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Anatol J Cardiol: 9 (2)
Volume: 9  Issue: 2 - April 2009
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1.Target audience, new applications, remembering Prof. Dr. Philip Poole-Wilson
Bilgin Timuralp
PMID: 19357046  Page 74
Abstract | Full Text PDF

2.Serum levels of interleukin (IL)-13, IL-17 and IL-18 in patients with ischemic heart disease
Abdollah Jafarzadeha, Ali Esmaeeli- Nadimi, Hossain Nough, Maryam Nemati, Mohammad Taghi Rezayati
PMID: 19357047  Pages 75 - 83
Objective: It has been reported that the cytokines play an important role in the pathogenesis of cardiovascular diseases. The aim of this study was to evaluate the serum levels of interleukin (IL)-13, IL-17 and IL-18 in patients with ischemic heart disease (IHD) and also to clarify their association with traditional risk factors of disease. Methods: A total of 60 patients with IHD as having acute myocardial infarction (AMI; n=30) or unstable angina (UA; n=30) and 30 sex- and age- matched healthy subjects as a control group were enrolled to this cross-sectional, case-controlled study. Serum samples were collected from all participants (for AMI patients at 3-5 days after events and for UA at admission time) and tested for the IL-13, IL-17 and IL-18 by use of ELISA method. Statistical analysis was performed using ANOVA, Student t, Kruskal-Wallis, Mann-Whitney U and Chi-square tests as appropriate. Results: The frequencies of subjects with detectable levels of IL-13 were 6.7%, 20% and 33.3% in AMI, UA and control groups, respectively. The frequency of subjects with detectable levels of IL-13 in control group was significantly higher as compared to AMI group and total group of patients with IHD (p<0.02 and p<0.05, respectively). The mean serum levels of IL-17 in AMI group (6.68±1.2 pg/ml) and UA group (5.48±1.01 pg/ml) were significantly higher than that observed in control group (2.07±0.60 pg/ml; p<0.005 and p<0.04, respectively). Moreover, the mean serum levels of IL-18 in UA group (122.92±18.16 pg/ml) were significantly higher than in control group (67.82±5.98 pg/ml; p<0.03). The mean serum levels of IL-18 in IHD patients without a certain traditional risk factor including non-hypertensive patients (120.14±17.04 pg/ml), non-dyslipidemic patients (131.86±20.04 pg/ml), non-diabetic patients (111.96±14.71 pg/ml) and non-smoker patients (113.93±16.41 pg/ml) were significantly higher as compared to control group (p<0.04, p<0.004, p<0.03 and p<0.03, respectively). Although, the mean serum levels of IL-18 in patients with a certain traditional risk factor were higher in comparison to control group, but the differences were not significant. The means serum levels of IL-17 in patients with or without a certain traditional risk factor were also markedly higher as compared to healthy group. Conclusions: These results showed that the higher serum levels of IL-17 and IL-18 were associated with IHD. The presence or absence of a certain traditional risk factors of IHD may influence the serum levels of cytokines. These findings may be considered to improve the predictive or prognostic values of inflammatory cytokines for IHD and also to design possible novel therapeutic approaches.

3.The early predictors of ventricular remodeling after myocardial infarction: the role of tumor necrosis factor-alpha
Ergün Barış Kaya, Necla Özer, Onur Sinan Deveci, Alper Kepez, Erol Tülümen, Serdar Aksöyek, Enver Atalar, Kenan Övünç, Ferhan Özmen, Hilmi Özkutlu
PMID: 19357048  Pages 84 - 90
Objective: Ventricular remodeling (VR) is a pathologic process characterized by progressive ventricular dilatation occurring after acute myocardial infarction (MI) leading to left ventricular systolic dysfunction. The purpose of the study was to evaluate the efficacy of plasma tumor necrosis factor alpha (TNF-α) levels to predict the left VR. Methods: This prospective observational cohort study included 72 consecutive patients with newly diagnosed MI with age ranging between 38-87 years (mean 59 ± 12 years). Control group was consisted of 30 patients with no additional systemic disease and normal coronary arteriograms. Transthoracic echocardiography was performed to all patients and controls both in the beginning of the study and in the 6th follow-up. A coronary arteriography was also performed to all patients. Patients with an increment in the diastolic volume index more than 20% in the follow-up compared with basal values included in the VR subgroup. The patient subgroup with VR consisted of 19 patients. Statistical analyses were performed using ANOVA and Kruskal Wallis tests for comparison of variables between groups. Logistic regression and ROC analyses were used for evaluation of accuracy of TNF-alpha in prediction of VR. Results: There were no significant differences between groups according to demographic characters. The basal plasma levels of TNF-α were higher in the patient subgroup with VR as compared with patients without VR and controls (14.59 ± 4.28 pg/ml vs 7.30 ± 4.48 pg/ml, and 1.64 ± 1.49 pg/ml, p < 0.001). In logistic regression analysis only TNF-α predicted the VR (OR-1.356, 95% CI 1.117-1.647). Plasma TNF-α levels with a cut-off ≥ 10.33 pg/ml were found to have 89.5% sensitivity and 79.3% specificity to predict the development of VR. Conclusion: These results demonstrate the increment of plasma TNF-α levels in the acute phase of MI and the close relationship between the TNF-α levels and VR in the patients with first MI.

4.The relation between coronary lesion distribution and risk factors in young adults
Cem Köz, Hüseyin Çelebi, Mehmet Yokuşoğlu, Oben Baysan, Adnan Haşimi, Muhittin Serdaroğlu, Mehmet Uzun
PMID: 19357049  Pages 91 - 95
Objective: In this cross-sectional, case-controlled study, we aimed to evaluate classical and novel risk factors in young patients with coronary artery disease (CAD), and the relation between coronary risk factors and coronary lesion distribution. Methods: Fifty-three patients under age of 45 years with severe coronary artery stenosis on angiography (group A) and age matched sixty patients having normal or non-critical stenosis on coronary angiography (group B) comprised the study groups. Conventional (smoking, family history, diabetes, hypertension) and novel risk factors (lipoprotein (a), homocysteine) were compared between the groups. Moreover, the relation between risk factors, and coronary lesions distribution, including left main artery (LMA) or proximal or mid left anterior descending (LAD) artery and remaining coronary lesions was investigated. Logistic regression analysis was used to define confounding factors predicting severe CAD and coronary lesion distribution and ROC curve analysis was performed to determine the cut-off value of independent factors, which were assessed by logistic regression analysis. Results: Smoking was more prevalent in group A compared to group B. Lipoprotein (a) and homocysteine levels were also higher in group A than group B. For group A and B median (max-min) values of lipoprotein (a) were 34 (2-174) mg/dl and 38 (2-203) mg/dl (p=0.038), respectively and homocysteine levels were 12.3 (5-56.6) µmol/L and 9 (1.4-19) µmol/L (p=0.012), respectively. Smoking and homocysteine were independent predictors of severe CAD in young patients according to logistic regression analysis with an Odds ratio of 3.7 (95% CI=1.572-8.763; p=0.002) and 1.2 (95% CI=1.045-1.341; p=0.008), respectively. For predicting significant CAD the cut-off value of homocysteine was 11.6 µmol/L with a sensitivity and specificity of 53% and 77%, respectively (AUC=0.637; 95% CI=0.542-0.725; p=0.008). Within group analysis in group A patients revealed that only homocysteine was an independent predictor of LMA or proximal or mid-LAD lesion presence with an Odds ratio of 1.2 (95% CI=1.011-1.465; p=0.016). ROC curve analysis revealed a cut-off value of 12 µmol/L in predicting LMA or proximal or mid-LAD lesions with a sensitivity and specificity of 65% and 91%, respectively (AUC=0.735; 95% CI=0.594-0.850; p=0.002). Conclusion: In our study, we found that young patients with severe CAD had different risk profile with higher frequency of smoking and increased levels of lipoprotein (a) and homocysteine. While smoking status and homocysteine may be used for prediction of severe CAD in young individuals, only homocysteine predicted coronary lesion distribution in LMA and proximal or mid-LAD.

5.The quality of arterial hypertension treatment in cardiology service in Kosovo - a single center study
Gani Bajraktari, Xhevahire Sylejmani, Kimete Thaçi, Shpend Elezi, Gjin Ndrepepa
PMID: 19357050  Pages 96 - 101
Objective: The epidemiological data have shown that the goal blood pressure (BP) control is achieved in only a small percentage of the hypertensive patients. The aim of this study was to assess the quality of the management of arterial hypertension (AH) in patients hospitalized in Service of Cardiology, University Clinical Centre of Kosovo, in Prishtina, and to determine the predictors of uncontrolled AH. Methods: This retrospective study included 938 consecutive hypertensive patients (63.1±11.3 years, 55.1% females), admitted to our institution between January 2003 and June 2006. Systolic and diastolic blood pressure, blood analyses, drug prescription and echocardiographic findings were analyzed in all study patients. Multiple regression analysis was used to identify the independent associates of poor BP control. Results: Overall, 83%f of patients were discharged on angiotensin-converting enzyme inhibitors (A), 71% - on beta-blockers (B), 26% - on calcium channel blockers (C) and 60% - on diuretics (D). The most frequent drug combination used was ABD (30.5%), followed by AB (18%) and AD (8%). The goal systolic and diastolic BP was achieved in 50% of patients. Multivariate analysis identified diabetes, (OR=0.479, 95% confidence interval [CI] 0.339-0.677, p<0.001), creatinine level (OR=0.997, 95% CI 0.996-0.999, p=0.001], and ABCD combination therapy (OR=0.445, 95% CI 0.253-0.774, p=0.046)], as independent correlates of in-hospital poor BP control. Conclusions: Half of hypertensive patients hospitalized in the Service of Cardiology had achieved the goal blood pressure. The diabetes, level of creatinine and a combination of 4 antihypertensive drugs were independent predictors of poor hypertension control.

6.The assessment of adherence of hypertensive individuals to treatment and lifestyle change recommendations
Şenay Uzun, Belgüzar Kara, Mehmet Yokuşoğlu, Filiz Arslan, Mehmet Birhan Yılmaz, Hayrettin Karaeren
PMID: 19357051  Pages 102 - 109
Objective: Most of studies about adherence in hypertension highlight the adherence to the medical treatment but do not include the adherence to the other recommendations, such as lifestyle modifications. The factors effective on adherence to each type of recommendation may differ. Accordingly, we aimed in this study to show that nonadherence to each recommendation should be assessed individually. Methods: The study, which was designed as cross-sectional and descriptive, included 150 patients who were followed by the outpatient clinics for at least one year. A data collecting form with 44 questions was prepared by the investigators, and the patient adherence was assessed in five categories: medicine-related adherence, diet-related adherence, exercise-related adherence, measurement-related adherence and smoking related adherence. The face-to-face interview method was used to collect data. Statistical analysis was accomplished by Chi-square test and logistic regression analysis. Results: Of 150 subjects included in the study, 94 (63%) were female and mean age was 56±12 (20-81) years. Mean duration of drug use was 6.5± 6.5 years and the mean number of drugs used was 1.6± 0.8. The adherence to recommendations of medication, diet, exercise, home-blood measurement and smoking were 72%, 65%, 31%, 63% and 83%, respectively. Each patient was adherent to at least one recommendation, while 11% of patients were adherent to one recommendation, 23% - to two, 29% - to three, 24% - to four and 13% - to five. According to the regression analysis, factors effective on each type of adherence were found to be different from others. The presence of three or more types of adherence was related to income level (OR= 0.297; 95%CI - 0.132-0.666; p<0.001) and presence of any other chronic disease (OR=2.329; 95% CI - 1.114-4.859; p=0.002). Conclusion: The rates of adherence to medicine and life-style changes were generally found to be low in hypertension. The cause of nonadherence is different according to the type of adherence. Each recommendation should be assessed individually in terms of adherence

7.Correlations between autonomic dysfunction and circadian changes and arrhythmia prevalence in women with fibromyalgia syndrome
Mehmet Tolga Doğru, Gülümser Aydın, Aliye Tosun, Işık Keleş, Mahmut Güneri, Ayşe Arslan, Haksun Ebinç, Sevim Orkun
PMID: 19357052  Pages 110 - 117
Objective: It is known that increased sympathetic activity and decreased parasympathetic activity are present in patients with fibromyalgia syndrome (FMS). This study aims to investigate the correlations of autonomic dysfunction and differences in autonomic circadian activity with arrhythmia prevalence in women with FMS. Methods: Fifty female patients with FMS and 30 healthy female controls were included in this cross-sectional, case-controlled study. A 12-lead electrocardiogram and 24-hour Holter monitoring were performed in all patients to evaluate arrhythmias and autonomic function tests. Heart rate variability (HRV) parameters were utilized to detect autonomic dysfunction in patients with FMS. HRV measurements were performed in total 24-hour, day time (06: 00-22: 59), night time (23: 00-05: 59) periods and during autonomic tests (stand - supine, inspiration-expiration and Valsalva tests) using 24-hour Holter monitoring recordings. Student t-test, Mann–Whitney U and Pearson Chi-square tests were used for comparisons of the data between groups. The correlation of data was tested by using Spearman correlation analysis. Results: The mean ages of the patient and control groups were 38±7.4 and 36±8.1 years, respectively. In HRV measurements, high frequency (HF) power, was significantly decreased in the patient group as compared with control group (167.4 msec2 (107.0- 312.0) vs.314.5 msec2 (124.0- 905.0), p=0.017). The low frequency/HF ratio (LF/HF) values for total 24 hours (2.22±0.18 vs. 1.22±0.12, p<0.001) and in the night time period (2.78±1.97 vs.1.15±0.77, p<0.001) were found to be significantly higher in the patient group than in control one. The ratio of LF/HFDay / LF/HFNight was markedly higher in the control group (2.67 (1.22- 5.65) vs. 1.45 (0.83- 2.05), p=0.004). The prevalence (p=0.028) and total number (127.1±21.4 vs. 187.3±62.3, p=0.019) of supraventricular extrasystoles in 24-hour period was higher in the patient group. Conclusion: The sympathetic activity was significantly increased and parasympathetic activity significantly decreased in FMS patients. Additionally, significant autonomic circadian activity changes were also detected in these patients. These autonomic changes might be linked to increased arrhythmia prevalence.

8.P-wave dispersion and P-wave duration in children with stable asthma bronchiale
Oya Yücel, Mustafa Yıldız, Sevin Altınkaynak, Ayşe Sayan
PMID: 19357053  Pages 118 - 122
Objective: P-wave dispersion is associated with inhomogeneous and discontinuous propagation of sinus impulses. The aim of this present study was to investigate the impact of P-wave dispersion in children with stable asthma. Methods: In this cross-sectional study, the study group consisted of 20 children (12 boys, 8 girls) with stable asthma and mean age of 7.7 ± 2.0 years. During the study, these patients were treated with low dose inhaled corticosteroids for at least six months. Control group consisted of 20 healthy children matched by same sex and age population. Age, weight, height, echocardiographic values, P-wave maximum duration and P-wave dispersion were compared between asthmatic and healthy children. P - wave duration was calculated in 12-leads of the surface electrocardiography. The difference between P maximum and P minimum durations was defined as P - wave dispersion. The obtained results were compared by independent samples t test and Mann-Whitney U test. Correlations for P- wave dispersion were calculated using Pearson test. Results: P-wave maximum duration is slightly increased in patients with stable asthma (0.092 ± 0.017 ms) as compared with healthy controls (0.083 ± 0.011 ms) (p=0.07). We found significant correlation between P-wave dispersion and age (r=0.40, p=0.01), weight (r=0.41, p=0.008) and height (r=0.41, p=0.008). Conclusion: P-wave maximum duration is slightly increased and P- wave dispersion is correlated with age, weight and height in children with stable asthma.

9.The effect of competitive flow on both the flow and the velocity in venous grafts in a bypass model
Muzaffer Bahçivan, Muzaffer Elmalı, Fersat Kolbakır, Kamil Göl
PMID: 19357054  Pages 123 - 127
Objective: The term “competitive flow” defines the flow from a partially stenosed native artery that “competes” with the flow from a graft to perfuse the distal tissues. The purpose of our study is to investigate the effects of competitive flow at different degrees of stenosis at common carotid artery, in a rabbit model by measuring both the flow volume and velocity in the venous graft. Methods: This prospective experimental study included 33 rabbits, which were divided into three groups: in Group 1, the common carotid arteries were ligated to form a total occlusion, in Group 2, the common carotid arteries were externally incompletely ligated to achieve 50% stenosis, and in Group 3, common carotid arteries were fully patent. The jugular vein was reversed and anastomosed to proximal and distal common carotid arteries using end to side anastomosis technique. Mean arterial pressure, the total flow and velocity were measured in native carotid arteries prior to surgery and in venous grafts 2 months after surgery using Doppler ultrasonography. Statistical analysis was performed using Chi-square test and Kruskal Wallis analysis of variances. Results: There were no differences in graft mean velocity (Group 1 - 16.8±6.7 cm/sec, Group 2 - 14.1±6.1 cm/sec and Group 3 - 12.1±6.7 cm/sec), and mean flow volume (Group 1 - 33.9±11.5 mL/min, Group 2 - 29.0±8.3 mL/min, and Group 3 - 24.4±12.8 mL/min) between groups after surgery (p>0.05 for both). Conclusion: As it was the case in this rabbit model, the reduction of flow volume or velocity in lesser degrees of stenosis in the carotid artery venous bypass grafts is not significant in a statistical perspective. Although in short-term this effect did not create a difference for graft patencies between the groups, it may be important in long-term

10.Does harvesting of radial artery in the early postoperative period perturb the palmar blood supply and functions?
Nezihi Küçükarslan, Ata Kırılmaz, Mehmet Ali Şahin, Adem Güler, Kubilay Karabacak, Ertuğrul Özal, Yavuz Sanısoğlu, Harun Tatar
PMID: 19357055  Pages 128 - 131
Objective: The aim of this prospective study was to assess whether the removal of the radial artery (RA) caused any alteration in the function or power of hand on postoperative 15th day. Methods: The study group included 25 patients with objective or subjective complaints on postoperative 15th day regarding harvest site following coronary bypass surgery by using RA. Patients were examined for bilateral forearm function (soft touch and pin-prick neural sensation, handgrip power). The ulnar artery and palmar arcus Doppler measurements such as peak systolic and end-diastolic velocity, and radius of the arteries have been measured both at rest and following handgrip test. The operated arm was evaluated and compared with the opposite arm. Wilcoxon test was used to compare continuous variables. Results: Among 18 patients complained a loss of sense in the RA excised arm, the sensory defects were documented in 5. Among 7 patients presented with a feel of strength loss, handgrip power revealed a nonsignificant decrease of strength in the harvested arm. After squeezing test, ipsilateral ulnar artery peak systolic velocity increased from 86±15 to 105±15 cm/sec (p<0.001), end-diastolic flow velocity from 28±5 to 36±8 cm/sec (p<0.001) without any change in the ulnar artery radius. In contrast, no significant change in the flow velocity and the diameter of palmar arcus was noted before and after squeezing test. The comparison of the ulnar artery radius and blood flow velocity parameters in the RA excised arm to those of contralateral one after exercise test demonstrated no difference. Conclusions: With an assumption of appropriate selection, removal of RA does not change the forearm blood supply and functions with little sensory disturbances in the early postoperative period.

11.Medical ethics in residency training
Murat Civaner, Özlem Sarıkaya, Harun Balcıoğlu
PMID: 19357056  Pages 132 - 138
Medical ethics education in residency training is one of the hot topics of continuous medical education debates. Its importance and necessity is constantly stressed in declarations and statements on national and international level. Parallel to the major structural changes in the organization and the finance model of health care system, patient-physician relationship, identity of physicianship, social perception and status of profession are changing. Besides, scientific developments and technological advancements create possibilities that never exists before, and bring new ethical dilemmas along with. To be able to transplant human organs has created two major problems for instance; procurement of organs in sufficient numbers, and allocating them to the patients in need by using some prioritizing criteria. All those new and challenging questions force the health care workers to find authentic and justifiable solutions while keeping the basic professional values. In that sense, proper medical ethics education in undergraduate and postgraduate term that would make physician-to-be’s and student-physicians acquire the core professional values and skill to notice, analyze and develop justifiable solutions to ethical problems is paramount. This article aims to express the importance of medical ethics education in residency training, and to propose major topics and educational methods to be implemented into. To this aim, first, undergraduate medical education, physician’s working conditions, the exam of selection for residency training, and educational environment were revised, and then, some topics and educational methods, which are oriented to educate physicians regarding the professional values that they should have, were proposed

12.The growth of death rate from cardiovascular diseases in the Kyrgyz Republic
Ryskul B. Kydyralieva, Ainagul S. Dzhumagulova
PMID: 19357057  Pages 139 - 140
Abstract | Full Text PDF

13.Occurrence of a slowly growing pseudoaneurysm and restenosis in coronary artery following primary percutaneous coronary intervention in a patient with acute myocardial infarction
Mahmut Açıkel, Hüseyin Şenocak, Alpay Arıbaş
PMID: 19357058  Pages 141 - 142
Abstract | Full Text PDF

14.Coronary artery mycotic aneurysm presenting with pericardial effusion
Göksel Kahraman, Haluk Akbaş, Birsen Mutlu, Bahar Müezzinoğlu, Yonca Anık, Dilek Ural
PMID: 19357059  Pages 143 - 144
Abstract | Full Text PDF

15.A rare congenital cardiac anomaly: ectopia cordis
Hasan Tahsin Keçeligil, Mustafa Kemal Demirağ, Semih Murat Yücel, Ali Yüksel
PMID: 19357060  Pages 144 - 146
Abstract | Full Text PDF

16.Abdominal obesity criteria for Turkish men and women, and relevance of smoking for obesity/Obesity and abdominal obesity; an alarming challenge for cardio-metabolic risk in Turkish adults
Altan Onat, Gülay Hergenç, Günay Can
PMID: 19357061  Page 147
Abstract | Full Text PDF

17.Choosing cohort for epidemiologic studies
Oben Baysan, Mehmet Yokuşoğlu
PMID: 19357063  Page 148
Abstract | Full Text PDF

18.Assessment of aortic stiffness and ventricular functions in familial Mediterranean fever
Rıfat Eralp Ulusoy
PMID: 19357062  Pages 148 - 150
Abstract | Full Text PDF

19.A case of exercise-induced sinus node deceleration without evident coronary artery disease
Şükrü Karaarslan, Yusuf Alihanoğlu, Hatem Arı, Mehmet A. Vatankulu, Ahmet Keser, Hasan Gök
PMID: 19357064  Pages 150 - 151
Abstract | Full Text PDF

20.Intraoperative measurement of Qp/Qs ratio may be helpful in determining the strategy for sinus venosus type ASD
Mustafa Emmiler, Mehmet Melek, Cevdet Uğur Koçoğulları, Ahmet Çekirdekçi
PMID: 19357065  Pages 151 - 152
Abstract | Full Text PDF

21.Two unresolved questions in medicine
Siber Göksel
PMID: 19357066  Pages 153 - 156
Abstract | Full Text PDF

22.A single coronary artery branching out a hyper-dominant right coronary artery and small left coronary arteries
Mutlu Vural, Ömer Şatıroğlu, Bahadır Dağdeviren
PMID: 19357042  Page E4
Abstract | Full Text PDF

23.Severe tricuspid stenosis caused by myxoma originated from septal leaflet of tricuspid valve
Mehmet Can, İbrahim Tanboğa, Gökhan Gözübüyük, Taylan Akgün, Erdem Türkyılmaz, Vecih Oduncu, Cihangir Kaymaz
PMID: 19357041  Pages E4 - E5
Abstract | Full Text PDF

24.Abnormal elongated chordae tendinea protruding to the left ventricular outflow tract
Uğur Önsel Türk, Emin Alioğlu, Ertuğrul Ercan, Hamza Duygu
PMID: 19357043  Page E5
Abstract | Full Text PDF

25.An interesting case with prosthetic valve thrombosis
Necla Özer, Onur Sinan Deveci, Erol Tülümen, Hakan Aksoy, Ergün Barış Kaya, Sercan Okutucu
PMID: 19357045  Page E6
Abstract | Full Text PDF

26.Limb salvage with a cross-over femoropopliteal bypass procedure
Ufuk Yetkin, Orhan Gökalp, İsmail Yürekli, Ali Gürbüz
PMID: 19357044  Pages E6 - E7

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