Objective: Diastolic dysfunction is considered as the most important cause of heart failure and morbidity in hypertensives. This study was designed to evaluate the relationship between the transmitral diastolic color M-mode flow propagation velocity (FPV) and left ventricular relaxation by using Doppler echocardiography. Methods: In the present study, thirty-nine patients (21 male, %58.3, age mean 52.7 ± 5.9 years) with hypertension stage-I and over, were included. Transmitral diastolic E and A velocities, E-deceleration time (DT) and isovolumic relaxation time (IVRT) were measured by pulse Doppler method. We performed color M-mode technique for measurement of FPV of transmitral diastolic flow in the apical four-chamber view. We measured slope of aliasing velocity (blue aliasing) determined by color M-mode images. Results: Flow propagation velocity values were not statistically related with age and gender, whereas differentiation of age groups were estimated as poor parabolic relationship, specially in patients over fifty years, FPV is estimated to be decreasing. Color M-mode FPV is correlated with DT, (r = -0.715, p<0.01), IVRT (r = -0.736, p<0.01) and interventricular septum thickness (r = –0.498, p<0.01), but not correlated with E/A ratio. Conclusion: Color M-mode FPV is correlated with DT and IVRT, which are important parameters for evaluation of diastolic function in hypertensive patients. This parameter is related with left ventricular relaxation and should be considered as a routine echocardiographic evaluation, because it is not affected by minimal changes in left ventricular filling pressure.

Objective: Diabetic patients have a higher risk to acquire coronary artery disease at younger ages and vein grafts used in these patients have a tendency to develop stenosis earlier. No significant differences have been reported between the patency of internal thoracic artery (ITA) grafts in diabetic and non-diabetic patients. However, bilateral ITA grafting in diabetic patients remains a controversial topic due to increased risks in the perioperative morbidity. Methods: The effects of bilateral ITA grafting on perioperative morbidity for diabetic patients were studied in two different trials. The first study compared 25 diabetic patients with 25 non-diabetic patients with bilateral ITA grafts for the length of the intensive care unit and hospital stay periods, for superficial wound infection, sternal dehiscence, mediastinitis rates and readmissions following discharge. The second study compared 30 diabetic patients with bilateral ITA grafts to 30 diabetic patients with unilateral ITA grafts for the same criteria as in the first study. Results: The first study showed no statistical difference between diabetic and non-diabetic patients for the criteria studied, but a slight increase was clinically observed in the readmission rate for diabetic patients due to superficial wound infection. The second study showed neither statistical, nor clinical differences between the two groups. Conclusion: Full arterial revascularization is very important for the prognosis of diabetic patients. With a careful management, the slight increase in the perioperative morbidity could be reduced to acceptable levels enabling the diabetic patients to benefit from the long-term advantages of bilateral ITA grafting

Objective: This study was undertaken to evaluate the effect of Enalaprilat infusion on hemodynamics and renal function during cardiopulmonary bypass (CPB). Methods: Thirty adults undergoing CPB were randomly allocated into 2 groups. All patients received the same anesthetic protocol and same dopamine infusion protocol (2 mg/kg -1/min-1) during the study. In addition to dopamine infusion 15 patients received enalaprilat infusion (0.06 mg/kg-1/hr-1) during CPB. Blood creatinine, urea levels, and creatinine clearance (CLcr) were measured and cardiac output (CO) was calculated by echocardiography preoperatively and on the 6th postoperative day. Mean arterial pressure (MAP), central venous pressure (CVP), systemic vascular resistance (SVR) measurements were recorded during the operation and during postoperative 24 hours. Results: In the control group postoperative blood creatinine and urea levels were significantly higher and CLcr measurements were significantly lower than the preoperative values (p<0.05). These values did not change in the enalaprilat group. Mean arterial pressure was similar in both groups (p>0.05), but SVR was lower (p<0.05) and CVP was higher (p<0.05) in the enalaprilat group than in the control group. In the enalaprilat group postoperative CO measurements were higher than the preoperative values (p<0.05). Conclusion: Our results demonstrate that enalaprilat infusion during CPB improves renal function and CO measurements in the early postoperative period.

Objective: Socioeconomic status (SES) is associated with coronary artery disease (CAD) risk factors, coronary morbidity and mortality. In industrialized countries several studies showed that the lowest SES groups have higher coronary morbidity and mortality rates and higher coronary risk factors profile. The aim of our study was to investigate the distribution of risk factors in cases with CAD in different socioeconomic groups. Methods: Our study group consists of 550 consecutive cases with ≥50% lesions in at least one coronary artery. Educational level and income were taken into consideration for the determination of the SES. In both sexes the distribution of eight risk factors such as, smoking, family history, diabetes mellitus, hypertension, high low-density lipoprotein cholesterol (LDL-C), low high-density lipoprotein cholesterol (HDL-C), body mass index, central obesity was compared in three different groups determined according to the education and income levels. Results: In men, the distribution of risk factors did not differ according to education levels. In women, central obesity was found to be higher in the group with low education level. In men, the prevalence of low HDL-C, high LDL-C and obesity increased with increasing levels of economical status. In women, central obesity was found to be inversely related with the economic status. Conclusion: Our data show a higher risk factor profile in men with higher income level, while in women central obesity was inversely related to the income and educational level. These data should be considered in secondary prevention efforts.

Objective: This study has been performed in order to define the prevalence of sexual dysfunction (SD) in patients with myocardial infraction (MI), and to identify potential correlations between sexual dysfunction and socio-demographical attributes, cardio-vascular diseases, and factors that pose risks for SDs, as well as to define whether there is a relationship between sexual dysfunction and quality of life. Methods: In this study, which was carried out with a total of 102 patients with MI (36 women, 66 men), the data were gathered via an information form that assesses socio-demographical attributes and risk factors related to cardiovascular diseases and sexual dysfunction; international sexual dysfunction assessment forms; Short Sexual Index Inventory for women (IFSF); Erection Function International Assessment Form (IIEF) for men; and SF-36 Quality of Life Scale. Obtained data were evaluated using statistical evaluations, Student t-test, Chi-square, Fisher precise Chi-square, Yates corrected Chi-square, and Pearson correlation tests. Results: Sexual dysfunction was defined in 80% of women, and 37% of men. Its prevalence was higher than expected in women. Reductions in the frequency of intercourse and sexual satisfaction were reported by 53.9% and 32.4% subjects, respectively. The most important reason associated with the decreased prevalence of sexual intercourse was the fear of re-infarction, with a rate of 85.5%. All quality of life sub-dimension scores, other than social functioning (p>0.05), were low showing statistical differences. Of the subjects, 97.1% were not given information before being discharged. On the other hand, only 57.8% of them desired to be informed on the subject. Conclusion: Sexual dysfunction prevalence is high in patients with MI history; SD is more frequent in women than in men, and the patients are not assessed on this aspect.

Objective: This study was designed to compare the effects of simvastatin versus a combination of simvastatin with vitamin C or E on serum lipid profile, particularly, high density lipoprotein (HDL)-cholesterol (C) level, in patients with a low HDL-C level. Methods: Fifty-nine women and 49 men, who had a baseline HDL-C level equal to or lower than 40 mg/dl were randomized to one of the following study treatment groups: Group S (n=39) simvastatin 20 mg/day, Group S+C (n=33) simvastatin 20 mg/day + vitamin C 500 mg/day, and Group S+E (n=36) simvastatin 20 mg/day + vitamin E 400 IU/day. The groups’ lipid profiles were obtained at baseline, 3rd and 6th months. Results: Comparing with baseline values, total-C and low density cholesterol (LDL-C) values significantly reduced (p<0.001) and HDL-C values significantly increased (Group S-33.9 ± 3.9 mg/dl vs. 39.8 ± 6.9 mg/dl, Group S+C-34.2 ± 3.5 mg/dl vs. 38.1 ± 6.1 mg/dl, Group S+E-33.1 ± 3.6 mg/dl vs. 34.8 ± 5.9 mg/dl, p<0.001) on therapy within the groups; however, there were no significant differences among the groups with regards to these parameters. The HDL-C levels increased from baseline by 14.0 %, 11.7 % and 10.2% in Group S, S+C, and S+E, respectively (p>0.05). Conclusion: A combination of simvastatin with antioxidant vitamins does not offer any beneficial effect over simvastatin alone. Particularly vitamin E seems to blunt the simvastatin induced HDL-C increase.

Objective: To determine the effects of nebivolol on diastolic functions of the left ventricle in the hypertensive patients in the early treatment period. Methods: Twenty patients with mild to moderate hypertension taking daily 5 mg of nebivolol were assessed by using Doppler echocardiography before and after 6-week drug treatment period. The results were analyzed with Wilcoxon test and p<0.05 was accepted as statistically significant value. Results: The arterial blood pressure and heart rate of the patients significantly decreased after 6 weeks of treatment. Statistically significant decrease was found in the peak of A wave velocity, isovolumetric relaxation time, E wave deceleration time and increase in E/A ratio with Doppler echocardiography after 6-week treatment period. No statistically significant difference was observed in the peak velocity of E wave after treatment period. Conclusion: We found that nebivolol improved left ventricle diastolic function in patients with hypertension in the early term.

Hypertrophic cardiomyopathy (HCM) is a heterogeneous genetic cardiac disorder with various genotypic and phenotypic manifestations, and is often a diagnostic challenge. Although more than forty years have passed since the first description of HCM, a variety of mutations in genes encoding sarcomeric proteins, that cause the disease have been defined by laboratory and clinical studies over the past few years. The fact that HCM is the most common cause of sudden death in young competitive athletes and that, it is actually an important cause of morbidity and mortality in people of all ages, has made the researchers to concentrate more on the molecular basis and treatment strategies of the disease. This study aims to summarize both pathological features and rapidly evolving molecular genetics of HCM, and so to understand this not infrequently seen, complex disorder better.

Because of the increasing use of radiocontrast agents, radiocontrast-induced nephropathy has become an important cause of iatrogenic acute renal impairment. This necessitates physician awareness of radiocontrast nephropathy, a disorder, which develops as a result of exposure to contrast agents. Radiocontrast-induced nephropathy causes significant morbidity and mortality and increase in hospital length of stay and costs. It can be minimized by the identification of patients with risk factors before the procedure. The risk factors are synergistic, and the most important major risk factors for the development of radiocontrast-induced nephropathy are the presence of pre-existing renal impairment and diabetes mellitus. We discussed the risk factors of contrast media induced nephropathy in this review.

Myofibrillar myopathy (MFM) is a rare autosomal dominant disorder characterized by cardiac and skeletal myopathy. Either of these can dominate in the clinical picture. It is associated with cardiomyopathy, arrhythmia and/or atrioventricular (AV) conduction defects. Myofibrillar myopathy is often an overlooked disorder because of its variable clinical presentation. We highlight the various cardiovascular manifestations of MFM that have been reported in the literature and address the importance of considering this syndrome in young patients presenting with idiopathic cardiomyopathy and /or AV conduction defects.