Objectives: Little information exists concerning the role of natriuretic peptides in the prognosis of hypertrophic cardiomyopathy (HCM). In this study, we evaluated the value of N-terminal pro-brain natriuretic peptide (Nt-proBNP) in predicting clinical prognoses of patients with HCM. Study design: On a prospective design, 61 consecutive patients (36 males, 25 females; mean age 47 years; range 13-74 years) were monitored following a diagnosis of HCM upon detection of hypertrophy of the left ventricle (at least 15 mm in thickness) by transthoracic echocardiography. Peripheral blood samples were obtained to determine Nt-proBNP levels. Functional capacity was classified according to the NYHA (New York Heart Association) system. The patients were monitored for adverse clinical events defined as cardiovascular death, syncope, or worsening of heart failure symptoms for a mean of 416 days (range 150-570 days). Independent prognostic factors of adverse clinical events were determined with the use of the univariate and stepwise multivariate Cox proportional hazard regression analysis. A receiver operating characteristic (ROC) curve was used to validate the predictive performance of log Nt-proBNP for adverse clinical events. Results: Adverse clinical events developed in 11 patients (18%). Mortality occurred in one patient. In the multivariate analysis, log Nt-proBNP was found to be the only predictor of adverse clinical events (p=0.002, %95 CI). With an area of ROC curve being 0.9, the best value of log Nt-proBNP with the highest sensitivity (87%) and specificity (88%) was 7.3, equivalent to a level of 1500 pg/ml. The Kaplan-Meier analysis showed a significantly higher event-free survival in patients having a Nt-proBNP level of less than 1500 pg/ml. Conclusion: Plasma levels of Nt-proBNP seem to be a reliable and practical parameter that can be used in predicting the clinical course of patients with HCM.

Objectives: Although short-term results of renal angioplasty with stent placement are well-established in the treatment of renovascular hypertension, its long-term effects remain controversial. In this study, we aimed to evaluate the long-term effects of stent therapy on blood pressure control in renal artery stenosis. Study design: The study included 26 patients (17 males, 9 females; mean age 59 years; range 43 to 75 years) who had renovascular hypertension and ostial-proximal arteriosclerotic renal artery stenosis above 70%. Twenty-five patients had unilateral stenosis. The mean stenosis rate, stent diameter, length, and follow-up period were 83.2±5.9 percent, 7.11±0.3 mm, 15.36±2.2 mm, and 2.8 years, respectively. Results: The procedure was fully successful with no major adverse events. Three patients (11.5%) died during the follow-up period. Although the mean systolic and diastolic pressures significantly decreased at 24 hours after stenting, no significant differences were noted between the values measured at 24 hours and those obtained in the following period (p>0.05). Blood pressure was controlled by 81% within nine months, and by 69% throughout the follow-up period, during which medicaments were discontinued in six (23.1%), were reduced in 12 (46.2%), remained unchanged in four patients (15.4%), and were increased in one patient (3.9%). The mean creatinine level showed an insignificant decrease (p>0.05). Two patients developed restenosis (7.7%) which was treated with by balloon angioplasty. Conclusion: Our findings suggest that the beneficial effect of stent placement on blood pressure is not confined to the short-term in renal artery stenosis.

Objectives: We retrospectively investigated the prevalence of coronary artery disease (CAD), distribution of lesions, and associated risk factors in patients who underwent coronary angiography during treatment of chronic renal failure (CRF). Study design: A total of 112 chronic hemodialysis patients (33 women, 79 men; mean age 55.7 years) were examined by coronary angiography for angina or angina-like symptoms, ischemic findings, or for further evaluation before renal transplantation. Angiographically, significant CAD was defined as the detection of narrowing (50% or more) in at least one coronary artery. Results: Coronary artery disease was detected in 80 patients (71.4%). Patients with CAD exhibited significant differences with regard to age (p=0.002), male gender and the presence of angina (p=0.03), triglyceride level (p=0.02), and diabetes mellitus (p=0.04). Isolated stenosis of the left main coronary artery was detected in one patient (1.3%); 17 (21.3%), 20 (25%), and 42 patients (52.5%) had one-, two-, and three-vessel disease, respectively. The left main coronary artery was involved in four patients (5%), the left anterior descending artery in 70 (87.5%), the circumflex artery in 56 (70%), and the right coronary artery in 57 (71.3%) patients. Though not significant, systolic and diastolic dysfunction of the left ventricle was more common in CAD patients, whereas two groups had a similar left ventricular ejection fraction (p>0.05). Multivariate logistic regression analysis showed that age (p=0.01) and male gender (p=0.02) were independent predictors for CAD. Treatment consisted of monitoring in 21 (26.3%), percutaneous coronary intervention in 15 (18.8%), and coronary artery bypass surgery in 44 (55%) patients. Conclusion: The occurrence of CAD is frequent in patients with CRF, with the lesions showing diffuse involvement. Treatment should not be delayed especially in the presence of risk factors.

Objectives: We determined coronary risk factors in a homogeneous population of young, healthy Turkish men having regular exercise and the same diet, and compared our results with those reported in the cohort study of TEKHARF. Study design: A total of 1,173 young men (mean age 21.4± 1.5 years) attending a military school were examined. All the subjects were living under similar conditions including diet (4000-4500 kcal/day) and exercise (at least 1 hour daily). Venous blood samples were collected after a 12-hour fasting. Arterial blood pressures, waist and hip circumferences were measured. Current smokers were divided into three groups (<10, 11 to 20, and >20 cigarettes daily). The results were evaluated according to the seven geographical regions of Turkey, from which the participants were collected. Results: The mean values obtained were as follows: total cholesterol 149±26 mg/dl, LDL-cholesterol 85±23 mg/dl, HDL-cholesterol 48±9 mg/dl, triglyceride 80±31 mg/dl, fasting blood glucose 86±8 mg/dl, systolic arterial pressure 107±11 mmHg, diastolic arterial pressure 68±9, body mass index 22.2±1.6 kg/m2, and waist circumference 77±5 cm. Smokers accounted for 39.8% (n=467). Fasting blood glucose was the only significant parameter between the seven geographical regions. None of the subjects was hypertensive. Metabolic syndrome was detected in one case. Eight individuals (0.7%) had an LDL level exceeding 160 mg/dl. HDL cholesterol differed significantly between smokers and nonsmokers. Linear regression analysis showed that smoking, serum triglyceride, and total cholesterol were significant predictors for HDL cholesterol. Conclusion: Our data suggest that Turkish men who are engaged in regular exercises and do not have obesity or hypertension starts adulthood with a very favorable coronary risk profile.

Chronic total occlusion of the inferior vena cava is a rare entity. Although it mainly occurs during the course of chronic diseases, it may also appear as a complication of cardiovascular interventions. Total occlusion of the inferior vena cava was detected in a 64-year-old woman during right heart catheterization performed to evaluate her complaints of breathlessness and chest pain. She had mitral valve surgery of 20-year history. Venous blood coming from the lower extremities was found to be directed to the azygos vein through a wide collateral network, which was then transferred to the right atrium. Due to appropriate functioning of the azygos vein, the patient had remained totally asymptomatic until the onset of her complaints.

A cardiac consultation was asked for a 58-year-old man prior to surgery for a bladder tumor, upon detection of increased heart size and cardiothoracic ratio by telecardiography. He did not have any cardiac symptoms. Transthoracic echocardiography showed two masses in the right atrium and ventricular apex, respectively. As he had undergone surgery, seven years before, for a chondrosarcoma in the left chest wall, a metastatic lesion was suspected, for which a decision for surgery was made. At surgery, the masses were found to be unresectable due to advanced involvement of the heart and the aorta, so only a biopsy was obtained. Histopathologic diagnosis was metastatic chondrosarcoma. The patient was submitted to the oncology department. He did not have any cardiac symptoms in the fifth postoperative month. To our knowledge, this is the first case report of a metastatic chondrosarcoma to the heart in the Turkish literature.

Spontaneous coronary artery dissection is a very rare, but increasingly reported cause of myocardial infarction or sudden cardiac death. In most cases, diagnosis is made on postmortem examinations. In a minority of cases, it is detected incidentally on angiographic studies during or after an acute coronary syndrome. We present a 49-year-old man who had atherosclerotic risk factors, stable angina pectoris, and decompensated heart failure. Following medical stabilization of the patient, coronary angiography revealed a linear dissection of the left anterior descending coronary artery. On thallium scintigraphy, anterior and inferior myocardial infarction was detected, so percutaneous or surgical revascularization were not considered and the patient was submitted to cardiac transplantation.

Percutaneous coronary intervention with stenting is an appropriate alternative to surgical revascularization in the management of coronary artery disease. Despite new medications and techniques, in-stent restenosis still remains an unresolved problem. Brachytherapy and drug-eluting stents are current therapeutic options to reduce in-stent restenosis and decrease the probability of its occurrence, respectively. This article revisits the pathophysiology and current therapeutic modalities of in-stent restenosis.

The occurrence of fatal events after percutaneous coronary interventions associated with distal embolization of plaque contents has led to the development of new protection strategies. Firstly, pharmacological methods were attempted to deal with the emboli and accompanying myocardial ischemia. Among them, glycoprotein IIb-IIIa receptor antagonists were shown to be beneficial especially during primary percutaneous coronary interventions in patients with acute myocardial infarction. However, as far as the prevention of distal embolization was concerned, these medications were found not to offer a desirable efficacy especially in interventions for lesions with a heavy thrombus load, and in those involving degenerated saphenous vein grafts and carotid lesions. Today, several types of distal mechanical protection devices have been developed to prevent and/or treat distal embolization. They are classified under two headings, namely those having a filter system and a balloon system. The merits and demerits of these devices are reviewed in the light of the literature.