Objectives: We analyzed all-cause and coronary mortality, incidence and prevalence of coronary heart disease (CHD) in a cohort of the Turkish Adult Risk Factor Study which was surveyed in the summer of 2006 essentially in geographic regions other than Marmara and Middle Anatolia.
Study design: The survey consisted of 1585 participants (776 men, 809 women; mean age 55.3±11.8 years), accounting for 49% of all living participants of the overall cohort. Information on death was obtained from first-degree relatives and/or health personnel of local health offices. Survivors were evaluated by history, physical examination, and 12-lead electrocardiography. New coronary event was defined as fatal or nonfatal myocardial infarction, new stable angina, and/or myocardial ischemia that had occurred after the former survey.
Results: Of the participants, 946 were examined, 599 subjects were evaluated on the basis of information gathered, and 40 deaths (27 men, 13 women) were documented. Cumulative follow-up of the survey starting from 1990 increased to 45,490 person-years with the addition of 2,842 person-years. Fifteen deaths were attributed to CHD. Annual overall mortality and coronary mortality rates were 14.1 and 5.1 per 1000 adults, respectively. In the 45 to 74 years age bracket, overall mortality declined to 10.9 (p=0.09) and coronary mortality to 5.6 per thousand. A decreasing trend in mortality was pronounced in women. The mean age at death increased to 67.1 years in men, and to 75.9 years in women. The prevalences of CHD were found to be 3%, 11%, and 27% in age groups of 39-49, 50-59, and ≥60 years, respectively, which corresponded to an estimated population of 2.75 million.
Conclusion: In the 45 to 74 years age bracket, overall and coronary deaths show a decreasing trend, particularly in women, which extends the mean age at death. However, the prevalence of CHD specific to age groups continues to rise, as well.

Objectives: Mitral valve pressure gradient measured by echocardiography is a very useful method for the evaluation of mitral valve disease. The standard method is based on the calculation of mean mitral valve pressure gradient with the use of the modified Bernoulli equation, which includes manual drawing of the border of Doppler signal. Recently, two new methods have been described by Devlin M et al. and Yang SS, respectively. This study aimed to compare the results of the standard method with those of the new methods.
Study design: We prospectively studied 78 patients (55 women, 23 men; mean age 43±14 years; range 17 to 78 years) with mitral valve gradient either due to mitral stenosis or mitral valve replacement. Atrial fibrillation was present in 31 patients. The mean mitral valve gradient was measured using the standard method. As for the new methods, measurements of the mean mitral valve gradient were made without manual drawing of the border of Doppler signal and using the formulas which included the peak and trough velocities. Transmitral gradient was also obtained by cardiac catheterization in 14 patients.
Results: The mean transmitral pressure gradients were 9.2±5.7 mmHg, 9.4±6.2 mmHg, and 10.6±6.6 mmHg by the standard method, the first, and the second methods, respectively. The new methods were in good correlation with the standard method (for both methods, r=0.98, p<0.001). Subgroup analyses based on mitral valve area, rhythm, and the presence of associated valve lesions did not change the consistency of correlations. Transmitral gradients obtained by catheterization were also correlated with those obtained by the standard, first, and second methods (r=0.97, r=0.96, r=0.96, respectively).
Conclusion: Considering that the standard Doppler method and two different approaches yield similar results, the new approaches seem to facilitate the measurement of mitral valve gradient in daily clinical practice.

Objectives: We investigated the effect of frequent ventricular premature beats (VPB) originating from the right ventricular outflow tract (RVOT) on diastolic functions and the relationship between VPBs and serum N-terminal pro-brain natriuretic peptide (NT-proBNP) levels.
Study design: The study included 33 symptomatic patients (10 males, 23 females; mean age 40±8 years) with normal left ventricular functions, who had frequent VPBs originating from the RVOT on 24-hour Holter monitoring. All the patients underwent 2D transthoracic echocardiography and Doppler analyses and mitral inflow patterns and serum NT-proBNP levels were evaluated. The results were compared with those of 30 healthy individuals (9 males, 21 females; 37±9 years).
Results: Compared to the controls, the patients had a longer isovolumetric relaxation time (IVRT) (p<0.0001) and E-wave deceleration time (EDT) (p<0.0001), a smaller ratio of early diastolic wave to atrial wave (E/A) (p=0.001), and higher NT-proBNP levels (p=0.016). While the mitral inflow pattern was normal in all the controls, it was associated with impaired relaxation in 13 patients. Patients with diastolic dysfunction (n=13) had higher NT-proBNP levels (p=0.03) and greater VPB counts (p=0.001) than those without diastolic dysfunction (n=20). The number of VPBs was inversely correlated with the mitral E/A ratio, and positively correlated with EDT, IVRT, and NT-proBNP levels.
Conclusion: Frequent VPBs from the RVOT cause deterioration in diastolic functions in patients without structural heart disease. Considering a parallel rise in NT-proBNP levels with the VPB count, NT-proBNP measurement can be used as a predictor of diastolic dysfunction in symptomatic patients.

Objectives: This study sought to determine the effect of metabolic syndrome (MS) on the development of major adverse cardiac events (MACE) in the early period of primary coronary intervention (PCI).
Study design: The study included 152 patients (132 males, 20 females; mean age 56.5±11 years) who underwent primary PCI within ≤12 hours of acute myocardial infarction with ST-segment elevation. Patients with diabetes mellitus were excluded. The patients were divided into two groups according to whether they met the NCEP ATP III criteria for MS; hence, 69 patients (45.4%) with MS, and 83 patients (54.6%) without MS (controls). The two groups were compared with respect to clinical and angiographic features, ECG findings, and the development of MACE (death, reinfarction, and repeat vessel revascularization) at one month.
Results: The two groups were similar with respect to culprit arteries and the number of diseased vessels. Initial TIMI flow grade was lower in the MS group compared to controls (p=0.009), but the final TIMI flow grades were similar in both groups (p=0.5). However, patients with MS had a lower rate of ST-segment resolution ≥50% at 90 minutes (p=0.002). At one month follow-up, none of the patients in the control group had MACE, whereas nine patients (13%) in the MS group developed MACE (p=0.001).
Conclusion: Patients with MS have a higher risk for developing MACE after primary PCI. Therefore, the presence of MS should be taken into consideration in patients undergoing PCI.

Objectives: Definition of metabolic syndrome (MS) was made according to the NCEP-ATP III criteria and the new MS scoring system developed by Macchia et al., and the role of each method was assessed in predicting the severity and extent of coronary artery disease (CAD).
Study design: The study included 158 patients (103 males, 55 females) who underwent coronary angiography for CAD. Metabolic syndrome was identified according to both the NCEP-ATP III criteria and the MS score. MS scores were calculated by summing all the points rated for sex, age, body mass index, hypertension, and levels of HDL-cholesterol, triglyceride, and fasting glucose. The severity and extent of CAD were evaluated by the Gensini score. Patients were classified as having severe (≥20, n=69) or mild (<20, n=89) CAD according to the Gensini scores, and by high (≥27.5, n=103) and low (<27.5, n=55) MS scores, depending on the optimal cut-off point by ROC analysis.
Results: The mean MS score was significantly higher in patients having severe CAD than those having mild disease (p<0.001). However, these two groups did not differ significantly with respect to the number of patients diagnosed as having MS according to the NCEP-ATP III criteria and parameters thereof other than glucose and triglyceride levels. The Gensini score was significantly higher in patients having a MS score of ≥27.5 (p=0.001). There was a moderate correlation between the MS score and the severity and extent of CAD (r=0.347; p<0.001). Multivariate logistic regression analysis revealed that the MS score was the only independent factor that significantly increased the severity and extent of CAD by 3.4 times (p=0.012; %95 confidence interval: 1.3-8.9).
Conclusion: The MS score may be a better predictor of metabolic risk in MS patients than the NCEP-ATP III criteria. Patients with a high MS score are more likely to develop severe CAD.

A 33-year-old woman presented with unconsciousness and complete heart block 20 days postpartum. On admission, her blood pressure was 70/50 mmHg and heart rate was 30/min. Immediately, a temporary transvenous pacemaker was inserted via the right femoral vein and her blood pressure increased to 100/70 mmHg with restoration of consciousness. Echocardiographic examination showed reduced left ventricular systolic function. The following day, complete heart block resolved spontaneously to sinus rhythm with right bundle branch block. Ten days later, right bundle branch block resolved together with improvement in left ventricular ejection fraction. To our knowledge, a case of peripartum cardiomyopathy presenting with complete heart block has not been reported.

Quadricuspid aortic valve is a rare congenital malformation which used to be discovered incidentally at necropsy, or during aortic valve replacement surgery or aortic angiography until the recent advances in transesophegeal echocardiography. It mostly results in aortic insufficiency, though it may be functionally normal. Congestive heart failure was detected in a 33-year-old male patient with a history of acute rheumatic fever. Transthoracic echocardiography showed dilatation of the left ventricle, thickening and fibrosis of the mitral valve, third degree mitral regurgitation, and a quadricuspid aortic valve. Coronary angiography showed global hypokinesia, aortic and mitral insufficiency. Aortic valve replacement and mitral valve repair were recommended to the patient.

A 44-year-old man presented with a complaint of dyspnea on exertion. Transthoracic two-dimensional echocardiography showed a cystic lesion in the basal region of the interventricular septum, 4.5x8 cm in size, suggesting a hydatid cyst. Color Doppler echocardiography demonstrated turbulent flow and mild aortic and mitral insufficiency. An indirect hemagglutination test yielded a positive result. The patient refused surgical treatment. A month later, it was found that he had died during surgery for the hydatid cyst at another center.

Disorders in the function of cardiac ion channels present as electrocardiographic abnormalities and arrhythmias and are described as cardiac channelopathies. Mutations in genes encoding specific ion channels have been shown to underlie these heritable arrhythmogenic disorders occurring in structurally normal hearts. These disorders include long QT syndromes, short QT syndromes (SQTS), Brugada syndrome, progressive cardiac conduction defect, idiopathic sick sinus syndrome, catecholaminergic polymorphic ventricular tachycardia, and familial atrial fibrillation. Short QT syndromes characterized by an abnormally short QT interval (<300 ms) and a propensity to atrial fibrillation and sudden cardiac death are new members of this group. Three distinct mutations in genes encoding cardiac potassium channels have been identified in this syndrome. Implantable cardioverter defibrillator (ICD) is presently the first choice of treatment. Because quinidine has been shown as the only drug that markedly prolongs the QT interval, this therapy can be considered in patients who refuse an ICD or in those who get frequent shocks from the ICD. This article aims to summarize cardiac channelopathies, with special reference to the diagnosis, pathophysiology, and treatment of SQTS

Case Image, no abstract.

73-year-old man with a history of previous myocardial infarction was admitted to the hospital with progressive dyspnea.