Two cases with similar pseudoaneurysms but different outcomes.

The pseudoaneurysm is a rare cardiac pathology, in which the left ventricular free wall ruptures and the pericardium surrounds the rupture in combination with thrombus and inflammation and thus prevents the development of a hemopericardium. Left ventricular pseudoaneurysm may remain silent unless it gives rise to cardiac tamponade, collapse, and finally sudden death. In this case report, we present two cases with left ventricular pseudoaneurysms in the same area. One of them had a stable outcome and the other had a fatal outcome.

Multivessel variant angina after a radical nephrectomy operation.

A case of multivessel variant angina after an open radical nephrectomy operation (RNO) is presented. A 52-year-old man was admitted to the coronary care unit with recurrent chest pain and dynamic ST-T wave changes on electrocardiogram early after an RNO. The first diagnosis of the clinical condition was non-ST segment elevation acute coronary syndrome. However, recurrent angina with ST segment elevation occurred after the standard medical therapy, which included beta-blockers. Emergency coronary angiography showed diffuse and multiple narrowing of all the three major coronary arteries during the chest pain, which was relieved by intracoronary nitroglycerine injection. Variant angina was suspected, and beta-blocker therapy was replaced with calcium channel blocker treatment. No angina attacks were observed during the clinical follow-up. Although a direct relationship between the type of surgery and variant angina was not established, coronary vasospasm after an RNO should be kept in mind, especially in the differential diagnosis of a patient with recurrent angina and dynamic ST-T changes on electrocardiogram. Although beta-blocker therapy is a first-line treatment for all acute coronary syndromes, it can be harmful in patients with variant angina and should be stopped immediately after verification of diagnosis.

Silent cerebral infarction in chronic heart failure: ischemic and nonischemic dilated cardiomyopathy.

OBJECTIVES: Patients with dilated cardiomyopathy (DCM) may have a high incidence of clinically asymptomatic silent cerebral infarction (SCI). Prevalence of SCI and its risk factors may differ between ischemic and nonischemic DCM. The purpose of this study was to evaluate prevalence and related parameters of silent cerebral infarction in patients with ischemic and nonischemic DCM. METHODS: Patients with ischemic and nonischemic DCM (53 male, 19 female, aged 62 +/- 12 years) were included in the study. Etiology of DCM was ischemic in 46 and nonischemic in 26 patients. Fifty-six age- and gender-matched healthy volunteers served as a control group for comparison of SCI prevalence. RESULTS: Prevalence of SCI was 39%, 27%, and 3.6% in ischemic, nonischemic DCM, and control group, respectively (ischemic DCM vs control group, p < 0.001, nonischemic DCM vs control group, p = 002). In patients with nonischemic DCM, the mean age of the subjects with SCI was significantly higher than that of subjects without lesions (67 +/- 5 years vs 53 +/- 13, p < 0.001), whereas in ischemic DCM NHYA Functional Class was statistically higher in patients with SCI than without SCI (p = 0.03). In both groups, patients with SCI had lower systolic functions than patients with normal MRI findings. In multivariable logistic regression analysis, restrictive type of diastolic filling pattern was found as an independent factor for SCI occurrence on the whole patient population (OR: 16.5, 95% CI: 4.4-61.8, p < 0.001). CONCLUSION: SCI is common in patients with both ischemic and nonischemic DCM. In univariate analysis, both groups have similar systolic and diastolic characteristics in the occurrence of SCI. Logistic regression analysis revealed that restrictive diastolic filling pattern is an independent risk factor in the occurrence of SCI for the whole patient population.

Infective endocarditis in the setting of infundibular-valvular pulmonary stenosis with incomplete cor triatriatum dextrum and patent foramen ovale.

Cor triatriatum dextrum is a rare congenital malformation, usually associated with complex right heart abnormalities, characterized by a membrane that divides the right atrium into two chambers. It is considered the result of the incomplete and abnormal regression of the embryonic right valve of the sinus venosus. With an incomplete regression, a fenestrated or an unfenestrated membrane may persist in the right atrium. Cor triatriatum dextrum may be seen with congenital cardiac defects associated with the right heart. We have diagnosed infective endocarditis in a 19 year old male patient with asymptomatic incomplete cor triatriatum dextrum, PFO and valvular-infundibular severe pulmonary stenosis based on the Duck criteria, with a positive blood culture and 3 minor criteria. Echocardiography did not reveal any vegetations. Antibiotherapy was given and then regions responsible of the stenosis were resected surgically. After surgery a small outlet type VSD development was observed.

Cardiac resynchronization therapy in a case of myotonic dystrophy (Steinert's disease) and dilated cardiomyopathy.

Steinert's disease (Dystrophia myotonica type 1) is an autosomal dominant neuromuscular disease characterized by myotonia, muscle weakness, frontal balding, cataracts, cardiac conduction abnormalities, especially long PR interval and wide QRS complex. Although subclinical mild myocardial dysfunction may be detected in this syndrome, overt myocardial dysfunction with heart failure called as "myotonic heart disease" is not frequent. Cardiac resynchronization therapy is an effective treatment modality to improve morbidity and mortality in patients with intraventricular conduction delay and congestive heart failure. We report improvement of cardiac dyssynchrony and symptoms of heart failure with biventricular pacing in a 37-year-old male patient with overt myotonic heart disease, PR segment prolongation, and complete left bundle branch block.

The frequency of aspirin resistance and its risk factors in patients with metabolic syndrome.

BACKGROUND: Although different populations were examined for the incidence of aspirin resistance, the frequency and related risk factors for aspirin resistance in patients with metabolic syndrome have not been reported yet. This study aimed to determine the frequency of aspirin resistance and its risk factors in patients with metabolic syndrome. METHODS: We performed a cross-sectional study in 110 patients with metabolic syndrome. After one week of 100 mg/day aspirin, blood samples were obtained. Platelet function analyzer (PFA-100) was used to determine the frequency of aspirin resistance. Endothelial functions, carotid intima media thickness, and the presence of plaques in the carotid arteries were evaluated for subclinical atherosclerosis and the levels of inflammatory markers were assessed as risk factors for aspirin resistance. The presence of subclinical atherosclerosis was defined as a maximum carotid intima media thickness of > or = 0.9 mm and/or the presence of carotid atheroma. RESULTS: Aspirin resistance was detected in 21.9% of the patients. In the multivariate analysis, hs-CRP levels (odds ratio [95% CI]=2.8 [1.3-5.9], p=0.009), diastolic blood pressure, (0.9 [0.8-1.0], p=0.007), and the presence of subclinical atherosclerosis (4.1 [1.4-12.2], p=0.012) were statistically significant risk factors for aspirin resistance. CONCLUSIONS: We concluded that the frequency of aspirin resistance confirmed in this cohort of patients with metabolic syndrome was higher in patients with a lower diastolic blood pressure, higher hs-CRP levels and atherosclerotic changes in their carotid arteries.

Asymptomatic single coronary artery in patient with severe peripheric artery disease.

This report describes a 70-year-old patient with single coronary artery, in whom the right coronary artery originated from the distal left circumflex. This patient did not have any other cardiovascular anomaly. However, this patient suffered from severe and progressive peripheric arterial disease.

Coronary embolism complicating aortic valve endocarditis: treatment with successful coronary angioplasty.

A 59-year-old female was hospitalised with the diagnosis of infective endocarditis. On the fifth day of her antibiotic treatment, she experienced an anterior ST segment elevation myocardial infarction. Emergency transthoracic echocardiography showed that the vegetation on the aortic valve did not exist anymore. It was thought to be an embolic myocardial infarction. Primary percutaneous coronary intervention with conventional balloon angioplasty was performed. TIMI-3 flow was obtained after intervention. Antibiotic treatment was continued for 6 weeks. She was uneventful at the end of the 3-month follow-up.

Cardiac MRI in ischemic heart disease with severe coronary artery stenosis.

RATIONALE AND OBJECTIVES: The aim was to evaluate the left ventricular wall motion abnormalities, perfusion and late contrast enhancement patterns on magnetic resonance imaging (MRI) in patients with 70% or higher degree stenosis or occlusion of coronary arteries on coronary angiography. MATERIALS AND METHODS: Twenty-four patients (5 women, 19 men, age range 38-78, mean age 59.1) who had 70% or higher degree stenosis or occlusion of coronary arteries on coronary angiography who had been referred for cardiac MRI were included. On coronary angiography, 20 vessels were totally occluded [left anterior descending artery (LAD) 12; left circumflex coronary artery (LCx) 2; right coronary artery 6] and 20 vessels were severely stenotic (70-99%). In 5 patients' three vessels, in 6 patients' two vessels, and in 13 patients' a single vessel was involved. Wall motion, perfusion abnormalities, and late contrast enhancement consistent with nonviable myocardium were analyzed at apical, at midventricular, and basal levels on short-axis images of cardiac MRI in concordance with the segmental irrigation areas of the coronary arteries. RESULTS: Impaired perfusion was observed on the corresponding irrigation segments of 39 vessels of 40 coronary artery branches. Wall motion abnormalities were present on corresponding irrigation areas of 30 severely stenotic vessels. Combined evaluation of wall motion and perfusion, segments with the decreased left ventricular contraction, and perfusion matched with the corresponding irrigation areas of all of the 40 stenotic or occluded vessels. CONCLUSION: A correlation was found between the combined assessments of myocardial perfusion, wall motion, and viability on late contrast enhancement on cardiac MRI with the clinical and angiography findings. Thus this combined MRI protocol can be used for the evaluation of ischemic heart disease.

Effect of biventricular pacing on left ventricular outflow tract pressure gradient in a patient with hypertrophic cardiomyopathy and normal interventricular conduction.

We report a case of hypertrophic obstructive cardiomyopathy (HOCM) that was markedly improved by biventricular pacing. A 55-year-old woman with HOCM presented with palpitation and presyncope. Electrophysiologic study revealed an atrioventricular nodal reentrant tachycardia. After radiofrequency catheter ablation, a Mobitz type II atrioventricular block developed and a permanent pacemaker implantation was decided. Cardiac catheterization showed a left ventricular outflow tract (LVOT) gradient of 130 mmHg. Right dual-chamber and atrial-synchronous left ventricular epicardial pacing failed to reduce the gradient. After biventricular pacing, LVOT gradient decreased to 20 mmHg. Biventricular pacing may be an alternative therapy for patients with HOCM.

Silent cerebral infarction in patients with dilated cardiomyopathy: echocardiographic correlates.

BACKGROUND: Patients with dilated cardiomyopathy (DCM) have an increased risk of thromboembolic events. Incidence of silent cerebral infarction (SCI) has not been investigated in these patients. The aim of this study was to investigate the incidence of SCI in patients with DCM and to determine its associations with echocardiographic parameters. METHODS AND RESULTS: Seventy-two patients (mean age 62+/-12 years) with DCM underwent cranial magnetic resonance imaging in addition to transthoracic and transesophageal echocardiographic examination. A total of 56 age-matched healthy volunteers served as a control group for comparison SCI prevalence. Prevalence of SCI was significantly higher in patients with DCM (35% vs. 3.6%; p<0.001). In DCM group, patients with SCI had significantly impaired left ventricular systolic function, higher frequency of restrictive diastolic filling, moderate to severe left atrial spontaneous echo contrast (SEC), aortic SEC, and complex atherosclerosis or calcified plaques in the aorta. In logistic regression analysis, type of diastolic filling emerged as the only independent risk factor for SCI (p<0.001). When the type of diastolic filling was removed from the analysis, ejection fraction, marked left atrial SEC, complex-calcified aortic atheroma and age appeared as the other independent risk factors (p = 0.003, p = 0.009, p = 0.013 and p = 0.018, respectively). CONCLUSION: SCI is a frequent finding in DCM patients. Impaired systolic function, restrictive filling pattern, presence of moderate to severe left atrial SEC, and complex atherosclerosis in the aorta are the factors contributing to the development of SCI.

Evaluation of left ventricular function and volume in patients with dilated cardiomyopathy: gated myocardial single-photon emission tomography (SPECT) versus echocardiography.

BACKGROUND: Left ventricular function, volumes and regional wall motion provide valuable diagnostic information and are of long-term prognostic importance in patients with dilated cardiomyopathy (DCM). This study was designed to compare the effectiveness of 2D-echocardiography and gated single-photon emission tomography (SPECT) for evaluation of these parameters in patients with DCM. PATIENTS AND METHODS: Gated SPECT and 2D-echocardiography were performed in 33 patients having DCM. Gated SPECT data, including left ventricular volumes and left ventricular ejection fraction (LVEF), were processed using an automated algorithm. Standard technique was used for 2D-echocardiography. Regional wall motion was evaluated using both modalities and was scored by two independent observers using a 16-segment model with a 5-point scoring system. RESULTS: The overall agreement between the two imaging modalities for the assessment of regional wall motion was 56% (298/528 segments). With gated SPECT, LVEF, end-diastolic volume (EDV), and end-systolic volume (ESV) were 27+/-9%, 217+/-77 mL, and 163+/-73 mL, respectively, and 30+/-8%, 195+/-58 mL, and 137+/-48 mL with echocardiography. The correlation between gated SPECT and 2D-echocardiography was good (r=0.76, P<0.01) for the assessment of LVEF. The correlation for EDV and ESV were also good, but with wider limits of agreement (r=0.72, P<0.01 and r=0.73, P<0.01, respectively) and significantly higher values were obtained with gated SPECT (P<0.01). CONCLUSIONS: Gated SPECT and 2D-echocardiography correlate well for the assessment of LV function and LV volumes. Like 2D-echocardiography, gated SPECT provides reliable information about LV function and dimension with the additional advantage of perfusion data.

Effect of rosiglitazone on insulin resistance, C-reactive protein and endothelial function in non-obese young women with polycystic ovary syndrome.

OBJECTIVE: Women with polycystic ovary syndrome (PCOS) exhibit elevated levels of serum C-reactive protein (CRP) and impaired endothelium dysfunction which are directly correlated with insulin resistance. Because rosiglitazone improves insulin sensitivity, we tested whether rosiglitazone treatment ameliorates high-sensitivity (hs)CRP levels and endothelial dysfunction in these patients. DESIGN: Thirty-one women with PCOS were recruited (mean age, 24.7+/-3.9 (s.e.) years; mean body mass index (BMI), 25.6+/-3.2 kg/m2). All women were treated with 4 mg rosiglitazone daily for 12 months. METHODS: Serum levels of testosterone, LH, FSH, sex hormone-binding globulin (SHBG), insulin and hsCRP were measured. The BMI, hirsutism scores and insulin sensitivity indices were calculated before and after treatment. Arterial endothelium and smooth muscle function was measured by examining brachial artery responses to endothelium-dependent and endothelium-independent stimuli before and after treatment. RESULTS: After treatment with rosigitazone there were significant decreases in serum testosterone (91.2+/-37.5 vs 56.1+/-21.8 ng/dl; P < 0.01) and fasting insulin concentrations (12.5+/-7.6 vs 8.75+/-4.03 microU/ml; P = 0.015). Insulin resistance indices were significantly improved after rosiglitazone treatment (P < 0.05). There were no significant changes in BMI, waist circumference, serum total cholesterol, low-density lipoprotein (LDL)-cholesterol, FSH and LH levels. Hirsutism score was decreased significantly after treatment (10.8+/-1.8 vs 7.6+/-1.7; P < 0.05). Twenty-four of the women reverted to regular menstrual cycles. Levels of SHBG increased significantly after treatment (28.7+/-8.7 vs 48.4+/-11.2 nmol/l; P < 0.01). Serum hsCRP levels were decreased significantly after rosiglitazone treatment (0.25+/-0.1 vs 0.09+/-0.02 mg/dl; P = 0.006). There was also significant improvement in endothelium-dependent vascular responses after rosiglitazone treatment (9.9+/-3.9 vs 16.4+/-5.1%; P < 0.01). CONCLUSIONS: We conclude that rosiglitazone treatment improves insulin sensitivity in women with PCOS. It also decreases androgen production without significant weight gain. More importantly, it has beneficial effects on endothelial dysfunction and low-grade chronic inflammation in normal weight young women with PCOS.

Effect of cardiac resynchronization therapy on left ventricular diastolic filling pattern in responder and nonresponder patients.

BACKGROUND: The aim of this study was to investigate the short- and long-term effects of cardiac resynchronization therapy (CRT) on left ventricular (LV) diastolic filling pattern and the relation between the diastolic filling pattern and the response to CRT. METHODS: Twenty-three patients with systolic heart failure and complete left bundle-branch block underwent implantation of biventricular pacemaker devices. In order to follow the changes in diastolic function, mitral inflow, pulmonary venous flow, and LV flow propagation (Vp) velocities were measured with pulsed-wave and color M-mode Doppler echocardiography 1 week before and 1 and 6 months after pacemaker implantation. At the 6-month follow-up, patients were divided into two groups according to their response to CRT defined as a relative increase in LV ejection fraction (LVEF) > or =25% versus baseline. RESULTS: After biventricular pacemaker implantation, significant clinical improvement was observed in all patients. Compared to baseline, the ratio of early-to-late peak velocities (E/A) decreased significantly at the 6th month (E/A ratio: from 1.5 +/- 0.9 to 0.8 +/- 0.5 at the 6th month (P = 0.02)). Pulmonary systolic flow to diastolic flow ratio (PVs/PVd) increased with CRT after 6 months (PVs/PVd ratio: from 0.9 +/- 0.4 to 1.3 +/- 0.7 at the 6th month (P = 0.02)). E/Vp ratio decreased significantly at the 1st and 6th month (E/Vp ratio: from 2.7 +/- 0.8 to 2 +/- 0.8 at the 1st (P < 0.002) and to 1.9 +/- 0.7 at the 6th month (P < 0.02)). In responders (n: 17, 74%), E wave and PVra velocity decreased, E-wave deceleration time increased, and E/Vp ratio improved significantly, whereas in nonresponders, changes in LV diastolic parameters remained insignificant. However, diastolic filling pattern improved significantly at the 1st and 6th month of CRT in both responders and nonresponders. CONCLUSION: CRT enhances diastolic filling patterns in both responder and nonresponder patients. This may be related to improvement in symptoms even in nonresponders who have a relative increase in LVEF <25%.

Effect of cardiac resynchronization therapy on left atrial appendage function and pulmonary venous flow pattern.

BACKGROUND: Previous studies have shown improvement in left ventricular function and development of the reverse remodeling in the left ventricle and left atrium after cardiac resynchronization therapy (CRT). The aim of this study was to investigate the effect of CRT on left atrial appendage (LAA) function and pulmonary venous flow pattern. METHODS: Eighteen patients with systolic heart failure and complete left bundle branch block underwent implantation of biventricular pacemaker devices. In order to follow changes in LAA, transthoracic and transesophageal echocardiographic examinations were performed 1 week before and repeated 1 and 6 months after pacemaker implantation. RESULTS: CRT resulted in significant clinical improvement and decrease in NYHA functional class in 17 patients (94%). Maximum and minimum areas of left atrial appendage (LAAAmax and LAAAmin) decreased, with a concomitant increase in LAA ejection fraction. [LAAAmax: from 4.6+/-2 to 4.2+/-1.8 cm2 at the first (P < 0.001) and to 4.0+/-1.8 cm2 at the sixth month (P < 0.001); LAAAmin: from 2.7+/-1.3 to 2.3+/-1.2 cm2 at the first (P < 0.001) and to 2.2+/-1.2 cm2 at the sixth month (P < 0.001) and LAA ejection fraction: from 41+/-12% to 46+/-10% at the first (P = 0.007) and to 47+/-8% at the sixth month (P = 0.003)]. LAA active emptying and filling flow and pulmonary venous systolic velocities also increased after CRT. The appendage active emptying velocity correlated significantly with left ventricular ejection fraction (r = 0.50, P = 0.002), LAA ejection fraction (r = 0.51, P = 0.002), left atrial maximal volume, LAVmax (r = -0.44, P = 0.007), left atrial minimal volume, LAVmin (r = -0.50, P = 0.002) and pulmonary vein systolic flow velocity (r = 0.33, P = 0.05). CONCLUSION: Treatment of heart failure by CRT results with marked improvements in LAA function and increases pulmonary venous systolic velocity.

Relation between free triiodothyronine/free thyroxine ratio, echocardiographic parameters and mortality in dilated cardiomyopathy.

BACKGROUND: Abnormalities in thyroid function are frequent in patients with heart failure and are associated with increased mortality. However, the relation between thyroid hormone levels and echocardiographic parameters has not been investigated sufficiently. AIM: The aims of this study were to investigate the correlations of thyroid hormone levels with echocardiographic parameters and to evaluate their associations with subsequent mortality in a group of patients with dilated cardiomyopathy (DCMP). METHODS: Serum levels of thyroid hormones were measured in 111 consecutive patients with DCMP (35 female, 76 male, mean age: 62+/-12 years). All patients underwent echocardiographic examination and were followed-up for a period of 12+/-8 months. RESULTS: Twenty-three patients (21%) had abnormalities in thyroid function tests. Free triiodothyronine (fT3)/free thyroxine (fT4) ratio was significantly correlated with most of echocardiographic parameters, such as chamber diameters and ejection fraction. Sixteen patients (14%) died during the follow-up period; their fT3/fT4 ratio was significantly lower than the patients who survived (1.31+/-0.37 vs. 2.01+/-0.72, p<0.001). A fT3/fT4 ratio of

Homocysteine concentrations in type 2 diabetic patients with silent myocardial ischemia: a predictive marker.

BACKGROUND: Silent myocardial ischemia (SMI) is a frequent finding among diabetic patients. There are very few data on the relationship between homocysteine, which is a novel cardiovascular risk factor, and SMI in diabetic patients. We investigated whether plasma homocysteine has a predictive value for early diagnosis of SMI in type 2 diabetic patients. METHODS: One hundred and twenty diabetic patients and 25 control subjects were evaluated. Among diabetic patients, 29 had a history or clinical signs of coronary artery disease (CAD). All other patients who had normal ECGs and no history or clinical signs of CAD were screened by exercise test. Thirty-eight patients with maximal negative exercise test were labelled as CAD (-) diabetic patient group. Angiography was performed on patients who had positive exercise tests and among them 23 patients had angiographically documented SMI. RESULTS: CAD (+) and SMI groups had significantly higher serum homocysteine concentrations than CAD (-) and control groups (14.2+/-6.6, 15.7+/-7.8, 9.6+/-3.23, 9.3+/-2.25 micromol/l, respectively). In the SMI (+) diabetic group there was a significant correlation between serum homocysteine concentrations and creatinine, microalbuminuria and folic acid levels. Multiple regression analysis showed that homocysteine concentration was dependent on microalbuminuria, folic acid levels and presence or absence of ischemia. CONCLUSION: The present investigation shows an association of homocysteine with SMI in diabetic patients. Other prospective studies are needed to establish whether homocysteine levels can be used as a suitable marker for CAD screening in type 2 diabetic patients.

Effect of cardiac resynchronization therapy on left atrial reverse remodeling and spontaneous echo contrast.

Recent studies revealed reverse remodeling in left ventricle with cardiac resynchronization therapy (CRT). However, effects on left atrial remodeling, left atrial total emptying fraction and left atrial spontaneous echo contrast (SEC) have not been adequately evaluated. The aim of this study was to investigate the long-term changes in SEC, left atrial reverse remodeling, and left atrial total emptying fraction after CRT. Twenty patients with systolic heart failure and complete left bundle-branch block underwent implantation of biventricular pacemaker devices. Transthoracic and transesophageal echocardiography were performed one week before and one and six months after pacemaker implantation. After biventricular pacemaker implantation, significant clinical improvement was observed in all patients. Left atrial maximal and minimal volumes showed a significant progressive decline after CRT (reverse remodeling). Left atrial total emptying ejection fraction (LATEF) was 33 +/- 19% at baseline and increased to 37 +/- 10% and 41 +/- 11% at the 1st and 6th months respectively (p = 0.01 and p = 0.04). SEC was detected in 18 of 20 patients (90%) at the beginning of the study. After six months SEC disappeared in 5 patients and frequency of SEC reduced to 45%. Decrease in the intensity of the SEC was also statistically significant (at the 1st and 6th months; p = 0.001 and p < 0.001 respectively). Long-term CRT results in atrial reverse remodeling, increases LATEF, and reduces both frequency and intensity of atrial SEC.

The effects of antioxidants on exercise-induced lipid peroxidation in patients with COPD.

OBJECTIVE: The oxidant-antioxidant balance plays an important role in the pathogenesis of COPD. The aim of the present study was to evaluate the effects of exercise, as an oxidative stress factor on the oxidant-antioxidant balance and to investigate whether short-term antioxidant treatment affects lipid peroxidation products. METHODOLOGY: Twenty-one stable COPD patients and 10 control subjects were included in the study. Symptom-limited exercise tests were performed by all subjects. Blood was collected before and 1 h after exercise in control subjects and before, 1 and 3 h after exercise in COPD patients, for analysis of malondialdehyde (MDA), reduced glutathione (GSH) and vitamin E (VE) levels. VE and vitamin C treatments were added to the regular bronchodilator therapy in 10 COPD patients for 1 month. After the treatment period, an exercise test was performed and blood was collected again for MDA, GSH and VE levels. RESULTS: Baseline GSH and VE levels were significantly lower in the COPD group when compared with the control subjects. There was no statistically significant difference in MDA levels between the two groups. In the COPD group, MDA levels 3 h after exercise were significantly higher than at baseline. In contrast there were no significant differences in MDA, VE and GSH levels in the control group after exercise. VE and MDA levels increased significantly after exercise in COPD patients but there was no difference in GSH levels. Baseline exercise time was significantly lower in the COPD group than in the controls. In 10 COPD patients who were given antioxidant therapy, their exercise time increased significantly and there was no increase in MDA and VE levels after the repeated exercise test. CONCLUSIONS: Antioxidant levels were significantly lower in COPD patients than in control subjects. In these patients, exercise results in more significant oxidative stress and lipid peroxidation than in control subjects and antioxidant therapy may decrease lipid peroxidation following exercise and improve exercise capacity.