ORIGINAL ARTICLE | |
1. | Family income in shaping cardiometabolic risk profile: a prospective analysis including gender-related differences Altan Onat, Hakan Özhan, Günay Can, Gülay Hergenç, Ahmet Karabulut, Sinan Albayrak Pages 471 - 478 Objectives: We investigated the extent to which family income predicts smoking, metabolic syndrome (MS) and its components, elevated levels of apolipoprotein (hyperapo) B and C-reactive protein (CRP), and incident coronary heart disease (CHD), with reference to gender-related differences. Study design: A total of 3,273 participants (1610 males, 1630 females; mean age 48.3±12 years, minimum age 28 years) of the TEKHARF surveys 1997/98 and 2002/03 were prospectively evaluated during a mean of 5.9 years. Monthly family incomes were grouped into four categories. Elevated apoB and CRP levels were based on the cutoff values of 120 mg/dl and 3 mg/l, respectively. Identification of MS was made according to the Adult Treatment Panel III criteria modified by the TEKHARF study. Diagnosis of CHD was based on history, physical examination, and the Minnesota coding of resting electrocardiograms. Results: In age-adjusted logistic regression analyses, men with higher income brackets had an increased incidence of diabetes, hypertension, and elevated hyperapo B. In women, income was positively associated with smoking and elevated hyperapo B, and inversely related with obesity, abdominal obesity, and - at borderline significance - triglyceride/HDL dyslipidemia; diabetes and hypertension were not predicted by income. Lower income brackets (<910 NTL) predicted elevated CRP levels in both genders (relative risk 1.47, p<0.002). Income exhibited an insignificant relative risk (1.27) for incident CHD. Conclusion: The level of family income contributes to the development of an adverse risk profile in Turks. Given increased smoking in women and its inhibitory effect on (abdominal) obesity, rising income seems to predict improvement in some elements of the cardiometabolic risk profile. |
2. | The effect of heart transplantation on mortality in end-stage heart failure patients with UNOS status 2 Hamza Duygu, Mehdi Zoghi, Sanem Nalbantgil, Çağatay Engin, Tahir Yağdı, Azem Akıllı, Mustafa Akın, Mustafa Özbaran Pages 479 - 483 Objectives: Despite recent developments in medical treatments and assist device applications, management strategies for end-stage heart failure patients with UNOS status 2 (United Network for Organ Sharing) are still controversial. We evaluated the clinical condition and prognosis of end-stage heart failure patients with UNOS status 2, who were placed on the waiting list for heart transplantation. Study design: The study included 78 patients (62 men, 16 women; mean age 43±12 years) with UNOS status 2. The patients were assessed in terms of frequency of hospitalization during waiting for transplantation, shift to a higher level of UNOS status, transplantations performed, and mortality. Results: The mean duration of waiting on the list was 17±10 months. The frequency of hospitalization due to heart failure was 4±2/year. An implantable cardioverter defibrillator was used in seven patients (9%) for persistent ventricular tachycardia. Nine patients (11.5%) shifted to UNOS status 1B. Eighteen patients (23.1%) underwent orthotopic heart transplantation following six months of waiting on the list. Mortality rates were 25% (n=15) and 22.2% (n=4) for patients on the waiting list and for transplant patients at the end of the first year of transplantation, respectively (p=0.03). The main cause of mortality was sudden cardiac death (73.3%, n=11) for patients on the transplantation list. There was a significant difference in terms of combined end-point of mortality and shift to UNOS status 1B between transplanted (n=24, 40%) and untransplanted (n=4, 22.2%) patients (p=0.01). Conclusion: Heart transplantation is an appropriate alternative for preventing impending clinical deterioration, frequent attacks of heart failure, and cardiac deaths in patients with UNOS status 2. |
3. | The relationship of high plasma levels of atrial and brain natriuretic peptides with disease severity in mitral valve stenosis Nevzat Uslu, Ahmet L. Orhan, Zekeriya Nurkalem, İlker Avcı, Hasan O. Özer, İbrahim Sarı, Zübeyir Acar, Şevket Görgülü, Mehmet Eren Pages 484 - 488 Objectives: We aimed to determine plasma levels of atrial (ANP) and brain (BNP) natriuretic peptides in patients with mitral stenosis (MS), and to seek clinical and echocardiographic correlations with these peptides. Study design: Thirty-eight patients (33 females, 5 males; mean age 44±9 years) with MS and 12 healthy controls (10 females, 2 males; mean age 46±7 years) were examined by echocardiography. All the patients were in sinus rhythm. Venous blood samples were taken to measure ANP and BNP levels. Results: Compared with controls, patients with MS had significantly higher plasma ANP (6±4 ng/ml vs 45±33 ng/ml) and BNP (12±7.2 pg/ml vs 79±55 pg/ml) levels (p<0.001). Diameters of the left atrium and left atrial volume index were significantly increased (p<0.001), and early (p=0.001) and late (p=0.02) diastolic velocities measured at the lateral annulus of the mitral valve were significantly decreased in the patient group. Systolic velocities showing systolic function of the left ventricle were found similar. Increased ANP and BNP levels showed significant correlations with functional capacity (r=0.43, p=0.007 and r=0.44, p=0.006, respectively), estimated pulmonary artery systolic pressure (r= 0.37, p= 0.022 and r= 0.39, p= 0.019), and left atrial volume index (r=0.48, p=0.003 and r=0.41, p=0.015). Mitral valve area was significantly correlated only with the ANP level (r=-0.37, p=0.022). In multivariate regression analysis, left atrial volume index and estimated pulmonary artery systolic pressure were found to be independent predictors for both BNP (ß=0.32, p=0.040 and ß=0.34, p=0.030, respectively) and ANP (ß=0.40, p=0.010 and ß=0.32, p=0.040) levels. Conclusion: Our data suggest that left atrial volume index and estimated pulmonary artery systolic pressure are strongly correlated with increases in BNP and ANP levels in MS, making BNP and ANP helpful in determining the severity of MS in patients with insufficient echocardiographic data. |
4. | Early postoperative results of emergency coronary bypass surgery in patients presenting within six hours of acute myocardial infarction Mustafa Bilge Erdoğan, Feragat Uygur, Bülent Meşe, Alper Serçelik, Cemil Cahit Öğütmen, Birol Yamak, Bülent Kısacıkoğlu Pages 489 - 493 Objectives: We evaluated early postoperative results of coronary bypass operations in patients presenting within the first six hours of acute myocardial infarction (AMI). Study design: A total of 128 patients (97 men, 31 women; mean age 61±5 years; range 41 to 78 years) underwent coronary bypass grafting within the first six hours of AMI. Indications for surgery were detection of critical multivessel disease on coronary angiography in 88 patients (68.8%), unsuccessful percutaneous transluminal coronary angioplasty (PTCA) in 20 patients (15.6%), and development of complications following elective primary PTCA in 20 patients. Six patients (4.7%) required cardiopulmonary resuscitation due to cardiac arrest at angiography. Surgery was undertaken by cardiopulmonary bypass in 104 patients (81.3%), and on the beating heart in 24 patients (18.8%). Intra-aortic balloon pump was applied to eight patients preoperatively, and to six patients postoperatively. Results: Mortality occurred in six patients (4.7%), three of whom received cardiopulmonary resuscitation. One patient and two patients died in the late postoperative period from sepsis and neurologic complications, respectively. After operation, positive inotropic support was required in 32 patients. Postoperative complications were severe ventricular arrhythmias (n=18), atrial fibrillation (n=4), and wound site infection (n=5). Four patients underwent revision due to hemorrhage. The mean intensive care unit stay was 3.7±1.9 days, and the mean hospitalization was 12.6±6.7 days. Conclusion: Coronary bypass operations are relatively safe with acceptable mortality and morbidity rates in patients requiring surgical treatment within the first six hours of AMI. |
EDITORIAL COMMENT | |
5. | The role of coronary bypass surgery in the treatment of acute myocardial infarction Atıf Akçevin Pages 494 - 495 Abstract | |
ORIGINAL ARTICLE | |
6. | The effect of continuous positive airway pressure on blood pressure and left ventricular structure in male patients with obstructive sleep apnea Dursun Dursunoglu, Nese Dursunoglu, Ömür Kuru, Sibel Özkurt, Şükrü Gür, Göksel Kiter, Fatma Evyapan, Mustafa Kılıç Pages 496 - 503 Objectives: We investigated the effect of nasal continuous positive airway pressure (CPAP) on blood pressure (BP) and left ventricular structure in male patients with severe obstructive sleep apnea (OSA). Study design: Thirty-three male patients with severe OSA underwent CPAP treatment for six months. Compliance was defined as the use of CPAP for at least 3.5 hours per night during treatment; thus, 25 patients (mean age 47.9±8.2 years) were compliant with a mean of 5.3±1.9 hours, and eight patients (mean age 48.6±8.4 years) were noncompliant with a mean of 1.0±0.8 hours. Before and after CPAP, echocardiographic assessments were made to determine left ventricular structure (interventricular septum thickness, left ventricular posterior wall thickness, left ventricular mass, and left ventricular mass index) and function (E/A ratio, isovolumic relaxation time, mitral deceleration time, and velocity of mitral flow propagation), and systolic and diastolic blood pressures were measured. In the compliant group, 20 patients had hypertension, 22 patients had diastolic dysfunction, and 16 patients had left ventricular hypertrophy (LVH). All noncompliant patients were hypertensive, four had diastolic dysfunction, and four had LVH. Results: Systolic and diastolic BPs significantly decreased after CPAP treatment, the decreases being more pronounced in the compliant group (p<0.001 vs p<0.01). Parameters of left ventricular structure and diastolic function significantly improved in compliant patients following CPAP. Left ventricular hypertrophy improved in nine patients (56.3%, p<0.0001) and diastolic dysfunction improved in 11 patients (50%, p<0.001). However, in the noncompliant group, parameters of left ventricular structure and diastolic functions did not differ significantly and the number of patients having LVH or diastolic dysfunction did not change. Conclusion: In severe OSA, CPAP treatment significantly decreases BP and left ventricular wall thickness, and improves left ventricular diastolic function. |
CASE REPORT | |
7. | A giant left ventricular pseudoaneurysm with severe mitral regurgitation after silent inferior myocardial infarction resulting in cardiogenic shock Bayram Bağırtan, Mutlu Vural, Ebru Tırnaksız, Hayrettin Tekümit, Murat Demirtaş Pages 504 - 507 A 60-year-old man presented with a two-week history of dyspnea and tachycardia at rest. Severe heart failure and findings of pulmonary edema without evidence of acute coronary syndrome were observed. Transthoracic echocardiography showed dilatation of the left ventricle (LV), severe mitral regurgitation, and a giant extra chamber, 11x14 cm in size, next to the posterior region of the LV, containing a massive thrombus. Coronary angiography performed on the same day showed total occlusion of the right coronary artery and a critical stenosis of the circumflex artery. An emergency operation was performed due to the sudden development of pulmonary edema and cardiogenic shock. The pseudoaneurysm was resected together with the thrombus, the defect in the LV myocardial wall was repaired, and mitral ring implantation and annuloplasty were performed. He was hospitalized for 22 days postoperatively due to heart failure and decreased oxygenation and was followed-up for three months. |
8. | Percutaneous transcatheter coil occlusion of a large patent ductus arteriosus following medical treatment of infective endarteritis Ahmet Çelebi, Yalım Yalçın, Cenap Zeybek, Celal Akdeniz Pages 508 - 511 A large patent ductus arteriosus (PDA) was detected in a seven-year-old girl with infective endarteritis. After appropriate medical treatment, the ductus which measured 4.1 mm on angiography was occluded percutaneously using two consecutive detachable coils (8 mm and 6.5 mm). Minimal residual shunt was observed in the catheterization laboratory, but echocardiographic examination performed on the following day showed complete occlusion. Percutaneous coil occlusion of PDAs complicated by infective endarteritis is a safe and effective procedure even if the defect is considerably large. However, special attention should be paid to complete closure without any residual shunt in order to prevent recurrent infections. |
9. | Implantation of a coronary sinus lead after stent dilatation of coronary vein stenosis Zekeriya Kaptan, Cemal Özbakır, Özcan Özdemir, İsmet Hisar, Mustafa Soylu Pages 512 - 514 Biventricular pacing for the treatment of congestive heart failure has been shown to improve symptoms. To pace the left ventricle, the lead is implanted in the tributaries of the coronary sinus. However, 8% to 10% of the procedures result in failure to implant the coronary sinus leads. Implantation of a biventricular pacemaker was planned in a 57-year-old male patient with severe symptoms of heart failure and left bundle-branch block. Angiography revealed severe stenosis in the posterolateral branch, preventing the insertion of the lead and no other branch was available for the procedure. Stent dilatation of the coronary sinus stenosis was performed, which enabled easy insertion of the lead in the posterolateral branch, resulting in successful cardiac resynchronization. |
REVIEW | |
10. | Evaluation of coronary arteries by multidetector computed tomography Cihan Duran, Murat Gülbaran, Mecit Kantarcı Pages 515 - 526 Although coronary angiography is recognized as the gold standard in the evaluation of coronary artery disease, there is still need for noninvasive imaging methods to detect and monitor asymptomatic or minimally symptomatic coronary artery disease. With technological improvements in multidetector computed tomography (CT), coronary CT angiography proved to be a potential noninvasive method in this field. This article reviews technological aspects, clinical applications, and indications of coronary CT angiography in the light of the most recent literature. |
CASE IMAGE | |
11. | Free-floating thrombi in the right atrium Hasan Kocatürk, Mustafa Yılmaz, Cevdet Uğur Koçoğulları, Ednan Bayram Page 527 Abstract | |
LETTER TO EDITOR | |
12. | Letter to editor Hüseyin Yılmaz Pages 529 - 530 bu bölümü boş bırakmam gerekiyor zannedersem. boş bırakmamı kabul etmediği için bu bölümü bu şekilde dolduruyorum. saygıularımla. |
13. | Letter to editor Erdem Diker Pages 530 - 531 No abstract |
OTHER ARTICLES | |
14. | Answers of specialist Bingür Sönmez, Tayyar Sarıoğlu, Atıf Akçevin Pages 533 - 534 Abstract | |
15. | Comment on cardiology publications Ertan Ural Page 535 Abstract | |
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