Familial Mediterranean fever gene mutations as a risk factor for early coronary artery disease.

OBJECTIVE: Cardiovascular diseases (CVD) are very common in the general population. Atherosclerosis is the main pathogenesis. Familial Mediterranean fever (FMF) is an autosomal recessive disease. The gene causing FMF, designated MEFV, encodes a protein called pyrin or marenostrin that is expressed mainly in myeloid bone marrow precursors, neutrophils and monocytes. We herein aimed to determine the prevalence of MEFV mutations (all exon 2, 10 mutations) in patients with early coronary heart disease (early CHD) and coronary heart disease (CHD) with multiple risk factors and among the healthy subjects as controls. METHODS: A total of 197 patients and 119 healthy subjects were recruited and enrolled into three groups in terms of inclusion criteria. Ninety-one patients diagnosed with early CHD enrolled into group one (men < 45 years of age, women < 40 years of age), 106 patients with CHD (men > 50 years of age) to group two and 119 healthy controls enrolled into group three. None of patients was diagnosed with FMF. The diagnosis of CHD was established on electrocardiographic changes, echocardiography and coronary angiography. RESULTS: Thirty-eight patients (41.8%) with early CHD, 17 patients (16%) with CHD and 24 healthy controls (20.2%) carried at least one mutated MEFV allele. Young patients with CHD have different risk factor profiles, clinical presentations and prognoses than older patients. Young patients with CHD usually have multiple risk factors. CONCLUSION: This study suggests that MEFV mutations in early CHD patients had significantly increased in contrast to CHD patients and healthy controls.

Impact of Chronic Rheumatic Valve Diseases on Large Vessels.

BACKGROUND AND AIM OF STUDY: Rheumatic valvular heart disease, which remains a common health problem in developing countries, has numerous consequences on the heart chambers and circulation. The study aim was to investigate the effects of chronic rheumatic valve disease on the diameters of the descending aorta (DA) and inferior vena cava (IVC). METHODS: A total of 88 patients with echocardiographically documented rheumatic valvular heart disease and 112 healthy controls were enrolled into the study. All patients underwent detailed echocardiographic examinations, while their height and body weight were recorded and adjusted to their body surface area. RESULTS: The most common involvement was mitral valve disease, followed by aortic valve disease and tricuspid valve disease. The mean diameter of the DA (indexed to BSA) was 1.79 ± 0.49 cm for patients and 1.53 ± 0.41 for controls (p <0.001). The mean diameter of the IVC (indexed to BSA) was 1.69 ± 0.73 for patients and 1.38 ± 0.35 cm for controls (p <0.001). There was a significant positive correlation between mitral valve mean gradient and IVC diameter (p = 0.01, r = 0.18). There were also strong associations between the mitral valve area and the diameters of the DA (p = 0.001, r = -0.239) and IVC (p <0.001, r = -0.246). CONCLUSION: Rheumatic valve disease, especially mitral stenosis, was closely related to remodeling of the great vessels.

Atrial Fibrillation Triggered By Drug-Induced Bradycardia.

Atrial fibrillation (AF) is the most frequently observed arrhythmia in clinical practice. Many causative factors have been identified from well-known structural heart disease to less understood triggers. Both sympathetic and parasympathetic (vagal) stimuli are able to trigger paroxysms of AF. Vagally mediated AF is especially observed in young healthy subjects and especially during nights when the heart rate is considerably slow. Tachycardia induced AF is demonstrated and the possible mechanisms are explained. However, a case of bradycardia induced AF, thus far, hasn't been reported. Here we present a case of AF induced by severe bradycardia which was triggered by concomitant use of beta-blockers and diltiazem.

Relationship between Neurocardiogenic Syncope and Ventricular Repolarization.

BACKGROUND: We aimed to analyze ventricular repolarization in neurocardiogenic syncope (NCS) patients by using T-peak-T-end interval, T-peak-T-end/QT ratio, T-peak-T-end/QTc ratio and corrected QT interval (QTc), QT dispersion (QTd), QT index (QTI) and corrected QT interval index (QTcI) comparing with the corrected JT dispersion (JTcd), and corrected JT (JTc) and the corrected JT interval index (JTcI), by inspecting ventricular activation until termination of repolarization. These parameters are used as an index of potential ventricular arrhythmogenesis. METHODS: We have studied patients with head-up tilt table test (HUTT) (+) (33 patients; mean age: 28 ± 11 years) and HUTT (-) as control group (33 patients; mean age: 30 ± 11 years). In all patients, T-peak-T-end interval, T-peak-T-end/QT ratio, T-peak-T-end/QTc ratio, QT, QTd, QTI, QTc, QTcI, JTd, JTc, and JTcI were measured on electrocardiogram. RESULTS: The following parameters were statistically significant between groups: QTd (22.72 ± 17.54 msn; 11.21 ± 13.40 msn; P = 0.004), QTc (424.27 ± 33.75 msn; 403.66 ± 38.08 msn; P = 0.023), QTcI (114.09 ± 14, 29%; 106.71 ± 15.33%, P = 0.047), and QTI (100.72 ± 7.19%; 97.14 ± 7.13%, P = 0.046). Furthermore, T-peak-T-end interval was significantly prolonged in the study group (93.78 ± 20.27 msn; 81.21 ± 11.66 msn; P = 0.003). T-peak-T-end/QT ratio was significantly higher in the study group (0.24 ± 0.04 msn; 0.22 ± 0.04 msn; P = 0.030). T-peak-T-end/QTc ratio was significantly higher in the study group (0.22 ± 0.04 msn; 0.20 ± 0.03 msn; P = 0.015). The JTc and JTd were also significantly higher in the study group ([103.00 ± 9, 72%; 95.44 ± 10.26%, P = 0.003], [27.57 ± 16.01 msn; 10.45 ± 16.08 msn; P < 0.001], respectively). CONCLUSIONS: Electrocardiographic ventricular repolarization parameters including T-peak-T-end interval, T-peak-T-end/QT ratio, T-peak-T-end/QTc ratio, QTc, QTd, QTI, QTcI, JTc, JTd, and JTI are prolonged in NCS.

Evaluation of early subclinical cardiotoxicity of chemotherapy in breast cancer.

OBJECTIVE: Cardiac effects of chemotherapy are usually recognized after clinical symptom or sign occurrence in patients with breast cancer. In this study, we aimed to determine the potential subclinical cardiotoxic effects of chemotherapy that were given lower dosage than well known cardiac safety dosage limits in patients with breast cancer during early period. METHODS: Fifty-one patients consecutively enrolled to this prospective cohort study. All patients were diagnosed as breast cancer at oncology hospital in University of Gaziantep. Before chemotherapy, all of the patients underwent to detailed ECG and echocardiography (ECHO) examinations. After 6 months, detailed ECG and ECHO examinations were repeated and compared with baseline values. Statistical analysis was performed using Shapiro-Wilk tests, Student t-test and Spearman correlation test. RESULTS: The average age of patients was 51 and one was male. Statistically significant decrease in ejection fraction was found after treatment (62.3%±3.3 and 59.9%±5.9, p=0.002). Evaluation of diastolic parameters; significant increase in the transmitral A flow velocity and significant decrease of E/A ratio were observed on Doppler ECHO analysis (77.4±19.1 cm/sec versus 86±18 cm/sec, p<0.001; 1.01±0.3 versus 0.9±0.2, p=0.03, respectively). On tissue Doppler analysis we observed that significant reduction in the value of E' and significantly increase E/E' ratio were present (12.5±3.6 cm/sec versus 10.7±2.9 cm/sec, p=0.001; 6.6±2.9 versus 7.7±3.3, p=0.04, respectively). CONCLUSION: Chemotherapy has detrimental subclinical effect on both of systolic and diastolic function in early six months period despite the prescription of lower dosage of chemotherapy than well-known cardiac safety dosage limits. Tissue Doppler imaging may be more sensitive than ECG, conventional ECHO and Doppler for determining the subclinical cardiac damage.

Extensive vascular and valvular involvement in Gaucher disease.

A 17-year-old patient with type III Gaucher disease was hospitalized for recurrent syncope. Echocardiography showed calcified aortic and mitral stenosis. Three-dimensional computed tomography showed severely calcified plaques on the ascending aorta, arcus, and abdominal aorta. On follow-up, palpitations and syncope were triggered by emotional stress, followed by severe bradycardia that was resulted in cardiogenic shock; the patient died after 8 h despite all efforts. Gaucher disease should be kept in mind in the differential diagnosis of a young patient with extensive vascular and valvular calcification. Patients with symptomatic severe valvular disease must be referred for early surgery.

Investigation of relationship between IL-6 gene variants and hypertension in Turkish population.

Hypertension (HT) is a common and life threating health problem worldwide leading to stroke, heart attack and renal failure. It is characterized by elevated blood pressure forced heart load. Human interleukin-6 (IL-6) and C- reactive protein (CRP) are known to be involved in inflammatory processes. IL-6 gene is a polymorphic gene which -174 G/C is a common and -572 G/C is a rare polymorphisms identified in promoter region. Publications on IL-6 gene polymorphisms raised the question whether this gene polymorphisms lead to susceptibility to HT or not. To investigate the effects of IL-6 gene -174 G/C (rs 1800795) and -572 G/C (rs1800796) polymorphisms on plasma IL-6 and CRP levels and their associations with hypertension disease in Turkish population we analyzed -174 G/C and -572 G/C polymorphisms and plasma IL-6 and CRP levels in 111 healthy controls and 108 hypertension patients from Adiyaman, Turkey. We determined the genotypes using polymerase chain reaction-restriction fragment length polymorphism and analyzed plasma levels of IL-6 by ELISA and CRP by automated standard biochemical methods. We have found no statistically significant differences between IL-6 gene -174 G/C and -572 G/C genotypes and allelic frequencies and IL-6 and CRP plasma levels and HT (p > 0.05). No CC genotype was found in control subjects for -572 G/C polymorphism. In conclusion, we found relation to -174 G/C and -572 G/C gene variants between neither IL-6 and CRP levels nor hypertension. The -572 G allele and GG genotype are predominant in Turkish population in Adiyaman, Turkey whereas the CC genotype is very rare.

Effects of lying position on P-wave dispersion in patients with heart failure.

OBJECTIVE: It was the aim of this study to investigate the effects of the right lateral decubitus, left lateral decubitus and supine lying position on P-wave dispersion (PWD) in patients with heart failure (HF). SUBJECTS AND METHODS: Seventeen patients with HF whose ejection fraction was <35% were included in the study. Right lateral decubitus, left lateral decubitus and supine electrocardiogram (ECG) recordings were obtained. The recordings for each of the three positions were taken after the patients had maintained each position for 30 min to ensure a stabilized hemodynamic position. For the baseline recording, in supine position, there was no 30-min waiting period before the ECG. RESULTS: After the right lateral decubitus position, there was a statistically significant reduction in the longest P-wave duration (100.0 ± 14.5 and 84.7 ± 16.2 ms; p = 0.001) and a significant decrease in PWD (41.7 ± 8.0 and 24.1 ± 7.1 ms; p < 0.0001). After the left lateral decubitus position, there was no significant change between the baseline PWD values (41.7 ± 8.0 and 40.2 ± 9.7 ms; p = 0.606). After the supine position, there was no significant change between the baseline PWD values (41.7 ± 8.0 and 39.7 ± 9.4 ms; p = 0.427). CONCLUSION: Our study revealed that patients' PWDs and maximum P-wave durations were lower in the right lateral decubitus lying position than in other positions. The clinical implication of this study needs to be further explored.

Impact of scorpion stings on electrocardiographic changes and relationship with body oxidant and antioxidant status.

OBJECTIVE: To investigate electrocardiogram changes due to scorpion stings and association between oxidative stress index, body oxidant/antioxidant system and the electrocardiogram changes. METHODS: The study was conducted at the Faculty of Medicine, Gaziantep University, Turkey, between May 2009 and October 2010. It comprised 44 patients admitted to the emergency department for scorpion sting, and a control group of matched age and gender of 20 persons. Electrocardiograms were taken promptly in the most painful phases of the patients. Cardiac parametres were measured. Erythrocyte packages were prepared to detect toxin/antioxidant levels. SPSS 18 was used for statistical analysis. RESULTS: Of the 44 patients, 22 (50%) were male. Overall average age of the patients was 45.22 +/- 17.99 years. None of the patients required intensive care and none of them had limb losses. Cardiac parametres of the patients in electrocardiogram were higher (p < 0.05). Difference between those with changed electrocardiogram and unchanged electrocardiogram in terms of the values of total antioxidant status, total oxidant status, and oxidative stress index, were not statistically significant (p > 0.05). CONCLUSION: Scorpion stings associated with electrocardiogram changes. The mechanism of this relationship is not related with the status of body oxidative stress index and body oxidant and antioxidant capacity. Some parametres warrant further study in terms of potential serious arrhythmias in scorpionism.

Prognostic role of echocardiographic and hematologic parameters in heart failure patients complicated with incidental pleural effusion diagnosed during echocardiographic evaluation.

We aimed to determine long-term prognostic role of echocardiographic and hematologic parameters in heart failure patients complicated with incidental pleural effusion (PE) diagnosed during echocardiographic evaluation. The study was performed by evaluating patient records in which PE was incidentally detected during echocardiographic examination in a tertiary teaching hospital between Jan 2002 and Dec 2012. Total 151 patients with heart failure complicated with PE were analyzed. All patients' mortality data were collected from registry center of Social Insurance Institution which is officially responsible for recording all mortality data in Turkey. Detailed echocardiographic and hematologic parameters including creatinine, uric acid, albumin, sodium, potassium, hemoglobin at the time of hospital admission were analyzed. Data from 151 eligible patients were analyzed. We compared patients who died (n = 51) during follow-up with the survivors (n = 100) in terms of patients' echocardiographic and hematological features. Mean duration of follow-up was 71.5 ± 45.6 months. Fifty-one patients (33.8 %) died during this follow-up period. From all echocardiographic parameters only dilated left atrium (LA) diameter was found to be associated with a poor prognosis (p = 0.034). Low albumin, sodium and hemoglobin levels were associated with poor prognosis (p < 0.001, p = 0.002 and p = 0.007, respectively). We showed that dilated LA, as well as low albumin, low sodium and low hemoglobin levels had a worse prognostic significance than patients with normal LA size, within normal limits of albumin, sodium and hemoglobin levels in patients with heart failure complicated with PE determined incidentally by echocardiography.

Influence of recurrent electroconvulsive therapy on cardiac function.

OBJECTIVE: To investigate the effects of recurrent electroconvulsive therapy (ECT) on cardiac function as assessed by echocardiography. SUBJECTS AND METHODS: Twenty-three patients (11 males and 12 females) with different psychiatric disorders who were apparently free of any cardiovascular disorders and underwent ECT were enrolled in the study. Echocardiographic findings including diastolic mitral inflow and tissue Doppler features were recorded at baseline and at the end of the 7th and last ECT in all patients. RESULTS: The mean age of the patients was 37.95 ± 13.28 years (range 19-71). There was no significant difference in mitral E wave velocities and tissue Doppler E' velocities between the baseline and after the 1st ECT (p = 0.161 and p = 0.083, respectively). The results were similar after the last ECT session (p = 0.463 and p = 0.310, respectively). However, there was a significant increase in transmitral A wave velocity after the 1st and 7th ECT session compared to the values at baseline (p = 0.008 and p = 0.017, respectively). CONCLUSION: The mitral diastolic inflow A wave velocity increased 20 min after ECT, and this increase persisted after recurrent ECT sessions. This finding could be considered as an indicator of acutely increased sympathetic tone.

Prognostic role of incidental pleural effusion diagnosed during echocardiographic evaluation.

BACKGROUND: The purpose of this study was to determine the long-term prognostic implications of incidental pleural effusion (PE) detected during echocardiographic examination and its relationship with concomitant diseases. HYPOTHESIS: The study hypothesis is to test whether incidental pleural PE detected during echocardiographic examination be used as a prognostic marker. METHODS: The study was performed by evaluating patient records (N = 251) in whom PE was incidentally detected during echocardiographic examination in a tertiary hospital between 1999 and 2012. The patients were classified into 4 major groups according to the concomitant primary disease: malignancy, and cardiovascular, renal, and pulmonary diseases. The total survival time was obtained from hospital records for patients who died during the hospital stay and social security institution records for patients with out-of-hospital death. RESULTS: One-year and 5-year life expectancies of PE cases concomitant with different disorders were as follows; heart failure (n = 151), 81% and 70%; malignancies (n = 45), 53% and 44%; pulmonary diseases (n = 37), 89% and 78%; renal diseases (n = 18), 100% and 83%; respectively. PE associated with heart failure, renal disease, and pulmonary disease had similar (P > 0.05 for all) and favorable outcomes compared to PE associated with malignancies (P < 0.001). CONCLUSIONS: The prognosis of incidental PE was the worst in patients with concomitant malignancies; however, PE associated with nonmalignant diseases including heart failure, pulmonary disease, and renal disease have similar and favorable outcomes.

Giant pulmonary artery aneurysm: 12 years of follow-up. case report and review of the literature.

Pulmonary artery aneurysm (PAA) is defined as pulmonary artery diameter of greater than 4 cm. PAA is not frequently encountered in clinical practice. There is a rare report in giant low-pressure PAA in terms of long-term follow-up. Herein, we sought to report a case of idiopathic PAA that was followed for 12 years in view of its learning points and to review the current literature for PAA. Herein we observed learning points according to long-term follow-up of PAA case as follows. PAA progressed dramatically after reaching a diameter greater than 6 cm and resulted in 7.87 cm in 2 years according to our case observation. Pericardial effusion may develop after a dramatic increase of PAA diameter. The reason for pericardial effusion is not always dissection or rupture; the presence of pericardial effusion possibly stemmed from the impairment of lymphatic drainage because of pressure effect on lymphatic circulation. Progressive increase of dilatation may lead to cough, as in our case.

Anxiety score as a risk factor for radial artery vasospasm during radial interventions: a pilot study.

We determined the role of anxiety level on radial artery spasm during transradial coronary angiography. Eighty-one patients who had an indication for coronary angiography were enrolled. Radial artery vasospasm was determined by addressing 5 signs: persistent forearm pain, pain response to catheter manipulation, pain response to sheath withdrawal, difficult catheter manipulation after being "trapped" by the radial artery, and considerable resistance on withdrawal of sheath. Radial spasm defined as at least 2 of the 5 signs. The Hamilton Anxiety scale questionnaire was used to determine the level of anxiety. Vasospasm was observed in 19.1% of the patients. Anxiety score was significantly higher in women (11.1 ± 7.2 vs 17.6 ± 7.3; P < .001). Vasospasm was significantly correlated with female sex (P < .001, r = .43) and anxiety score (P = .007, r = .29). Female sex was associated with higher anxiety scores (P < .001, r = .43). In conclusion, higher anxiety scores and female sex are important risk factors for radial artery vasospasm.

Cardiac metastasis of a low-grade myofibroblastic sarcoma.

We aim to present a rare case of low-grade myofibroblastic sarcoma arising in the inguinal region accompanied by cardiac metastasis. A 36-year-old male patient suffering from recurrent inguinal swelling was operated on and the initial histopathological evaluation mistakenly diagnosed the condition as benign. During follow-up, a recurrence of mass was detected in the same region and a pathological examination revealed a low-grade myofibroblastic sarcoma. Cardiac metastasis was diagnosed shortly before rapid disease progression and death. The learning points relevant to this case are as follows: (1) Echocardiographic screening in patients with noncardiac myofibroblastic sarcomas may be helpful in the detection of silent metastasis. (2) Low-grade myofibroblastic sarcomas in the inguinal region may be misdiagnosed as benign after enucleation. Thus, rigorous histopathological examination of myofibroblastic sarcomas is crucial. (3) According to our knowledge, this is the first report of a low-grade myofibroblastic sarcoma to have a potential for cardiac metastasis with potentially fatal course.