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Anatol J Cardiol: 12 (4)
Volume: 12  Issue: 4 - June 2012
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EDITORIAL
1.Cuba-Iran axis, Copyright,
Bilgin Timuralp
PMID: 22498875  doi: 10.5152/akd.2012.118  Pages 287 - 288
Abstract | Full Text PDF

ORIGINAL INVESTIGATION
2.Short stature is an independent risk marker for mortality and incident coronary heart disease only in women: a structural relationship?
Altan Onat, Ender Ödemiş, Günay Can, Gökhan Çiçek, Sani Murat
PMID: 22466360  doi: 10.5152/akd.2012.091  Pages 289 - 297
Amaç: Bireyin boyunun koroner kalp hastalığı (KKH) riski ve mortalite ile ilişkisi, cinsiyete ve etnisite/ırka göre değişir. Anılan ilişkiler, popülasyona dayalı bir Türk yetişkin örnekleminde incelendi. Yöntemler: Başlangıçta ortalama 44±11 yaşındaki 3394 yetişkin ortalama 13.5 yıllık izlemede Cox orantılı hazard modelleri kullanılarak incelendi. Boyun kovaryatları cinsiyete özgü üçte birlik dilimlerde araştırıldı. Bulgular: Ortalama boy erkekte 169.5±6.6 cm, kadında 156.0±6.4 cm idi. Yaş ayarlı serum trigliseridleri, C-reaktif protein ve kompleman C3 (erkek- te değil ama) kadında azalan boy dilimlerinde anlamlı olarak yüksek bulundu. Cinsiyet ve yaş ayarlı modellerde boy erkekte ne insidan KKH, ne de ölümle ilişkiliydi. Kadında ise, boyda 1 standart sapmalık (6.5 cm) artış KKH ile marjinal biçimde ters ilişki gösterirken, toplam ölüm oranını anlamlı olarak öngördü: hazard oranı (HR) -0.83 (%95GA 0.59-0.98). Ek olarak aile gelir dilimi, sigara içiciliği, alkol kullanımı, sistolik kan basıncı, serum yüksek-yoğunluklu lipoprotein (HDL)- ve HDL dışı- kolesterol için ayarlanınca, HR ancak marjinal biçimde zayıfladı. Kadında boyun 160 cm'den kısa olması, daha uzun olanlara kıyasla, ölüm oranını ikiye katlıyordu. Sonuç: Erkekten farklı olarak, Türk kadınında kısa boy KKH için bağımsız bir risk belirteci eğilimi sergilerken, 160 cm'den kısa boy ölüm için güçlü bir belirteçtir. Hayatın erken dönemlerinde yangı durumunu arttıran cinsiyete özgü etkiler ölüm ve gelecekteki KKH riskini etkileyebilir.
Objective: We evaluated the associations of short stature with coronary heart disease (CHD) risk or overall mortality, which vary with sex and ethnicity/race. Methods: Such associations were studied prospectively at a mean 13.5-years’ follow-up in a population-based sample of 3394 Turkish adults (mean age 44±11 years) using Cox proportional hazards models. Covariates of height were sought in sex-specific tertiles. Results: Height averaged 162.7±6.5 cm. Age-adjusted estimated marginal means for serum triglycerides, C-reactive protein and complement C3 in women (but not men) were significantly higher with decreasing height tertiles. In sex- and age-adjusted models, height was associated in men with neither incident CHD, nor death. In women, 1-SD increment (6.5 cm) in height only tended to marginal inverse association with CHD, but predicted significantly all-cause death (HR 0.83, 95% CI 0.59-0.98); HR attenuated only marginally after further adjustment for family income bracket, smoking status, alcohol usage, systolic blood pressure, serum high-density lipoprotein (HDL)- and non HDL-cholesterol. A threshold below 160 cm of female height doubled the adjusted risk of death compared to taller women. Conclusion: In contrast to men, short stature in Turkish women tends to be an independent risk marker for CHD, and height below 160 cm is a strong marker of death. Gender-specific early-life influences enhancing pro-inflammatory state may affect death and future CHD.

3.Elevated pentraxin-3 levels are related to blood pressure levels in hypertensive patients: an observational study
Adem Parlak, Ümit Aydoğan, Atila İyisoy, Mehmet Aytuğ Dikililer, Altuğ Kut, Erdinç Çakır, Kenan Sağlam
PMID: 22466361  doi: 10.5152/akd.2012.092  Pages 298 - 304
Objective: In this study, relationship between systolic and diastolic blood pressure and pentraxin-3 (PTX3) levels in hypertensive patients was investigated.
Methods: Overall, 80 patients with stage 1 hypertension between 40-61 years of age without any disease and 80 healthy volunteers were included to the study. Blood samples obtained to measure PTX3 levels and biochemical analysis. Relationship between PTX3 levels and clinical and biochemical parameters were analyzed using multivariate regression analysis.
Results: Although systolic and diastolic blood pressures were significant different, there were no differences regarding age and gender between hypertensives and normotensives. In each group, significant statistical differences were found between PTX3 and CRP levels (PTX3 (ng/mL) 35.25±5.45 and 0.27±0.24, p<0.001; CRP (mg/dL) 10.03±5.81 and 4.30±3.38, p<0.001; in hypertensive and normotensive groups respectively). It was observed that increase in PTX3 levels accompanies the increase in systolic and diastolic blood pressures (r2=0.78). It was observed that PTX3 levels are not effected from CRP, lipid levels and body mass index (p>0.05). On multivariate regression analysis PTX3 was found to strongly affect blood pressure (beta=0.82, 95% CI 0.644-0.799, p<0.001, and beta=0.84, 95% CI 0.422-0.799, p<0.001, respectively for systolic and diastolic blood pressures), CRP and total cholesterol are found to affect moderately (beta=0.115-0.265, 95% CI 0.101-0.572, p<0.05 and beta=0.107-0.141, 95% CI 0.041-0.110, p<0.05, respectively).
Conclusion: This study showed that PTX3 levels are higher in newly diagnosed hypertensive patients than in healthy individuals. In addition, it was noticed that increased PTX3 levels causes increase in systolic and diastolic blood pressures. (Anadolu Kardiyol Derg 2012; 12: 298-304)

EDITORIAL COMMENT
4.Inflammation and hypertension: new clinical information on pentraxin- 3
Yuichiro Yano, Kinta Hatakeyama
PMID: 22466362  doi: 10.5152/akd.2012.093  Pages 305 - 306
Abstract | Full Text PDF

ORIGINAL INVESTIGATION
5.The relation of serum paraoxonase-1 activity with isolated coronary artery ectasia: an observational study
İbrahim Halil Altıparmak, Zekeriya Kaya, Hatice Sezen, Mehmet Salih Aydın, Recep Demirbağ, Nurten Aksoy
PMID: 22466363  doi: 10.5152/akd.2012.094  Pages 307 - 312
Amaç: Koroner arter ektazisi (KAE), konjenital veya edinsel olabilen koroner arter dilatasyonlarıdır. Paraoksonaz, yüksek-dansiteli lipopro- tein-kolesterol (HDLK) aracılı antioksidan bir enzimdir ve düşük-dansiteli lipoprotein-kolesterol (LDLK)’ü bakır iyonu ve serbest radikallerin indüklemiş olduğu oksidasyondan koruyarak aterosklerozun önlenmesinde rol oynar. Bu çalışmada amaç izole KAE (İKAE) olan hastalarla normal koronerleri olan ve KAH olan hastalarda serum paroksanaz-1 enzim aktivitesini (SPA) açısından fark olup olmadığını araştırmak idi. Yöntemler: Bu enine-kesitli gözlemsel çalışmaya İKAE’si bulunan 44 hasta ile birlikte minimal koroner arter hastalığı (MKAH) olan 40; kritik koroner darlığı olan (KAH) 40 ve normal koroner arterleri olan (NKA) 40 olgu dâhil edildi. Tüm olgularda demografik veriler ve biyokimyasal veriler yanında SPA spektrofotometrik olarak değerlendirildi. Gruplar arası karşılaştırmalarda ANOVA, Kruskal-Wallis ve Ki-kare testleri, post-hoc analizler için Bonferroni testi, SPA’nın ilişkili parametrelerin belirlenmesinde Pearson korelasyon analizi kullanıldı. Bulgular: İKAE ve diğer gruplar arasında, yaş, cinsiyet, diyabet, hipertansiyon varlığı ve sigara içiciliği açısından istatistiksel anlamlı fark yoktu (hepsi için p>0.05). Gruplar arasında HDLK yönünden fark vardı (p=0.021). En yüksek SPA NKA grubunda saptanırken en düşük SPA KAH grubunda saptandı (sırası ile 250.78±59.37U/L; 163.39±49.28 U/L; p=0.005). Post-hoc analizlerde bu farkın İKAE grubu ile NKA grubu ve KAH grubu ile NKA grubu arasında olduğu gözlendi [p=0.005 (NKA ve İKAE); p=0.0045 (NKA ve MKAH ); p=0.007 (NKA ve KAH)]. Sonuç: İKAE’si olan hastalarda, HDLK düşüklüğü yanında SPA düşüklüğünün de KAH’na benzer şekilde görülmesi serum HDLK ve SPA sevi- yesindeki düşüklüğünün İKAE gelişimi ile yakından ilişkili olabileceğini düşündürmektedir.
Objective: Coronary artery ectasia (CAE) is a congenital or acquired anomaly characterized with localized or diffuse dilatations of coronary arteries. Paraoxonase (PON-1) is a high-density lipoprotein-cholesterol (HDLC) associated antioxidant enzyme that prevents atherosclero- sis. The aim of this study was to investigate serum paraoxonase-1 enzyme activity (SPA) in patients with CAE in comparison patients with coronary artery disease (CAD) and normal coronary arteries. Methods: We have evaluated 44 patients with isolated IKAE, 40 cases with normal coronary arteries (NCA), 40 cases with critical CAD (CAD) and 40 cases with minimal CAD (MCAD) in this cross-sectional observational study. Demographic and biochemical data of patients were collected. SPA was determined spectrophotometrically. Among-group comparisons, ANOVA, Kruskal-Wallis and Chi-square tests were used; Bonferroni test was used for post-hoc analysis, Pearson's correlation analysis to determine the parameters associated with the SPA. Results: There were no differences among groups with regard to age, sex, presence of diabetes, hypertension and smoking (p>0.05 for all). The highest HDLC was detected in patients with NCA and lowest HDLC was detected in patients with CAD (respectively 52±15 mg/dL; 41±16 mg/d L, p=0.021). CAD and CAE groups were similar with respect to HDLC levels (p>0.05). The highest SPA level was detected in patients with NKA and the lowest SPA level was detected in patients with CAD (respectively 250.78±59.37U/L; 163.39±49.28 U/L, p=0.005). CAD and CAE groups were similar with respect to SPA levels (p>0.05). Conclusion: Both decreased SPA and decreased HDLC levels are closely related to the development of the CAE similar to CAD.

6.Carotid-femoral pulse wave velocity in patients with isolated coronary artery ectasia: an observational study
Abdulkadir Kırış, Mehmet Bostan, Levent Korkmaz, Mustafa Tarık Ağaç, Zeydin Acar, Şahin Kaplan, Şükrü Çelik
PMID: 22466364  doi: 10.5152/akd.2012.095  Pages 313 - 319
Amaç: Karotis-femoral nabız dalga hızı (NDH) günümüzde arteriyel katılık ölçümünün altın standart yöntemidir ve kardiyovasküler olayların bağımsız öngördürücüsüdür. Artmış NDH aterosklerozun bir göstergesi olarak kabul edilmektedir. İzole koroner arter ektazisi (KAE) ve karotis-femoral NDH arasındaki ilişki tam olarak ortaya konamamıştır. Bu çalışmanın amacı, bu ilişkiyi araştırmaktır. Yöntemler: Enine-kesitli gözlemsel bu çalışmaya, herhangi bir görünür darlığı olmayan 34 izole KAE’li hasta ve anjiyografik olarak normal koroner arterli 24 kontrol dahil edildi. Karotis-femoral NDH değerlendirmek için aplanasyon tonometrisi kullanıldı. İstatiksel analiz Mann-Whitney U ve Ki-kare testleri ile yapıldı. Parametreler arası ilişkilerin değerlendirilmesi için çoklu lineer regresyon analizi kullanıldı. Bulgular: Her 2 grubun temel klinik ve laboratuvar parametreleri benzerdi. Karotis-femoral NDH, izole KAE hastalarında kontrol grubuna göre anlamlı olarak daha yüksekti (10.5±2.4 ve 9.2 ±1.7 m/sn, p=0.02). Çoklu regresyon analizinde, yaş (beta=0.23, %95 GA= 0.001-0.094, p=0.04), ekta- tik damar sayısı (beta=0.24, %95 GA= 0.044-1.07, p=0.03) ve sistolik kan basıncı (beta=0.52, %95 GA= 0.028-0.1, p=0.001) karotis-femoral NDH ile bağımsız ilişkili bulundu. Sonuç: Artmış karotis-femoral NDH ve izole KAE arasında bir ilişki vardır. Bu ilişki, yetişkin popülasyonda, herhangi bir stenozun olmadığı izole koroner arter ektazisinin patogenezinde aterosklerozun etkisi olduğunu göstermektedir.
Objective: Carotid-femoral pulse wave velocity (PWV), the current “gold-standard” measure of arterial stiffness, has emerged as an important independent predictor of cardiovascular events. The increased PWV is recognized as an indicator of atherosclerosis. The relationship between isolated coronary artery ectasia (CAE) and carotid-femoral PWV has not been well-described. The aim of our study was to assess this relation. Methods: Thirty-four patients with isolated CAE without any visible coronary stenosis and 24 control subjects with angiographically normal coronary arteries were enrolled to this cross-sectional observational study. Applanation tonometry was applied to assess the carotid-femoral PWV. Statistical analyses were performed by Mann-Whitney U and Chi-square tests. Multiple linear regression analysis was used for the evaluation of the relations of parameters. Results: The baseline clinical and laboratory parameters of the both groups were similar. Patients with isolated CAE had significantly higher carotid-femoral PWV compared to control subjects (10.5±2.4 vs 9.2±1.7 m/s, p=0.02). In multiple regression analysis, age (beta=0.23, 95% CI=0.001- 0.094, p=0.04), number of ectatic vessels (beta=0.24, 95% CI=0.044-1.07, p=0.03), and systolic blood pressure (beta=0.52, 95% CI=0.028-0.1, p=0.001) were found independently related to PWV. Conclusion: We have shown an association between increased carotid-femoral PWV and isolated CAE, suggesting that atherosclerosis may be involved in the pathogenesis of isolated CAE without any coronary stenosis in the adult population.

7.Evaluation of subclinical left ventricular systolic dysfunction in patients with obstructive sleep apnea by automated function imaging method; an observational study
Refik Emre Altekin, Atakan Yanıkoğlu, Mustafa Serkan Karakaş, Deniz Özel, Aytül Belgi Yıldırım, Mehmet Kabukçu
PMID: 22466365  doi: 10.5152/akd.2012.096  Pages 320 - 330
Amaç: Sol ventrikül ejeksiyon fraksiyonu normal ve miyokart fonksiyonlarını etkileyecek ek hastalığı bulunmayan, obstrüktif uyku apneli (OUA) hastalarda, subklinik sol ventrikül sistolik disfonksiyonunu, iki boyutlu benek izleme ekokardiyografi tekniğine dayanan, otomatik fonksiyonel görün- tüleme yöntemi (OFG) ile değerlendirmeyi amaçladık. Yöntemler: Gözlemsel enine-kesitli çalışmamıza 21’i sağlıklı, 58’i OUA hastası olan toplam 79 kişi alındı. OUA’lı hastalar hastalığın ciddiyetine göre hafif, orta ve ağır olarak 3 gruba ayrıldı. OFG değerlendirmesi için sol ventrikülün apikal 2-, 3-, 4- boşluk görüntüleri kullanıldı. İlgili boşluk- lara ait sistolik longitüdinal deformasyon değerlerinin aritmetik ortalaması olan, global longitüdinal deformasyon değerleri gruplar arasında karşılaştırıldı. İstatistiksel analiz için tek -yönlü ANOVA, Kruskal-Wallis, Pearson korelasyon testleri ve doğrusal regresyon analizi kullanıldı. Bulgular: Sağlıklı gruba göre hafif OUA grubundan itibaren hastalığın ciddiyeti ile global longitüdinal deformasyon değerleri azalmaktaydı (Sağlıklı: -%25.58±-2.16, Hafif OUA: -%23.93±-3.96, Orta OUA: -%21.27±-2.60, Ciddi OUA: -%16.94±-2.66). Orta OUA grubundan itibaren gruplar arası fark anlamlıydı (p<0.03). Ağır OUA grubunun değerleri tüm gruplardan düşük bulundu. Global longitüdinal deformasyon değerleri apne hipopne indeksi (AHİ) ile ilişkili bulundu (beta=-0.659, 95% GA: 0.09-0.17, p<0.001). Sonuç: Sol ventrikül ejeksiyon fraksiyonu normal OUA’lı hastalarda miyokardın longitüdinal fonksiyonları hastalığın ciddiyetine bağlı olarak subklinik evrede bozulabilir. AFI yöntemi yarı otomatik olması ve kullanım kolaylığının yanısıra kısa analiz süresi sayesinde, OUA’lı hastalarda miyokart fonksiyonlarının değerlendirilmesinde mevcut ekokardiyografik yöntemlere ek olarak, etkili ve güvenilir bir yöntem olarak kullanılabilir.
Objective: We aimed to evaluate the subclinical left ventricular (LV) systolic dysfunction with the automated function imaging method (AFI) based on speckle tracking echocardiography (STE) in obstructive sleep apnea patients (OSA) with normal left ventricular ejection fraction (LVEF) and without any confounding disease that can cause myocardial dysfunction. Methods: Twenty-one healthy individuals and 58 OSA patients were included in this observational cross-sectional study. According to the severity of disease, OSA patients were examined in three groups; mild, moderate and severe OSA. Apical 2-, 3- and 4- chamber images were obtained for AFI evaluation. The global systolic longitudinal strain (GLS) values were determined for each view, and averages of these were used in comparison of the patient groups. One-way ANOVA, Kruskal-Wallis, Pearson correlation tests and linear regression analysis were used for statistical analysis. Results: The GLS values of the OSA patients were lower than of the healthy individuals and these values were decreased along with the OSA sever- ity (Healthy: -25.58±-2.16%, Mild: -23.93±-3.96%, Moderate: -21.27±-2.60%, Severe: -16.94±-2.66%, respectively). The difference was significant between moderate OSA patients and healthy individuals, and significant between severe OSA patients and all other groups (p<0.03). The apnea-hypopnea index was found to be correlated with the GLS (β=-0.659, 95% CI: 0.09-0.17, p<0.001). Conclusion: Longitudinal LV mechanics in OSA patients with normal LVEF are deteriorated in the subclinical stage being associated with the sever- ity of disease. AFI can be used as an effective and safe method in the determination of subclinical myocardial dysfunction in OSA patients, because it is semi-automated and easy to use with a short analysis time.

8.Heart rate variability analysis of single-channel electrocardiogram can help to differentiate high-risk patients with obstructive sleep apnea syndrome - a study on diagnostic accuracy
Levent Karasulu, Levent Dalar, Sinem Sökücü, Sedat Altın
PMID: 22484710  doi: 10.5152/akd.2012.097  Pages 331 - 338
Objective: To evaluate the usefulness of heart rate variability analysis (HRV) analysis from the long duration electrocardiogram (ECG) recordings as a screening test for the diagnosis of moderate-to-severe obstructive sleep apnea syndrome (OSAS). Methods: Recordings from 87 patients who were admitted to sleep laboratory for polysomnographic study (PSG) were evaluated. Finally 30 cases with apnea-hypopnea index (AHI)≥15/hour included in patient’s group (male/female: 22/8; mean age: 49±10 years) and 21 cases with AHI<5 were included in control group (male/female: 10/11; mean age: 48±11 years). From the ECG recordings taken as a part of PSG, time -domain and fre- quency -domain HRV parameters were evaluated and their accuracy in the diagnosis of OSAS was investigated using ROC analysis. Results: Statistically significant differences were found in HRV variables in time- domain parameters such as SDNN, SDNN index; frequency- domain parameters VLF, LF, nuLF, nuHF, LF/HF and geometric parameter HRV triangular index values in between groups. Cut- off value of 16 for the HRV triangular index was found to be 50% sensitive and 85.7% specific with a positive likelihood ratio (LR) of 3.50% and negative LR of 0.58% When the total power was higher than 9.611, then the analysis sensitivity was 53.3%, specificity was 95.6%, positive LR was 11.2% and negative LR was 0.49% When the SDNN was higher than 83 then its sensitivity was 80%, specificity was 76.2%, positive LR was 3.36% and negative LR was 0.26% For the cut off value of 62 calculated for SDNN index, sensitivity was 73.3%, specificity was 85.7%, positive LR was 5.13% and nega- tive LR was 0.31%, for the cut off value of 9.12 was calculated for VLF, sensitivity was 90.4% specificity was 50% positive LR was 1.81% and negative LR was 0.19%. Conclusion: Heart rate variability analysis done over routine single channel ECG data gathered through routine Holter applications may be help- ful in distinguishing moderate-to-severe OSAS patients from mild OSAS patients and non-OSAS control subjects.

9.Assessment of left ventricular functions with tissue Doppler, strain and strain rate echocardiography in children with juvenile idiopathic arthritis: An observational study
Osman Yılmaz, Özben Ceylan, Utku Arman Örün, Senem Özgür, Selmin Karademir, Vehbi Doğan
PMID: 22484711  doi: 10.5152/akd.2012.098  Pages 339 - 346
Amaç: Juvenil idiyopatik artritte (JIA) kardiyak tutulum tipik semptomlar olmaksızın çoğu kez sessiz seyretmektedir. Bu çalışmanın amacı JIA’lı hastalarda sol ventrikül fonksiyonlarını doku Doppler ekokardiyografi (DDE), gerilme (strain) ve gerilme hızı (strain rate) ile değerlendirmektir. Yöntemler: Çalışmamız enine-kesitli gözlemsel olarak dizayn edildi. Çalışmaya 30 JIA’lı çocuk ve yaş ve cinsiyeti uygun 30 sağlıklı çocuk alındı. Tüm hastaların konvansiyonel ekokardiyografilerine ek olarak doku Doppler, gerilme ve gerilme hızı teknikleri uygulanarak sol ventrikül fonksiyonları değerlendirildi. Normal dağılım göstermeyen örneklerin ortalamaları Mann-Whitney U testi ile karşılaştırıldı. Bulgular: Juvenil idiyopatik artritli hastalarda DDE ile sol ventrikülün mid ve apikal-lateral bölgelerinde E’ değerleri kontrol grubuna göre düşük bulundu (15.76±3.24 cm/s karşın 17.91±3.29 cm/s, 11.10±2.96 cm/s karşın 12.64±2.42 cm/s, p<0.05). Sol ventrikül yerel sistolik fonksiyonları değerlendiren longitüdinal gerilmede apikal-lateral, bazal ve mid-septum pik S, sirkumferensiyal gerilmede lateral pik S (-17.30±6.22 karşın -21.97±4.32, -18.23±4.62 karşın -21.53±2.69, -20.35±3.75 karşın -22.75±3.50, -9.68±7.12 karşın -13.70±6.81, p<0.05, r: 0.42, 0.41, 0.42), diyastolik fonksiyonları değerlendiren longitüdinal gerilme hızı bulgularından apikal-lateral, mid-lateral ile apikal-septum, mid-septum pik E değerleri (2.22±1.00 karşın 3.17±0.87, 1.62±0.84 karşın 2.15±0.72, 2.51±0.76 karşın 3.31±0.87, 1.99±0.64 karşın 2.47±0.57 cm/s, p<0.05, r: -0.39, -0.55, -0.43) ile sirkumferen- siyal gerilme hızı lateral, posteriyor pik E değerleri (1.32±0.83 karşın 1.88±0.94, 1.31±0.71 karşın 1.85±0.91 sm/s, p<0.05, r: -0.33, -0.22) kontrol grubuna göre anlamlı düzeyde düşük bulundu. Sonuç: Kardiyak yönden subklinik seyreden JIA’lı hastalarda DDE ile belirgin miyokardiyal tutulum görülmezken sol ventrikül gerilme ve gerilme hızı değerlerinde bölgesel olarak azalmalar vardır.
Objective: In juvenile idiopathic arthritis (JIA) cardiac involvement is usually silent without typical symptoms. The purpose of this study was to assess left ventricular functions with tissue Doppler echocardiography (TDE), strain and strain rate in children with JIA. Methods: Our study was designed as a cross-sectional observational study. Thirty pediatric patients with JIA and 30 age- and sex-matched healthy controls were studied. In addition to standard echocardiographic methods, tissue Doppler, strain and strain rate imaging’s were per- formed to assess left ventricular functions in all participants. The means of variables that did not distributed normally were compared with Mann-Whitney U test. Results: In patients with JIA, E’ values of mid and apical regions of left ventricular lateral wall were significantly lower than those of the controls (15.76±3.24 vs 17.91±3.29 cm/s, 11.10±2.96 vs12.64± 2.42 cm/s, p<0.05). In longitudinal strain reflecting left ventricular regional systolic functions, apical-lateral, basal and mid-septum peak S values, lateral peak S values in circumferential strain (-17.30±6.22 vs -21.97±4.32, -18.23±4.62 vs -21.53±2.69, -20.35±3.75 vs -22.75±3.50, -9.68±7.12 vs -13.70±6.81 cm/s, p<0.05, r: 0.42, 0.41, 0.42), in longitudinal strain reflecting diastolic func- tions, apical-lateral, mid-lateral, apical-septum, mid-septum peak E values (2.22±1.00 vs 3.17±0.87, 1.62±0.84 vs 2.15±0.72, 2.51±0.76 vs 3.31±0.87, 1.99±0.64 vs 2.47±0.57 cm/s, p<0.05, r: -0.39,-0.55,-0.43) and in circumferential strain lateral and posterior peak E values (1.32±0.83 vs 1.88±0.94, 1.31±0.71 vs 1.85±0.91 cm/s, p<0.05, r: -0.33, -0.22) were significantly lower than those of the controls. Conclusion: Although marked myocardial involvement was not detected with tissue Doppler imaging in JIA patients with subclinical cardiac disease, regional impairments in left ventricular strain and strain rates were found.

10.Risk factors for postoperative arrhythmia in patients with physiologic univentricular hearts undergoing Fontan procedure
Mehmet Çelik, Bülent Sarıtaş, Tolga Tatar, Murat Özkan, Tankut Akay, Sait Aşlamacı
PMID: 22484712  doi: 10.5152/akd.2012.099  Pages 347 - 351
Amaç: Literatürde yapılan çalışmalarda ileri yaş, sağ atriyum boyutunun büyüklüğü, ortalama pulmoner arter basıncı, sağ atriyum basıncı, sistemik ventrikülün düşük ejeksiyon fraksiyonu, ameliyat tekniği postoperatif aritmi için risk faktörü olarak saptanmıştır. Bu çalışmada sistemik dolaşımı sağlayan ‘dominant ventrikül’ ün sağ ventrikül ya da sol ventrikül olmasının ve hemodinamik parametrelerin postoperatif aritmi açısından risk fak- törü olup olmadığı araştırılmıştır. Yöntemler: Fontan ameliyatı yapılmış 1997 ve 2008 yılları arasındaki 40 hastanın verileri retrospektif olarak değerlendirildi. Hastaların ekokardiyog- rafi notları, kardiyak kateterizasyon notları, ameliyat notları, yaş, kilo, dominant ventrikül tipi, kardiyak anomali tipi, geçirilmiş operasyonlar, kardiyo- pulmoner baypas süresi, aort klemp süresi, kardiyak ritim, pulmoner arter basıncı, Nakata indeksi, sistemik atriyoventriküler kapak yetmezliği kay- dedilerek çalışmamıza dahil edilmiştir. Hastalar dominant sol ventrikül ve dominant sağ ventrikül olarak ayrıştırıldılar. İstatistiksel analiz Mann- Whitney U test kullanılarak gerçekleştirildi. Bulgular: Postoperatif dönemde toplam 21 hastada (%52.5) aritmi görülmüştür. Preoperatif sağ atriyum basınçlarına bakıldığında sağ atriyum basın- cı 5 mmHg’dan düşük hastalarda postoperatif aritmi gözlenmezken sağ atriyum basıncı 5 mmHg ve daha yüksek olan hastalarda postoperatif aritmiler görülmüştür (p<0.05). Preoperatif ve postoperatif ortalama pulmoner arter basınçlarının postoperatif aritmiye etkisi incelendiğinde preopera- tif pulmoner arter basıncı 9 mmHg ve altında olan 8 hastanın sadece 2’sinde (%12.5) postoperatif aritmi saptanırken, preoperatif pulmoner arter basıncı 10 mmHg ve üstünde olan 32 hastanın 19’unda (%59.3) postoperatif dönemde aritmi saptanmıştır. Preoperatif ortalama pulmoner arter basıncının 10mmHg’dan yüksek olması postoperatif aritmi riskini arttırmaktadır (p<0.02). Sağ ventrikül dominansı olan 15 hastanın 8’ inde (%53) ve sol ventrikül dominansı olan 25 hastanın 13’ünde (%52) postoperatif aritmi saptanmıştır (p>0.05). Sonuç: Fontan ameliyatı yapılan hastalarda 10 mmHg’dan yüksek preoperatif ortalama pulmoner arter basıncı ve 5 mmHg’dan yüksek preoperatif sağ atriyum basıncı postoperatif aritmi için bir risk faktörü iken, ventrikül dominansı bir risk faktörü değildir.
Objective: Advanced age, dilated right atrium, increased preoperative pulmonary artery pressure, increased right atrial pressure, technique of operation, and poor ventricular function were reported to be risk factors for postoperative arrhythmia. Aim of this study is to determine the risk factor for postoperative arrhythmia after Fontan operation with regard to ventricle dominancy and hemodynamic parameters. Methods: In this retrospective study, the data of the patients including age, weight, dominant ventricle, type of cardiac anomaly, previous operations, duration of cardiopulmonary bypass (CPB), duration of aortic clamping, cardiac rhythm, pulmonary artery pressure, the Nakata Index, systemic atrioventricular (AV) valve insufficiency were obtained from the hospital records, the echocardiographic files, and cardiac catheterization records. Patients were assigned to dominant left ventricle or dominant right ventricle groups. Statistical analysis was performed using the Mann-Whitney U test. Results: Arrhythmia was observed in 21 (52.5%) patients in the postoperative period. No postoperative arrhythmia was observed in patients with a right atrial pressure of <5 mmHg, whereas postoperative arrhythmias were observed in patients with a right atrial pressure of ≥5 mmHg (p<0.05). When the effects of preoperative and postoperative pulmonary artery pressures on postoperative arrhythmia were evaluated, post- operative arrhythmia was determined in only 2 (12.5%) of 8 patients with a preoperative mean pulmonary artery pressure of ≤9 mmHg, where- as postoperative arrhythmia was observed in 19 (59.3%) of 32 patients with a preoperative pulmonary artery pressure of ≥10 mmHg. A preop- erative mean pulmonary artery pressure of >10 mmHg increased the risk of postoperative arrhythmia (p<0.02). Postoperative arrhythmia was determined in 8 (53%) of 15 patients with a dominant right ventricle, and in 13 (52%) of 25 patients with a dominant left ventricle (p>0.05). Conclusion: While a preoperative mean pulmonary artery pressure of >10 mmHg and a preoperative right atrial pressure of >5 mmHg were the risk factors for postoperative arrhythmia in patients undergoing Fontan procedure, the right or left ventricular dominance was not a risk factor.

11.The quality of life after cardiac surgery in octogenarians and evaluation of its early and mid-term results
İbrahim Kara, Yasin Ay, Cengiz Köksal, Cemalettin Aydın, Mehmet Yanartaş, Tekin Yıldırım
PMID: 22484713  doi: 10.5152/akd.2012.100  Pages 352 - 358
Objective: The aim of this study is to evaluate our early and mid- term results and the qualities of life of the patients aged eighty years or older who underwent heart surgery. Methods: Eighty- eight patients aged 80 years and older who underwent open-heart surgery at Göztepe Şafak Hospital between May 2004 and December 2010 have been included to the study. This study was designed as two-stage: in the first stage, determinants of survival were analyzed retrospectively. In the second stage, the quality of life of survived patients was evaluated by using Short- Form 36 (SF-36), Turkish version in the cross-sectional study. The statistical analysis was performed using Fischer’s exact, Pearson Chi-square test, Student t-test, Mann-Whitney U test and logistic regression analysis. Results: In the logistic regression analysis; the left ventricular ejection fraction as <50% (OR: 11.02, 95% CI: 2.6-46.6, p<0.05), application of redo surgery (OR: 8.3, 95% CI: 1.04-66.6, p<0.05), coronary bypass and mitral surgery procedures in the same session (OR: 9.2, 95% CI: 1.6-53.7, p<0.05), left main coronary lesion as >50% (OR: 4.3, 95% CI: 1.1-17.7, p<0.05), preoperative creatinine as >1.8 mg/dl (OR: 14.1, 95% CI: 2.6-76.1, p<0.01), New York Heart Association class III-IV (OR: 4.9, 95% CI: 1.2-20.1, p<0.05), chronic obstructive pulmonary disease (OR: 10.3, 95% CI: 2.5-41.7, p<0.01) were found to be risk factors of hospital mortality. Physical functions, social functions and all sub-scales other than the role limitation depending on the emotional situation were evaluated as general population mean or above. Conclusion: We think that with a successful heart surgery in patients aged 80 years and older under appropriate conditions, their life qualities and mean life expectations can return to normal and they can lead a symptomless life.

SCIENTIFIC LETTER
12.First virtual interactive symposium with synchronous distance education techniques
Serdar Kula, Velit Halit, Levent Oktar
PMID: 22484714  doi: 10.5152/akd.2012.101  Pages 359 - 360
Abstract | Full Text PDF

CASE REPORT
13.Biventricular noncompaction and mitral cleft
Zafer Işılak, Serkan Çay, Ömer Yiğiner, Mehmet Uzun
PMID: 22498859  doi: 10.5152/akd.2012.102  Pages 361 - 362
Noncompaction cardiomyopathy (NCC) is a rarely seen type of congenital cardiomyopathy. It is caused by the defective embryonic migration of myocardial fibers (1). It is frequently complicated with heart failure, arrhythmias and embolic events. In this report, we presented a case with biventricular noncompaction accompanying a cleft mitral valve.

14.A rare coexistence: Atrioventricular nodal reentry tachycardia and Mahaim accessory pathway mediated atrioventricular tachycardia
Taner Şen, Ümit Güray, Serkan Topaloğlu, Dursun Aras
PMID: 22498860  doi: 10.5152/akd.2012.103  Pages 362 - 363
Abstract | Full Text PDF

15.Closure of nonrestrictive aortopulmonary window in an infant by the transcatheter approach
Ender Ödemiş, Alper Güzeltaş, Meki Bilici, Erkut Öztürk
PMID: 22498861  doi: 10.5152/akd.2012.104  Page 364
Abstract | Full Text PDF

16.An unusual clinical state: atrial fibrillation due to mad-honey intoxication
Asım Kalkan, Mustafa Gökçe, Mehmet Erdem Memetoğlu
PMID: 22498862  doi: 10.5152/akd.2012.105  Pages 365 - 366
Abstract | Full Text PDF

17.Familial arterial tortuosity syndrome
Murat Çiftel, Fırat Kardelen, Ayşe Şimşek, Özlem Turan
PMID: 22498863  doi: 10.5152/akd.2012.106  Pages 366 - 367
Abstract | Full Text PDF

18.Cardiac hydatid cyst: a comment/ Cardiac hydatid cyst case recovered with medical treatment
Viroj Wiwanitkit
PMID: 22498864  doi: 10.5152/akd.2012.107  Page 368
Abstract | Full Text PDF

LETTER TO THE EDITOR
19.The importance of Himalayan P-wave in differentiation of cardiomyopathies
Uğur Canpolat, Muhammed Dural, Kudret Aytemir, Lale Tokgözoğlu
PMID: 22498865  doi: 10.5152/akd.2012.108  Pages 368 - 369
Abstract | Full Text PDF

20.Sex proportion of offspring in mothers with cardiac disease
Azin Alizadehasl, Rasoul Azarfarin, Anita Sadeghpour, Majid Maleki
PMID: 22498866  doi: 10.5152/akd.2012.109  Pages 369 - 370
Abstract | Full Text PDF

21.Comparison of blood lipid levels of people of Armenian and non-Armenian origin living in Istanbul, Turkey
Şebnem Tamay Coşkun, Özgür Tanrıverdi, Abdulbaki Kumbasar, Abdulkadir Ergen
PMID: 22498867  doi: 10.5152/akd.2012.110  Page 370
Abstract | Full Text PDF

22.Anesthesia for percutaneous transcatheter closure of atrial septal defects in adults
Heves Karagöz, Aysun Ankay Yılbaş, Banu Ayhan, Ergün Barış Kaya, Meral Kanbak
PMID: 22498868  doi: 10.5152/akd.2012.111  Page 371
Abstract | Full Text PDF

23.Simultaneous percutaneous peripheral arterial intervention and transfemoral transcatheter aortic valve implantation in bilateral iliac artery occlusive disease
Mehmet Gül, Özgür Akgül, Mehmet Ertürk, Aydın Yıldırım
PMID: 22498869  doi: 10.5152/akd.2012.112  Pages 371 - 373
Abstract | Full Text PDF

MISCELLANEOUS
24.Ord. Prof. Dr. Cemil Topuzlu (1866-1958)
Cemalettin Topuzlu
PMID: 22498876  doi: 10.5152/akd.2012.119  Page 374
Abstract | Full Text PDF

E-PAGE ORIGINAL IMAGES
25.A case of left circumflex artery supplying the left ventricular apex
Mustafa Yıldız, Gönenç Kocabay, Mehmet Özkan
PMID: 22498870  doi: 10.5152/akd.2012.113  Page E16
Abstract | Full Text PDF

26.Left main coronary artery-to- pulmonary artery fistula and concomitant severe coronary artery disease
Muhammet Raşit Sayın, Mehmet Ali Çetiner, Turgut Karabağ, Sait Mesut Doğan, Mustafa Aydın
PMID: 22498871  doi: 10.5152/akd.2012.114  Pages E16 - E17
Abstract | Full Text PDF

27.Pericardial cyst: a rare cause of recurrent palpitation episodes
Uğur Canpolat, Kudret Aytemir
PMID: 22498872  doi: 10.5152/akd.2012.115  Pages E17 - E18
Abstract | Full Text PDF

28.Transected common hepatic artery and treatment
Sean D. Kalagher, Onur Sıldıroğlu, Ülkü Cenk Turba
PMID: 22498873  doi: 10.5152/akd.2012.116  Pages E18 - E19
Abstract | Full Text PDF

29.Long-term adverse effect of Kawasaki syndrome: Two- vessel coronary artery by pass surgery for coronary artery aneurysm in a 16-year old male patient
Servet Altay, Hüseyin Altuğ Çakmak, Hatice Betül Erer, Mehmet Eren
PMID: 22498874  doi: 10.5152/akd.2012.117  Pages E19 - E20
Abstract | Full Text PDF



 
 
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