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Anatol J Cardiol: 9 (6)
Volume: 9  Issue: 6 - December 2009
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1.Supplements, changing of the guard, scientific summer school and details
Bilgin Timuralp
PMID: 19965311  Page 435
Abstract | Full Text PDF

2.Practical approach to acute heart failure with algorithms
Mehdi Zoghi, Yüksel Çavuşoğlu, Mehmet Birhan Yılmaz, Sanem Nalbantgil, Mehmet Eren, Alexandre Mebazaa
PMID: 19965312  Pages 436 - 446
Abstract | Full Text PDF

3.Retractions: Guidance from the Committee on Publication Ethics (COPE)
Elizabeth Wager, Virginia Barbour, Steven J. Yentis, Sabine Kleinert
PMID: 19965313  Pages 447 - 449
Abstract | Full Text PDF

4.Hypertension and overweight among Turkish adolescents in a city in Aegean region of Turkey: a strong relationship in a population with a relatively low prevalence of overweight
Gönül Dinç, Gül Saatli, Hakan Baydur, Cemil Özcan
PMID: 19965314  Pages 450 - 456
Objective: A school-based survey was performed in 1346 adolescents aged 15-18 years to determine the relationship between “overweight” and hypertension among adolescents in a western city in Turkey with a low prevalence of “overweight”. Methods: The data were collected by a self administered questionnaire. Weight and height of adolescents were measured. US CDC pediatricanthropometric reference data were used to establish the body mass index (BMI) percentile. “At risk of overweight” (BMI-for-age and sex ≥85th, and <95th percentile) and “overweight” (BMI-for-age and sex ≥95th percentile) were defined. Hypertension (systolic and/or diastolic blood pressure that is ≥95th percentile for sex, age and height percentile) was defined according to the 4th Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents (2004). The Chi-square test, Chi-square test for trend and logistic regression models were used for analysis. Results: Overall, prevalence of “at risk of overweight” and “overweight” were found to be 10.7% and 3.2%, respectively. About 3.5% of the adolescents were hypertensive. After adjustment for sex and age, income, family history of hypertension, the factors positively associated with hypertension were “at risk for overweight” (Odds Ratio [OR]=5.09, 95% CI: 2.57-10.07) and “overweight” (OR=7.60, 95% CI: 2.90-19.89). Conclusion: The results of this study confirm low hypertension risk among adolescents in Manisa, which may be attributed to the low prevalence of “overweight”. The relatively low cardiovascular disease risk factor profile of these adolescents needs to be encouraged through adulthood. Thus, a school program of health promotion should be established to prevent the epidemics of cardiovascular diseases in our region.

5.Autologous stem cell therapy with surgical myocardial revascularization - The Rostock University experience
Can Yerebakan, Murat Uğurlucan, Alexander Kaminski, Bernd Westphal, Andreas Liebold, Gustav Steinhoff
PMID: 19965315  Pages 457 - 464
Objective: Stem cell therapy has gained great attraction in the treatment of acute and chronic myocardial diseases in recent years. The aim was to evaluate our experience in light of the middle term results of intramyocardial stem cell treatment with concomitant coronary artery bypass surgery (CABG) since 2001. Methods: After encouraging initial results of the Phase I (safety) trial with the first 15 patients, a prospective, controlled Phase II (efficacy) study was begun with 40 patients aiming to determine functional benefit of stem cell treatment using bone marrow derived CD 133+ stem cell therapy with concomitant CABG in comparison to CABG only since 2003. Medium-term results of intervention were evaluated using patient’s clinical findings, Holter monitoring, echocardiography, magnetic resonance imaging, computed tomography and myocardial scintigraphy. Statistical analyses were performed using unpaired t, Mann-Whitney U, ANOVA for repeated measurements and Chi-square tests. Results: Left ventricular ejection fraction (LVEF) has increased significantly at 6th and 18th months follow-up in the first 15 patients who received therapy since 2001 (preoperative: 39.0±8.7%; 6th month: 50.2±8.5% and 18th month: 47.9±6.0%; p=0.012). In the late group of patients, LVEF increased from 37.4±8.4% to 47.1±8.3% (p<0.001) whilst although an increase in LVEF has been observed in the CABG alone group (from 37.9±10.3% to 41.3±9.1%) the increase has not been statistically significant. Mortality occurred in 2 patients [1 patient from the early and 1 patient from the medium term follow-up] due to non-cardiac reasons. Myocardial calcification, lethal ventricular arrhythmia, and tumor formation have not been observed in any of the patients in the long-term follow up. Conclusion: Direct injection of bone marrow derived CD 133+ stem cells into the myocardium with concomitant CABG is safe. However, this treatment modality may only be applied as standard treatment after completion of the long term detailed results of prospective, randomized multicenter trials.

6.Autologous stem cell therapy with surgical myocardial revascularization
Serkan Durdu, Günseli Çubukçuoğlu Deniz, Ahmet Rüçhan Akar
PMID: 19965316  Pages 465 - 466
Abstract | Full Text PDF

7.Left ventricular functions in patients with cardiac syndrome X: a tissue Doppler study
Hüseyin Uğur Yazıcı, Nihat Şen, Yusuf Tavil, Fatma Hızal, Murat Turfan, Fatih Poyraz, Bülent Boyacı, Atiye Çengel
PMID: 19965317  Pages 467 - 472
Objective:  The aim of the study was to compare diagnostic accuracy of tissue Doppler imaging (TDI) and conventional Doppler echocardiography in diagnosis of left ventricular diastolic dysfunction in patients with cardiac syndrome X. Methods:  Our study was designed as cross-sectional study. In our study, we compared 35 patients with cardiac syndrome X (19 female, mean age 47.2±7.3 years) with 33 healthy persons as control group (18 female, mean age 49.5±7.1 years) with no coronary artery disease and having no ischemic complaints or findings at exercise test. Left ventricular systolic function was found by considering mean values of modified Simpson method for left ventricular ejection fraction and TDI assessment of systolic wave peak velocity. The diastolic function of left ventricle was assessed with conventional echocardiography and TDI. Unpaired t test for independent samples or Mann-Whitney U test were used for comparison of continuous variables, Chi square test - for comparison of categorical variables. To define the capability of predicting diastolic dysfunction for conventional Doppler echocardiography and tissue Doppler imaging ROC curve analysis was applied.   Results:  Left ventricular ejection fraction and systolic wave peak velocity were similar for both groups. Conventional Doppler echocardiographic measurements for left ventricular diastolic functions delineated the more frequent presence of diastolic dysfunction in cardiac syndrome X group As compared with controls (48% vs 18%; p<0.01). When both methods used for assessing diastolic dysfunction, it was found more apparent (66% vs 24%; p<0.01). When ROC curve was drawn for conventional Doppler echocardiography the AUC was0.623, the sensitivity and the specificity were  49% and 76%,  respectively. When the same was done for TDI the values were AUC=0.669, the sensitivity - 66% and the specificity - 68%. Conclusion:  Our study revealed the deterioration of left ventricular diastolic function in patients with cardiac syndrome X. We found TDI echocardiography was more sensitive to delineate left ventricular diastolic dysfunction in this category of patients when compared with conventional Doppler echocardiography.

8.The utility of heart rate recovery to predict right ventricular systolic dysfunction in patients with obesity
Kürşat Tigen, Tansu Karaahmet, Emre Gürel, Cihan Çevik, Fatih Yılmaz, Anıl Avcı, Selçuk Pala, Bülent Mutlu, Yelda Başaran
PMID: 19965318  Pages 473 - 479
Objective: Obesity is a nutritional disorder, which is associated with impaired left and right ventricular function. Impaired heart rate recovery (HRR) following a treadmill exercise test is an indicator of cardiovascular mortality. We investigated the utility of impaired HRR on the tissue Doppler imaging (TDI) echocardiographic estimates of left and right ventricular function in an obese/overweight cohort. Methods: Eighty consecutive patients with body mass index >27 kg/m2 were evaluated for their post exercise HRR in this cross-sectional study. The results were compared with the tissue Doppler and conventional echocardiographic findings of the same cohort. Tricuspid annular TDI peak systolic velocities (RVs) were evaluated with receiver operating characteristic (ROC) analysis to predict the insufficient heart rate recovery (18/min or less). Logistic regression analysis was used to identify the independent predictors of significant right ventricular systolic dysfunction (RVs <10 cm/sec) among the clinical and echocardiographic parameters. Results: There was a positive correlation between HRR and tricuspid annulus peak systolic velocity, exercise distance, and METs. The patients with impaired HRR at post-exercise first minute had lower exercise distance (p<0.0001), METs (p=0.001), RVs (p=0.037), and basal septal peak systolic velocity (p=0.041) than the patients with normal HRR. A tricuspid annulus TDI peak systolic velocity of 10 cm/sec predicted post-exercise preserved HRR with 70% sensitivity and 55% specificity with ROC analysis (AUC=0.638, 95% CI- 0.509-0.767, p=0.037). The subjects with tricuspid annulus peak systolic velocity (RVs) <10cm/sec were found to have larger body mass indices, impaired post-exercise first minute HRR, shorter total exercise distance, and lower total METs than the subjects with tricuspid annulus peak systolic velocity >10cm/sec. Impaired HRR and septum TDI late diastolic velocity were found as the independent predictors of right ventricular systolic function (RVs<10cm/sec) by logistic regression analysis. Conclusion: Post-exercise first minute impaired HRR is associated with right ventricular systolic dysfunction in obese patients. Both HRR and right ventricular systolic function correlate well with the exercise distance and METs. Obese patients with impaired HRR should be evaluated with echocardiography to assess their right ventricular systolic function.

9.Heart rate recovery and right ventricular systolic dysfunction in patients with obesity
Oben Baysan
PMID: 19965319  Page 480
Abstract | Full Text PDF

10.Sinoatrial node artery arising from posterolateral branch of right coronary artery: definition by screening consecutive 1500 coronary angiographies
Arda Şanlı Ökmen, Ertan Ökmen
PMID: 19965320  Pages 481 - 485
Objective: Sinoatrial node (SAN) artery originates from proximal segment of right coronary artery (RCA) or from left circumflex artery. Sinoatrial node artery artery originating from posterolateral (PL) branch of RCA is very rare. Only several cases have been reported. The study was performed to seek the frequency of this variation, evaluate clinical relevance, and describe electrocardiographic, angiographic characteristics of patients. Methods: Consecutive 1500 coronary angiography were screened to detect specifically SAN artery originating from PL branch of RCA. Patients with this variation were followed-up for one year regarding the arrhythmic events. Results: The origin of SAN artery was proximal RCA in 1280 (85%), circumflex artery in 208 (14%), and PL branch of RCA in 12 (0.8%) patients (8 male, 4 female, mean age 64±9 years). There was no history of arrhythmia in all patients. One patient presented with atrioventricular block. Indications of angiography were stable angina in 5, unstable angina in 5, and acute myocardial infarction in 2 patients. The patient with inferior myocardial infarction due to RCA total occlusion did not develop bradycardia or conduction defect. In four patients (33%) there was another artery originating from proximal RCA, ending at same territory with the variant artery suggesting dual blood supply. During one-year follow-up none of the patients experienced arrhythmic event. Conclusions: Sinoatrial node artery originating from distal RCA is very rare. This variation, even in patients with severe RCA disease is not associated with severe arrhythmia. Dual blood supply may be a protective factor in this subgroup of patients from arrhythmic events. To be aware of the origin and course of variant SAN artery may provide safe approach to interventional cardiologist and cardiac surgeon during percutaneous and surgical coronary and atrial interventions.

11.The oxidative state of children with cyanotic and acyanotic congenital heart disease
Sümeyye Ercan, Alpay Çakmak, Mustafa Kösecik, Özcan Erel
PMID: 19965321  Pages 486 - 490
Objective: The type of congenital heart disease, early diagnosis, and treatment modality all play an important role in the morbidity and mortality of these diseases. This study examined the relationship between congenital heart disease and oxidative stress in children with cyanotic and acyanotic congenital heart disease. Methods: In this case-controlled cross-sectional study, the study groups consisted of 29 patients with cyanotic heart disease, 30 patients with acyanotic heart disease, and a control group of 32 healthy individuals. For all groups, the total oxidant status (TOS), total antioxidant status (TAS), and oxidative stress index (OSI) were calculated. Of the cyanotic group, 12 were diagnosed with tetralogy of Fallot, 7 with transposition of the great arteries, 4 with tricuspid atresia, 4 with double outlet right ventricle and 2 with truncus arteriosus. In the acyanotic group 19 patients had ventricular septal defect (VSD), 5 atrial septal defect (ASD) and 6 patent ductus arteriosus (PDA). Statistical analyses were performed using Chi-square, Mann-Whitney U and Kruskal-Wallis tests. Results: The plasma TAS, TOS, and OSI were significantly higher in the cyanotic group than in the acyanotic group (p<0.0001, p<0.01, and p<0.01, respectively) and controls (p<0.0001, p<0.0001, and p<0.0001, respectively). A comparison between the acyanotic and control groups showed no statistical differences. Conclusion: The level of oxidative stress in patients with cyanotic congenital heart disease was significantly higher than in the acyanotic and control groups, which were similar.

12.Evaluation of the oxidative state in children with congenital heart disease
Pınar Zeyneloğlu
PMID: 19965322  Page 491
Abstract | Full Text PDF

13.Analysis of intra-aortic balloon pump model with ovine myocardial infarction
Mona Abdolrazaghi, Mahdi Navidbakhsh, Kamran Hassani, Shahram Rabbani, Hossein Ahmadi
PMID: 19965323  Pages 492 - 498
Objective: In this study, we have tried to model the effects of intra-aortic balloon pump (IABP) on myocardial infarction (MI) using the standardized data of MI in sheep which was obtained by ligation of the left anterior descending coronary artery. Methods: Mathematical model of whole cardiovascular system was presented in accordance to the arterial tree. The lumped parameter model was primarily obtained for a rigid vessel regarding the vessel diameter. In this study, the proper lumped model of every vessel was obtained by incorporating the rigid vessel lumped model into the capacitance as a compliance of the vessel. Intra-aortic balloon pump was modeled with the hemodynamic parameters of the aorta. It was assumed that balloon pump inflates at the beginning of the diastole and deflates near the beginning of the next systole. Results: During balloon pumping, the vessel diameter variation function counter pulsates sinusoidally with the same period of the cardiac cycle. End systolic pressure and end diastolic pressure decreases along with hemodynamic flow optimized through systemic arteries due to balloon pumping in diastole. It has been shown that the blood flow in subclavian artery increases as well. Moreover, the cardiac work keeps low, which prone to lower oxygen consumption. The results of modeling are in good agreement with IABP documentation. Conclusions: The presented model is a useful tool for studying of the cardiovascular system pathology and the presented modeling data are in good agreement with the experimental ones.

14.Furosemide infusion prevents the requirement of renal replacement therapy after cardiac surgery
Atike Tekeli Kunt, Serdar Akgün, Nazan Atalan, Nazan Bitir, Sinan Arsan
PMID: 19965324  Pages 499 - 504
Objective: Acute kidney injury (AKI) is a devastating complication following cardiac surgery and the ideal management is controversial. This prospective, randomized, open-label and double-blinded study analyzed the renoprotective effects of furosemide infusion and intermittent bolus therapy administered with dopamine infusion in cardiac surgical patients. Methods: Between August 1, 2007 and July 31, 2008, 100 adult patients undergoing elective coronary artery bypass surgery (CABG) surgery with normal renal function (creatinine <1.4 mg/dl) were enrolled in the study. The patients were randomized for the comparison of intermittent (Group 1, n=50, 1mg-3mg/kg) and continuous infusion of furosemide (Group 2, n=50, 10mg/ml). Continuous variables were expressed as mean ± SD and compared by unpaired Student’s t test or ANOVA for repeated measures. Statistical significance was assumed if p value was <0.05. Results: Renal replacement therapy (RRT) was used in 5% of patients (all in group 1, p=0.028). The 30-day mortality was 5%. Only 2 patients became hemodialysis dependent in group 1. Group 2 patients showed a continuous and higher urine output postoperatively than group 1 (p<0.001). Both groups had significant increase in peak postoperative serum creatinine values (p<0.001), however peak postoperative creatinine-clearance was significantly lower in group 1 (p<0.001). Conclusion: Acute kidney injury necessitating RRT makes a small percentage of patients undergoing cardiac surgery and if RRT is not required the survival is excellent. Continuous infusion of furosemide seems to be effective in promoting diuresis and decreasing the need for RRT. However further multicenter studies with different doses of furosemide are required to confirm these results.

15.The effect of inhibition of renin-angiotensin system on cardioversion success and recurrences of atrial fibrillation
Abdullah Doğan, Selahaddin Akçay
PMID: 19965325  Pages 505 - 511
The renin-angiotensin system (RAS) can play an important role as the underlying mechanism for the development and recurrence of atrial fibrillation (AF). In addition, AF itself can lead to atrial structural and/or electrophysiologic remodeling by activating the RAS. This remodeling serves as an arrhythmogenic substrate for AF. Thus, the inhibition of RAS with angiotensin converting-enzyme inhibitor or angiotensin receptor blockers may be a strategy to prevent occurrence and recurrence of AF in certain patients such as those with heart failure and hypertension in associated with left ventricular hypertrophy. In addition, it may facilitate the cardioversion of AF. In this review, we overview the effect of RAS blockers on cardioversion success and recurrence of AF.

16.Vasospastic angina: nocturnal chest pain, eosinophilia and delayed diagnosis
Nihat Söylemez, Remzi Yılmaz, Hüseyin Aksoy, T. Fikret İlgenli, Onur Akpınar
PMID: 19965326  Pages 512 - 513
Abstract | Full Text PDF

17.Diffuse left anterior descending coronary artery dissection with aortic coarctation
Haluk Mergen, Yunus Nazlı, Mahmut Acar, Vedide Tavlı, Talat Tavlı
PMID: 19965327  Pages 513 - 515
Abstract | Full Text PDF

18.Intractable atrial flutter presented with severe bradycardia in an infant
Safa Barış, Alper Güzeltaş, Gülcan Seymen, İsa Özyılmaz, Ayşe Güler Eroğlu, Funda Öztunç
PMID: 19965328  Pages 515 - 517
Abstract | Full Text PDF

19.Japanese type cardiomyopathy without deep negative T-waves and with findings of preexcitation on ECG
M. Yunus Emiroğlu, Hidayet Kayançiçek, Erden Gülcü, Ramazan Kargın
PMID: 19965329  Pages 518 - 519
Abstract | Full Text PDF

20.A newborn with pentalogy of Cantrell and pulmonary hypoplasia
Sevim Ünal, Fatma Çakmak Çelik, Eda Özaydın, Ayper Kaçar, Nazlıhan Günal
PMID: 19965330  Pages 519 - 520
Abstract | Full Text PDF

21.Idiopathic twin aneurysm of right pulmonary artery diagnosed in a case 17 years after a successful surgical repair of ventricular septal defect
Cengiz Özbek, Ufuk Yetkin, İsmail Yürekli, Ali Gürbüz
PMID: 19965331  Pages 520 - 521
Abstract | Full Text PDF


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25.An isolated supramitral ring detected in an adult patient
Oben Baysan, Mehmet Ali Şahin, Mehmet Yokuşoğlu, Cem Köz, Adem Güler, Celal Genç, Hayrettin Karaeren
PMID: 19965307  Page E20
Abstract | Full Text PDF

26.A case of ventricular septal aneurysm producing right ventricular outflow obstruction
Abdullah Erdem, Cenap Zeybek, Yalım Yalçın, Ahmet Çelebi
PMID: 19965306  Pages E20 - E21
Abstract | Full Text PDF

27.Primary stenting of the anomalous left main coronary artery originating from right coronary sinus: multislice computerized tomography angiography imaging
Ahmet Yıldız, Ömer Yiğiner, Hakan Gürçınar, Murat Başkurt, Barış Ökçün
PMID: 19965309  Page E21
Abstract | Full Text PDF

28.Coincidentally determined floating rig ht ventricular thrombus in a patient withcoronary artery disease
Özer Kandemir, Mustafa Büyükateş, Erol Aktunç, S. Akın Turan, Mustafa Aydın
Pages E21 - E22
Abstract | Full Text PDF

29.A case of cardiac valvular dysplasia
Deniz N. Çağdaş, F. Ayşenur Paç
PMID: 19965310  Pages E22 - E23
Abstract | Full Text PDF

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