ORIJINAL ARAŞTIRMA | |
1. | The incidence of nondipping state in normotensive patients with coronary slow flow and its relationship with prognosis Mustafa Yazıcı, Sabri Demircan, Kenan Durna, Tek.Erdoğan Yaşar, Mahmut Şahin Pages 319 - 325 Objectives: We investigated the frequency of nondipping pattern, which is thought to be related with increased sympathetic activity, and its influence on the pathogenesis and prognosis of patients with coronary slow flow. Study design: The study included 51 normotensive patients (22 females, 29 males; mean age 54 years) in whom coronary slow flow (CSF) was diagnosed by coronary angiography and TIMI (thrombolysis in myocardial infarction) frame count. Venous blood samples were obtained at the same hours of the day to determine noradrenaline and adrenaline levels and 24-hour ambulatory blood pressure monitoring was performed. At least 10% of sleep-related nocturnal decrease in systolic and diastolic pressures was accepted as dipping, while decreases below 10% were defined as nondipping. The results were compared with those of 44 subjects (18 females, 26 males; mean age 55 years) with normal coronary flow. Results: The number of nondippers compared to dippers was significantly higher in the CSF group (n=35, 68.6% vs n=16, 31.4%, p<0.001), and vice versa in the control group (n=3, 6.8% vs n=41, 93.2%, p<0.0001). Compared to controls, CSF was significantly associated with increased plasma noradrenaline (127.9 ng/ml vs 79.3 ng/ml, p<0.0001) and adrenaline (63.9 ng/ml vs 44.7 ng/ml, p<0.001) levels (p<0.001). A positive correlation was found between TIMI frame counts and noradrenaline (r=0.421, p=0.012) and adrenaline (r=0.445, p=0.008) levels in the CSF group. Nondippers in the CSF group exhibited significantly higher noradrenaline (p<0.01) and adrenaline (p<0.05) levels, existence of slow flow in three coronary arteries (p<0.01), and TIMI frame counts (p<0.05) compared to dippers. During a four-year follow-up, chest pain like that of unstable angina, recurrent chest pain, malignant ventricular arrhythmias, and sudden cardiac death were more frequently encountered in nondippers than in dippers. Conclusion: Nondipping pattern seen in patients with CSF is associated with sympathetic hyperactivity and poor prognosis. |
2. | The prevalence, clinical, and morphological characteristics of cases with apical hypertrophic cardiomyopathy diagnosed in a training hospital of a medical faculty Hürkan Kurşaklıoğlu, Turgay Çelik, Atila İyisoy, Sedat Köse, Basri Amasyalı, Ersoy Işık Pages 326 - 330 Objectives: We evaluated the relative frequency and clinical and morphological features of apical hypertrophic cardiomyopathy (HCM) among patients diagnosed as having HCM in our hospital in the last 13 years. Study design: Among 193 patients whose diagnoses of HCM were made between 1991 and 2004, we reviewed clinical, demographic, electrocardiographic, echocardiographic, and angiographic data of 11 patients (5.7%; 3 males, 8 females; mean age 56 years; range 41 to 70 years) who were found to have apical HCM. Results: The most frequent electrocardiographic finding in patients with apical HCM was giant negative T waves more than 10 mm in depth in the precordial leads (7 patients, 63.6%) followed by voltage criteria for left ventricular hypertrophy (6 patients, 54.6%). Echocardiographic examination showed left ventricular apical wall thickness of greater than 15 mm below the papillary muscles in all the patients, and mild mitral (n=2), aortic (n=2), and tricuspid (n=2) valve insufficiencies. Most importantly, the typical “ace of spades" configuration of the left ventricle at end-diastole was observed in all the patients during contrast ventriculography. On coronary angiography, three patients had two-vessel disease, coronary ectasia, and myocardial muscular bridge in the middle segment of the left anterior descending artery, respectively. One patient had microfistulae between the left anterior descending artery and the left ventricle. Conclusion: Although it is difficult to generalize for the overall population, apical HCM seems to be more frequent in our patient population compared to that of western countries, with clinical, morphological, electrocardiographic, and ventriculographic findings similar to the Japanese type. |
3. | Classification of patients with ventricular tachycardia according to etiological, demographic and clinical features Ömer Alyan, Fehmi Kaçmaz, Özcan Özdemir, Fatma Metin, Mustafa Soylu, Ramazan Atak, Kubilay Şenen, Gökhan Cihan, Dursun Aras, Ahmet Duran Demir, İrfan Sabah Pages 331 - 340 Objectives: We evaluated patients with ventricular tachycardia (VT) with respect to etiological factors, demographic and clinical features, in-hospital mortality and reviewed recent therapeutic approaches in high-risk patients. Study design: This retrospective study included 392 consecutive patients (111 females, 281 males; mean age 59.2 years; range 20 to 90 years) who were admitted to our hospital with sustained VT or who developed in-hospital VT between January 2000 and May 2003. Results: The most common etiological cause was chronic ischemia (45.9%), followed by acute ischemia (18.6%) and dilated cardiomyopathy (14.3%), whereas no etiologic cause was found in 60 patients (15.3%). Ventricular tachycardia was accompanied by ventricular fibrillation (VF) and syncope in 109 (27.8%) and 196 (50%) patients, respectively. Of the patient group, 147 patients (37.5%) had three-vessel, 68 patients (17.4%) had two-vessel, and 35 patients (8.9%) had one-vessel disease. Ninety-two patients (23.5%) died during hospitalization. In-hospital mortality was significantly higher in patients with diabetes mellitus (p=0.002), acute myocardial infarction (p=0.004), syncope (p<0.001), and VF (p<0.001), whereas it was significantly lower in patients with idiopathic VT (p=0.01), and in those with an implanted cardioverter defibrillator (p=0.005). Logistic regression analysis revealed that syncope (p<0.001) and VF (p<0.001) were independent factors affecting mortality. Conclusion: The development of VT is associated with poor prognosis in patients with ischemia, which requires prompt and aggressive therapeutic approaches in intensive care units. |
4. | A case of coronary artery fistula detected by multidetector computed tomography Mehmet Yokuşloğlu, Savaş Karakoç, Oben Baysan, Mehmet Uzun Pages 341 - 343 A 20-year-old man presented with a complaint of easy fatigability. He had no history of angina, trauma, or previous surgery. A continuous cardiac murmur was heard at the level of the fourth intercostal space on the left parasternal border. A left axis deviation was seen on his electrocardiogram. Transthoracic echocardiography was normal. Multidetector computed tomography revealed a fistulous connection between the circumflex artery and the superior vena cava with a diameter of 2.4 mm. The presence of the coronary artery fistula was confirmed angiographically. Since there was no history of trauma or surgery, the fistula was considered congenital. The patient’s symptoms were not directly related to the coronary fistula, and he was discharged for close follow-up. |
OLGU | |
5. | A case of multiple abnormalities: aortic arch anomaly, aberrant left subclavian artery, left atrial diverticulum, and myocardial noncompaction Hürkan Kurşaklıoğlu, Atila İyisoy, Turgay Çelik, Sedat Köse Pages 344 - 347 A 21-year-old male patient presented with atypical chest pain. Examinations with echocardiography, ventriculography, and pulmonary angiography showed multiple abnormalities including an aortic arch anomaly, aberrant origin of the left subclavian artery, connection of the left pulmonary veins to the left atrium via a single root, left atrial diverticulum, and left ventricular myocardial noncompaction. A 24-hour Holter monitoring detected no arrhythmias and the left ventricular systolic function was in normal range. Surgical correction was not considered, so a medical follow-up program was initiated with an angiotensin-converting enzyme inhibitor and aspirin. To our knowledge, association of the above-mentioned anomalies has been hitherto unreported. |
DERLEME | |
6. | Avrupa’da primer perkütan koroner girişimin miyokard infarktüsünde ana reperfüzyon stratejisi olarak gelişimi Petr Widimsky, Michael Aschermann, Frantisek Tousek Pages 348 - 353 Randomized trials have confirmed the superiority of primary percutaneous coronary intervention (p-PCI) over thrombolysis as the reperfusion therapy for ST-elevation myocardial infarction. The Czech Republic, where two of these trials were performed, developed a network of PCI centers and satellite hospitals throughout the country, enabling 93% of the reperfusion therapy to be p-PCI in 2003, with thrombolysis accounting for only 7%. In other European countries, however, the p-PCI-to-thrombolysis ratio largely varies between 80:20 and 1:99. In this article, the infrastructure and logistics of the achievement in the Czech Republic are described. |
EDITORYAL YORUM | |
7. | Management of patients with ST-elevation myocardial infarction: an overview of the real world situations through randomized studies Erdoğan İlkay Pages 354 - 355 Abstract | |
DERLEME | |
8. | Coronary artery ectasia Bilal Boztosun, Yılmaz Güneş, Cevat Kırma Pages 356 - 359 Coronary artery ectasia is a rare entity among coronary artery anomalies. Its etiology is not clear. It is usually considered to be a variant of coronary atherosclerosis; however, a significant number of cases have been associated with conditions other than atherosclerosis, such as inflammatory disease, connective tissue disease, or a congenital disorder. Clinical symptoms may vary including stable or unstable angina pectoris, and atypical chest pain. This article aimed to review the pathogenesis and clinical course of coronary artery ectasia together with therapeutic approaches. |
9. | High sensitivity C-reactive protein (hsCRP) as a new risk factor Aylin Yıldırır Pages 360 - 371 Recently, demonstration of a clear association between atherosclerosis and inflammation have led to the thought that several circulatory inflammatory markers can be of use in the management of cardiovascular risk stratification. Among these markers, the most interest has been concentrated on high sensitivity C-reactive protein (hsCRP). There is growing evidence that hsCRP may be of value in predicting adverse cardiac events both in patients with acute coronary syndromes and those without any known cardiovascular disease. Moderately elevated hsCRP levels are associated with an increased risk for cardiovascular events, independent of other risk factors. In primary prevention, hsCRP provides additional information on the risks associated with lipid levels, thus helping us determine candidates for statin therapy. This review aims to summarize the most recent literature data concerning factors affecting hsCRP levels, the role of hsCRP in risk stratification, and suggestions for its clinical use. |
10. | Detection of a coronary arteriovenous fistula between the circumflex artery and pulmonary vein by CT angiography Erdoğan İlkay, Orhan Maden, Kemal Arda, Fehmi Kaçmaz Page 372 Abstract | |
11. | Comment on cardiology publications Ertan Ural Page 375 Abstract | |
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