Prognostic value of the Intermediate QRS prolongation in patients with acute myocardial infarction.

OBJECTIVE: Studies have shown different effect of intermediate QRS prolongation on major cardiovascular events in acute myocardial infarction (AMI) patients. The aim of this study was to investigate the predictive and prognostic value of intermediate QRS prolongation on in-hospital complication rate and long term mortality in patients with AMI. MATERIALS AND METHODS: We performed an observational study that enrolled 114 consecutive patients with AMI. Patient's admission electrocardiography (ECG) were enlarged two fold, and QRS duration (QRSd) was measured manually. Patients were divided into two groups according to the admission EKG QRSd. Group A defined as patient with QRSd between 90-120 msn and group B QRSd <90msn. Echocardiographic, angiographic, clinic and laboratory results were recorded for all patients. Patients were followed next twelve months. RESULTS: In-hospital follow-up period, major adverse cardiac events were higher in group A than group B (0.9 ±0.9 vs. 0.5 ±0.5 p=0.02). There were increased end-diastolic and end-systolic volume in group A (91±15 vs. 82±12 p=0.002; 50±10 vs. 44±9 p=0.002. respectively). Left ventricular ejection fraction (LVEF) was lower in group A. but it did not reach statistical significance (43.5±6.3 vs. 45.5±5.5 p=0.06). Angiographic evaluation was detected severe coronary artery disease (CAD) in group A than group B (1.9±0.8 vs. 1.5±0.7 p=0.013). During 12 months of follow-up period. five patients were died. Although these patients had longer QRSd on admission, it was not statistically significant (96±14 vs. 90±11 p=0.3). CONCLUSIONS: Intermediate QRS prolongation on admission EKG were found to be positively correlated with increased EDV, ESV, major in-hospital cardiovascular events, and multivessel coronary artery disease and inversely correlated with LVEF. Although deceased patients had prolonged QRSd it was not statistically significant.

Replacement of circumflex branch of left coronary artery originating from the right aortic sinus.

Replacement of the circumflex branch of the left coronary artery is extremely rare. We conducted a retrospective study to determine the incidence of this anomaly of circumflex branch of the left coronary artery. Two such patients were identified from 850 adults undergoing cardiac catheterization procedures. The circumflex branch of the left coronary artery was replaced by a vessel arising from the right aortic sinus. The course of this vessel was retroaortic. A knowledge of this anomaly is important for coronary artery bypass surgery.

The value of hemodynamic changes induced by carotid sinus massage on the diagnosis of coronary artery disease.

The aim of this study is to investigate the value of hemodynamic changes induced by carotid sinus massage (CSM) on the diagnosis of coronary artery disease (CAD). A total 108 patients (mean age, 54 +/- 10 years, range 33-70) who had no significant stenosis in the carotid artery by duplex ultrasonography (USG) and no history of syncope were included in this study. Carotid sinus massage was performed before coronary angiography with monitoring of electrocardiography and blood pressure. The patients were divided into three groups according to response to CSM: group 1 patients had a decrease in blood pressure or < 10 beats/minute (bpm); group 2 patients had a decrease between 10 and 20 bpm; and group 3 patients had > 20 mm Hg decrease in blood pressure or > 20 bpm. Coronary angiography was performed after CSM in all patients. There was single-vessel disease (VD) in 23 cases, two-VD in 24 cases, and three-VD in 35 cases. Coronary angiography results were normal in 26 cases. The changes in systolic and diastolic blood pressures and heart rate before and after CSM correlated with number of VD. These changes were highest in patients with three-VD, but lowest in patients with normal coronary angiography. The number of diseased vessels and total coronary artery score were lowest in group 1, but highest in group 3. The specificity and sensitivity of CSM-induced > 10 mm Hg in blood pressure (BP) or > 10 bpm changes in heart rate in the diagnosis of CAD were 85% and 71%, respectively. The positive and negative predictive values were 93% and 49%, respectively in the diagnosis of CAD. At the end of this study, we concluded that CSM induced the fall in blood pressure and heart rate and was correlated with number of diseased vessels and the score of coronary artery disease. As dichotomized values, the decrease of > 10 mm Hg in blood pressure and/or > 10 bpm has highest specificity, sensitivity, and positive predictive value in the diagnosis of CAD.

[The relation between infarction localization and late potentials]. / Infarktüs lokalizasyonu ile geç potansiyel arasindaki iliski.

OBJECTIVE: There are controversies about the relation between infarction localization and late potentials (LP) following acute myocardial infarction (AMI). To evaluate this issue 124 consecutive patients with first Q-wave AMI fulfilling the inclusion criteria were enrolled in this signal--averaged ECG (SAECG) study. METHODS: The patients were divided into three groups according to infarction localization: anterior (Group I n = 62; 50%), inferior (Group II: n = 42; 34%) and both inferior and right ventricular (RV) involvement (Group III n = 20; 16%). SAECG records were performed during the second week. LP results were evaluated as positive when at least two of the major criteria (QRS > 114 ms, LAS 40 > 38 ms, RMS < 20 V) were obtained. Tukey--Cramer multivariate analysis was performed. RESULTS: Positive LP results were obtained in 29% of group I, 35.7% of group II and 55% of group III patients. Patients with both inferior and RV involvement had a significantly higher positive LP results independent from left ventricular ejection fraction. CONCLUSION: Therefore, increased risk of arrhythmia in those patients with both inferior MI localization and RV involvement should be taken into consideration.

A complicated case of pericardial hydatid cyst manifesting as constrictive pericarditis.

Although cardiac involvement with hydatid cyst is quite rare as a major complication, constrictive pericarditis is even less common. A 55-year-old man is presented in whom a hydatid cyst located in the right cardiophrenic angle anterior to the right ventricle ruptured into the pericardial sac, resulting in constrictive pericarditis.

Contribution of the peak exercise QT dispersion to the accuracy of an exercise test during the evaluation of coronary artery disease.

OBJECTIVE: Regional defects in ventricle repolarization are extremely sensitive to ischaemia which can be measured as QT dispersion (QTd). We investigated the role of QTd calculated at the time of peak exercise during treadmill studies. METHODS AND RESULTS: Thirty-three women and eighty men, whose treadmill test results and coronary angiography studies had been examined, were divided into four groups according to the test results: 1) subjects with a negative treadmill test and without significant stenosis results in the angiography, were considered normal (N; n = 35); 2) subjects with both a positive exercise test and a significant presence of stenotic coronary arteries, were considered true positive (TP; n = 52); 3) subjects with a positive exercise test, but without significant stenosis results in the angiography, were considered false positive (FP; n = 14); 4) subjects with a negative treadmill study, despite significantly stenotic arteries, were considered false negative (FN; n = 12). All subjects were evaluated on the basis of age, significant ST-segment depression, peak heart rate, rest and peak exercise QT, and QpT (measured from the beginning of the QRS complex to the highest point of the T wave) dispersion, and corrected (QTcd, QpTcd) values for heart rate. The most significant differences were observed between the N and the TP groups in terms of QTd and QTcd (p < 0.01), with a higher correlation (r = 0.48). A significant relationship was also observed in terms of QpT and QpTcd values during peak exercise (p < 0.01). The sensitivity of the peak exercise QTcd and QTcd > or = 70 ms in determining coronary artery disease was found to be 74%. In cases of QTcd > or = 70 ms, in addition to ST-segment depression, the test was found to be less sensitive, but more specific at 96%. CONCLUSION: It suggests that when peak exercise QTd and QpTd values are taken into account, with the exception of the ST-segment depression, the accuracy of the exercise test will increase and false positive results will decrease.

Cardiac hydatid cysts located in both the left ventricular apex and the intraventricular septum: case report.

Cardiac hydatid cyst is rarely encountered and constitutes 0.5%-2% of all hydatid cases. Although left ventricular (LV) location for hydatid cysts has been frequently reported, the involvement of both the left ventricle and the interventricular septum (IVS) has not been previously reported in the literature. We present a case of cardiac hydatid cyst with fatal recurrent cerebral embolism and the unusual involvement of both LV and IVS demonstrated by transthoracic echocardiography.

Relation between QT dispersion and ventricular arrhythmias in uncomplicated isolated mitral valve prolapse.

Complications of mitral valve prolapse (MVP), among which serious ventricular arrhythmia and sudden death are of major importance, affect many individuals due to the high incidence of MVP itself in the community despite the actual low incidence of these complications. The present study investigated the incidence and distribution of ventricular arrhythmias according to their severity and relationship with the QT interval and dispersion of repolarization in uncomplicated isolated MVP (IMVP) cases. Fifty-eight uncomplicated IMVP patients, 33 patients with accompanying tricuspid valve prolapse (TVP), to compare its relationship with ventricular arrhythmia, and 60 age- and sex-matched control subjects were enrolled in the study. Individuals with accompanying cardiac or systemic disease, or who were on drug therapy that could potentially affect QT characteristics, were excluded. The incidence of ventricular arrhythmia was 48% in the IMVP group and 64% in the TVP group; the difference was statistically insignificant. In addition, the differences of the QT and Q peak T values were insignificant, whereas QT dispersion (QTd) and Q peak T dispersion (QpeakTd) values were significantly higher in the patient group (60+/-14, 54+/-14 ms, respectively) compared with the control group (42+/-10, 38+/-10 ms, respectively, p<0.001). Complex ventricular arrhythmias (Lown Grade > or =III) in the IMVP group had a significant relationship with QTd and QpeakTd (p<0.001), but not with QT or QpeakT. As a result of the study, it is concluded that TVP accompanying MVP does not increase the incidence of ventricular arrhythmia, that ventricular arrhythmia is related to QT dispersion rather than QT interval in IMVP, that the QT dispersion is a fairly good marker for identifying the high-risk group for serious ventricular arrhythmia and sudden death, and that QpeakT dispersion measurement is an additional indicator that could be an alternative when QT is difficult to determine in conditions such as high heart rate or the presence of U wave.