Objectives: We investigated the incidence, prevalence, and mortality of chronic atrial fibrillation (AF) in Turkish adults.
Study design: In a prospective and cross-sectional design, we analyzed 3,450 eligible participants (1707 men, 1743 women; mean age 52±13 years) of the Turkish Adult Risk Factor Study, who had been surveyed until 2006/07. Those who were dead and were found to have AF at baseline were excluded in the estimation of AF prevalence and incidence, respectively.
Results: Atrial fibrillation was determined in 67 participants. The total follow-up was 34,100 person-years (mean 9.9 years). There were 43 prevalent and 46 incident cases, which corresponded to 1.25% and 1.35 per 1000 personyears, respectively. For age brackets of 32-59, 60-69, and ≥70 years, the prevalence rates were 0.46%, 2.09%, and 2.49%, and the incidence rates were 0.31, 1.98, and 3.50 per 1000 person-years, respectively. Both were higher in women of all age groups, with female-to-male ratios for overall prevalence and incidence being 1.69 and 1.19, respectively. Survival after onset of AF was 5 to 9 years and overall mortality was 6.8 per 100 person-years. Hypertension was the most common cause of AF, followed by advanced age. Contrary to expectations, waist circumference of men with AF was smaller by 1.9 cm than that of women. Serum C-reactive protein levels in men with AF (mean 1.21 mg/l) were significantly lower than women with AF (mean 2.62 mg/l) and than males without AF (mean 1.78 mg/l).
Conclusion: In Turkish adults, the current incidence and prevalence of chronic AF can be extrapolated to be 35,000 per year (22,000 in women) and 310,000 (200,000 in women), respectively. Considering the low incidence in males, it seems that inflammatory processes may play a minor role in the development of AF in Turkish men.

Objectives: We evaluated the effect of baseline pulmonary artery pressure (PAP) on right ventricular functions after percutaneous mitral balloon valvuloplasty (PMBV) for rheumatic mitral stenosis (MS).
Study design: The study included 56 patients (15 males, 41 females; mean age 35 years) who underwent PMBV for isolated rheumatic MS. The patients were divided into two groups according to the baseline median systolic pulmonary artery pressure (PAP ≥40 mmHg, n=33; PAP <40 mmHg, n=23) measured before PMBV by echocardiography. Right ventricular function was assessed by pulse wave Doppler tissue imaging and the Tei index. Assessments were repeated 48 hours and three months after PMBV.
Results: The peak systolic (S) velocity of the lateral tricuspid annulus did not differ between the two groups at baseline. In patients with pulmonary artery hypertension (PAH), it showed a slight increase at 48 hours, but fell behind the baseline at three months. In patients without PAH, it showed a significant increase at 48 hours and remained unchanged at three months. Peak late diastolic (A) velocities were significantly higher at all times in patients without PAH. Patients with PAH had a significantly higher E/A ratio both at baseline and at 48 hours; however, at three months, this difference disappeared. Patients with PAH had higher isovolumic relaxation time (IVRT) at baseline and 48 hours; however, final IVRT was lower than the baseline only in patients with PAH. Isovolumic contraction time showed a steady but insignificant increase in both groups over three months. E-wave deceleration time showed a significant increase and contraction time showed a slight increase over three months only in patients with PAH. The baseline Tei index was higher in patients with PAH (p=0.004). Changes in the Tei index over time were not significant.
Conclusion: Our findings suggest that, If PMBV is performed before the development of PAH, it may be more effective in the improvement of right ventricular longitudinal functions in patients with rheumatic MS.

Objectives: We assessed lymphocyte DNA damage and total antioxidant status (TAS) in patients with white-coat hypertension (WCH) and sustained hypertension (SHT).
Study design: The study included 23 patients (14 females, 9 males; mean age 46±6 years) with WCH, 21 patients (13 females, 8 males; mean age 45±7 years) with newly diagnosed SHT, and 19 age- and sex-matched healthy volunteers as controls. All subjects underwent echocardiographic examination, office blood pressure measurements, and 24-hour ambulatory blood pressure monitoring. DNA damage was assessed by the alkaline comet assay in peripheral lymphocytes, and plasma TAS levels were determined using an automated measurement method.
Results: The two hypertensive groups had similar echocardiographic measurements and office systolic and diastolic blood pressures. The mean daytime and nighttime pressures were significantly higher in the SHT group (p<0.05). Patients with WCH had similar daytime and nighttime pressures compared to the controls (p>0.05). Patients with SHT had significantly increased lymphocyte DNA damage (p<0.001, for both WCH and control groups) and decreased TAS level (p=0.012 vs WCH group; p<0.001 vs controls). Patients with WCH did not differ significantly from the control group with regard to lymphocyte DNA damage (p=0.052), but had significantly lower TAS levels (p<0.001). In the SHT group, lymphocyte DNA damage was correlated with TAS (r= -0.818, p<0.001), age (r=0.453, p=0.039), total cholesterol (r=0.550, p=0.010), and LDL-cholesterol (r=0.539, p=0.012). In multiple linear regression analysis, lymphocyte DNA damage was independently correlated with serum TAS level (ß= -0.717, p<0.001). In the WCH group, lymphocyte DNA damage was only correlated with serum TAS level (r= -0.458, p=0.028).
Conclusion: Decreased TAS showing increased oxidative stress and increased lymphocyte DNA damage may contribute to target organ damage in patients with WCH.

Objectives: We compared brachial artery blood pressures (BP) measured by aneroid sphygmomanometer with ascending aortic blood pressures and evaluated the factors affecting the differences between the two methods.
Study design: The study included 463 patients (177 women, 286 men; mean age 60±11 years) undergoing routine coronary angiography. Simultaneously, ascending aortic pressures were measured using a pigtail catheter and brachial artery pressures were measured from the right arm with an aneroid sphygmomanometer. Pulse pressure, fractional pulse pressure, and pulsatility index were calculated from systolic and diastolic BP values.
Results: Overall, systolic (-3.1±10 mmHg) and diastolic (+3.0±7.1 mmHg) brachial pressures showed significant deviations from aortic pressures (p=0.001). Although systolic BP did not differ significantly in both methods for men and women, brachial diastolic BP was significantly different in women (+4.8 mmHg, p=0.0001). Brachial diastolic BP showed a greater deviation from the aortic diastolic pressure in patients ≥60 years of age (+4.5 mmHg and +1.1 mmHg, respectively; p=0.0001). Deviation of systolic BP in hypertensive patients (-4 mmHg) was greater than that in normotensives (-2.0 mmHg, p=0.04). Deviation of brachial systolic BP was highly correlated with increases in aortic systolic pressure (p=0.0001). Differences between the two methods in systolic (-5.8 mmHg, p=0.01) and diastolic (+4.2 mmHg, p=0.03) BP were significant in patients with coexisting diabetes and hypertension. Body mass index and arm circumference were not correlated with deviations between the two methods.
Conclusion: The main factors (female gender, age, hypertension, diabetes) affecting BP differences between the two methods should be considered in clinical practice. Key words: Aorta; blood pressure; blood pressure determination/ methods; brachial artery; hypertension; sphygmomanometers.

Objectives: We evaluated the effect of carvedilol, a nonselective beta-blocker with vasodilating action, on coronary flow reserve (CFR) in patients with idiopathic dilated cardiomyopathy (IDC).
Study design: Twenty-four patients (17 males, 7 females; mean age 57±11 years) with IDC were consecutively enrolled. After obtaining clinical and hemodynamic stabilization, transthoracic echocardiography was performed including CFR measurement and carvedilol therapy was initiated with 3.125 mg twice daily and titrated to a target dose of 25 mg twice daily. Twenty-three patients reached the target dose in a mean of 11±3 weeks. The mean duration of carvedilol therapy was 19±3 weeks, after which echocardiography was repeated and findings were recorded at baseline and after dipyridamole infusion. Clinical and echocardiographic findings were compared with those of 23 age- and sex-matched patients (13 males, 10 females; mean age 55±4 years) with atypical chest pain.
Results: Compared to the control group, left ventricular end-diastolic and end-systolic volumes, left ventricular mass index, and isovolumic relaxation time were significantly higher and ejection fraction was significantly lower in the IDC group. Before carvedilol therapy, patients with IDC had a significantly higher baseline diastolic peak flow velocity (DPFV) and a significantly lower CFR; however, hyperemic DPFV was similar in the two groups. After carvedilol therapy, left ventricular end-systolic volume decreased significantly and ejection fraction increased significantly. Decreases in baseline DPFV and hyperemic DPFV were slight and there was no improvement in CFR. Even after elimination of the confounding effect of ratepressure product using analysis of covariance, pre- and post-treatment CFR remained similar.
Conclusion: Carvedilol therapy does not improve coronary microvascular functions in patients with IDC.

We report an extremely rare case of cystic-tumor like formations that originated from the mitral valve tissue affected by verrucous endocarditis, leading to floppy mitral valve syndrome. These cystic tumoral formations were discovered during two-dimensional echocardiographic examination of a 46 year-old woman with cardiac symptoms of palpitation, dyspnea, and exertional angina pectoris. Multiple cysts were attached to the anterior mitral leaflet, resulting in pansystolic pseudoparachute-like floppy mitral valve prolapse, and severe mitral regurgitation. The patient underwent prosthetic mitral valve replacement following removal of the mitral valve and multiple cystic-tumoral formations. She had an uneventful postoperative course. Histological diagnosis was diffuse angiomatous cystic development of vasculatory tumor-like structures due to verrucous endocarditis.

A 37-year-old man presented with complaints of palpitation and fatigue. Physical examination and laboratory findings were normal except for moderately elevated erythrocyte sedimentation rate (52 mm/hr). Transthoracic echocardiography revealed an extremely mobile mass in the left atrium, 6.5 x 1.5 cm in size, with a fragmented distal portion. It arose from the superior part of the interatrial septum and, in each cardiac cycle, was moving into the left ventricle through the mitral valve. Transesophageal echocardiography showed that the mass was attached with a thin pedicle to the posterosuperior part of the interatrial septum, close to the right upper pulmonary vein. The mass was surgically excised and histopathologic diagnosis was myxoma.

Cor triatriatum sinister is a rare congenital cardiac anomaly in which the left atrium is divided into two chambers by a fibromuscular septum. Although the disease is generally diagnosed in early childhood, some patients remain asymptomatic until adulthood. A 19-year-old female patient presented with dyspnea that increased in severity for the past year. Her functional capacity was NYHA class II. She had no other complaints in history. Cardiac auscultation revealed a grade 2/6 apical diastolic murmur. Findings of electrocardiography and chest radiography were normal. Transthoracic echocardiography showed a thin membrane dividing the left atrium, but no transmembrane flow was visualized. The flow could be visualized by transesophageal echocardiography, but the area of membrane fenestration could not be determined. The diagnosis was made as cor triatriatum sinister and the patient underwent cardiac catheterization, which revealed a pressure gradient of 10 mmHg between the pulmonary capillary wedge pressure and left ventricular end-diastolic pressure. The patient was submitted to surgical correction.

Atrioventricular (AV) block is rare in patients with rheumatoid arthritis (RA), but it is usually of complete type. A 55-year-old woman had complaints of fatigue, dizziness, and light-headedness, all of a week history. She had been receiving treatment for RA for about six years, and had been on methylprednisolone 5 mg/day for a year. On physical examination, her heart rate was 32 bpm, blood pressure was 160/80 mmHg. She had a grade 1-2/6 apical systolic ejection murmur. The electrocardiogram showed complete AV block. Transthoracic echocardiography showed grade I mitral regurgitation. No rheumatoid nodule was noted on transesophageal echocardiography. Coronary arteries appeared normal on coronary angiography. A temporary pacemaker was implanted in the coronary care unit, after which complete AV block improved to a second-degree Mobitz type II block. Her heart rate was 45 bpm. As no further improvement was observed in the AV block during a 10-day monitoring, she underwent DDD-R permanent pacemaker implantation.

A 56-year-old woman presented with a complaint of dyspnea on minimal exertion for the past two months and orthopnea of three-day history. She was first examined at another hospital two years before for nonproductive cough, for which computed tomography was performed that showed a right pulmonary mass. The patient refused further evaluation and treatment at that time. Transthoracic echocardiography revealed a large mass filling the entire left atrium via the inferior pulmonary vein and causing mitral flow obstruction during diastole. Computed tomography of the thorax showed a large mass filling the entire right lower lobe, which occluded the right lateral lobe superior segmental bronchus and obliterated the lower lobe segment bronchi. As the patient was severely symptomatic, she underwent right lower and middle lobectomy and left atrial mass resection, based on the decision of the surgery council. The pathological examination of the specimens from both atrial and pulmonary masses revealed pulmonary large cell carcinoma. The patient died due to cardiopulmonary arrest on the postoperative 20th day.

Cardiac troponins (cTn) are highly sensitive and specific markers of myocardial injury. Elevated cTn levels have considerable significance in both prognosis and guidance of the therapy of acute coronary syndrome. Thus, cTn measurements are commonly utilized in coronary care units and emergency departments to diagnose acute coronary syndrome. However, it must be considered that cTn elevations may be seen in many diseases other than acute coronary syndrome. In this article, we reviewed the clinical syndromes associated with elevated cTn levels.