Diagnostic value of ischaemia-modified albumin for predicting myocardial ischaemia during myocardial perfusion scintigraphy.

During acute ischaemia the N-terminal site of albumin is altered, reducing its binding capacity; the modified protein is termed ischaemia-modified albumin (IMA). IMA is a sensitive marker of acute myocardial ischaemia but its diagnostic value in chronic angina pectoris patients is unclear. We investigated changes in blood levels of IMA during myocardial perfusion scintigraphy in patients with chronic angina pectoris in a study including 26 male and 20 female patients, with mean age 60 years. Technetium 99m perfusion imaging detected myocardial ischaemia in 26 patients. Coronary angiography was carried out in these 26 ischaemic patients. Mean IMA values at rest and peak exercise were significantly higher in the ischaemic than the nonischaemic group. All IMA values were considered negative for cardiac ischaemia. Peak exercise IMA was significantly lower than the pre-exercise level only in the non-ischaemic group. IMA measurements during myocardial perfusion scintigraphy are not helpful in the diagnosis of myocardial ischaemia in patients with stable angina pectoris.

Assessment of interventricular septal motion using colour tissue Doppler imaging in adult patients with atrial septal defect.

We aimed to characterize changes in interventricular septum (IVS) motion and any relationship between them and the pulmonary-to-systemic flow ratio (Qp/Qs) in adult patients with atrial septal defect (ASD). Patients and controls were studied using colour tissue Doppler imaging (TDI). The septum length (SL) and distance from the colour change point (CCP) on the IVS to the aortic valve (the CCP distance) were measured on parasternal long axis views. Values normalized for body surface area, and the CCP distance to SL ratio, were calculated. Qp/Qs values were correlated with CCP distance, normalized CCP distance and CCP distance:SL ratio. Statistically significant differences in CCP distance, normalized CCP distance and CCP distance:SL ratio were found between the two groups. In the ASD group, there was no correlation between Qp/Qs and the echocardiographic measurements. The point between the motions in two different directions from the IVS shifted toward the apex in ASD patients compared with controls, and may be a mechanism involved in paradoxical septal motion.

Wellens' syndrome: a case report.

The pattern of clinical findings and electrocardiography (ECG) changes known as Wellens' syndrome is associated with significant stenosis of the proximal left anterior descending coronary artery. Cases can be classified according to the ECG pattern into type 1 (biphasic T waves) or type 2 (deeply inverted T waves, especially in leads V2 and V3). We present here an unusual case of Wellens' syndrome in which the ECG pattern changed from type 2 to type 1 during observation, and in which the coronary lesion was in the middle rather than the proximal part of the left anterior descending artery.

Role of homocysteine for thromboembolic complication in patients with non-valvular atrial fibrilation.

Thromboembolism is the most important complication in patients with atrial fibrilation (AF). Homocysteine is a toxic amino acid that has been recently accepted as a risk factor for atherosclerosis and stroke. The aim of the present study is to show whether there is a relation between hyperhomocysteinemia and thromboembolic complications in patients with non-valvular AF. We admitted 38 patients with non-valvular AF. The patients were divided into two groups: group A (n = 20; mean age, 75.7 +/- 10.4 years; three males/17 females), and group B (n = 18; mean age, 68.0 +/- 10.6 years; 11 males/seven females). While group A consisted of the patients with AF and stroke, group B was composed of the patients with AF but without stroke. The patients having sinus rhythm (15 subjects) were used as the reference group to obtain the cut-off value. Homocysteine was measured by the immunoassay method. The means of the homocysteine levels were 12.4 +/- 3.3 micromol/l in group A, 8.3 +/- 2.3 micromol/l in group B and 9.3 +/- 1.8 micromol/l in the reference group. The cut-off value was 10.6 micromol/l. Group A had a statistically higher homocysteine level than not only group B, but also the reference group (P < 0.05). While 60% of group A (n = 12) had the elevated homocysteine level, the rate was only 22% for group B (n = 4). In conclusion, hyperhomocysteinemia may be one of the explanations for the increased rate of thromboembolic complications in older patients with AF.

The effects of valsartan on insulin sensitivity in patients with primary hypertension.

Insulin resistance is an important risk factor of cardiovascular disease. This study was performed to determine the effects of valsartan on insulin sensitivity in patients with primary hypertension. In this study, non-obese subjects with primary hypertension and a reference group of healthy subjects matched by age, sex and body mass index were evaluated; patients with any other causes of peripheral insulin resistance and hyperlipidaemia were excluded. The effect of valsartan on insulin resistance, assessed by homeostasis model assessment (HOMA-IR), fasting serum insulin levels, determined by radioimmunoassay, and fasting blood glucose concentrations, measured by the glucose oxidase method, were evaluated. All obtained data were evaluated by Pearson correlation analysis. Before valsartan treatment, the fasting serum insulin levels were significantly elevated in the 20 hypertensive patients with primary hypertension compared with the 20 subjects in the reference group (19.6 +/- 7.1 versus 8.7 +/- 1.9 microIU/ml). The fasting serum insulin levels correlated with HOMA-IR. Correlation analysis also showed a significant relationship between HOMA-IR and both systolic and diastolic blood pressures (r = 0.71 and r = 0.77, respectively). In our study, we showed that patients with primary hypertension have a decreased insulin sensitivity that was reflected in high serum fasting insulin levels. Anti-hypertensive treatment with valsartan increases insulin sensitivity.

Effects of fluvastatin treatment on insulin sensitivity in patients with hyperlipidaemia.

This study aimed to determine the effects of fluvastatin treatment on insulin sensitivity in patients with hyperlipidaemia. Non-obese, normoglycaemic, normotensive patients with hyperlipidaemia (n = 20) and a reference group of healthy subjects of similar age, sex, and body mass index (n = 20) were evaluated. Patients with other causes of peripheral insulin resistance were excluded. All participants underwent a diagnostic protocol, which included measurements of insulin sensitivity index and other metabolic parameters. Insulin sensitivity was assessed by Homeostasis Model Assessment (HOMA). Serum insulin levels were tested by radioimmunoassay. Patients were treated with fluvastatin 40 mg once daily for 3 months. Before fluvastatin treatment, fasting serum insulin levels were significantly raised in patients with hyperlipidaemia compared with subjects from the reference group (19.1 +/- 13.4 versus 8.1 +/- 3.4 microIU/ml). The fasting serum insulin levels and HOMA-estimated insulin sensitivity were correlated in the whole group. Correlation analysis showed a significant relationship between HOMA-estimated insulin resistance and plasma cholesterol and triglyceride concentrations. Patients with hyperlipidaemia had reduced insulin sensitivity that was reflected by high serum fasting insulin levels. Anti-hyperlipidaemic treatment with fluvastatin increases insulin sensitivity.

[Estimate of the artery responsible for acute inferior myocardial infarct attack using arterial electrocardiograph tracings]. / Akut inferior miyokard infarktüsünde infarktan sorumlu arteri elektrokardiyografik olarak tahmin edebilme.

OBJECTIVE: The aim of the study was to determine IRA (infarct-related artery) by analysis of the initial ECG (electrocardiogram) in patients with acute inferior wall myocardial infarction. METHODS: Forty patients (36 male, 4 female) admitted to coronary care unit with the diagnosis of acute inferior wall myocardial infarction were included in the study. The mean age of patients was 62.2 year (29-85 years). The coronary angiography was performed in all patients at the first week of admission. To determine the relationship between IRA and R/S ratio, ST segment depression in lead aVL, statistical analysis was performed. RESULTS: IRA was the right coronary artery (RCA) in 20 cases, circumflex artery (Cx) in 15 cases, RCA + Cx in 5 cases. R/S ratio was bigger than one in patients with Cx lesion and R/S ratio was smaller than one in patients with RCA lesion. The degree of the ST segment depression was equal or smaller than 2 mm in patients with Cx lesion and greater than 2 mm in patients with RCA lesion (p < 0.05). There was no correlation between IRA and precordial reciprocal electrocardiographic changes. Diagnosis of right ventricular infarction was established in 75% of patients with RCA lesion, 26% of patients with Cx lesion and 100% of patients with RCA + Cx lesions. CONCLUSION: We concluded that it was possible to predict IRA after examining the initial ECG changes such as R/S ratio, ST segment depression. This prediction can shorten the time required to perform primary percutaneous transluminal coronary angioplasty. Non-invasive prediction of IRA was useful for suggestion of clinical course in patients with high complication risk, such as patients with RCA lesion.