ISSN 1016-5169 | E-ISSN 1308-4488
Archives of the Turkish Society of Cardiology - Turk Kardiyol Dern Ars: 32 (9)
Volume: 32  Issue: 9 - December 2004
1. 
Yayın Kurulu Olarak TKD Arşivi'ni Devrederken: Makale İşlemleri Artık İnternetten
Altan Onat
Page 595
Abstract |Full Text PDF

2. Strategies for Cardiovascular Prevention Related to a National Cardiac Health Policy
Altan ONAT
Pages 596 - 602
This article reviews the options of prevention strategies for the purpose of developing a rational policy for cardiovascular health in Turkish adults. Individual (high-risk) strategy should be combined with a population strategy, for which estimates of population-attributable risk of 7 major risk factors for our adults were provided, based on the data of the Turkish Adult Risk Factor Study. The targeted population may be narrowed to men aged ?40 and women aged ?45 years. Based on the existence of significant differences in the risk profile of Turkish from Western adults, it would be appropriate to incorporate some adjustments to the national guidelines in adopting from the international guidelines in areas of the metabolic syndrome, abdominal obesity and normal limit of total cholesterol. Governments should be convinced firmly that lending importance and priority to cardiovascular health protection is cost-effective and indispensible, and they should both raise the share of prevention within the health expenditure and develop a related convincing policy. It is also required to conform to criteria of cost-effectiveness in areas of interventional and noninterventional treatment. (Türk Kardiyol Dern Arş 2004; 32: 596-602)

DERLEME
3. Are the Parameters of Inflammation a Measure of Success of Thrombolytic Treatment in Acute Myocardial Infarction?
Mesut DEMİR, Mehmet KANADAŞI, Onur AKPINAR, Mevlüt KOÇ, Mahir AVKAROĞULLARI, Yurdaer DÖNMEZ, Murat ÇAYLI, Cumhur ALHAN, Mustafa DEMİRTAŞ, Ayhan USAL, Mustafa ŞAN, Tamer İnal
Pages 603 - 610
In the present study, we investigated the role of pre-treatment highly sensitive C reactive protein (hsCRP) and serum amyloid A (SAA) levels in predicting the success of thrombolytic treatment in patients with acute ST elevation myocardial infarction STEMI. Forty two patients (4 female and 38 male) between the ages of 28 and 70 (mean age 54.8 ± 9.4 years) treated for STEMI were included in the study. After serum samples were collected for the assessment of CK-MB, troponin T, lipids, hsCRP and SAA levels, the patients were all given thrombolytic treatment. Electrocardiography obtained at presentation and 3 hours later were evaluated. An ST segment resolution 70% and above with respect to the initial ST elevation was accepted as complete resolution, while resolution values of respectively 31-69% and 0-30% were designated as moderate and weak resolution. On their 5th day of hospitalization, a second serum sample was collected from all patients for the determination of hsCRP and SAA values. Their coronary angiography and TIMI flow patterns were also evaluated. There was an inverse relationship between the initial hsCRP and SAA levels on one hand and the ST resolution after thrombolytic treatment on the other, which persisted at the 5th day after presentation. Complete resolution was predicted with a sensitivity of 67% and a specificity of 74% in patients with hsCRP levels below 3.5 mg/dl. Conversely, for patients with hsCRP values above 7.0 mg/dl, poor ST resolution was predicted with a sensitivity of 70% and a specificity of 88%. Serum hsCRP level measured before thrombolytic therapy in patients with AMI with ST elevations is a practical and reliable method in determining the efficacy of thrombolytic treatment. (Türk Kardiyol Dern Arş 2004; 32: 603-610)

4. Assessment of Overall and Coronary Mortality Observed in the Turkish Adult Risk Factor Survey
Altan Onat, İbrahim Sarı, Mustafa Tuncer, Ahmet Karabulut, Mehmet Yazıcı, Serdar Türkmen, Yüksel Doğan, İbrahim Keleş, Vedat Sansoy
Pages 611 - 617
Findings of the Turkish Adult Risk Factor Study pertaining to coronary morbidity and mortality in the past 13.5-year period were assessed. Epidemiological methods applied were as previously described. Total fallawup amounted to 39,540 person-years, during which 410 cases of death were ascertained. Distribution of main ca u ses were coronary hem·t disease (CHD) deathin 39% and cerehrovascular in ll%. Estimated annual all-cause mortality amounted to 10.4 per mil/e, coronary mortality to 4.0 per mil/e. In the age-bracket 45-74 years, total mortality was 15.2 and coronary mortaliıy 6.0 per mille, with an insignificanttrend lawards decline in the fatter half of the period. All-cause mortality was slightly but significantly (p=0.046) tower in urban areas with 9.6 per 1000 person-years, compared to JJ .6 in rural areas. in the /ası survey in 2004, a total of31 cases of new fatal and nonfatal CHD were recorded. When results of the la st two surveys are combined, the annual rat e of new coronary event s were estimated as 11.7 per mi/le among adults aged >33 years. This pointed to a continued ri se of CH D event s in the pa st few years. In conclusion, a high ra te of cardiovascular deaths persisted among Turkish adults, but a diminishing trend of age-standardized coronary mortality was noted among women. Nonetheless, the overall ineidence of new coronary events apparently continued to rise among adults, probably al so secondary to an aging of the population.

5. Assessment of Left Ventricular Diastolic Dysfunction with a New Method: Tissue Doppler Imaging
Murat Çaylı, Ayhan Usal, Mehmet Kanadaşı, Mesut Demir, Onur Akpınar
Pages 618 - 625
Diastofic dysfunction is frequent in patients w ith congestive heart failure and hypertension. lt can be defined as "an abnormafity of ventricufar filfing with low pressw·e !ike with normal cardiac function and compensatory increased atrial pressure". Diastofic dysfunction has 3 eliffereni categories: impaired refaxation, pseudonormafization and restrictive1Jattem. Althouglı a lot of invasive and noninvasive methods coufd be used, cfassicaf pulsed wave Doppler (PWD) method which inciuc/e mitralflow and pufmonary venousflow are the most used nıethods for assessment of diastofic dysfunction. Nonethefess, PWD is affectedfrom prefoad and the re are s ome difficufties distinction about of normal from pseudonormalization. Due to these limitations, the re is necessity of new method for accurate assesment of diasıolic dysfunction. Tissue Doppler lmaging (TDI) is a new method which alfows assessment of systolic and diastolic function of myocardiunı and mitral annufus. Diastolicfunction coufd be easify evaluated with TDI independentfy from prefoad. This method alfows differential diagnosis of diastolic dysfunction from constrictive pericarditis and restrictive cardiomyopathy and af so distinction of normal and pseudonormafization which it coufd be done by using PWD. Therefore, TDJ method recently has been repfaced to traditionaf methods.



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