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Anatol J Cardiol: 8 (3)
Volume: 8  Issue: 3 - June 2008
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1.Second part of the story: What will Turkey’s situation become?
Bilgin Timuralp
PMID: 18524722  Page 181
Abstract | Full Text PDF

2.Value of brain natriuretic peptide after acute myocardial infarction
Yılmaz Güneş, Barış Ökçün, Ela Kavlak, Cennet Erbaş, Sezer Karcıer
PMID: 18524723  Pages 182 - 187
Brain natriuretic peptide (BNP) is secreted predominantly from the ventricles in response to increased wall stress, which is known to be oneof the major forces driving left ventricular (LV) remodeling. In this prospective study, we evaluated value of BNP levels in acute myocardial infarction (MI) patients for the prediction of heart failure during one year of follow-up.
Seventy-four patients with a first ST-elevation MI were examined prospectively after 5 days and 1 month with echocardiography and blood samples for BNP were obtained. Clinical events were recorded during 12 months of follow-up. Multivariate linear regression analysis was used to analyze the value of different baseline characteristics as independent predictors of LV ejection fraction (LVEF) ≤ 40% and clinical heart failure. Diagnostic ability of BNP to detect LVEF ≤ 40% and heart failure was evaluated with receiver operating characteristic (ROC) curves.
Brain natriuretic peptide levels were higher in patients developing symptomatic heart failure during follow up irrespective of presence of LVEF ≤40% (68.9±52.5 vs 21.4±18.4, p=0.003, for baseline BNP and 79.3±35.8 pg/ml vs. 22.9±15.8 pg/ml for one month BNP, p<0.001). Regression analysis including pain duration, peak creatine kinase-MB levels, MI localization, baseline BNP levels and baseline LV volumes yielded that baseline BNP was the most powerful predictor of one-year LVEF ≤40% (Beta: 0.376, p=0.004). Multivariate analyses, testing for independent predictive information of pain duration, peak creatine kinase-MB, MI localization, thrombolytic therapy or primary percutaneous intervention, fifth day and one month LV volumes, LVEF and BNP levels, for development of clinical heart failure, showed that one month BNP was the single significant predictor (Beta: 0.675, p<0.001). There was a negative correlation between BNP levels and LVEF (r=-0.599, p<0.001, for baseline BNP level). Higher BNP levels were associated with greater increase in LV end-systolic (r= 0.531, p< 0.001) and end-diastolic volumes (r= 0.385, p= 0.001) during one year of follow-up. A baseline BNP level of >39 pg/ml identified LVEF ≤ 40% at one year with a sensitivity of 72.7% and specificity of 91.9% (OR=30.4, 95% CI, 6.1-152.3, p<0.001, AUC=0.852). ABNP level >39 pg/ml also increased the risk of clinical heart failure (for baseline BNP sensitivity: 60.0%, specificity 89.1%, OR=12.2; 95% CI, 2.7-54.1, p=0.001 and for one month BNP sensitivity: 80.0%, specificity 85.9%, OR=24.4; 95% CI, 4.5-134.1, p<0.001).
High level of BNP is a powerful marker of LV systolic dysfunction and poor prognosis after MI. Increased BNP levels are associated with progressive ventricular dilatation and development of clinical heart failure.

3.The role of adrenomedullin and brain natriuretic peptide levels in acute rheumatic fever in adults
Ednan Bayram, Hasan Kocatürk, Osman Yücel, Canan Atalay, Mehmet Cengiz Çolak, Sebahattin Ateşal
PMID: 18524724  Pages 188 - 191
Objective: Rheumatic fever, a multisystem disease following infection with group A beta-hemolytic streptococcus, is common among young (5-15 years) but can occur in adults as well. Recently, brain natriuretic peptide (BNP) has been validated as a marker of cardiac function and prognosis. Plasma adrenomedullin (ADM) levels are elevated in various pathological states including cardiovascular and inflammatory diseases. We aim to assess the relationship between ADM and BNP levels in adult patients with acute and convalescent rheumatic fever (ARF).
Methods: This case -controlled prospective study included 45 patients with ARF (mean age 21.04±1.91 years) and 30 age/gender-matched control subjects. Brain natriuretic peptide and adrenomedullin levels were studied in the acute and convalescent phase of ARF. Adrenomedullin was detected by enzyme immunoassay kit of peptides, while brain natriuretic peptide was measured by a commercially available instrument. The study was carried out between May 2006 and October 2006 in Atatürk University Medical Faculty Hospital. Statistical analysis was performed using Shapiro-Wilk, Mann Whitney U, Wilcoxon signed rank, Chi-square tests and Pearson correlation analysis.
Results: Plasma ADM and plasma BNP levels were significantly higher (p<0.05) in adults with ARF, regardless of whether they were in acute or convalescent phase of disease. Plasma ADM levels were 74.43±3.4 pmol/mL in acute phases, 59.35±1.45 pmol/mL in the convalescent phase, and 44.79±13.12 pmol/mL in control group. Plasma BNP levels were 197.51±47.41 pg/mL in the acute phase, 145.25±51.25 pg/mL in the convalescent phase, and 33.45±10.42 pg/mL in control group. The differences were statistically significant for all (p<0.05). Plasma ADM and BNP levels in the acute phase of disease showed significant negative correlation with the left ventricular ejection fraction (r=-0.56, p<0.05 and r=-0.61, p<0.05, respectively).
Conclusion: In patients with acute and convalescent rheumatic fever, BNP and ADM levels were high compared to those of healthy subjects and this could be used as a complementary tool in the treatment and prognosis of ARF.

4.Submaximal target heart rate and the detection of myocardial ischemia by stress myocardial perfusion imaging using the treadmill exercise Bruce protocol
Ali Gholamrezanezhad, Sahar Mirpour, Hadi Hajimohammadi, Aydin Pourmoslemi
PMID: 18524725  Pages 192 - 196
Objective: It has been postulated that if patients fail to achieve their age-predicted target heart rate (THR: 85% of predicted maximal HR), the electrocardiographic changes following exercise treadmill test (ETT) and also scintigraphic results of this stress protocol for myocardial perfusion imaging (MPI) are unreliable. We decided to assess the ability of submaximal ETT in provoking ischemia as determined by MPI.
Methods: One hundred and nine patients (60 female, 49 male, mean age: 50.8±11.4, range: 32-76 years), were prospectively assessed with MPI after stress protocol of ETT. Forty-nine patients failed to attain THR. Myocardial perfusion imaging was performed based on the 1-day protocol, using Technetium-99m sestamibi (99mTc-MIBI).
Results: Sixty patients attained THR, of which 28 patients (46.7%) had normal myocardial perfusion pattern and 32 patients (53.3%) had scintigraphic evidence of ischemia. The remaining 49 patients had submaximal ETT, of which 15 patients (30.6%) had normal results and 34 patients (69.4%) had scintigraphic evidence of ischemia. Although ischemia was more common in those patients with submaximal ETT, however the difference was not statistically significant (p=0.088).
Conclusion: Ischemia is more common in patients who had performed a sub-maximal ETT. It could be a logical hypothesis that ischemic heart disease may limit the ability of patients to complete ETT and therefore, it would not be judged that submaximal ETT is always insufficient for MPI. In these settings, in patients who fail to attain the THR, it would be possible to proceed to the stress MPI test.

5.The effect of losartan on the intima-media thickness of carotid artery
Hulki Meltem Sönmez, Filiz Canlı Turan, Kutsi Köseoğlu
PMID: 18524726  Pages 197 - 205
Objective: There are findings about negative effects of angiotensin 1 (AT1) receptor stimulation at every stage of atherosclerosis formation. Recently, AT1 receptors, especially the effects of AT1 receptor antagonists on the regression of atherosclerosis, are being researched intensively. Measurement of carotid artery thickness has been accepted as a marker of atherosclerosis. In our study, we investigated the effect of AT1 receptor antagonist, losartan, on the carotid artery intima-media thickness of newly diagnosed hypertensive patients.
Methods: We reached to 450 individuals by the stratified and random sampling method and measured their blood pressure to find out undiagnosed hypertensive patients. Fifty-one patients (mean age 54±9 years) were accepted to participate in our study. Forty-nine of them (33 women and 16 men) completed the study. After the measurements of the carotid artery intima-media thicknesses by B-mode Doppler ultrasonography, their blood tests were performed and arterial blood pressures were measured. Soon after, treatment with losartan as an antihypertensive agent was begun. All measurements were repeated on the eighth month of this therapy.
Results: The mean systolic and diastolic blood pressure of the cases were 167±14 mmHg and 102±8 mmHg, respectively. At the end of the eighth month these measurements regressed to 139±11 mmHg and 84±8 mmHg, respectively (p<0.05). Meaningful regression of carotid artery intima-media thickness was established. The mean regression was 0.10±0.19 mm (p=0.004) for women, 0.18±0.29 mm (p=0.007) for men and 0.13±0.23 mm (p<0.001) for the study population. No relation was seen between the carotid artery intima-media thickness and first systolic and diastolic blood pressure measurements of the patients (r=0.122, p=0.403 and r=0.032, p=0.828, respectively).
Conclusion: We think that losartan should be recommended to use for protection against atherosclerosis at the young aged individuals that have multiple risks for atherosclerosis, other than hypertension.

6.The comparison between the efficiency of different anti-arrhythmic agents in preventing postoperative atrial fibrillation after open heart surgery
Ebubekir Emre Men, Özlem Yıldırımtürk, Aylin Tuğcu, Vedat Aytekin, Saide Aytekin
PMID: 18524727  Pages 206 - 212
Objective: Atrial fibrillation (AF) is one of the most frequent complications that may occur after open-heart surgery. Clinical reports regarding comparison of different anti-arrhythmic agent’s usage to maintain sinus rhythm after open-heart surgery are not conclusive. We examined the effects of different anti-arrhythmic agents administration before operation on postoperative AF incidence, duration of hospitalization and complications.
Methods: Overall, 180 patients (130 men and 50 women, mean age 58.13±11.71 years) who were candidates for open-heart surgery, were included in this prospective, single-blind study. All patients divided into five different groups. All anti-arrhythmic drugs were administered approximately 7 days before the operation. Propafenone was given to Group 1 (G1); sotalol to Group 2 (G2); amiodarone to Group 3 (G3) and diltiazem to Group 4 (G4) at doses of 300 mg/day, 80 mg/day, 400 mg/day and 180 mg/day orally respectively. The fifth group (G5) did not receive any of anti-arrhythmic drugs. The medication was continued for ten days postoperatively. Statistical analysis was performed using Chi-Square and one-way ANOVA tests.
Results: Atrial fibrillation developed during postoperative period in 18.1% patients in G1, 9.1% patients in G2, 16.2% patients in G3, 28.6% patients in G4 and 38.1% patients in G5. The prevalence of postoperative AF was significantly higher in G5 as compared with other groups (p=0.026). There were significant differences across groups in duration of hospitalization (p=0.033), with shortest mean duration of hospitalization in G2 (8.9±2.7 days).
Conclusion: Any anti-arrhythmic agent started 7 days before the operation and continued for 10 days, may reduce the prevalence of postoperative AF, morbidity and duration of hospitalization. However, we found that sotalol and amiodarone were more effective than other anti-arrhythmic agents in our patient population.

7.Off-pump coronary artery bypass surgery in patients with chronic renal failure
Ömer Tetik, Bilgin Emrecan, Berkan Özpak, Levent Yilik, Mert Kestelli, Nagihan Karahan, Cengiz Özbek, Ali Gürbüz
PMID: 18524728  Pages 213 - 216
Objective: Patients with dialysis-dependent renal disease frequently present with coronary artery disease. These patients are considered to be at high risk for coronary artery bypass grafting. Therefore, off-pump coronary artery surgery may become a good option for these patients. Off-pump coronary artery bypass surgery in patients with dialysis-dependent renal failure was retrospectively reviewed in this study.
Methods: From March 2001 through May 2005, we performed off-pump coronary bypass grafting in 10 patients with dialysis-dependent renal failure. Coronary artery bypass grafting was performed on beating heart in all of the patients. The patients were evaluated for perioperative variables and postoperative outcomes.
Results: Mean age was 58.7±8.9 years with a range between 45 to 76 years. Eight of the patients were male and two were female. No perioperative and postoperative deaths or ischemic cardiac events were observed. Anginal symptoms of the patients were relieved during the postoperative period. Functional status of the patients was improved postoperatively. None of the patients needed revision due to hemorrhage. Mean distal anastomosis number was 1.8±0.6. Mean intensive care unit stay was 1.8±0.8 days and hospital stay was 5.3±0.9 days.
Conclusion: Off-pump coronary artery bypass grafting can be performed with good clinical results. We believe that off-pump coronary revascularization is a good option in patients with dialysis-dependent renal failure.

8.Statins in stroke prevention
Ömer Gedikli, Merih Baykan
PMID: 18524729  Pages 217 - 222
Cholesterol lowering with statins has been proven to reduce vascular events in primary and secondary prevention of coronary artery disease (CAD). Epidemiologic studies found no or little association between blood cholesterol levels and stroke. However, randomized trials in patients with CAD have shown that statins decrease stroke incidence. These statin trials indicate 21% relative risk reductions for stroke. In subgroup analysis of the Heart Protection Study, simvastatin had no effect on stroke recurrence, in patients with a previous stroke. Recently, Stroke Prevention by Aggressive Reduction in Cholesterol Levels study showed that treatment with high dose atorvastatin reduced risk of stroke in patients with recent stroke and transient ischemic attack and no known CAD. In this review, we will discuss the effects of statins on stroke and the potential mechanisms of action.

9.Complex congenital anomalies of superior vena cava and pulmonary veins with left-sided inferior vena cava
Cem Köz, Mehmet Yokuşoğlu, Mustafa Taşar, Fatih Örs, Celal Genç
PMID: 18524730  Pages 223 - 225
Abstract | Full Text PDF

10.Incidentally diagnosed congenital left ventricular aneurysm: report of two cases
Oben Baysan, Mehmet Uzun, Mehmet Yokuşoğlu, Cem Köz, Güvenç İnanç, Özdeş Emer
PMID: 18524731  Pages 225 - 227
Abstract | Full Text PDF

11.Diagnostic techniques in a case of patent ductus arteriosus: Is the computerized tomography angiography gold-standard method for the diagnosis of patent ductus arteriosus?
Şenay Funda Bıyıkoğlu, Ayça Boyacı, Erdal Duru, Aysel Türkvatan, Ali Şaşmaz
PMID: 18524732  Pages 227 - 229
Abstract | Full Text PDF

12.Surgical repair of supravalvular aortic stenosis in Williams syndrome
Hakan Vural, P›nar Vural, Nurcan Özyazıcıoğlu, Ahmet Özyazıcıoğlu
PMID: 18524733  Pages 229 - 230
Abstract | Full Text PDF

13.A case with homozygote familial hypercholesterolemia treated with LDL apheresis and coronary bypass in adolescence period
Esma Altınel, Semra Çetinkaya, Cengiz Kara, Utku Arman Örün, Hakan Aydın, Ali Kutsal
PMID: 18524734  Pages 231 - 232
Abstract | Full Text PDF

14.True left ventricular aneurysms and rupture/Midterm survival followingrepair of a giant left ventricular true aneurysm ruptured during operation and associated with papillary muscle rupture
Osman Tiryakioğlu, Tuğrul Göncü
PMID: 18524735  Pages 233 - 234
Abstract | Full Text PDF

15.Incomplete Kawasaki disease: a pediatric diagnostic conflict
Jae Il Shin, Byung Won Yoo, Dong Soo Kim, Jae Young Choi
PMID: 18524736  Pages 234 - 235
Abstract | Full Text PDF

16.University, Science and Ethic at the Period of Republic
Cumhur Ertekin
PMID: 18524737  Pages 236 - 240
Abstract | Full Text PDF

17.Elite Reviewers of the Anatolian Journal of Cardiology for the last years
Bilgin Timuralp
Page 241
Abstract | Full Text PDF

18.Reciprocal ST segment depression in a patient with acute pericarditis
Turgay Çelik, Atila İyisoy, Hürkan Kurşaklıoğlu
PMID: 18524713  Page E1
Abstract | Full Text PDF

19.Complication of a prosthetic valve endocarditis: complete atrioventricular block with variable QRS morphology due to aortic ring abscess
Yeşim Güray, Ali Ekber Ataş, Sezgin Öztürk, Ayça Boyacı
PMID: 18524712  Pages E1 - E2
Abstract | Full Text PDF

20.A pseudoaneurysm of the saphenous vein graft to the posterior descending coronary artery
Turgay Çelik, Atila İyisoy, U. Çağdaş Yüksel, Ersoy Işık
PMID: 18524715  Page E2
Abstract | Full Text PDF

21.A case of left ventricular diverticulum diagnosed by left ventriculography
Turgay Çelik, Atila İyisoy, Hürkan Kurşaklıoğlu
PMID: 18524716  Page E2
Abstract | Full Text PDF

22.Successful stent implantation to bilateral renal artery stenosis in a case with diffuse atherosclerotic involvement
Mehmet Yazıcı, Mehmet S. Ülgen, Mehmet Kayrak, Fatih Koç, Kadriye Zengin
PMID: 18524714  Pages E2 - E3
Abstract | Full Text PDF

23.Antiaggregant and anticoagulant therapy of free-floating thrombus in left atrium
Kurtuluş Özdemir, Nazif Aygül, İlknur Can, Alpay Arıbaş
PMID: 18524717  Pages E3 - E4
Abstract | Full Text PDF

24.Asymptomatic accessory mitral valve tissue diagnosed by echocardiography
Şenay Funda Bıyıkoğlu, Yeşim Güray, Sezgin Öztürk, Omaç Tüfekçioğlu
PMID: 18524718  Pages E4 - E5
Abstract | Full Text PDF

25.Hepatocellular carcinoma with right atrial extension causing clinical deterioration in a patient with ischemic cardiomyopathy
Yeşim Güray, Kazım Başer, Ayça Boyacı
PMID: 18524720  Page E5
Abstract | Full Text PDF

26.Incidentally found pulmonary aspergilloma in a patient with dilated cardiomyopathy
Serkan Çay, Osman Turak, Serkan Topaloğlu, Nurdan Çay
PMID: 18524719  Pages E5 - E6
Abstract | Full Text PDF

27.Surgical approach to giant femoral artery pseudoaneurysm due to gunshot injury
Ömer Tetik, Ufuk Yetkin, Serdar Bayata, Serdar Bayrak, Ali Gürbüz
PMID: 18524721  Pages E6 - E7
Abstract | Full Text PDF

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