Objective:  The objectives of the study were to assess myocardial systolic and diastolic functions by myocardial performance index (MPI) and its relationship with E – wave deceleration time (DT) in early phase of acute Q-wave myocardial infarction (MI). Methods:  We performed nongeometric Doppler-derived echocardiography to assess combined systolic and diastolic functions using myocardial performance index in 50 patients with acute Q-wave MI at early phase of events, (25 pts with anterior MI and 25 pts with inferior MI). The index is defined as the sum of the isovolumic contraction and isovolumic relaxation times divided by ventricular ejection time and was obtained by Doppler measurement from the diastolic mitral inflow and left ventricular outflow velocity-time intervals. Results:  As a result, the index was 0.54±0.1 in all patients with MI. We also estimated the higher MPI and DT values in anterior than inferior MI (MPI: 0.61±0.07 vs., 0.46±0.06, p<0.001; DT: 244±64 msec vs. 204±31.2 msec, p=0.005, respectively). Myocardial performance index was positively correlated with DT in inferior MI (r=0.42, p<0.035) and negatively correlated with anterior Mİ (r=- 0.72, p=0.0001). Conclusion:  These data suggest that Doppler-derived MPI reflects severity of global left ventricular dysfunction in early phase of acute MI and may be a useful parameter in these patients.

Objective: To determine whether glutamat and aspartat enriched cold crystalloid cardioplegia which was given in antegrade way has any effect on the myocardial protection during cardiopulmonary bypass. Material and Methods: Thirty-four patients who were electively undergone open heart surgery at Osmangazi University Faculty of Medicine, thoracic and cardiovascular surgery department, between March 2001 and May 2001 were included in this study. The patients were divided in two groups, each consisting of 17 patients. In group 1 coronary artery bypass surgery (CABG) was performed in 11 patients, mitral valve replacement (MVR) in 3 patients, aortic valve replacement (AVR) in 1 patient and AVR and MVR in 2 patients. While in group 2 CABG was performed in 13 patients and MVR was done in 4 patients. Group 1 patients received antegrade glutamat and aspartat (15 mmol/L) enriched cold crystalloid cardioplegia and group 2 patients were given cold crystalloid cardioplegia by antegrade route. Age, gender, diabetes mellitus, hypertension, preoperative myocardial infarction, smoking, ejection fraction, aortic cross-clamp time, need to defibrillation, inotropic support, and intraaortic balloon pump were recorded. The levels of cardiac troponin I (cTI) and creatine kinase myocardial band fraction (CK-MB) were measured in arterial blood samples at five different times. Statistical analysis was performed using Student’s t-test and Chi-square test. Results: There were no statistically significant differences in cTI and CK-MB values in blood samples taken at 5 different times pre and postoperatively between group 1 and group 2. Conclusion: It is concluded that glutamat and aspartat enriched cold crystalloid cardioplegia does not have any effect on myocardial protection.

Objective: Transesophageal echocardiography (TEE) is indicated for suspected atrial septal pathology and for monitoring of interventional procedures such as an atrial septal defect (ASD) closure during cardiac catheterization. Transesophageal echocardiography also helps to demonstrate postoperative complications and residual defects of complex congenital cardiac anomalies. Methods: Transesophageal echocardiography was performed in 112 pediatric patients with or suspected atrial pathology at our institution between 1999-2002, using the standard techniques. The mean age was 8.7 ±4.2 years. Results: In 45 of 112 children the suspected atrial defects were confirmed with the TEE. Patent foramen ovale was correctly predicted in 13.4% of patients by TEE, but only in 8.7% of patients by echocardiography. Multiple ASD’s were correctly defined in 4.1%, and high venosus defects were documented in 6,1% of children by the TEE. We used TEE in 13% of patients for detecting atrial vegetations in patients with possible endocarditis, and evaluation of the postoperative care of atrial surgery such as Fontan or Senning operations and total correction of abnormal pulmonary venous return. Successful transcatheter closure of 7 ASD's was accomplished under TEE guidance. Conclusion: Transesophageal echocardiography allows a much more detailed evaluation of atrial morphology than transthoracic echocardiography even in infants. Transesophageal echocardiography is also indicated during interventional procedures and postoperative evaluation of the atrial pathology.

Objective: Myocardial dysfunction in patients with cardiomyopathy is proposed to occur due to membrane changes caused by oxidative stress. In our study we evaluate whether there is any relation between the degree of myocardial dysfunction and antioxidant enzymes. Methods: We studied superoxide dismutase (SOD), glutathione peroxidase (GSHPx) and catalase (CAT) enzyme activities from blood samples of 60 patients (30 patients had ejection fraction (EF) <%35 and 30 patients had EF= %35-50) who have myocardial dysfunction according to clinical findings and two-dimensional echocardiography, and 20 healthy volunteers. Results: We found erythrocyte SOD enzyme activities of patients with EF <%35 (group 3) were significantly lower than in control subjects (group 1) (p=0.01). However in group 2 patients (EF= %35-50), erythrocyte SOD activities were found to be lower than in control subjects but this difference was not significant. Erythrocyte CAT and GSHPx enzyme activities of group 3 were also significantly lower than in control group (p=0.04 and p=0.02 respectively). Conclusion: In conclusion, reactive oxygen species play a significant role in the initiation and the progression of congestive heart failure. Increased free radicals levels may cause myocardial muscle dysfunction.

Objective: The aim of this study was to compare the electrocardiographic (ECG) abnormalities in patients with acute ischemic and hemorrhagic stroke who had no history of heart disease. Method: During 12 months, 222 consecutive stroke patients were enrolled in this study. Of them 162 had ischemic stroke and 60 had hemorrhagic stroke. Frequency of arrhythmias and ECG changes were compared between two stroke groups. Electrocardiographic abnormalities included ischemia-like changes (ST-segment depression or elevation, abnormal T and U waves), QTc prolongation and arrhythmias. Results: Ischemic stroke patients were elder than hemorrhagic ones (64±14 vs 57±13 years, p=0.003). Other clinical characteristics were comparable in both groups. Ischemia-like ECG changes were found in 65% of ischemic stroke patients while they were observed in 57% of hemorrhagic stroke patients (p=0.33). Atrial fibrillation was more frequent in ischemic stroke than in hemorrhagic stroke (34% vs 13%, p=0.01) patients. Individually, other ECG abnormalities were not different in both groups. With relation of ECG abnormalities to location of the brain lesion, there was a trend in favor of involvement of the temporal, frontal and parietal lobes. Conclusion: Regardless stroke-related lesion, ECG abnormalities can be seen frequently in stroke patients without primary heart disease. They can lead to diagnostic and therapeutic difficulties for cardiologists and neurologists.

Objective: Recent studies suggest the association of atherosclerotic cardiovascular disease with Chlamydia pneumoniae infection. We investigated C. pneumoniae DNA in internal mammarian artery (IMA) (used as a coronary bypass conduit) and its relationship with atherosclerosis. Methods: Sixty-six consecutive patients who underwent coronary artery bypass grafting (CABG) during an eight-month period were included in this study. From all patients, we attempted to obtain surplus segments of harvested IMA grafts. The vessels were examined histopathologically, and presence of C. pneumoniae DNA in IMA grafts was assessed by polymerase chain reaction (PCR). Results: C. pneumoniae DNA was found in 7 (10.6%) of 66 IMA specimens. The light microscopic examinations of IMA segments from the C. pneumonia positive group showed atherosclerotic intimal changes in four of the seven patients. These atherosclerotic changes were type II in three patients and type III in one patient according to the AHA classification. The rest of the IMA segments from 62 patients did not show any discernible atherosclerotic lesion. Conclusion: The IMA graft examination by PCR and histopathology may be helpful in the determination of future graft patency for IMA bypass surgery.

Objective: The aim of this study was to evaluate angiographic changes in the ulnar and interosseous arteries, and the collateral circulation of forehand after harvesting radial artery. Methods: Forty patients were studied between June 1998 and June 2001. Study group consisted of 30 patients who received radial artery as a conduit for coronary artery bypass operation, and control group consisted of 10 patients who did not undergo any cardiac or vascular operation before. Preoperative risk factors were similar between the two groups. All patients underwent angiographic evaluation to detect coronary artery and left forehand arterial circulation. Results: Angiographic evaluation was performed 25.5 ± 2.0 months after the initial operation in the study group. Mean diameter of ulnar artery was 2.9 ± 0.59 mm (range 2.1 - 4.8) in the study group and 3.2 ± 0.8 mm (range 1.5 t- 4.7) in the control group (p > 0.05). Mean diameter of interosseous artery was significantly higher in the study group than in control one: 2.06 ± 0.57 mm (range 1.2 t- 4.2) versus 1.46 ± 0.79 mm (range 0.8 t- 3.6); (p = 0.003). Conclusion: Although angiography was performed in a limited number of patients, interosseous artery rather than ulnar artery enlarged to compensate blood supply of forehand 25 months after harvesting the radial artery for coronary artery bypass grafting.

Aerobic exercise training has an important role within the cardiac rehabilitation program. An exercise test performed in the early period after myocardial infarction (MI) allows to determine early the functional status and the risk factors of the patients and can accelerate their return to their occupational life. Patients can get back faster and safely to their active lifestyle following MI with exercises carried out at least 3 days per week, for 20 to 60 minutes and at intensities between 40 to 85% of VO2max. These exercises may concern the lower extremity like walking or running, upper extremity like arm cycle ergometer or combinations of these like rowing or swimming. Regular aerobic exercises increase the functional capacity and parasympathetic tone, and these together lead to an improvement in cardiovascular autonomic control. As a result, freguency of coronary artery disease and other cardiovascular diseases declines to an important extent. Studies conducted in humans and animals have shown contradictory outcomes about left ventricular remodelling. General opinion is that aerobic exercise has no favourable effect on ventricular remodelling.

Myocardial perfusion scintigraphy is an established method in cardiology for the diagnosis and evaluation of coronary artery disease (CAD). Thallium-201 and Tc-99m sestamibi myocardial perfusion imaging has been widely accepted as non-invasive diagnostic procedure for detection of CAD, risk stratification and myocardial viability assessment. But, standard Tl-201 redistribution and same day or 2-day rest/stress Tc-99m sestamibi protocols are time-consuming. Hence, the dual isotope rest thallium-201/stress technetium-99m sestamibi gated single-photon emission tomography protocol has gained increasing popularity for these applications. Combining the use of thallium-201 with technetium-99m agents permits optimal image resolution and simultaneous assessment of viability. Dual-isotope imaging may be separate or simultaneous acquisition set-up. The more rapid completion of these studies is appreciated as an advantage by patients, technologists, interpreting and referring physicians, nurses and hospital management. Simultaneous imaging has the potential advantages of precise pixel registration and artifacts, if present, are identical in both thallium and sestamibi, and require only one set of imaging. Also, there are some disadvantages of spillover of activity from the Tc-99m to the Tl-201 window. Fortunately, despite this problem it can be overcome. Separate acquisition dual isotope also has some disadvantages. Difference in defect resolution in attenuation and scatter between T-201 and Tc-99m sestamibi potentially results in interpretation problems. But, studies about cost-effectiveness of dual isotope imaging showed that some selective elimination of the rest studies may decrease the cost of the nuclear procedures and should be considered in the current care health system.