Conduction characteristics in atrial fibrillation. Predictive value of tissue Doppler echocardiography.

BACKGROUND: Atrial fibrillation (AF) is one of the most common arrhythmias observed in clinical practice. The frequency of AF is increased in patients with impaired interatrial conduction. We aimed to investigate whether tissue Doppler echocardiography could be used for the evaluation of atrial conduction characteristics instead of an electrophysiological study, and to examine the predictive accuracy of tissue Doppler echocardiography for the inducibility of sustained AF. METHODS: We enrolled 86 consecutive patients who underwent an electrophysiological study. We performed electrocardiographic P wave dispersion, M-mode, two-dimensional, Doppler, and tissue Doppler echocardiography as well as an electrophysiological study (EPS) to evaluate the intra- and interatrial conduction times. We tried to induce AF, and the patients were categorized according to the inducibility of sustained (> 120 s) AF. RESULTS: We found a good correlation between intra-left atrial conduction time detected by tissue Doppler echocardiography (ILCT-echo) and by EPS (ILCT-eps; r = 0.744, p < 0.001), and a weak correlation between interatrial conduction times (IACT-echo and IACT-eps, r = 0.396, p < 0.001). In patients with inducible sustained AF, P wave dispersion (46 ± 19 ms vs. 27 ± 18, p < 0.001), ILCT-echo (29 ± 10 ms vs. 17 ± 7 ms, p < 0.001), and IACT-eps (47 ± 11 ms vs. 36 ± 13 ms, p < 0.001) were found to be higher than those of the noninducible/nonsustained AF group. These three parameters were independent predictors of the inducibility of sustained AF. CONCLUSION: We demonstrated that ILCT-echo could be used instead of ILCT-eps for the evaluation of left atrial conduction characteristics. We also showed that ILCT-eps could be a valuable parameter for predicting the development of long-lasting AF.

Effects of apolipoprotein E genotypes and other risk factors on the development of coronary artery disease in Southern Turkey.

BACKGROUND: Apolipoprotein E (apoE) plays a major role in lipoprotein metabolism and lipid transport. Associations between apoE genotypes, coronary artery disease (CAD) and other risk factors have been described by many investigators. The aim of this study was to investigate the role of apoE gene polymorphism and other risk factors in the development of CAD in subjects whose coronary arteries were evaluated by means of coronary angiography. METHODS: The study population consisted of 199 subjects (114 male and 55 female). Of the total, 107 had CAD. The apoE gene was amplified by polymerase chain reaction (PCR) and then digested by CfoI restriction enzyme. The plasma lipid levels and other risk factors were also determined in all subjects. RESULTS: The epsilon2 and epsilon4 allele frequencies and genotypes carrying epsilon4 allele were significantly higher in CAD (+) patients. Plasma lipids except triglycerides were increased in CAD (+) cases. We found that apoE genotypes, HT, DM, male gender, age and smoking were the independent predictors of CAD. There was no association between apoE alleles and lipids. CONCLUSION: We conclude that apoE polymorphism (presence of epsilon4 allele) is associated with the development of CAD in Southern Turkey. In our study, we did not observe any effect of apoE alleles on lipid levels.

Pseudoaneurysm following high lateral myocardial infarction: a case report.

Male patient with a history of high lateral myocardial infarction experienced 45 days before admission was accepted to our clinic with the initial diagnosis of congestive heart failure. Physical examination revealed 2-3 degrees/6 systolic murmur in the mesocardiac region. Telecardiography revealed a mass of 12 x 6 cms in the left hilus. Pseudoaneurysm was diagnosed by transthoracic echocardiography and followed by left ventriculography. The symptoms of heart failure disappeared after successful surgical repair.

Mobile right atrial hydatid cyst with multiorgan involvement.

A 25-year-old woman who had hydatid cysts in her lung was referred to our clinic for the hydatid cyst in her cardiac localization. Multiple hydatid cysts of different cardiac localizations were diagnosed by two-dimensional echocardiography, confirmed by computed tomography and magnetic resonance imaging, supported by enzyme-linked immunosorbent assay (ELISA) for echinococcosis. Surgical resection was performed for the right atrial cyst and pathology confirmed the diagnosis. Oral albendazole treatment was given postoperatively. Cathet. Cardiovasc. Intervent. 49:204-207, 2000.

Aortic atherosclerosis is a marker for significant coronary artery disease.

Atherosclerosis is a generalized process that may involve the entire vasculature as well as the coronary arteries. Aortic atherosclerosis (AA) is associated with an increased risk for recurrent ischemic stroke and cardiovascular death and can be diagnosed by transesophageal echocardiography (TEE). We performed TEE in 60 patients (47 men and 13 women; age range 37-78, mean 53.5 +/- 9.9) who underwent coronary angiography, to assess whether atherosclerosis in the thoracic aorta correlates with coronary artery disease (CAD) or may be a marker for it. Significant CAD was defined as either > 50% reduction of internal diameter of the left main coronary artery or > 70% reduction of the internal diameter in the anterior descending, right coronary or circumflex artery. The number of diseased vessels was based on the Coronary Artery Surgery Study criteria. A grading system was used to detect AA. The thoracic aorta was considered to be normal and classified as grade I when the internal surface was smooth and without lumen irregularities or increased echo-intensity. Grade II changes consisted of increased echodensity of the intima without lumen irregularity or thickening. Grade III changes consisted of increased echodensity of intima with well defined atheroma extending < 3 mm in the aorta. Grade IV and V changes consisted of atheroma > 3 mm and protruding mobile plaques, respectively. Grades III-V were considered as AA. Twenty two of the 29 patients (75.9%) with CAD and 10 of the 31 patients (32.3%) without CAD had AA detected by TEE. There was a significant relationship between CAD and AA (r = 0.44, p < 0.001). The sensitivity and specificity of AA in detecting CAD were 75.9% and 67.7%, respectively. Our data suggest that AA is common in patients with significant CAD. Detection of AA by TEE may be a marker for CAD and early detection of aortic atherosclerosis may contribute to diagnostic and therapeutic interventions and thereby improve the prognosis.