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Anatol J Cardiol: 10 (2)
Volume: 10  Issue: 2 - April 2010
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EDITORIAL
1.Our summer school, dedicated referees, and unlucky scientists
Bilgin? Timuralp
PMID: 20382604  doi: 10.5152/akd.2010.030  Page 97
Abstract | Full Text PDF

ORIGINAL INVESTIGATION
2.The effect of anti-tumor necrosis factor (TNF)-alpha therapy with etanercept on endothelial functions in patients with rheumatoid arthritis tedavisinin endotel fonksiyonları üzerine etkisi
Hakan Tıkız, Özlem Arslan, Timur Pırıldar, Canan Tıkız, Petek Bayındır
PMID: 20382605  doi: 10.5152/akd.2010.031  Pages 98 - 103
Objective: To investigate the effects of tumor necrosis factor (TNF)-α antagonism with etanercept (ENC) on endothelial functions in patients with active rheumatoid arthritis (RA). Methods: A total of 21 patients with RA were enrolled in this prospective study. Eleven of them (8 women, 3 men mean age 47.0±10.1 years) with high disease activity despite the conventional treatment were assigned to Group 1 and were given ENC treatment twice a week (25 mg SC injection) for 12 weeks. Ten patients with RA (8 women, 2 men mean age 55.0±6.4 years) under conventional methotrexate and prednisone therapy were assigned as Control group (Group 2). Endothelium-dependent and -independent vasodilator responses of the brachial artery were assessed by high-resolution ultrasound. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were also measured at baseline and at the post treatment period. Mann-Whitney U and Wilcoxon tests were used to compare the data and correlation analysis was performed using Pearson correlation test. Results: Endothelium-dependent vasodilatation improved from 5.2±0.8% to 7.9±1.3% (p=0.04) in ENC group, while no significant change was observed in the control group (from 6.6±1.1% to 7.0±1.8% p=0.67). No significant changes were found in endothelium-independent vasodilatation and baseline brachial artery diameters in both groups. A significant reduction in ESR and CRP were observed in patients receiving ENC (from 16.2±6.8 to 9.2± 5.1 mm/h, p=0.003 and from 14.68±3.4 to 9.25± 3.7 mg/L, p=0.003, respectively). Conclusion: Treatment with ENC for 12 weeks significantly improved endothelial function in patients with active RA compared to those under conventional therapy. The findings of the present study support the hypothesis that the use of TNF-α blockers in patients with active RA may reduce the high incidence of cardiovascular complications.

3.Cardiac autonomic responses to exercise testing in patients with chronic obstructive pulmonary disease
Deniz İnal İnce, Sema Savcı, Hülya Arıkan, Melda Sağlam, Meral Boşnak Güçlü, Lale Tokgözoğlu, Lütfi Çöplü
PMID: 20382606  doi: 10.5152/akd.2010.032  Pages 104 - 110
Objective: Incremental exercise testing is used to evaluate exercise intolerance in patients with chronic obstructive pulmonary disease (COPD). The purpose of this cross-sectional, observational study was to compare cardiac autonomic responses of patients to exercise testing with healthy subjects and to investigate their determinants. Methods: Twenty-five COPD patients and 20 healthy subjects participated in the study. Pulmonary function test, arterial blood gas analysis and exercise test were performed. Heart rate, blood pressure and dyspnea were measured before and after the test. Peak oxygen uptake, chronotropic index and heart rate recovery were recorded. Dyspnea perception during daily activities was measured using the modified Medical Research Council dyspnea scale. Student t test, Mann Whitney u test, Spearman correlation coefficients and multiple linear regression analysis were used for statistical analysis. Results: Peak heart rate, chronotropic index and peak oxygen uptake were significantly lower and exercise dyspnea perception was significantly higher in COPD patients than those of healthy subjects (p<0.05). Forty-eight percent of patients had chronotropic incompetence. Body weight and body mass index of these patients were significantly higher than in those with normal chronotropic response (p<0.05). Baseline, peak and recovery heart rate were significantly lower in patients with chronotropic incompetence (p<0.05). Modified Medical Research Council dyspnea score explained 44% of the variance in chronotropic index (r=0.66; r2=0.44, F (1, 16) =12.46, p=0.003). Conclusion: Chronic obstructive pulmonary disease patients had chronotropic incompetence to maximal volitional exercise. Dyspnea perception during daily activities is an important determinant of chronotropic incompetence. Effects of desensitization of dyspnea on sympathetic system activation in COPD should be investigated.

4.Frequency and affecting factors of metabolic syndrome in women older than 20 years of age
Yeter Kitiş, Naile Bilgili, Filiz Hisar, Sultan Ayaz
PMID: 20382607  doi: 10.5152/akd.2010.033  Pages 111 - 119
Objective: Metabolic syndrome (MetS) is a major cause of morbidity and mortality affecting increasing number of people. This was a cross-sectional study aiming to identify the prevalence of MS and risk factors in women aged 20 years and older. Methods: Study’s universe consisted of women aged 20 years and older living in Gölbaşı Ali Soydan Health Centre’s territory. Eight hundred fifty women were accessed among them. Data were collected by a questionnaire. Measurements were done in the health centre following fasting 12 hours. One way ANOVA, correlation and logistic regression analyses were used for statistical analysis. Results: The mean age was 39.4 years, 62% have primary school education. Prevalence of MetS was found 39.1%; low high-density lipoprotein (HDL) and abdominal obesity were the most common MetS components. On the contrary, education and age had negative correlation with HDL and positive correlation with other MetS components. Age (OR=1.091; 95%CI = 1.071-1.110; p<0.0001), and education lower than middle school (literate OR=2.491; 95%CI = 1.334-2.855; p=0.007; primary school OR=1.841; 95%CI 1.281-2.855; p=0.006) were found to increase MetS risk. Conclusion: Even more than half of our study group who has urban life style has two or more MetS components. Because of older age, accelerant factor for MetS, improving of healthy lifestyle behaviors in study group with genetic and environmental risk factors should be primary goal in terms of prevention of cardiovascular diseases and diabetes.

EDITORIAL COMMENT
5.Metabolic syndrome: importance and prevention
Hüseyin Bozbaş
PMID: 20382608  doi: 10.5152/akd.2010.034  Page 120
Abstract | Full Text PDF

ORIGINAL INVESTIGATION
6.Is there any relation between coronary atherosclerosis and tympanosclerosis?
Dilek Çiçek, Yusuf Vayisoğlu, Kemal Görür, Ahmet Çamsarı, Türkay Özcan, Burak Akçay, Asuhan Aksoy Kara
PMID: 20382609  doi: 10.5152/akd.2010.035  Pages 121 - 125
Objective: Atherosclerosis is a chronic inflammatory disease of medium and large-sized arteries. Tympanosclerosis is the hyalinization and calcification of the connective tissue in the middle ear, including the tympanic membrane. The etiology and pathogenesis of tympanosclerosis are still controversial. There are some reports about the possible relationship between development of tympanosclerosis and atherosclerosis. Therefore, we aimed a cross-sectional study to investigate relationship between tympanosclerosis and atherosclerosis in patients referred for coronary angiography. Methods: The study population consisted of 203 consecutive patients (145 men, mean age 59±11years) who underwent coronary angiography. Otoscopic examination was performed in all patients. All angiographies were examined to calculate coronary artery vessel stenosis and extent scores. Mann-Whitney U test was used to compare the angiographic scores with existence of tympanosclerosis. Results: Among the 203 patients, 35 (17%) patients had angiographically normal coronary arteries without any atheroma plaque and 168 (83%) had coronary atherosclerosis. In the otoscopic examination, tympanosclerosis was found in 14 patients (6.9%). No significant differences in distribution of clinical atherosclerotic risk factors (age, gender, body mass index, hypertension, diabetes mellitus, cigarette smoking and cholesterol levels) were found between groups with and without tympanosclerosis. Tympanosclerosis was found in 4 patients with normal coronary arteries (11.4%). In the group of coronary atherosclerosis, 10 patients have tympanosclerosis (5.9%). In addition, there was no statistically significant association of coronary artery vessel, stenosis or extent scores of atherosclerosis with tympanosclerosis (p>0.05). Conclusions: We could not find any association between tympanosclerosis and angiographic extent and severity of atherosclerosis, contrary to other studies. More studies are needed to understand etiological mechanisms and association between them.

7.Which parameters describe the electrophysiological properties of successful slow pathway RF ablation in patients with common atrioventricular nodal reentrant tachycardia?
Gerardo Nigro, Vincenzo Russo, Anna Rago, Annabella de Chiara, Raffaele Chianese, Nadia Della Cioppa, Raffaele Calabrò
PMID: 20382610  doi: 10.5152/akd.2010.036  Pages 126 - 129
Objective: Atrioventricular nodal reentrant tachycardia (AVNRT) accounts for about 60% of the patients presenting with paroxysmal supraventricular tachycardia. The radiofrequency (RF) catheter ablation of the slow atrioventricular (AV) node pathway is the preferred therapeutic approach in patients with AV node reentrant tachycardia. The aim of our study was describe the electrophysiological properties of successful slow pathway RF ablation in patients with common atrioventricular nodal reentrant tachycardia. Methods: The study design was a retrospective analysis involving fifty consecutive patients (18 males; mean age of 39±22 years) who underwent slow pathway ablation because of AVNRT. Results: Slow junctional beats with a cycle length longer than 550 ms were observed in 39 patients (79%); the presence of rapid junctional beats with a cycle length less than 550 ms was showed in 5 patients (10%). Moreover, in 32 of 50 patients (65%) duration of atrial electrogram more than 40 ms was noticed. Analyzing data reported, we found the statistically significant presence of slow junctional beats (p<0.001) and atrial electrogram >40 ms (p<0.05) in successful RF ablation procedures. Conclusion: In patients with AVNRT undergoing slow pathway ablation, the duration of atrial electrogram >40 ms and slow junctional beats with cycle length >550 ms during the application of RF energy describe the electrophysiological properties of successful slow pathway RF ablation.

8.Retrospective analysis of 1650 permanent pacemaker implantations experience over two different consecutive time periods in a single cardiology clinic
Serdar Bayata, Murat Yeşil, Erdinç Arıkan, Nurşen Postacı, Rida Berilğen, Özgür Ceylan, Eyüp Avcı
PMID: 20382611  doi: 10.5152/akd.2010.037  Pages 130 - 134

EDITORIAL COMMENT
9.Does our permanent pacemaker implantation practice change?
Fethi Kılıçaslan
PMID: 20382612  doi: 10.5152/akd.2010.038  Pages 135 - 136
Abstract | Full Text PDF

ORIGINAL INVESTIGATION
10.Association between renin-angiotensin-aldosterone system blockers and postoperative atrial fibrillation in patients with mild and moderate left ventricular dysfunction
Mehmet Özaydın, Ercan Varol, Yasin Türker, Oktay Peker, Doğan Erdoğan, Abdullah Doğan, Erdoğan İbrişim
PMID: 20382613  doi: 10.5152/akd.2010.039  Pages 137 - 142
Objective: The aim of the study was to evaluate the association between renin - angiotensin - aldosterone system blockers and risk of postoperative atrial fibrillation (AF) development in patients with mild and moderate left ventricular systolic dysfunction. Methods: The population of this prospective and observational study consisted of 269 patients with an ejection fraction of ≤ 50% undergoing coronary artery bypass and/or valve surgery. Use of renin -angiotensin-aldosterone system blockers (angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB) and spironolactone) and their association with postoperative AF (AF episode lasting > 5 min) were evaluated. In statistical analysis t test for independent samples, Chi-square test and Mann Whitney U test were used for comparison of variables between groups. Predictors of postoperative AF were determined by multiple logistic regression analysis. Results: During follow-up, 50 patients (13%) developed postoperative AF. With multiple logistic regression analysis, risk factors for postoperative AF were determined: left atrial diameter (OR- 1.09; 95%CI 1.01-1.16, p=0.02), age (OR-1.04; 95%CI 1.002- 1.08, p=0.04), aortic cross-clamp duration (OR- 1.03, 95%CI -1.00-1.05, p=0.01), use of left internal mammarian artery (OR-0.33; 95%CI 0.13-0.88, p=0.03), ACEIs treatment (OR-0.27; 95%CI 0.12-0.62, p=0.002), and ARBs treatment (OR - 0.21, 95%CI 0.07-0.62, p=0.005). Conclusions: Our results indicate that although treatments with ACEIs and ARBs are associated with low incidence of postoperative AF in patients with mild and moderate left ventricular systolic dysfunction, treatment with spironolactone is not.

11.The relationship between B-type natriuretic peptide levels and echocardiographic parameters in patients with heart failure admitted to the emergency department
Evvah Karakılıç, Alper Canbay, Gülcan Abalı, Figen Coşkun, Mahir Kunt, Lale Tokgözoğlu
PMID: 20382614  doi: 10.5152/akd.2010.040  Pages 143 - 149
Objective: Brain natriuretic peptide (BNP) is a peptide, which has recently been used in the differential diagnosis and follow-up of patients with heart failure. Our aim in the present prospective and diagnostic designed study is to investigate the role of BNP in determining the etiology of dyspnea and to evaluate its relation with newer echocardiographic parameters. Methods: Thirty-four patients presenting to the emergency department with dyspnea and fulfilling the Framingham criteria for heart failure were included in the study. Blood samples were obtained in the first hour of presentation for measurement of BNP levels from all patients. Detailed transthoracic two-dimensional, Doppler and tissue Doppler echocardiographic studies were then performed within 24 hours of presentation. Statistical analyses were performed using Student’s t-test for independent samples, Mann Whitney U test and Pearson or Spearman correlation tests. Results: Plasma BNP levels were found to be significantly correlated with left ventricular end-systolic and end-diastolic diameter, left atrial diameter and the degree of mitral insufficiency (r=0.46, p=0.007; r=0.39, p=0.02; r=0.32, p=0.065; r=0.50, p=0.014, respectively). A significant inverse correlation was observed between plasma BNP levels and left ventricular ejection fraction (r=-0.5, p=0.003). When the patients were grouped according to their BNP levels, the mean ejection fraction of the group with BNP levels below median (578 pg/l) was 60.65±13.84%, whereas the mean ejection fraction of the group with BNP levels of 578 pg/l or above (BNP 2) was 49.41±15.26% (p=0.027). Out of parameters reflecting left ventricular diastolic functions, only transmitral Epeak/Apeak ratio was found to be significantly associated with BNP levels (r=0.4, p=0.05). Tissue Doppler study revealed significant correlations between BNP levels and right ventricular basal and midsystolic velocities (r=-0.507, p=0.008; r=-0.562, p=0.005, respectively) while none of the left ventricular tissue velocities displayed significant correlation with BNP values. Conclusion: Plasma BNP levels are found to be significantly associated with conventional echocardiographic parameters reflecting left ventricular systolic and diastolic functions and tissue Doppler velocities reflecting right ventricular functions. Our findings are in agreement with the notion that plasma BNP levels are beneficial in the differential diagnosis of patients admitted to emergency service with acute dyspnea.

12.Echocardiographic evaluation of systolic and diastolic heart function in patients suffering from beta-thalassemia major aged 5-10 years at the Zahedan Research Center for Children and Adolescent Health
Noor Mohammad i, Semira Mehralizadeh
PMID: 20382615  doi: 10.5152/akd.2010.041  Pages 150 - 153
Objective: Cardiac complications are the major cause of morbidity and mortality in beta-thalassemia major. The aim of the study was to evaluate right (RV) and left (LV) ventricular systolic and diastolic functions using myocardial performance index in young, asymptomatic children suffering from thalassemia major, for early detection of cardiac function impairment, preventing further cardiac damage by modifying disease progression and treatment. Methods: A case-controlled, cross-sectional study involving 80 patients suffering from beta- thalassemia major and 80 children adjusted in terms of age and sex served as a control group were studied in Research Center for Children and Adolescent Health Zahedan. The relevant echocardiographic parameters were measured in both subject groups: myocardial performance index (MPI), isovolumic relaxation time (IRT), isovolumic contraction time (ICT), pre-ejection period (PEP), ejection time (ET), PEP/ET ratio, deceleration time (DT) and acceleration time (AT). Data were analyzed by unpaired Student t test. Results: The left ventricular mean IRT in the patient group was 114±21 and in the control group 94±10 msec (p<0.05). The mean MPI (LV) in the patient group was 0.58±0.18 and in the control group 0.41±0.08 (p<0.05). The mean ET (LV) in the patient group was 237±36 msec and in the control group 266±25 msec (p<0.05). The mean ET (RV) in the patient group was 237±39 msec and in the control group 261±36 msec (p<0.05). Conclusion: There is an early systolic and diastolic dysfunction in children younger than 10 years with beta-thalassemia major. Even in young asymptomatic children with beta-thalassemia major, serial echocardiography seems warranted in order to adjust cardioprotective therapy.

13.The role of dobutamine stress echocardiography in early diagnosis of cardiac toxicity in long-term survivors of asymptomatic children treated with anthracycline
Ayşe Yıldırım, F. Sedef Tunaoğlu, Faruk Güçlü Pınarlı, Mustafa İlhan, Aynur Oğuz, Ceyda Karadeniz, Rana Olguntürk, Deniz Oğuz, Serdar Kula
PMID: 20382616  doi: 10.5152/akd.2010.042  Pages 154 - 162

14.Delayed sternal closure: an effective procedure for life-saving in open-heart surgery
Haydar Yasa, Banu Bahriye Lafçı, Levent Yılık, Mehmet Bademci, Aykut Şahin, Mert Kestelli, Murat Yeşil, Ali Gürbüz
PMID: 20382617  Pages 163 - 167
Objective: To determine the incidence, short term survival and safety of delayed sternal closure following open-heart operation due to myocardial edema, non-surgical bleeding and malignant arrhythmia. Methods: We retrospectively reviewed our medical records to identify the patients who underwent delayed sternal closure following open-heart operation and recorded morbidity, mortality postoperative complications of these patients. Among 2698 patients who underwent on- pump cardiac surgery, the sternum was left open in 46 (1.7%) patients, 31 men and 15 women, ranging in age from 2 to 73 years (mean 57.0±7.6 years). In 39 patients sternum was left opened following the initial operation and in 7 patients sternum was re-opened due to bleeding or hemodynamic instability after initial surgery. Statistical analysis was accomplished using Chi-square test, Mann Whitney U test and analysis of variances for repeated measurements. Results: The operative procedures were classified as elective in 24 (52.8%), emergency in 10 (22%), urgent in 7 (15.4%), and redo cardiac operations in 5 patients (11%). Bleeding (n=21), hemodynamic instability (n=16), arrest (n=5), and arrhythmia (n=4) were the reasons of delayed sternal closure. The patients had an open sternum for 3.48±0.35 days. Time to discharge was 21.5±1.6 days after operation and 17.6±1.6 days after sternal closure. Mortality within 30 days was 23.9% (7 patients died before closure and the remaining 4 after closure). Complications were mediastinitis (n=2), minor wound infection (n=3) and renal failure (n=5). Conclusion: Delayed sternal closure is a safe and simple method for treating bleeding, arrhythmia and myocardial edema following on pump cardiac surgery. It is anticipated that as cardiac surgeons become more familiar with the technique of delayed sternal closure, the frequency of its use following on pump cardiac surgery may increase.

REVIEW
15.Cardiovascular consequences of sleep apnea: II-Cardiovascular mechanisms
Yelda Turgut Çelen, Yüksel Peker
PMID: 20382618  doi: 10.5152/akd.2010.044  Pages 168 - 175
Obstructive sleep apnea (OSA) is a common disorder with serious cardiovascular consequences. The pathogenesis in this context is likely to be multifactorial process including large negative swings in intrathoracic pressure, intermittent hypoxemia and hypercapnia, increased sympathetic nervous system activity, vascular endothelial dysfunction, oxidative stress, systemic inflammation, excessive platelet activation as well as metabolic dysregulation. Although there is scientific support for a considerable impact of OSA on vascular structure and function, it is likely that development of cardiovascular diseases is determined by multiple genotypic and phenotypic factors. The current article focuses on the available research evidence addressing the cardiovascular mechanisms in this context.

16.A promising new inotrope: levosimendan
Hakan Fotbolcu, Dursun Duman
PMID: 20382619  doi: 10.5152/akd.2010.045  Pages 176 - 182
Intravenous positive inotropic agents are commonly used to treat the patients with acute decompensated heart failure due to left ventricular systolic dysfunction. Although these agents seem to be beneficial for improving symptoms of heart failure in the short-term; it has been reported that they are associated with increased mortality and morbidity. Levosimendan is a new calcium sensitizer and K-ATP channel opener, has emerged as an alternative option of pharmacologic inotropic support in patients with decompensated heart failure. Recent reports on levosimendan's use in severe heart failure demonstrated that this agent is more favorable drug compared with conventional inotropic agents, though its better profile in terms of myocardial efficiency has not been completely understood. This review summarizes the evidence from current scientific literature including our recent trials regarding the mechanism of action, efficiency and the use of levosimendan.

SCIENTIFIC LETTER
17.QT dispersion: Does it worsen with the increasing number of affected coronary vessels?
Wail Nammas, Osama Hassan, Amr Attia
PMID: 20382620  doi: 10.5152/akd.2010.046  Pages 183 - 184
Abstract | Full Text PDF

CASE REPORT
18.Long Eustachian valve interfering with the access to coronary sinus during biventricular pacemaker implantation
Özgül Uçar, Alper Canbay, Erdem Diker, Sinan Aydoğdu
PMID: 20382621  doi: 10.5152/akd.2010.047  Pages 185 - 186
Abstract | Full Text PDF

19.Coexistence of cor triatriatum and rheumatic mitral stenosis in an adult patient
Necla Özer, Hakan Aksoy, Onur Sinan Deveci, Erol Tülümen, Enver Atalar, Kenan Övünç, Serdar Aksöyek
PMID: 20382622  doi: 10.5152/akd.2010.048  Pages 187 - 188
Abstract | Full Text PDF

20.Adult bi-ventricular noncompaction cardiomyopathy
Giovanni Minardi, Carla Manzara, Giovanni Pulignano, Giuseppe Paolo Pino, Herribert Pavaci, Martina Sordi
PMID: 20382623  doi: 10.5152/akd.2010.049  Pages 188 - 190
Abstract | Full Text PDF

EDITORIAL COMMENT
21.Frequency of coronary artery ectasia among patients undergoing cardiac catheterization
Selahaddin Akçay, Yasin Türker, Mehmet Özaydın, Habil Yücel, Ahmet Altınbaş
PMID: 20382624  doi: 10.5152/akd.2010.050  Page 191
Abstract | Full Text PDF

E-PAGE ORIGINAL IMAGES
22.An unusual coronary artery anomaly: type IV double left anterior descending coronary artery
Serkan Çay, Ramazan Atak
PMID: 20382600  doi: 10.5152/akd.2010.051  Page E5
Abstract | Full Text PDF

23.Single coronary artery in a patient with acute myocardial infarction: atypical connection of left main coronary artery with left coronary system
Nilüfer Ekşi Duran, Ahmet Çağrı Aykan, Sabahattin Gündüz, Mehmet Özkan
PMID: 20382599  doi: 10.5152/akd.2010.052  Pages E5 - E6
Abstract | Full Text PDF

24.Parachute tricuspid valve
Özgül Uçar, Hülya Çiçekçioğlu, Murat Vural, İbrahim Kocaoğlu, Sinan Aydoğdu
PMID: 20382601  doi: 10.5152/akd.2010.053  Pages E6 - E7
Abstract | Full Text PDF

25.Right atrial hemangioendothelioma: a three-dimensional echocardiographic evaluation
Yeşim Güray, Burcu Demirkan, Ümit Güray, Ayça Ata Boyacı
PMID: 20382602  doi: 10.5152/akd.2010.054  Pages E7 - E8
Abstract | Full Text PDF

26.Coronary artery bypass in a patient with Swyer-James syndrome due to pulmonary tuberculosis
Ali Vefa Özcan, Ahmet Baltalarlı, Fahri Adalı, Bilgin Emrecan, Serper Pazarcıkcı
PMID: 20382603  doi: 10.5152/akd.2010.055  Pages E8 - E9
Abstract | Full Text PDF



 
 
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