Objective: It has been speculated that trace elements may play a role in the pathogenesis of heart failure. In the present study, we aimed to assess serum concentrations of selenium (Se), zinc (Zn) and copper (Cu) in patients with heart failure (HF) and to compare idiopathic dilated cardiomyopathy (IDCM) and ischemic cardiomyopathy (ICM) patients with healthy controls. Methods: This study population included 54 HF patients (26 IDCM patients and 28 ICM patients) and 30 healthy subjects. Serum levels of selenium, zinc, and copper were assessed by atomic absorption spectrophotometry method. Results: Serum concentrations of Se and Zn in HF patients were significantly lower than in healthy controls (p=0.000 and p<0.01, respec- tively). However, serum Cu concentrations in these patients were significantly higher than in controls (p=0.000). There were no significant difference in the trace elements status between IDCM and ICM patients (p>0.05 for all parameters). Relationships of the serum trace ele- ment concentrations studied with echocardiographic and hemodynamic parameters were not statistically significant. Conclusion: Our study showed that heart failure is associated with lower Se and Zn concentrations, and higher Cu concentration, and se- rum Se, Zn and Cu element profiles were similar in IDCM and ICM.

Objective: The myocardial performance index (MPI) enables noninvasive estimation of combined systolic and diastolic function. The only di- astolic function parameter used in the index is the isovolumic relaxation time (IRT). We assessed the impact of shortened IRT in restrictive filling pattern on MPI. Methods: The MPI was defined as the sum of the isovolumic contraction time (ICT) and the IRT divided by the ejection time (ET), and was calculated in 13 controls (group 1), and 39 patients with ischemic heart disease with left ventricular systolic dysfunction (ejection fracti- on<50%). The patients were classified into two groups according to mitral early filling deceleration time (DT): group 2 with DT>140 ms (n = 20), and group 3 with DT ≤140 ms (n = 19). Results: The ICT was longer and the ET was shorter in group 2 and group 3 than in group 1. The ICT and ET were not different in group 2 and group 3. The IRT was longer in group 2 (130±23 ms) compared to group 1 (82±10 ms, p<0.001) and group 3 (85±19 ms, p<0.001), but did not differ between group 1 and group 3. The MPI was higher in group 2 and group 3 compared to group 1 (0.79±0.25 and 0.65±0.19 vs 0.42±0.08, p<0.001 and p<0.001; respectively). However, it was lower in group 3 than in group 2 (p=0.03) due to significantly shortened IRT. Conclusion: Shortened IRT in patients with restrictive filling pattern results in reduction of the MPI. Therefore, the MPI may not reflect true level of ventricular dysfunction in these patients.

Objective: The radial approach has been increasingly used as an alternative to femoral access. The purpose of the present study was to assess the feasibility, success, and safety of the transradial approach (TRA) for diagnostic coronary angiography, and to describe the dif- ficulties associated with the technique as compared with transfemoral approach (TRF). Methods: A series of 180 consecutive patients were divided to TRA or TFA groups by two operators. We compared the groups regarding procedural time, access time, fluoroscopy time, procedural failure, complications, contrast volume, length of hospital stay, and number of used coronary catheters. Results: The number of used coronary catheters was not different between the two groups (p = 0.6). Total hospital length of stay was sig- nificantly shorter in the radial group (p < 0.0001) than in femoral one. We found differences between the radial and femoral groups in the success rate (p<0.0001), contrast volume (p = 0.012), procedural time (p<0.0001), access time (p<0.0001), and fluoroscopy time (p<0.0001). We did not find any major complication in the radial group. There was a major bleeding in the femoral group. Conclusion: The TRA is a safe alternative to femoral catheterization although with lesser procedural success, longer procedural access, and radiation time, and more contrast volume.

Objective: We aimed to investigate the value of N-terminal pro-Brain Natriuretic Peptide (NT-proBNP) in combination with tissue Dopp- ler imaging (TDI) to predict the presence of significant coronary artery (CAD) in patients with conventionally normal systolic and diasto- lic function. Methods: Plasma NT-proBNP concentrations were measured in 87 patients who had been referred to coronary angiography with stable anginal symptoms, and preserved systolic and diastolic LV function in conventional echocardiography. Regional diastolic function was additionally assessed by TDI in all patients. Patients were then divided into 2 groups according to having normal or abnormal diastolic function with TDI. Group 1 had preserved diastolic function with conventional and TDI methods. Group 2 had conventionally normal func- tion and abnormal regional function with TDI. Groups were divided into 2 subgroups according to the cut-off NT-proBNP value of 100pg/ml. Coronary artery disease was classified as 0 (absence of >70% diameter stenosis in any coronary artery), 1, 2 or 3 vessel dise- ase (with lesions >70%). Results: The NT-proBNP levels were positively correlated with the number of coronary vessels involved. There was statistically signifi- cant difference between 0-2, 0-3, 1-3 vessels involvement, but no significant difference between 0-1, 1-2, 2-3 vessels involvement. In gro- up 1 all patients with plasma NT-proBNP levels >100 pg/ml had severe CAD (p=0.003). But in group 2 only 60% of patients with NT- proBNP>100 pg/ml had severe CAD. Conclusion: In patients with stable angina who have normal systolic and diastolic function, NT-proBNP is useful to predict the angiog- raphic severity of CAD. In patients with unimpaired regional diastolic function, NT-proBNP may be valuable to predict the presence of se- vere CAD in stable angina.

Objective: To investigate the relationship between atherosclerosis, an inflammatory disease and hepcidin which is reported as an indi- cator of inflammation Methods: A total of 75 subjects between 40 and 70 years of age were included in the study. The patient group consisted of 40 stable pa- tients who had previously experienced an atherosclerotic event (18 women, 22 men; mean age 56.4±7.1 years). There were two control groups. The first control group consisted of 19 healthy subjects (11 women, 8 men; mean age 52.6± 7.4 years), while the second group inc- luded 16 patients (11 women, 5 men; mean age 56.5±9.3 years) with rheumatoid arthritis and anemia (diseased control group). Hepcidin measurement was performed using Hepcidin Prohormone ELISA (Solid Phase Enzyme-Linked Immunosorbent Assay) test kit. Results: Mean serum hepcidin levels were 243.2±48.8 ng/ml, 374.5±86.4 ng/ml, and 234±59.9 ng/ml in the patient group, in diseased cont- rols, and in healthy controls, respectively. Hepcidin levels were higher in diseased controls compared to the patient group and healthy controls (p=0.001). There were no significant differences between the patient group and healthy controls. Conclusion: These findings did not support the hypothesis that hepcidin levels could be increased in atherosclerotic cardiovascular di- seases as a marker of chronic inflammation.

Objective: To evaluate both left ventricular (LV) and right ventricular (RV) diastolic performance adaptation to variable atrioventricular interval (AVI), in patients with DDD pacing for complete heart block and to investigate a possible interaction between LV and RV in this specific cohort of patients. Methods: We studied 22 consecutive patients (mean age 65.2 ± 14.3) who underwent DDD pacemaker implantation following admission for complete heart block. One day following implantation, patients were paced at 3 different pacing modes, under the same programmed heart rate and a different AVI (100, 150 and 200 ms respectively). Standard Doppler echocardiography of mitral and tricuspid valve inflow was performed to evaluate LV and RV diastolic function, during each pacing mode. Results: Left ventricular and RV diastolic performance adaptation to variable AVI modifications was similar, showing a progressive increase of late diastolic filling velocities and a subsequent decrease of E/A wave ratios following AVI prolongation. A short AVI of 100 or 150 ms was associated with improved LV and RV diastolic filling dynamics. Conclusions: In elderly patients with complete heart block and unimpaired systolic function undergoing DDD pacemaker implantation, both ventricles share a similar pattern of diastolic function adaptation to AVI modifications and that might be the reflection of ventricular interaction under this specific pacing mode.

Objective: The aim of this study is to evaluate the effects of single dose insulin, given prior to reperfusion, in patients undergoing coro- nary artery bypass surgery (CABG). Methods: One hundred and twenty patients were prospectively randomized to be given either insulin (Group 1;n=60), or saline (Group 2;n= 60). Blood samples were taken 15 minutes before the reperfusion and insulin was given (0.3 IU/kg) to the patients in Group 1. Arterial and coronary sinus blood samples were taken, after the release of aortic cross-clamp (0. min), and 5th -10th -15th minutes of reperfusion. Arterial and coronary sinus lactate and glucose levels, postoperative insulin, inotropic and intraaortic balloon pump requirements, need for defibrillation and postoperative dysrhythmia, creatine kinase- MB (CPK-MB) levels, and length of stay in intensive care unit (ICU) and hospital were compared. Results: In Group 1, arterial lactate levels were found to be lower at 0.min, coronary sinus lactate levels were found to be lower at 0-5-10th minutes of reperfusion compared to Group 2. Similarly, defibrillation, glucose, postoperative insulin and inotrop requirements, postoperative arrhythmia and length of ICU stay were lower in Group 1. The CPK-MB levels and length of hospital stay were similar in all patients. Conclusions: We conclude that single dose insulin given before the reperfusion period, has positive perioperative effects. Therefore it can be used in patients undergoing CABG surgery to decrease ischemia-reperfusion injury.

Restoration of epicardial blood flow is not necessarily associated with microvascular and tissue perfusion. The mechanisms responsib- le for no-reflow are uncertain and prevailing mechanism operating in the individual patient may also differ. Restoration of perfusion at the tissue level is expected to have beneficial effects on left ventricular function. Therapeutic approach to such a phenomenon requires knowledge of mechanisms, methods of diagnosis and response to treatment modalities.

Early data from clinical studies suggest that intracoronary injection of autologous progenitor cells may beneficially affect postinfarction remodeling and perfusion. Beyond intracoronary infusion of autologous bone marrow mononuclear CD34+ cells (MNCCD34+), mobiliza- tion of stem cells by G-CSF has recently attracted attention because of various advantages such as the noninvasive nature of MNCCD34+ mobilization by subcutaneous injections. It is the aim of the present work to give an overview about the current experimental and clinical findings of G-CSF treatment in acute myocardial infarction.

The question “extents of sexual activity”, especially for a cardiac patient, seems enigmatic for patient himself and his physician. Cardiac patient`s prejudice is that limitation of sexual activity is necessary to avoid complications like myocardial infarction. This misconception worsensquality of life of patient which is already limited. In this kind of situations, a physician is supposed to answer lots of questions. Pa- tient's risk status should be interpreted and stratified by further examinations, before deciding to treat. Pharmacological and rehabilitati- ve modalities can be applied when indicated, on the other hand, majority of the patients are classified as low risk status that are assumed to be safe. A routine follow- up is recommended for this kind of patients by 6 months intervals, regardless the patient is under medication or not.