VT was repeatedly inducible with programmed ventricular stimulation. An S wave in lead I, a precordial R wave transition in lead V1 and the absence of S wave in leads V5 or V6 conducted the origin of VT as left ventricular outflow and supravalvular region. Pace- and activation-mapping and diastolic activity directed the ablation catheter to the Valsalva of the left coronary sinus. With the guidance of coronary angiography, a single radiofrequency application terminated the VT. No early or late complications or recurrence of VT was observed during follow-up. (Türk Kardiyol Dern Arş 2004; 32: 393-396)