P-wave dispersion doesn't increase in patients with epilepsy.

AIM: Epileptic seizures have occasionally been associated with cardiac conditions as atrioventricular blocks, long QT syndrome etc. P-wave dispersion (PWD), which is the difference between the longest (P max) and shortest P-wave duration (P min), is considered as a forerunner of atrial fibrillation. In this study, we investigated P-wave dispersion (PWD) in epileptic patients; based on the hypothesis that microthromboembolism may occur in atrial fibrillation. METHODS: Seventy five patients with mixed types of epilepsy and 50 age and sex matched healthy individuals were included into the study. P max, P min and PWD values were calculated for each subject from an ECG. RESULTS: The mean age of subjects in the epilepsy group and control group were similar (p>0.05). P max in patients with epilepsy was 125.1±0.7 ms, P min was 67.3±10.3 ms, and PWD was 57.6±8.3 ms while these values in the control group were 116.8±11.0 ms, 66.5±5.5 ms and 46.8±7.1 ms, respectively. There were no statistically significant difference between two groups (p>0.05). CONCLUSIONS: PWD does not increase in patients with mixed types of epilepsy. Therefore we believe that microthromboembolism due to atrial fibrillation can't cause epileptic seizures in patients with no structural heart disease.

Classic mitral valve prolapse causes enlargement in left ventricle even in the absence of significant mitral regurgitation.

AIM: The aim of this study was to evaluate whether left ventricular size was increased in patients with classic bileaflet mitral valve prolapse (MVP) in the absence of significant mitral regurgitation (MR). METHOD: Patients with classic bileaflet MVP were included as the case group. Two different control groups were established. The first control group was composed of the patients with mild MR caused by the reasons except MVP. The second control group consisted of healthy individuals whose echocardiograms were normal. The patients with moderate or severe MR and having abnormality in the other valves were excluded. RESULTS: There were 20 patients in each group. Systolic and diastolic diameters and volumes of left ventricle (LV) in the MVP group were significantly higher than those in the control groups. In 10 of the patients in the MVP group, LV internal diastolic diameter (LVIDD) values were measured as ≥5.7 cm, whereas increased LVIDD value was detected in only one patient in the other two control groups. There was a significant difference in terms of the presence of increased LVIDD values between the MVP group and the control groups. Despite this enlargement in the LV dimension, the LV ejection fractions were found similar in all groups. Furthermore, it was found that the lengths of both anterior and posterior mitral leaflets in MVP group were significantly higher than those in the control groups. CONCLUSION: The LV diameters and volumes of patients with classic bileaflet MVP were found to be increased even in the absence of significant MR. These results need to be supported by large-scale clinical studies.

Cardiovascular risk scores for coronary atherosclerosis.

OBJECTIVE: The objective of this study was to compare frequently used cardiovascular risk scores in predicting the presence of coronary artery disease (CAD) and 3-vessel disease. METHODS AND RESULTS: In 350 consecutive patients (218 men and 132 women) who underwent coronary angiography, the cardiovascular risk level was determined using the Framingham Risk Score (FRS), the Modified Framingham Risk Score (MFRS), the Prospective Cardiovascular Münster (PROCAM) score, and the Systematic Coronary Risk Evaluation (SCORE). The area under the curve for receiver operating characteristic curves showed that FRS had more predictive value than the other scores for CAD (area under curve, 0.76, P < or = 0.001), but all scores had good specificity and positive predictive value. For 3-vessel disease, the FRS had better predictive value than the other scores (area under curve, 0.74, P < or = 0.001), but all scores had good specificity and negative predictive value. CONCLUSION: The risk scores (FRS, MFRS, PROCAM, and SCORE) may predict the presence and severity of coronary atherosclerosis.The FRS had better predictive value than the other scores.

Alternative method for accessing the target coronary artery in patients with difficult coronary anatomy: exchanging the diagnostic catheter with a guiding catheter.

We report a method of the placement of the guiding catheter in two cases in which the diagnostic catheter could be easily engaged to the target coronary arteries but not a guiding catheter, due to a distorted aortic sinus and an osteal subtotal occlusion, respectively. After engaging to the target coronary artery with a diagnostic catheter, a coronary guidewire was advanced through the diagnostic catheter, and exchanged with a guiding catheter over the guidewires. The procedures were completed with success.

Effect of position changes on myocardial velocity in healthy subjects evaluated by tissue Doppler echocardiography.

OBJECTIVES: This study designed to assess the effect of different positions of head of the bed on myocardial velocity by tissue Doppler echocardiography in healthy subjects. METHODS: Thirty-nine healthy subjects (32 males/7 females, mean age 24.7 ± 4.9 years) were studied. Tissue Doppler imaging (TDI) was performed and velocities were recorded during systole (Sm) and early (Em) and late (Am) diastole at the tricuspid annulus, septum, and mitral annulus in the four-chamber view. Measurements were performed from different positions of left lateral decubitus (0°, 30°, and 60°). Repeated-measures general linear models were used to assess the change in myocardial velocities. RESULTS: No significant difference between myocardial velocities was found at the mitral anulus and septal TDI recordings in the different angles of left lateral decubitus positions (P > 0.05). However, there were statistically significant difference among tricuspid anulus myocardial tissue velocities in these positions (P < 0.05). CONCLUSIONS: Tricuspid anulus myocardial tissue velocities may be significantly influenced by changing of position in healthy subjects. Effect of position changes should be considered in the assessment of these velocities.

[Successful percutaneous retrieval of a broken intravascular ultrasound catheter tip from the renal artery]. / Intravasküler ultrason islemi sirasinda renal artere kaçan kirik kateter parçasinin perkütan yolla çikarilmasi

Intravascular ultrasound (IVUS) is widely used to assess the severity of coronary artery lesions. Fracture of the IVUS catheter in the coronary artery is very rare and embolization of a fractured segment into other organs has not been reported. A 41-year-old male patient underwent IVUS imaging for further assessment of a lesion detected angiographically in the left main coronary artery. During the procedure, the distal tip of the IVUS catheter fractured in the left main coronary artery. Percutaneous retrieval of the broken fragment was attempted using a coronary snare, but the fragment freed from the snare and embolized into the right renal artery. After placement of a right coronary guide wire catheter in the right renal artery, the fractured tip was captured with a coronary snare and was successfully retrieved.

[Adherence to statin therapy and LDL cholesterol goal attainment in type 2 diabetics and secondary prevention patients: the role of education and knowledge]. / Tip 2 diyabetiklerde ve ikincil koruma hastalarinda statin kullanimina uyum ve LDL-kolesterol hedefine ulasma düzeyleri: Egitim ve bilgi düzeyinin rolü

OBJECTIVES: Lipid levels of most patients receiving antilipidemic therapy are not under control as proposed by the guidelines. We evaluated adherence to statin therapy and LDL cholesterol goal attainment in type 2 diabetic and secondary prevention patients. STUDY DESIGN: A total of 194 patients (131 men, 63 women; mean age 57 ± 11 years) who had been on statin therapy for at least a year for a target LDL cholesterol level of <100 mg/dl were administered a two-part questionnaire. The first part inquired demographic and clinical characteristics, duration of hyperlipidemia, referral to a dietician, risk factors and, if present, the reasons for drug discontinuation. The second part consisted of 23 questions (total score 30) inquiring the knowledge levels of patients about hypercholesterolemia. RESULTS: There were 61 primary (31.4%, diabetics) and 133 secondary (68.6%) prevention patients. The mean LDL level was 122.6 ± 28.7 mg/dl. The incidence of attaining target LDL level was only 23.7% (n=46), being lower in diabetics compared to secondary prevention patients (6.6% vs. 31.6, p<0.0001). The mean knowledge score was 18.2 ± 5. When the threshold score was taken as 18 (median), attainment of the target LDL level was significantly higher in patients having a score of ≥ 18 (32%) compared to those with a lower score (14.9%). There were 77 patients (40%) who sought dietician counseling. Patients with a high school or higher education and those with dietician counseling had higher knowledge scores compared to those with a lower education level and without dietician counseling (p<0.0001). Intermittent drug discontinuation was seen in 109 patients (56.2%), the most common reason being decrease in cholesterol levels to normal (35%). CONCLUSION: Target LDL level was achieved in only about 24%. As the knowledge on hypercholesterolemia accrues, the success rate of LDL cholesterol goal attainment increases.

The relationship between coronary calcification and the metabolic markers of osteopontin, fetuin-A, and visfatin.

OBJECTIVES: We investigated whether coronary calcification detected by multislice computed tomography (MSCT) was correlated with plasma osteopontin, serum fetuin-A, and visfatin levels. STUDY DESIGN: The study included 64 consecutive patients (51 males, 13 females; mean age 49.5+/-10.9 years; range 33 to 78 years) who underwent MSCT for suspected coronary artery disease. Coronary artery calcification (CAC) scores of the patients were calculated using the Agatston scoring method. Plasma osteopontin, serum fetuin-A, and visfatin levels were measured from fasting blood samples and correlations were sought with calcium scores. RESULTS: Coronary calcification was detected in 32 patients (50%). The mean CAC score was 146.5+/-333.7 Agatston units (AU), indicating an intermediate risk for coronary artery disease. In 10 patients (15.6%), the CAC score exceeded 400 AU. The mean fetuin-A, visfatin, and osteopontin levels were 25.6+/-6.4 ng/ml, 19.7+/-47.2 ng/ml, and 20.4+/-16.1 ng/ml, respectively. Serum visfatin (r=0.15, p=0.37) and fetuin-A (r=0.17, p=0.22) were not correlated with the CAC score, whereas plasma osteopontin level showed a moderate correlation with the CAC score (r=0.35; p=0.008). In ROC analysis, the area under the curve for identification of CAC was greatest for osteopontin (0.741; p=0.004), followed by fetuin-A (0.574; p=0.31), and visfatin (0.580; p=0.27). The cut-off value was 18.45 ng/ml for osteopontin, with a sensitivity of 72% and specificity of 73%. CONCLUSION: Our results suggest that there might be an association between CAC and plasma osteopontin levels. Research should continue to find out a metabolic parameter that will strongly indicate coronary calcification.

Secondary prevention of coronary heart disease in elderly population of Turkey: A subgroup analysis of ELDERTURK study.

BACKGROUND: Secondary prevention plays an important role after acute coronary event due to high risk of adverse events in elderly. In present study we aimed to evaluate the lifestyle, management of risk factors and medical treatment for secondary protection in elderly patients with known coronary heart disease (CHD). METHODS: ELDERTURK is a non-interventional, multi-centered, observational study, which included total of 5694 elderly patients ( > 65 years) from 50 centers in Turkey. In this study elderly patients from the ELDERTURK population with known CHD were evaluated for cardiovascular risk factors, comor- bidities and medication usage. RESULTS: A total of 2976 (52.3% of study) out of 5694 patients included in the ELDERTURK study were evaluated. All had known CHD with a mean age of 73.4 ± 6.2 years and 60.3% were male. 13.0% of patients were smokers, 42.4% were overweight and 21.1% were obese. Only 23.6% of patients reported to do regular exercise, 73.4% had history of hypertension, 47.4% had dyslipidemia and 33.9% had diabetes mellitus. The rate of patients with systolic blood pressure > 140 mmHg were 31.1% and only 13.9% of patients had a recommended ≤ 70 mg/dL level of low-density lipoprotein cholesterol. Anti- platelet, statin, beta-blocker and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker usage was limited to 27.3%. CONCLUSIONS: The ELDERTURK study shows that many patients with CHD have a high prevalence of modifiable risk factors and unhealthy lifestyle. Apart from this, many patients are not receiving thera- peutic intervention and as a consequence most were not achieving the recommended goals.

The spectrum of diseases causing fever of unknown origin in Turkey: a multicenter study.

OBJECTIVE: The purpose of this trial was to determine the spectrum of diseases with fever of unknown origin (FUO) in Turkey. METHODS: A prospective multicenter study of 154 patients with FUO in twelve Turkish tertiary-care hospitals was conducted. RESULTS: The mean age of the patients was 42+/-17 years (range 17-75). Fifty-three (34.4%) had infectious diseases (ID), 47 (30.5%) had non-infectious inflammatory diseases (NIID), 22 (14.3%) had malignant diseases (MD), and eight (5.2%) had miscellaneous diseases (Mi). In 24 (15.6%) of the cases, the reason for high fever could not be determined despite intensive efforts. The most common ID etiologies were tuberculosis (13.6%) and cytomegalovirus (CMV) infection (3.2%). Adult Still's disease was the most common NIID (13.6%) and hematological malignancy was the most common MD (7.8%). In patients with NIID, the mean duration of reaching a definite diagnosis (37+/-23 days) was significantly longer compared to the patients with ID (25+/-12 days) (p=0.007). In patients with MD, the mean duration of fever (51+/-35 days) was longer compared to patients with ID (37+/-38 days) (p=0.052). CONCLUSIONS: Although infection remains the most common cause of FUO, with the highest percentage for tuberculosis, non-infectious etiologies seem to have increased when compared with previous studies.

Effect of corticosteroids on hemostasis and pulmonary arterial pressure during chronic obstructive pulmonary disease exacerbation.

BACKGROUND: Hemodynamic and hemostatic abnormalities are reportedly frequent in chronic obstructive pulmonary disease (COPD). OBJECTIVES: We investigated the changes in systolic pulmonary artery pressure (PAPs) and hemostatic status and the effects of systemic steroid treatment (SST) during COPD exacerbation. METHODS: Consecutive 26 male and 4 female patients as well as 10 controls were enrolled. The nonsteroid treatment (NST) group received standard treatment without steroids, and the other group received additional SST. Initial values of blood gases, spirometry and PAPs, P-selectin, D-dimer and fibrinogen levels, activities of thrombocyte aggregation, antithrombin III (AT III), protein C (PC), protein S, activated PC resistance (APCR), prothrombin time and partial thromboplastin time were obtained and compared with values at day 10. RESULTS: Improvement in spirometry and blood gases was more prominent with SST. At presentation, patients had higher PAPs, P-selectin, D-dimer and fibrinogen but lower AT III levels than controls. PAPs and fibrinogen levels significantly decreased in the SST group while P-selectin levels further increased in the NST group. The D-dimer level significantly decreased in both groups. Means of AT III, PC and protein S increased in the SST and decreased in the NST group, but only the decrease in PC in the NST group was meaningful. Compared with the controls, AT III levels in the NST group and activated PC resistance in the SST group were significantly decreased. Thrombocyte aggregation tests suggested an incline after 10 days in both groups. CONCLUSIONS: We suggest that in patients with COPD exacerbation, addition of systemic corticosteroids to treatment results in better outcome in normalization of PAPs, hemostasis, pulmonary functions and blood gases.

The relationship between severity of coronary artery disease and plasma level of vascular endothelial growth factor.

OBJECTIVE: It has been known that ischemia or occlusion of coronary arteries in animal models increases the production of vascular endothelial growth factor (VEGF); however, little is known about the relationship between coronary artery disease and VEGF in humans. In this study, our aim was to evaluate the relationships between the degree of coronary occlusion and plasma VEGF level as well as other risk factors, including age, weight, arterial blood pressure, cholesterol, triglyceride, blood glucose, and high-sensitive C-reactive protein (hsCRP) in patients with established coronary artery disease. MATERIALS AND METHODS: Our study group consisted of 77 patients. Of these, 38 patients had normal coronary angiography (control group; group C) and 39 had abnormal angiography (17 critical lesion; group CL, 22 noncritical lesion; non-CL group). RESULTS: Plasma VEGF level was 116.95+/-30.12 pg/ml in the control group, 212.47+/-75.28 pg/ml in group CL, and 138.89+/-45.18 pg/ml in the non-CL group. Plasma VEGF level of group C was found to be lower than that of group CL (P<.05), but the difference between groups C and non-CL was insignificant (P>.05). However, logistic regression analysis showed that VEGF level of group CL was significantly higher (P<.001). There was a negative correlation between VEGF and haemoglobin (r=-0.58, P<.01), and positive correlation between VEGF and age (r=0.29, P<.04). There was no relationship between plasma VEGF level and other cardiac risk parameters. Group CL had a higher level of total and LDL-cholesterol levels. CONCLUSION: Increased plasma VEGF levels in patients with coronary artery disease may point that the coronary lesion is critical, and VEGF increase in patients with established coronary artery disease may be used as an indicator of the need for revascularization.

Prognostic significance of ischemia-modified albumin in patients with acute coronary syndrome.

To improve prognosis in acute coronary syndrome, new clinical applications in terms of diagnosis, risk stratification, and treatment strategies are still under investigation. Ischemia-modified albumin was one of the novel markers of myocardial ischemia. In our study, we aimed to determine the prognostic significance of the albumin cobalt binding capacity test in patients with acute coronary syndromes. We compared the ischemia-modified albumin levels of patients with acute coronary syndrome with those of patients with stable coronary artery disease and those of normal individuals and found them to be significantly higher in the first group (P<0.05). A cutoff value of ischemia-modified albumin of 477 U/ml was found by using receiver operating characteristic curve analysis. Mortality in groups of patients whose ischemia-modified albumin levels were above 477 U (50%) was found to be significantly higher than in those whose levels were below 477 U (8.3%) (P<0.05). The sensitivity and specificity of the cutoff value, 477 U/ml, for the 1-year mortality were found to be 70 and 82%, respectively. Using the Cox regression model the relation of albumin cobalt binding capacity test results with mortality was statistically significant (beta=1.013, confidence interval 95%, P=0.01) and independent of the existence of hypertension, diabetes, and advanced age. In conclusion, ischemia-modified albumin was found to be significantly related to 1-year mortality. Prognostic significance of ischemia-modified albumin should be evaluated in large populated and randomized study groups. Afterwards, ischemia-modified albumin could be used in risk stratification modality in patients with acute coronary syndrome.

Abnormal elastic properties of the aorta in the mitral valve prolapse syndrome.

BACKGROUND: Mitral valve prolapse (MVP) is the most common valvular heart disease representing a generalized disease of connective tissue in the primary form. Elastic properties of the aorta with primary MVP may be expected to be increased. We aimed to determine the aortic elasticity in the primary form of MVP. METHODS AND RESULTS: Twenty male patients with a primary form of MVP not having any sign of Marfan syndrome and joint hyperlaxity syndrome and twenty healthy individuals were included in the study. Aortic strain, aortic distensibility index and aortic stiffness index were calculated by using aortic diameters obtained by echocardiography and blood pressures measured by sphygmomanometer. When comparing the MVP group and the control group it was found that the aortic stiffness index was increased (P < 0.05) whereas the aortic distensibility and strain index were decreased (P < 0.05) in the MVP group. There was no significant difference between the characteristics of the groups (P > 0.05). CONCLUSION: We concluded that the elastic properties of the aorta were decreased in the primary form of MVP, unexpectedly.Therefore, results of decreased aortic elasticity should also be followed up in patients with MVP.

Giant J (Osborn) Wave due to Bonsai Abuse: Comments on Clinical Practice.

BACKGROUND: Osborn wave, typically associated with hypothermia, is currently referred to as one of the J wave syndromes due to its clinical potential to develop lethal cardiac arrhythmia; it may rarely be observed in a non-hypothermic setting such as cannabis abuse. CASE REPORT: In this paper, we presented two young cases who presented to the emergency services with unconsciousness, drowsiness, and hypoxia, and also J wave on electrocardiography (ECG) due to Bonsai abuse. CONCLUSION: Osborn wave may be a significant criterion to initiate close monitoring in a coronary care unit, with supportive treatment and mechanical ventilation as necessary in those patients who abuse Bonsai.

Impact of metabolic syndrome on myocardial perfusion grade after primary percutaneous coronary intervention in patients with acute ST elevation myocardial infarction.

AIMS: Metabolic syndrome with its associated cardiovascular risk factors and prothrombotic, procoagulant and proinflammatory properties and its detrimental effects on coronary microcirculation may play a role in the occurrence of poor myocardial perfusion after primary percutaneous coronary intervention in patients with acute myocardial infarction. Accordingly, this study was designed to evaluate the association between metabolic syndrome and myocardial perfusion grade in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention. MATERIAL AND METHODS: The study population included 283 consecutive patients (229 men, mean age=62+/-8 years) admitted to our hospital with ST-elevation myocardial infarction and who underwent primary percutaneous coronary intervention. Thrombolysis in myocardial infarction (TIMI) myocardial perfusion grade (TMPG) was graded densitometrically on the basis of visual assessment of relative contrast opacification of the myocardial territory subtended by the infarct vessel in relation to epicardial density. Metabolic syndrome was diagnosed according to the National Cholesterol Education Program Adult Treatment Panel III criteria. Patients were divided into two groups on the basis of the myocardial perfusion grade determined after percutaneous coronary intervention. Group I consisted of 223 patients with good myocardial perfusion (TMPG 2-3) after successful percutaneous coronary intervention and group II of 60 patients with poor myocardial perfusion (TMPG 0-1). RESULTS: The prevalence of metabolic syndrome was found to be significantly higher in patients with poor myocardial perfusion than in those with good myocardial perfusion (40 vs. 20%, respectively, P=0.002). Moreover, we detected an independent association between metabolic syndrome and the occurrence of poor myocardial perfusion grade (adjusted OR=2.54, 95% CI=1.35-4.75, P=0.003). CONCLUSIONS: We have shown, for the first time, a significant association between metabolic syndrome and impaired myocardial perfusion after percutaneous coronary intervention in patients with acute myocardial infarction. This data may partially explain the poor short and long-term outcomes of acute myocardial infarction in patients with metabolic syndrome.

[Inflammatory markers in heart failure]. / Kalp yetersizliginde inflamatuvar göstergeler.

Heart failure is a leading cause of cardiovascular mortality and morbidity. It has been shown that inflammatory markers may play a role in the pathogenesis of heart failure. Therefore, inflammatory markers and anticytokine therapy in heart failure have become the attractive subjects in the literature. There are new studies regarding this issue in the literature. In this article, we reviewed inflammatory markers in heart failure and their prognostic significance based on the literature data.

P wave dispersion is increased in pulmonary stenosis.

AIM: The right atrium pressure load is increased in pulmonary stenosis (PS) that is a congenital anomaly and this changes the electrophysiological characteristics of the atria. However, there is not enough data on the issue of P wave dispersion (PWD) in PS. METHODS: Forty-two patients diagnosed as having valvular PS with echocardiography and 33 completely healthy individuals as the control group were included in the study. P wave duration, p wave maximum (p max) and p minimum (p min) were calculated from resting electrocardiography (ECG) obtained at the rate of 50 mm/sec. P wave dispersion was derived by subtracting p min from p max. The mean pressure gradient (MPG) at the pulmonary valve, structure of the valve and diameters of the right and left atria were measured with echocardiography. The data from two groups were compared with the Mann-Whitney U test and correlation analysis was performed with the Pearson correlation technique. RESULTS: There wasn't any statistically significance in the comparison of age, left atrial diameter and p min between two groups. While the MPG at the pulmonary valve was 43.11 +/- 18.8 mmHg in PS patients, it was 8.4 +/- 4.5 mmHg in the control group. While p max was 107.1 +/- 11.5 in PS group, it was 98.2 +/- 5.1 in control group (p=0.01), PWD was 40.4 +/- 1.2 in PS group, and 27.2 +/- 9.3 in the control group (p=0.01). Moreover, while the diameter of the right atrium in PS group was greater than that of the control group, (38.7 +/- 3.9 vs 30.2 +/- 2.5, p=0.02). We detected a correlation between PWD and pressure gradient in regression analysis. CONCLUSION: P wave dispersion and p max are increased in PS. While PWD was correlated with the pressure gradient that is the degree of narrowing, it was not correlated with the diameters of the right and left atria.