ISSN 1016-5169 | E-ISSN 1308-4488
Archives of the Turkish Society of Cardiology - Turk Kardiyol Dern Ars: 35 (4)
Volume: 35  Issue: 4 - June 2007
ORIGINAL ARTICLE
1. The relationship between neopterin levels and cardiac troponinin patients with non-ST segment elevation acute coronary syndromes
Mustafa Yazıcı, Kenan Durna, Sabri Demircan, Okan Gülel, Mahmut Şahin
Pages 209 - 215
Objectives: We examined the relationship between neopterin level, a locally and specific marker of inflammation, and cardiac troponin release in patients with non-ST elevation acute coronary syndromes (NSTE-ACS).
Study design: The study included 234 patients with NSTE-ACS and angiographically documented coronary artery disease. Serum levels of neopterin and cardiac troponin-I (cTn-I) were measured on admission. The patients were analyzed in two groups: 137 patients were cTn-I negative (<0.2 ng/ml), 97 patients were cTn-I positive (≥0.2 ng/ml). The presence of thrombus, lesion morphology, and TIMI flow were examined by coronary angiography.
Results: The two groups did not differ significantly with regard to the localization of culprit lesions and lesion morphology. The presence of TIMI ≤2 flow was significantly higher in cTn-I positive patients (p<0.001). The rates of visible thrombi during coronary angiography were 24.7% and 7.3% in cTn-I positive and negative patients, respectively (p=0.012). Serum neopterin levels were higher in cTn-I positive patients (p<0.001) and were correlated with cTn-I levels (r=0.817, p<0.001). In logistic regression analysis, neopterin was found as the only independent factor affecting cTn-I positivity (Odds ratio=1.4; p<0.001). ROC analysis showed 12.55 nmol as the optimal cutoff for neopterin level. The rates of sensitivity, specificity, positive predictive value, and negative predictive value for neopterin in distinguishing cTn-I positive and negative patients were 65.9%, 64.2%, 56.2%, and 72.1%, respectively.
Conclusion: Our results demonstrate that higher cTn-I levels may be related with neopterin levels, which reflect local inflammatory activity in patients with NSTE-ACS.

2. The relationship between the QT interval and autonomous and anthropometric features
Tolga Doğru, Serdar Günaydın, Vedat Şimşek, Murat Tulmaç, Mahmut Güneri
Pages 216 - 226
Objectives: We investigated the effect of anthropometric and autonomous factors on the QT interval in both sexes.
Study design: The study included 237 individuals (114 males, 123 females) who were asymptomatic and had no abnormal laboratory or physical findings. The mean age was 47 years (range 20 to 79 years) for men, and 39 years (range 20 to 71 years) for women. All the participants were subjected to a careful history taking, physical examination, routine biochemical examinations, electrocardiographic recording, 24-hour Holter monitoring, and when necessary, color Doppler echocardiography and treadmill exercise test. Serum estrogen levels, serum free and total testosterone levels were also measured in males.
Results: The minimum QT interval was significantly lower in males (p=0.043). The mean QT (p=0.022) and QTc (p<0.001) intervals in females, and QT dispersion in males (p=0.025) were significantly higher. In male participants, the maximum QT interval (p=0.049) and QT dispersion (p=0.043) were significantly different between age groups of 20-44 years and 45-69 years. Parasympathetic activity played a determinant role in the mean and maximum QT intervals. Anthropometric features were not correlated with the QT interval in females, whereas in males, waist-hip ratio was positively correlated with the mean QT and minimum QTc intervals (r=0.188, p=0.049 and r=0.236, p=0.013, respectively). Serum sex hormone levels were significantly effective on the QT interval in males.
Conclusion: Concerning anthropometric and autonomic factors, the QT interval is significantly influenced by gender-related features.

3. Early ambulation after percutaneous coronary interventions
Bilal Boztosun, Yılmaz Güneş, Ayhan Olcay, Ahmet Yıldız, Mustafa Sağlam, Mustafa Bulut, Ramazan Kargın
Pages 227 - 230
Objectives: Early ambulation after coronary interventions may reduce in-hospital stay and add to the patients’ comfort. This approach, however, may increase the risk for puncture site-related complications. We evaluated the safety of early ambulation after elective coronary stenting or angioplasty.
Study design: The study included 342 patients (212 males, 130 females; mean age 53±14 years) undergoing elective coronary stenting or angioplasty using a 6-F guiding catheter through the femoral artery and a standard dose of heparin 5,000 IU. Arterial sheath was removed immediately after the procedure. Homeostasis was achieved by manual compression and maintained with a compressive bandage. Subcutaneous low-molecular-weight heparin was administered one hour after sheath removal. Ambulation was allowed two hours after bed rest. Inguinal complications were recorded during a week follow-up.
Results: Bleeding occurred during ambulation in eight patients (2.3%). No hematoma developed after ambulation during hospital stay. Ecchymosis was the most frequent delayed complication (n=32, 9.4%). Late bleeding was observed in three patients (0.9%) and managed by compression and bed rest. Small hematomas, 1 to 2 cm in diameter, were noted in nine patients (2.6%). A large hematoma requiring blood transfusion and surgical intervention developed in a patient (0.3%) who was obese and had uncontrolled hypertension.
Conclusion: Early ambulation after coronary interventions using a 6-F sheath through the femoral route and low-dose procedural heparin and subcutaneous low-molecular-weight heparin one hour after sheath removal is associated with an acceptable rate of insertion site complications.

4. The relationship between metabolic syndrome and TIMI risk score in nondiabetic patients with acute coronary syndrome
Zekeriya Nurkalem, Ahmet Lütfü Orhan, Ahmet Taha Alper, Nevzat Uslu, Hüseyin Aksu, Muhammed Gürdoğan, İrfan Şahin, Betül Erer, Şevket Görgülü, Mehmet Eren
Pages 231 - 236
Objectives: We compared fasting and postprandial glycemia levels and their correlation with the TIMI risk score in nondiabetic patients with metabolic syndrome (MS).
Study design: The study included 73 consecutive nondiabetic patients (9 women, 64 men; mean age 58±11 years) who were admitted with unstable angina pectoris and acute myocardial infarction without ST elevation. TIMI risk scores were calculated on admission and coronary angiographies were evaluated. Prior to discharge, fasting glucose levels and lipid parameters were estimated and oral glucose tolerance test (OGTT) was performed. The presence of metabolic syndrome was determined in two ways: first using the ATP III criteria, and then using the same criteria, but with impaired glucose tolerance (GT) instead of impaired fasting glucose.
Results: According to the ATP III criteria, MS was diagnosed in 30 patients (41.1%). The mean TIMI risk score in these patients was higher than that of patients without MS, but this did not reach a significant level (p=0.052). When impaired GT was included into the MS criteria instead of impaired fasting glucose, the number of patients with MS increased to 34 (46.6%), at which time the mean TIMI risk score showed a significant rise in the MS group (p=0.017). In multivariate analysis, the number of stenotic vessels (OR 3.02, p=0.02, 95% CI: 1.91-7.64) and postprandial glucose level (OR 1.040, p<0.001, 95% CI: 1.018-1.063) were found as independent predictors of a high TIMI risk score.
Conclusion: The incidence of MS is considerable in nondiabetic patients with acute coronary syndrome. The use of impaired GT instead of fasting glucose for the diagnosis of MS results in a better correlation with the TIMI risk score.

5. The effectiveness of intraventricular pulsed Doppler E-wave dispersion in assessing diastolic functions of patients with atrial fibrillation
Eyüp Aygül, Özcan Yılmaz, Mustafa Yazıcı, Korhan Soylu, Firdovsi İbrahimov, Muharrem Arslandağ, Sabri Demircan, Osman Yeşildağ
Pages 237 - 241
Objectives: We investigated the effectiveness of intraventricular E-wave dispersion in assessing diastolic functions in patients with atrial fibrillation.
Study design: The study included 51 patients (32 females, 19 males; mean age 66±10 years) with atrial fibrillation. The patients were divided into two groups according to the presence (n=31; 60.8%) or absence (n=20; 39.2%) of diastolic dysfunction defined by propagation velocities (Vp) of <0.45 m/s and ≥0.45 m/s, respectively, determined by color M-mode Doppler echocardiography. Regional peak E-wave velocities were measured with pulsed wave Doppler echocardiography at every 1 cm from the mitral valve annulus to the left ventricular apex.
Results: The highest and the lowest E-wave velocities were measured at E1 position (E velocity at 1 cm) and at E3 position (E velocity at 3 cm) in both groups, respectively. E2 and E3 velocities were significantly lower in patients with diastolic dysfunction (p<0.01 and p<0.001, respectively). It was noted that, in patients without diastolic dysfunction, the E-wave velocity measured at the mitral annulus was preserved even 3 cm away from the annulus in the left ventricular cavity (E0: 0.93±0.21 m/sec, E3: 0.87±0.25 m/sec; p=0.166). In contrast, regional E-wave velocities decreased significantly toward the apex in patients with diastolic dysfunction (E0: 0.87±0.20 m/sec, E3: 0.66±0.18 m/sec; p<0.001).
Conclusion: Our results demonstrate that intraventricular E-wave dispersion may be helpful in determining diastolic dysfunction in patients with atrial fibrillation.

CASE REPORT
6. A case of ranitidine-induced bradycardia
Mehmet Uzun, Ufuk Dizer, Mehmet Yokuşoğlu, Mehmet Cem Başel
Pages 242 - 245
Ranitidine, a selective histamine-2 antagonist, may seldom cause bradycardia. A 28-year-old male patient was admitted with high fever, nausea, vomiting, headache, and joint tenderness. He was conscious and in good general status. His temperature was 38.4 °C, pulse rate was 84/min, and blood pressure was 100/60 mmHg. He had a history of vasovagal syncope. Treatment was instituted for infection and fever. His temperature became normal on the second day. On the third day, the patient complained of stomach ache. Intravenous ranitidine was administered on the fourth day, after which heart rate decreased to 30/min. His temperature was 36.4 °C and blood pressure was 110/70 mmHg. Electrocardiographic (ECG) monitoring was instituted in the intensive care unit, at which time he was in sinus rhythm with a heart rate of 34/min. During ECG monitoring heart rate ranged from 28/min to 35/min. Upon discontinuation of ranitidine, heart rate returned to normal on the ninth day.

7. Surgical repair of a giant internal carotid artery aneurysm using a jugular venous double layer patch
Bilal Boztosun, Ali Fedakar, Hasan Sunar, Cevat Kırma
Pages 246 - 249
Aneurysms of the extracranial carotid arteries are uncommon vascular lesions. We report a case of giant extracranial internal carotid artery aneurysm and its repair with an autogenic double layer jugular venous patch. A 46-year-old female patient had a growing mass in her neck for two years. On physical examination, a pulsatile mass was palpated under the sternocleidomastoid muscle between the mandibular angle and the mastoid process. Angiographic examination showed a saccular aneurysm of the internal carotid artery, measuring 6x8 cm, starting 1 cm after the carotid artery bifurcation and ending at the cranial base. The sac was not completely excised to avoid damage to the vagus and ansa cervicalis nerves which were attached to the aneurysmal sac. Then, a double layer jugular venous patch was sutured to the defect on the vessel wall. On control examinations in the first postoperative month, the patient had no complaints and normal blood flow pattern was observed in Doppler ultrasonography and control angiography. Partial aneurysmectomy with double layer venous patch repair is an appropriate alternative in extracranial internal carotid artery aneurysms with cranial nerve attachment to the aneurysmatic sac.

8. Dual left anterior descending coronary artery: a rare coronary anomaly
Enbiya Aksakal, Mustafa Kemal Erol, Mecit Kantarcı
Pages 250 - 252
Dual left anterior descending artery (LAD) originating from the left and right coronary arteries is an extremely rare congenital coronary artery anomaly. A 65-year-old male patient was admitted with inferior acute myocardial infarction. Coronary angiography showed normal left main coronary artery, a short LAD artery terminating proximally after bifurcating a few diagonal branches, and total occlusion of the proximal left circumflex artery. Selective right coronary angiography showed a vessel arising just after the origin of the right coronary artery, travelling to the left side. Primary angioplasty and stent implantation were successfully performed. The origin and course of the anomaly was also documented by 16-slice multidetector spiral computed tomography, which confirmed angiographic findings.

REVIEW
9. Coronary flow reserve and fractional flow reserve
Ali Özyol, Mehmet Birhan Yılmaz
Pages 253 - 261
Coronary flow reserve (CFR) and fractional flow reserve (FFR) are two methods used to provide information for functional significance of coronary artery stenosis. Despite having some limitations, both parameters not only designate severity of stenosis but also provide prognostic information when they are used within appropriate indications. In this review, invasive CFR and FFR measurements were revisited in parallel to improvements in revascularization technologies, with an emphasis on their guiding role in borderline lesions.

CASE IMAGE
10. Isolated left ventricular diverticulum in an adult
Cihan Duran, Murat Şener, Demet Erciyes, Murat Gülbaran
Page 262
Isolated left ventricular diverticulum is a rare cardiac anomaly.It’s classified into two groups as muscular and fibrous. There is still not a consensus about its classification. Usually patients are asymptomatic however some may chest pain, and dispnea symptoms. Ventricular diverticulum may cause ventricular arrhythmias, heart failure, and systemic embolization. These patients are diagnosed by angiography, echocardiography, cardiac magnetic resonance and computerized tomography (CT).Our case has admitted to our center with atypical chest pain, and he was evaluated by multislice CT with suspicion of coronary artery disease. Isolated left ventricular diverticulum located at inferoseptal wall was demonstrated during this evaluation.

OTHER ARTICLES
11. Answers of specialist
Ahmet Vural, Enis Oğuz, Alpay Çeliker
Pages 264 - 265
Abstract |Full Text PDF

12. Comment on cardiology publications
Ertan Ural
Page 267
Abstract |Full Text PDF



Journal Metrics

Journal Citation Indicator: 0.18
CiteScore: 1.1
Source Normalized Impact
per Paper:
0.22
SCImago Journal Rank: 0.348

Quick Search



Copyright © 2025 Archives of the Turkish Society of Cardiology



Kare Publishing is a subsidiary of Kare Media.