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Anatol J Cardiol: 2 (4)
Volume: 2  Issue: 4 - December 2002
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EDITORIAL
1.Meeting of the Associate Editors, Prof. Robert Mahley Europace 2003 and Some of Them
Bilgin Timuralp
PMID: 12460820  Pages 277 - 278
Abstract | Full Text PDF

ORIGINAL INVESTIGATION
2.Distribution of Coronary Artery Lesions in Patients With Permanent Pacemakers
İzzet Tandoğan, Ertan Yetkin, Yeşim Güray, Yüksel Aksoy, Alpay Turan Sezgin, Ramazan Özdemir, Şengül Çehreli, Ali Şaşmaz
PMID: 12460821  Pages 279 - 283
Objective: In the present study we examined retrospectively the coronary anatomy pathology of 78 consecutive patients with coronary artery disease (CAD) who underwent permanent pacemaker implantation in order to find a common pathological anatomic basis for conduction disturbances and to compare them with a group of matched patients with angiographically proven CAD. Methods: Study group consists of seventy-eight patients with angiographically documented CAD and permanent pacemaker implantation. Control group included comparable patients with CAD and without a pacemaker implantation. Coronary angiography was performed using standard Judkins approach in all patients within 2 months before pacemaker implantation. The locations of narrowings in the left anterior descending (LAD) and right (RCA) coronary arteries, as the arteries supplying the conduction system, were documented accurately and further classified as follows. Type I: Anatomy not compromising blood supply to the conduction system, namely, either the absence of significant narrowing in the LAD, RCA, left circumflex, posterolateral, or posterior descending arteries or the presence of mid-distal LAD lesions beyond the septal branches. Type II: Pathological coronary anatomy involving septal branches emerging from the LAD (and without significant lesions in the RCA). Type III: Pathological coronary anatomy compromising blood supply to the sinoatrial (SAN) or atrioventricular (AVN) nodes but not compromising blood flow to the septal branches. This subset included patients with distal LAD lesions after the septal branches. Type IV: Combination of types II and III pathological coronary anatomy that compromises blood supply both to the septal branches and SAN and AVN arteries. Results: Occurrence of the type IV coronary anatomy (45%) was significantly higher than type I (19%), type II(24%) and type III (11%) in the study group (p<0.02). Statistically significant differences were found between the two groups (p<0.05): more patients in the study group had type II (24%) and IV(45%) coronary anatomy (p<0.02) while type I (35%) and III (37%) anatomy were more frequently observed in control group (p<0.05). Analysis of flow quality of septal perforators, SAN and AVN arteries, in the study group demonstrated a significant tendency for reduced blood flow in the conduction system. Conclusion: Presence of first perforator lesions with poor quality of flow and right coronary artery lesions shown angiographically should be considered as the risk factors requiring permanent pacemaker implantation in patients with coronary artery disease.

3.Does the Short-Term Mortality Differ Between Men and Women with First Acute Myocardial Infarction?
Belgin Ünal Aslan, Özgür Karcıoğlu, Özgür Aslan, Cüneyt Ayrık, Esin Kulaç, Sema Güneri
PMID: 12460822  Pages 284 - 290
Objective: Women with myocardial infarction (MI) have been reported to have worse short-term prognosis than men. We aimed to compare men and women with first MI regarding 28 days survival, cardiovascular (CV) risk factors, clinical findings, and the treatment in the emergency setting. Methods: One-hundred and seventy-five consecutive patients with first MI admitted to the emergency department of our hospital within one year were included in the study. Data on admission time, CV risk factors, clinical findings and treatment options were obtained from the patient charts. Twenty-eight days after the first admission, patients were called by phone and asked information about their health status. Survival curves for men and women were compared using log rank test. Results: After the exclusion of 20 cases who were lost during the follow up, 117 men and 38 women were evaluated in the study; 9.4% of the men and 10.5% of the women died within 28 days (p=0.85). Women were older (10 years), had higher prevalence of hypertension (p=0.04), diabetes (p=0.01) and stroke history (p=0.02) than men. Men had higher levels of smoking history than women (79.1%, 31.6%; p<0.001). There were no significant gender differences regarding clinical findings, time to hospital admission after chest pain onset and time to thrombolysis. Thrombolysis was applied in 35.8% of women and in 48.6% of men patients. Primary PTCA was performed in %26.4 of men and 11.4% of women patients (p=0.16). Conclusion: Women tended to be older and had more co-morbidities, but did not differ from men regarding clinical findings, treatment given in emergency department and short-term survival.

EDITORIAL COMMENT
4.Effects of Gender on 28 days Mortality in Acute Myocardial Infarction
Turhan Kürüm
PMID: 12793447  Pages 291 - 292
Abstract | Full Text PDF

ORIGINAL INVESTIGATION
5.Left Ventricular Hypertrophy Increases the Frequency of Ventricular Arrhythmia in Hypertensive Patients
Ayşe Özdemir, Hasan Hüseyin Telli, Ahmet Temizhan, Bülent B. Altunkeser, Kurtuluş Özdemir, Mete Alpaslan, Turgut Karabağ
PMID: 12460824  Pages 293 - 299
Objective: To evaluate the relationship between left ventricular hypertrophy (LVH) and geometrical structure of the left ventricle with the risk of arrhythmia and QT dispersion (QTd) in hypertensive patients. Methods: Eighty patients were included (mean age 53 ± 11 years, 45 women,) in the study. Among them, concentric LVH was present in 30, concentric remodelling in 15 and normal left ventricular geometry in 35 patients. Twenty-four hours electrocardiographic monitoring and QTd calculation were performed for all patients. Results: Lown grade 2-3 ventricular arrhythmia was found in 30 patients (%37) and Lown grade 4a–4b ventricular arrhythmia was documented in 17 patients (%21). The frequency of > Lown 2 ventricular arrhythmia in patients with concentric LVH was significantly higher than those of the subjects with concentric remodelling or normal geometry (p <0.01). The percentage of > Lown 2 ventricular arrhythmias were %80 in patients with LVH and %10 in patients wihout LVH. QT and QTc dispersions in patients with concentric hypertrophy were significantly longer than those of the patients with concentric remodelling and normal geometry. Additionally, QT and QTc dispersions in patients with ventricular arrhythmias were more frequent than in those without (p<0.001). The left ventricular mass index correlated positively both with the QTd and the QTc dispersions (r=0.33, p=0.007, r=0.26, p= 0.03, respectively). The left ventricular mass index also correlated significantly with both grades (Lown 2-3 and Lown 4a-4b) of ventricular arrhythmia (r=0.59, p=0.001; r= 0.53, p=0.001, respectively). Conclusion: In hypertensive patients, especially in those with concentric LVH, the incidence of ventricular arrhythmia increases in relation with QT dispersion.

EDITORIAL COMMENT
6.Hypertension and Ventricular Arrhythmias
Sema Güneri
PMID: 12793449  Pages 300 - 301
Abstract | Full Text PDF

ORIGINAL INVESTIGATION
7.The Prediction of Pulmonary Artery Systolic Pressure and Vascular Resistance by Using Tricuspid Annular Tissue Doppler Imaging
Osman Bolca, Gültekin Hobikoğlu, Tuğrul Norgaz, Recep Asiltürk, Şennur Ünal Dayi, Ufuk Gürkan, Ahmet Narin
PMID: 12460826  Pages 302 - 306
Objective: This study was planned to determine pulmonary artery pressure and pulmonary vascular resistance by using tricuspid annular tissue Doppler imaging in patients with valvular and congenital heart disease. Methods: The study group consisted of patients with valvular and congenital heart disease (n=28). Healthy volunteers (n=10) were included into the control group. Systolic (Sm), early (Em) and late diastolic velocity (Am), isovolumetric relaxation time (İVRTm) were measured from tricuspid annulus by tissue Doppler imaging. Patients of the study group underwent cardiac catheterization and right atrial mean pressure, right ventricle and pulmonary artery systolic- diastolic pressures (PASP and PADP), and pulmonary capillary wedge pressure (PVR, dyn/s/cm-5) were obtained. Results: There were no significant differences between the groups according to age, gender, left and right ventricle ejection fraction, tricuspid annular Sm, Em and Am velocities and velocity- time integrales (p>0.05). IVRTm was increased in the study group (73.75±3.1 msn, p<0.05). For Sm velocities of 11 cm/sec, prediction of PASP ≥ 30 mmHg was calculated with specificity of 57%, sensitivity of 93%, positive predictive value of 88%, negative predictive value of 68% and accuracy of 75%. For Sm velocities - time integral value of 2.7 cm/sec, prediction of the PVR ≥ 65 dyn/s/cm-5 was estimated with sensitivity of 88%, specificity of 36%, positive predictive value of 68%, negative predictive value of 66% and accuracy of 68 %. Conclusion: Pulmonary artery pressure and pulmonary vascular resistance in patients with valvular and congenital heart disease can be predicted by using the Sm wave parameters detected with tricuspid annular tissue Doppler imaging.

EDITORIAL COMMENT
8.Relationship of Tricuspid Annular Tissue Doppler with Pulmonary Artery Pressure and Vascular Resistance
Necmi Ata
PMID: 12793451  Pages 307 - 308
Abstract | Full Text PDF

ORIGINAL INVESTIGATION
9.Our Experience on Minimally Invasive Heart Surgery Operations Through Right Anterolateral Minithoracotomy
Yavuz Beşoğul, Ali Vefa Özcan, Turhan Yavuz, Bülent Tünerir, Recep Aslan
PMID: 12460828  Pages 309 - 312
Objective: Minimal invasive cardiac surgical techniques recently have been applied in the management of various cardiac lesions. The aim of the study was to evaluate right anterolateral minithoracotomy as an alternative procedure with a better cosmetic and clinical outcomes. Methods: Fifteen male and 64 female patients underwent open heart surgery during cardiopulmonary bypass through a right anterolateral minithoracotomy at the fourth intercostal space. The average age was 41±6 years. Fifty-two (65.8%) patients underwent mitral valve replacement, 5 (6.3%) patients underwent mitral valve replacement + tricuspid annuloplasty, 5 (6.3%) patients underwent tricuspid valve replacement, 7 (8.9%) patients underwent closure of the atrial septal defect (ASD), 3 (3.8%) patients underwent closure of the ventricular septal defect (VSD), 1 (1.2%) patient underwent closure of the ASD+VSD and 5(6.3%) patients underwent mitral re-replacement. Results: The postoperative average ventilation time was 6±2 h in 38 (48.1%) patients and 11±3 h in 41 (51.9%) patients. The postoperative average mediastinal drainage was 350±110 ml during first 24 hours, and postoperatif stay in intensive care was 1.8±0.8 days. Conclusion: As a result, the right anterolateral minithoracotomy incision is a safe and effective alternative to the median sternotomy for open heart surgical procedures. Most of minimal surgical accesses can be achieved with better cosmetic results and faster recovery.

EDITORIAL COMMENT
10.Requirements for Minimally Invasive Cardiac Surgery
Mehmet Ateş
PMID: 12793452  Pages 313 - 314
Abstract | Full Text PDF

REVIEW
11.Managing Dyslipidemia in Turkey: Suggested Guidelines for a Population Characterized by Low Levels of High Density Lipoprotein Cholesterol
Thomas P. Bersot, K. Erhan Palaoğlu, Robert W. Mahley
PMID: 12460830  Pages 315 - 322
Based on data from the Turkish Society of Cardiology and others, it is established that Turks have a high prevalence of coronary heart disease (CHD). Several risk factors are prominent in Turks: dyslipidemia, cigarette smoking, and hypertension. The dyslipidemia is unique in that very low levels of HDL-C and typically “normal” LDL-C levels characterize the Turkish population. The low HDL-C levels appear to be genetic in origin and are largely independent of high triglyceride levels (73% of Turkish men and 94% of women with HDL-C <40 mg/dl have triglyceride levels <150 mg/dl; only 15% of men and 3% of women with HDL-C <40 mg/dl have triglyceride levels >200 mg/dl). HDL-C levels are 10-15% mg/dl lower in Turks than seen in the United States or western Europe. Low HDL-C is a major risk factor; CHD risk increases 2-4% for every 1 mg/dl decrease in HDL-C levels. Existing treatment guidelines focus on plasma LDL-C levels and fail to take into account the continuous increase in CHD risk that occurs as HDL-C levels decrease. However, several studies show that patients with CHD or free of CHD but with multiple risk factors, who have low HDL-C and near optimal LDL-C, benefit very significantly from lipid-lowering therapy. Many of these patients with low HDL-C levels do not qualify for drug therapy based on existing guidelines. Therefore, we believe that unique guidelines must be developed to guide the treatment of low HDL-C Turkish patients. We suggest that treatment based on both the LDL-C level and the total cholesterol/HDL-C (TC/HDL-C) ratio is the best way to address treatment of patients with low HDL-C levels. The most effective drug treatment available presently in Turkey relies on lowering LDL-C levels to optimize the TC/HDL-C ratio.

12.Apoptosis and Cardiovascular Disease
Hakan Kültürsay, Meral Kayıkçıoğlu
PMID: 12460831  Pages 323 - 329
Apoptosis is defined as a genetically programmed cell death. Apoptotic cell death plays an important role both in heart development and cardiac disease. This review deals with the key features of this process. The modification of possible interactions between extrinsic and intrinsic factors affecting the cell during apoptotic process may be of major interest in preventing the progression of cardiovascular disease. Current issues on the pathogenetic role of apoptosis in heart disease and how these knowledge can be applied in clinical usage is also evaluated in this review.

13.CARTO Three-Dimensional Non-Fluoroscopic Electroanatomic Mapping for Catheter Ablation of Arrhythmias: A Useful Tool or an Expensive Toy for the Electrophysiologist?
Fırat Duru
PMID: 12460832  Pages 330 - 337
This review enlightens the application issues of the novel CARTO electroanatomic mapping system (Biosense Webster, Diamond Bar, CA, USA) in both research and clinical electrophysiology.It is a very useful tool in catheter ablation procedures in patients with sustained atrial tachycardias, macroreentrant atrial arrhythmias after surgical correction of congenital heart disease, and ventricular tachycardia in the setting of previous myocardial infarction or other structural heart disease. It can also be useful in other types of arrhythmias, including isthmus dependent atrial flutter and idiopathic ventricular tachycardia, by guiding the ablation procedure and limiting fluoroscopy. The major drawbacks for more widespread use of electroanatomic mapping at present time include the inability to map nonsustained arrhythmias and the associated high costs of the mapping system.

MISCELLANEOUS
14.Effect of Cardiac Resynchronization on Cardiac Functions
Enis Oğuz, Şevket Görgülü
PMID: 12460833  Pages 338 - 341
Abstract | Full Text PDF

CASE REPORT
15.Approach to a Middle-Aged Patient with Ventricular Septal Defect and Pulmonary Hypertension
Sanem Nalbantgil, Anıl Z. Apaydın, Hakan Posacıoğlu, Ali Telli
PMID: 12460834  Pages 342 - 344
Abstract | Full Text PDF

16.Unusual Presentation of Cardiac Angiosarcoma Mimicking Left Ventricular Myxoma
Mete Alpaslan, Ersel Onrat, Murat İkizler, Sait Aşlamacı, Ünser Arıkan, Ali Oto
PMID: 12460835  Pages 345 - 346
Abstract | Full Text PDF

17.Left Superior Vena Cava - Left Atrium Communication Diagnosed by Bedside Contrast Echocardiography
Murat Mert, Funda Öztunç, Gürkan Çetin, İhsan Bakır, Ahmet Özkara
PMID: 12460836  Pages 347 - 348
Abstract | Full Text PDF

E-PAGE ORIGINAL IMAGES
18.ST Elevation in AVR Could Be a Sign of the Left Main Coronary Artery Lesion
Onur Akpınar, Mehmet Kanadaşı, Ayça Açıkalın
PMID: 12460837  Page 349
Abstract | Full Text PDF

19."Whooping" Due to Mitral and Tricuspid Regurgitation - Original Image
Alparslan Birdane
PMID: 12460838  Page 350
Abstract | Full Text PDF

MISCELLANEOUS
20.After the XVIIIth National Congress of Cardiology
Altan Onat
Page 351
Abstract | Full Text PDF

MISCELLANEOUS
21.Participation of Turkey in the 2002 Congress of the European Society of Cardiology
Barış İlerigelen
Pages 352 - 353
Abstract | Full Text PDF

22.ÜNAK: I. National Symposium on Medical Information Management and Technologies

Pages 354 - 355
Abstract | Full Text PDF

23.Yields and Shortfalls of the New Bylaws on Specialization in Medicine
Semih Baskan
Pages 356 - 358
Abstract | Full Text PDF

24.Heartache
M. Zati Altay
Pages 359 - 360
Abstract | Full Text PDF



 
 
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