Red Cell Distribution Width with CHADS2 and CHA2DS2-VASc score is associated with Post-operative Atrial Fibrillation after Coronary Artery Bypass Grafting.

BACKGROUND: The use of the CHA2DS2-VASc scoring system and red cell distribution width (RDW) as post-op Atrial Fibrillation (POAF) predictors may be promising for the identification of patients that are at a higher risk of POAF. METHODS: A total of 358 patients (57 patients with POAF, and 301 patients with non-POAF ) with sinus rhythm undergoing a coronary artery bypass graft (CABG) operation were included in the study retrospectively. Preoperative RDW levels and electrocardiograms with sinus rhythm were recorded. Patients with at least one 12-lead electrocardiogram with atrial fibrillation in the postoperative period, with or without medical or electrical cardioversion, were considered to have postoperative atrial fibrillation. A CHADS2 and CHA2DS2-VASc score was calculated for all of the patients. RESULTS: RDW levels were significantly higher in POAF group. RDW levels were significantly correlated with CHADS2 ( r = 0.15, P = .007) and CHA2DS2-VASc (r = 0.19 P = .0001) scores. CHA2DS2-VASc scores were significantly higher in patients with POAF, whereas CHADS2 scores did not differ between groups. In multivariate analysis, left atrial diameter (LAD) (OR:2.44 [95% CI 1.16 - 5.1], P = .018), age (OR:1.04 [95% CI 1.01 - 1.08], P = .01), and RDW (OR:1.16 [95% CI 1.0 - 1.36], P = .05) were found to be predictive for POAF. The area under the receiver-operating characteristic curve of RDW was 0.65 (0.57 - 0.72, P = .0001) with 68.4% sensitivity and 51.2 % specificity to predict POAF. CONCLUSION: Our study showed that age, LAD, and the reduced probability of RDW are predictors of POAF, and that RDW is strongly associated with the thromboembolic risk as determined by CHADS2 and CHA2DS2-VASc scores.

Relationship between left ventricular diastolic function and arterial stiffness in patients with bicuspid aortic valve.

BACKGROUND AND AIM OF THE STUDY: Bicuspid aortic valve (BAV), one of the most common congenital cardiac abnormalities, is the result of abnormal aortic leaflet formation during valvulogenesis. Recent studies have reported BAV to be associated with abnormal aortic stiffness, which has a negative impact on left ventricular (LV) diastolic function. The study aim was to investigate the relationship between LV diastolic function, as measured with two-dimensional speckle tracking echocardiography (2D-STE), and arterial stiffness. METHODS: A total of 38 patients with isolated BAV, and 18 age- and gender-matched healthy controls were enrolled prospectively. Patients with aortic valve velocity > 1.7 m/s, more than mild aortic regurgitation (AR) and ascending aorta diameter > 3.6 cm (indexed diameter > 2.1 cm/m2) were excluded. BAV was classified as either anterior-posterior (AP) orientation or right-left (RL) orientation. The LV diastolic function (E/A and E/Em ratio), left atrial (LA) volume index (LAVI), LA systolic strain and strain rate (SR) was assessed using echocardiography. Strain measurements were reported as longitudinal LA strain during ventricular systole (LA-Res), strain during late diastole (LA-Pump), and also as SR during ventricular contraction (LA-SR(s)), during passive ventricular filling (LA-SR(E)), and during active atrial contraction (LA-SR(A)) from four-chamber views. Arterial stiffness was evaluated by measuring the aortic pulse wave velocity (PWV), wave reflection was assessed by measuring the central systolic blood pressure (cSBP), central pulse pressure (cPP) and augmentation index (AIx) with applanation tonometry. RESULTS: The aortic diameter at the proximal ascending aorta was larger in patients with BAV than in controls. Compared to controls, the E/Em ratio and LAVI were significantly higher in BAV patients. Although PWV was higher in BAV patients than in controls, no differences were found between the groups in terms of cSBP, cPP and AIx. The BAV group was observed to have significant lower LA-Res and LA-Pump strain values compared to controls. Significant correlations were identified between the PWV and echocardiographic parameters of LV diastolic function determinants, such as LA-Res and LA-Pump. However, there were no significant differences between BAV subgroups in terms of LV diastolic parameters and PWV. CONCLUSION: Patients with isolated BAV have early features of subclinical LV diastolic dysfunction, as measured with 2D-STE. In addition, aortic stiffness assessed by PWV was impaired. The LV diastolic parameters were related to aortic stiffness.

Infective endocarditis and complications; a single center experience.

OBJECTIVES: The aim was to investigate the microbiological characteristics and complications of infective endocarditis (IE) in 119 patients treated in our center for IE, diagnosed by modified Duke criteria. STUDY DESIGN: The archive records of 119 patients (82 [69%] males; 37 [31%] females; mean age 39 ± 16 years) with a definite diagnosis of IE between January 1997 and November 2004 were systematically reviewed for clinical and microbiological properties and complications. RESULTS: The most common complaint of the patients was fever and malaise (102 patients, 85.7%, each). Culture was negative in 68 patients (57.1%), while Staphylococcus aureus was the most common etiological agent in culture positive cases. The aortic valve was the most common region of vegetation (43 patients, 36.1%). The frequency of surgical operation for valvular insufficiency due to IE was 75.6%, and the frequency of congestive heart failure was 53.8% (64 patients). CONCLUSION: IE is still an important disease considering its high morbidity and mortality rates, increased life expectancy of the patients, and increased number of valve replacement procedures.

Effect of mitral valve repair versus replacement on left ventricular rotational deformation: a study with speckle tracking echocardiography.

BACKGROUND AND AIM OF THE STUDY: Radial and longitudinal movements of the heart do not fully reflect cardiac hemodynamics and physiology. Twist deformation of the heart is essential for adequate cardiac filling and stroke volume. The study aim was to examine the effects of mitral valve replacement or repair on left ventricular rotational parameters, evaluated by speckle tracking echocardiography, in patients with severe mitral regurgitation (MR). METHODS: A total of 51 patients (22 males, 29 females; mean age 45.7 +/- 13.5 years) with severe MR, sinus rhythm and left ventricular ejection fraction (LVEF) > 50% was included in the study. Mitral valve repair was performed in 29 patients (group A), and mitral valve replacement in 22 patients (group B). Rotational parameters (basal rotation, apical rotation, twist and untwist), LVEF and left ventricular diameters and volumes were compared before and after surgery. The postoperative percentage change in twist was calculated as follows: (preoperative twist - postoperative twist)/preoperative twist x 100. RESULTS: Rotational parameters of basal rotation were significantly decreased in both groups (group A: -5.6 +/- 3.1 degrees versus -4.0 +/- 3.0 degrees; p = 0.035; group B: -6.7 +/- 3.0 degrees versus -3.4 +/- 2.6 degrees; p < 0.001). However, apical rotation (group A: 11.4 +/- 6.6 degrees versus 9.7 +/- 8.3 degrees; p = 0.4; group B: 10.9 +/- 5 degrees versus 7.2 +/- 6.8 degrees; p = 0.009), twist (group A: 16.9 +/- 8.4 degrees versus 13.4 +/- 8.4 degrees; p = 0.1); group B: 17.1 +/- 5.7 degrees versus 10.1 +/- 8.7 degrees; p < 0.001) and untwist (group A: -109.2 +/- 57.8 degrees versus -104.6 +/- 56.0 degrees; p = 0.69; group B: -120.4 +/- 47.8 degrees versus -79.2 +/- 39.5 degrees; p = 0.002) were decreased significantly in the replacement group, but the decreases were not statistically significant in the repair group. The change in twist was observed to be significantly higher in the replacement group compared to the repair group (43.2 +/- 34.7% versus 9.4 +/- 54.1%; p = 0009; overall twist change 24 +/- 49.3%). To identify independent predictors of change in twist, a multivariate regression analysis was performed, whereby the left ventricular end-diastolic volume and type of operation were identified as independent predictors of change in twist. CONCLUSION: Compared to mitral valve replacement, mitral valve repair results in better rotational deformation parameters. Maintaining the mitral apparatus and enabling valvular-ventricular interaction contributes to a preservation of left ventricular twist and untwist. However, the prognostic and clinical impact of preserved rotational deformation parameters need to be determined.

Relation of left atrial peak systolic strain with left ventricular diastolic dysfunction and brain natriuretic peptide level in patients presenting with ST-elevation myocardial infarction.

BACKGROUND: In patients presenting with ST-elevation myocardial infarction (STEMI), we investigated the relation of left atrial (LA) deformational parameters evaluated by two-dimensional speckle tracking imaging (2D-STI) with conventional echocardiographic diastolic dysfunction parameters and B-type natriuretic peptide (BNP) level. METHODS: Ninety STEMI patients who were treated with primary percutaneous coronary intervention (PCI) and 22 healthy control subjects were enrolled. STEMI patients had echocardiographic examination 48 hours after the PCI procedure and venous blood samples were drawn simultaneously. In addition to conventional echocardiographic parameters, LA strain curves were obtained for each patient. Average peak LA strain values during left ventricular (LV) systole (LAs-strain) were measured. RESULTS: BNP values were higher in MI patients compared to controls. Mean LAs-strain in control group was higher than MI group (30.6 ± 5.6% vs. 21.6 ± 6.6%; p = 0.001). LAs-strain had significant correlation with LVEF (r = 0.51, p = 0.001), also significant inverse correlations between LAs-strain and BNP level (r = -0.41, p = 0.001), E/Em (r = -0.30, p = 0.001), LA maximal volume (r = -0.41, p = 0.001), LA minimal volume (r = -0.50, p = 0.001) and LV end systolic volume (r = -0.37, p = 0.001) were detected. The cut off value of LAs-strain to predict BNP > 100 pg/ml was determined as 19.9% with 55.3% sensitivity and 77.2% specificity (p < 0.05 AUC:0.7). CONCLUSION: Our study showed that LAs-strain values decreased consistently with deteriorating systolic and diastolic function in STEMI patients treated with primary PCI. LA-s strain measurements may be helpful as a complimentary method to evaluate diastolic function in this patient population.

Extent of left ventricular hypertrophy is related to interatrial conduction delay in hypertensive patients.

The aim of this study was to investigate the relationship between left ventricular mass (LVM) and interatrial conduction delay (CD) measured by tissue Doppler echocardiography. In enrolled 66 hypertensive patients, positive correlation between interatrial CD and LVM index (r = 0.32) was detected. Meanwhile, intra-atrial CD was correlated to early diastolic tissue Doppler mitral annular velocity measured from septum (r = 0.34), tricuspid annular velocity (r = 0.29), and left atrial volume index (r = 0.26). By using stepwise linear regression analysis, LVM index was determined as an independent predictor of interatrial CD.

Prognostic significance of the absence of normal septal Q waves before aortic valve replacement.

PURPOSE: Aim of this study was to investigate the prognostic significance of absence of septal Q waves in patients scheduled for aortic valve replacement. MATERIAL AND METHODS: Sixty-one patients who underwent isolated aortic valve replacement for aortic stenosis were retrospectively evaluated. Septal Q waves were defined as Q waves of<2mm in amplitude and<40ms in width and absence of septal Q waves was defined as simultaneous loss of Q waves from at least three of the leads I, aVL, V5 and V6. Septal Q waves were absent in 17 patients (Group AQ, 27.8%) and were present in 44 patients (Group PQ, 72.1 %) preoperatively. Newly developed AV block>1st degree and newly developed left bundle branch block were primary endpoints. RESULTS: Preoperatively, absence of normal septal Q waves was significantly associated with increased risk of postoperative AV block (HR: 11.18, range 1.37-91.21, 95% CI, p=0.02) whereas it was not associated with increased risk for newly developed LBBB (HR: 3.15 0.62-15.83, 95% CI, p=0.16). CONCLUSION: Absence of normal septal Q waves in the preoperative ECG may predict further delay in conduction which might develop in the early postoperative course of aortic valve replacement.

Multimodality imaging of a giant caseous calcification of the mitral annulus.

We present an unusual case of giant caseous calcification of the mitral annulus in a 58-year-old female patient. The mass was detected during echocardiography and was defined as a big, round echodense lesion attached to the posterior mitral ring annulus. The patient was further evaluated with a full spectrum of cardiac noninvasive imaging modalities and the diagnosis was confirmed. Caseous calcification of the mitral annulus is a rare entity usually diagnosed by transthoracic echocardiography. Since it is very important to differentiate it from cardiac tumors, complimentary imaging modalities could be used for this purpose if a doubt exists about the diagnosis.

[Relationship between D-dimer and systemic embolism in patients with infective endocarditis]. / Enfektif endokarditli hastalarda D-dimer düzeyinin sistemik emboliyle iliskisi.

OBJECTIVES: The aim of this study was to investigate the value of plasma D-dimer (DD) levels for predicting systemic embolism in patients with infective endocarditis (IE). STUDY DESIGN: A total of 42 patients (mean age: 46±16 years; 78% males) with IE were included. Clinical, laboratory and echocardiographic findings of the patients were evaluated. RESULTS: Increased plasma DD levels were determined in 13 patients with systemic embolism (p=0.016). Moreover, when patients were divided in two groups as DD >500 ng/dl and DD <500 ng/dl, systemic embolism was increased in the DD >500 ng/dl group (p=0.036). Receiver operating characteristics (ROC) curve analysis was performed to detect the best cut-off value of DD in the prediction of systemic embolism. DD >425 ng/dl yielded an area under the curve (AUC) value of 0.735 (95% CI 0.560-0.909, p=0.016). DD >425 ng/dl demonstrated a sensitivity of 77% and specificity of 62% for the prediction of clinical embolism. Hematocrit (r=-0.31, p=0.045), platelet count (r=-0.40, p=0.009), albumin (r=-0.37, p=0.026), and globulin (r=0.38, p=0.028) levels were correlated with DD levels. CONCLUSION: Plasma DD levels are increased in patients with IE who suffered from clinically significant systemic embolism. Further studies are needed to determine the predictive value of DD levels for clinically silent systemic embolism.

Early Systolic Lengthening Is Associated with SYNTAX Score in Patients with Non-ST-Elevation Acute Coronary Syndrome.

BACKGROUND: Early systolic lengthening is a echocardiographic strain parameter previously used to determine the lesion severity in patients with stable coronary artery disease. In the present study, we aimed to evaluate the relationship between early systolic lengthening and anatomic SYNTAX score in troponin (-) and (+) groups among patients with non-ST-elevation acute coronary syndrome (ACS). METHODS: A total of 95 patients diagnosed with non-ST-elevation ACS were included in the prospective, non-randomized, single-center study. The patients were categorized into 2 groups as troponin (+) and troponin (-). The patients were evaluated in terms of echocardiographic, clinical, and angiographic parameters. RESULTS: The baseline characteristics, including age (58 ± 13 vs. 60 ± 10 respectively, P =.340), a history of hypertension (67.1% vs. 64%, respectively, P =.479), diabetes (28.6% vs. 32%, respectively, P =.467), global longitudinal strain (-14.37 ± 5.11 vs. -16.42 ± 3.93, respectively, P =.095), left ventricular ejection fraction (58.71 ± 8.73 vs. 57.20 ± 8.70, respectively, P =.263), and E/e' (8.44 ± 2.13 vs. 8.33 ± 1.99, respectively, P =.785), were similar between troponin (+) and troponin (-) groups. Left ventricle end-systolic diameter (3.2 ± 0.78; 3.50 ± 0.74 vs. 3.2 ± 0.78, respectively, P =.031), left ventricle end-systolic volume (55.57 ± 32.17 vs. 38.28 ± 13.63, respectively, P =.013), left ventricle end-diastolic volume (115.31 ± 49.54 vs. 91.23 ± 20.57, respectively, P =.042), the rate of early systolic lengthening (65.7% vs. 28%, respectively, P =.001), the duration of early systolic lengthening (24.02 ± 31 ms vs. 15.56 ± 30.19 ms, respectively, P =.009), and the SYNTAX score (16 ± 11 vs. 10 ± 10, respectively, P =.023) were higher in the troponin (+) group. Furthermore, a significant correlation was found between early systolic lengthening and SYNTAX score (r = 0.43, P <.001). CONCLUSION: The rate and duration of early systolic lengthening were higher in patients in the troponin (+) group. Early systolic lengthening is related to SYNTAX score in patients with non-ST-elevation ACS.

Relationship between histopathological features of aspirated thrombi and long-term left ventricular function in patients with ST-segment elevation myocardial infarction.

OBJECTIVE: This study was an investigation of the severity of inflammation (SOI) in aspirated material and thrombus age to examine any association with pre-discharge and long-term left ventricular (LV) function after ST-elevation myocardial infarction (STEMI). METHODS: The study group comprised 25 patients with STEMI from whom an occlusive thrombus was aspirated from the infarct-related artery with a 7-F catheter. The SOI in the aspirate was determined according to the mean leukocyte count in 5 high-power magnification fields and graded as mild in the presence of ≤100 leukocytes per field or significant if there were >100 leukocytes per field. The thrombi were categorized as fresh or lytic/organized (L/O) using predefined criteria. Echocardiographic assessment was performed prior to discharge and at 1 year. Adverse left ventricular remodeling (LVR) was defined as a 20% increase in LV end-diastolic volume in comparison with baseline values. RESULTS: LVR was observed in 8 patients. The mean leukocyte count of the aspirate (127.5±86.0 vs 227.2±120.7; p=0.026) and frequency of significant inflammation (35% vs 75% p=0.046) were significantly higher in the group with LVR. The serum high-sensitivity C-reactive protein (hsCRP) level was significantly correlated with the leukocyte count of the aspirate (r=0.532; p=0.006). An L/O thrombus was related to better pre-discharge and long-term LV volumes and ejection fraction values compared with a fresh thrombus. CONCLUSION: A significant increase in the leukocyte count in the aspirate and a fresh thrombus might predict long-term LV functional deterioration irrespective of the clinical and procedure-related characteristics. In addition, serum markers of inflammation, like hsCRP, might also reflect the intensity of the local inflammatory response at the site of occlusion.

Severe obstructive hypertrophic cardiomyopathy occurring secondary to mitochondrial disease.

Mitochondrial disorders have been recognized as important secondary causes of cardiomyopathies. Differentiation of these cases from primary cardiomyopathies is important since the pathogenesis, accompanying systemic manifestations, and prognosis may be different. The typical cardiac manifestation of mitochondrial disorders is hypertrophic cardiomyopathy. We report on an 11-year-old girl with severe obstructive hypertrophic cardiomyopathy and mild myopathy of the lower extremities. Surgical left ventricular septal myectomy was performed and ragged red fibers typical of mitochondrial disorders were detected on histological examination of the resected myocardial sample. Subsequent electron microscopic examination revealed ultrastructurally abnormal mitochondria in the skeletal muscle biopsy, though respiratory chain enzyme analysis was normal. Cardiomyopathy may be the presenting or the sole manifestation of a mitochondrial disorder. Nonobstructive hypertrophic cardiomyopathy has been considered to be the typical cardiac phenotype of mitochondrial disorders, and cases with left ventricular outflow tract obstruction have only rarely been reported.

Red cell distribution width and its relationship with global longitudinal strain in patients with heart failure with reduced ejection fraction: a study using two-dimensional speckle tracking echocardiography.

BACKGROUND: Red cell distribution width (RDW) is a measurement of size variability of the red blood cells and has been shown to be a powerful predictor of prognosis in heart failure (HF). Recently, global longitudinal strain (GLS) emerged as a more accurate marker of left ventricular (LV) systolic function. AIM: We aimed to assess the relationship between RDW and standard echocardiographic parameters and LV global strain measured by two-dimensional (2D) speckle tracking echocardiography in patients with HF with reduced EF (HFrEF). METHODS: Fifty-nine HF patients with an EF < 50%, and 40 age-matched controls with normal EF were included in the study. Standard and 2D strain imaging examinations were performed. Blood tests including RDW were scheduled on the same day as the echocardiographic study. RESULTS: Left atrial volume index, LV end-systolic and end-diastolic dimensions, and E/A and E/e' ratios were higher and LVEF together with LV GLS were significantly lower in the HFrEF group. RDW showed positive correlations with log B-type natri-uretic peptide (r = 0.45, p = 0.0001), left atrial volume index (r = 0.38, p = 0.001), LV end-diastolic dimensions (r = 0.37, p = 0.001), and E/e' (r = 0.33, p = 0.005) and negative correlations with haemoglobin (r = -0.54, p = 0.0001), LVEF (r = -0.27, p = 0.004) and finally LV GLS (r = -0.41, p = 0.001). HFrEF patients were divided into two groups based on the median RDW value. Patients with higher than median RDW had significantly lower GLS despite similar EF. CONCLUSIONS: Elevated RDW is associated with poorer LV deformation assessed by speckle tracking echocardiography in HF patients with similar EF. Therefore, the degree of anisocytosis could be used as an additional marker to identify these high-risk patients as well as improve treatment strategy.

Increased urinary albumin excretion rates can be a marker of coexisting coronary artery disease in patients with peripheral arterial disease.

Coexisting coronary artery disease (CAD) is an important cause of morbidity and mortality in patients with peripheral arterial disease (PAD). Clinical evaluation and noninvasive tests have some important limitations for the detection of CAD in patients with PAD. The purpose of this study was to investigate whether urinary albumin excretion (UAE) was a sign of atherosclerotic involvement of coronary arteries in patients with PAD. Our study consisted of 65 consecutive patients (56 men, 9 women, mean age; 59.7+/-7.9 years) with PAD who underwent coronary angiography. Urinary albumin excretion was measured in 24-hour urine samples by immunoprecipitation technique. PAD was defined as the presence of > or =50% stenotic lesions in at least 1 of the iliac, femoral, popliteal, tibialis anterior, tibialis posterior, or peroneal arteries. CAD was defined as > or =25% diameter stenosis in at least 1 coronary artery. Patients without any coronary lesions were accepted as having normal coronaries. Age, sex, distributions of coronary risk factors, and UAE rates were compared between patients with and without CAD. Mean UAE was 17.9+/-15.6 mg/day in the total population. Thirty-seven percent of patients had CAD, and 63% had no coronary lesion. UAE rates were 22.33+/-18.74 and 15.32+/-13.01 mg/day in patients with CAD and those with normal coronary arteries, respectively (p = 0.021). Microalbuminuria was detected in 25% in patients with CAD and 12% in those without coronary artery lesions (p = 0.184). The difference was not statistically significant. The distributions of other risk factors and sex were not different between the 2 groups. These data suggest that in patients with PAD, urinary albumin excretion rates may be used to determine those with a high probability of CAD. Further studies are required to decide whether this noninvasive testing is appropriate in detecting high-risk patients.

Severe biventricular hypertrophy mimicking infiltrative cardiomyopathy in old man with pulmonary stenosis and systemic hypertension.

Hypertrophic biventricular cardiomyopathy is a rare finding and generally caused by systemic infiltrative diseases. Its association with pulmonary stenosis in same patient is even rarer. We report a case report of male patient with biventricular hypertrophy coexisting with pulmonary valve stenosis and systemic hypertension.

Prediction of elevated left ventricular filling pressures in patients with preserved ejection fraction using longitudinal deformation indices of the left ventricle.

AIMS: Estimation of left ventricular (LV) filling pressures is a clinical challenge in patients with preserved ejection fraction (EF). In the present study, we investigated whether LV and atrial longitudinal strain and strain rate (SR) parameters derived by speckle tracking echocardiography (STE) could be used to predict invasively measured LV end-diastolic pressure (LVEDP) in this patient population. METHODS AND RESULTS: LVEDP was measured before coronary angiography was performed in 65 patients with preserved EF (≥50%) referred to elective cardiac catheterization; besides, patients enrolled underwent comprehensive echocardiographic examination before the procedure. In addition to conventional echocardiographic parameters used to evaluate diastolic function LV longitudinal strain and SR, as well as peak atrial longitudinal strain during LV systole, measurements were performed using STE. Only log-diastolic blood pressure, systolic SR, early diastolic SR, SR during isovolumetric relaxation (SRIVR), and mitral early diastolic flow velocity/SRIVR significantly correlated with LVEDP. When age-adjusted stepwise linear regression analysis was performed, SRIVRT values (ß= -20.682, t = -3.292; P = 0.002) and log-diastolic blood pressure levels (ß= 21.118, t = 3.784; P < 0.001) were independently correlated with LVEDP. CONCLUSION: When compared with conventional echocardiographic parameters, other longitudinal strain, and SR indices, SRIVRT independently predicted LVEDP in conjunction with log diastolic blood pressure. We suggest that SRIVRT is a valuable parameter to evaluate diastolic function in patients with preserved EF.

[Risk factor distribution according to the obesity degree in patients with coronary artery disease]. / Koroner arter hastaligi bulunan olgularda obezite derecelerinin diger risk faktörleriyle iliskisi.

OBJECTIVE: World Health Organization and other international guide committees defined different obesity categories according to the body mass index (BMI) and waist circumferences. The purpose of our study was (i) to compare the dispersion of other coronary risk factors in patients with coronary artery disease (CAD) with different obesity categories that were defined according to the body mass index (BMI) and the waist circumference, (ii) to determine to which extent these cut-off values effect the dispersion of other coronary risk factors. METHODS: The study group included 617 consecutive subjects (516 male, mean age - 57.2+/-10.8 years) who underwent their first angiography between January 2000 and May 2000 and in whom significant coronary lesions were detected. The distribution of risk factors such as, age, smoking, hypertension, diabetes mellitus, high LDL-C, low HDL-C, total cholesterol/HDL-C ratio, triglycerides, family history of premature CAD was compared between overweight and obese cases defined according to BMI values. The same risk factors were compared among the cases grouped as action level 1 and action level 2 defined by the waist circumference. RESULTS: In male patients; smoking was found to be higher in overweight individuals than in obese cases (71% vs. 56%) (p<0.05). In female patients; the only difference was the ratio of total-C/HDL-C as being greater in obese group than overweight group (p<0.05). In male and female patients there was no significant difference between obese and overweight cases regarding the number of total risk factors. According to the waist circumference, in male patients, smoking was more prevalent in action level 1 group than in action level 2 group. In female patients risk factors prevalence was similar in both groups. CONCLUSION: In patients with CAD, the amount of total risk factors doesn't differ between overweight and obese cases and between patients with action level 1 and action level 2 of the waist circumference. These findings indicate the necessity of using the same secondary prevention approaches in patients with CAD and different levels of obesity.

[Distribution of risk factors according to socioeconomic status in male and female cases with coronary artery disease]. / Koroner arter hastaligi bulunan olgularda risk faktörlerinin erkek ve kadinlarda sosyoekonomik duruma göre dagilimi.

OBJECTIVE: Socioeconomic status (SES) is associated with coronary artery disease (CAD) risk factors, coronary morbidity and mortality. In industrialized countries several studies showed that the lowest SES groups have higher coronary morbidity and mortality rates and higher coronary risk factors profile. The aim of our study was to investigate the distribution of risk factors in cases with CAD in different socioeconomic groups. METHODS: Our study group consists of 550 consecutive cases with > or = 50% lesions in at least one coronary artery. Educational level and income were taken into consideration for the determination of the SES. In both sexes the distribution of eight risk factors such as, smoking, family history, diabetes mellitus, hypertension, high low-density lipoprotein cholesterol (LDL-C), low high-density lipoprotein cholesterol (HDL-C), body mass index, central obesity was compared in three different groups determined according to the education and income levels. RESULTS: In men, the distribution of risk factors did not differ according to education levels. In women, central obesity was found to be higher in the group with low education level. In men, the prevalence of low HDL-C, high LDL-C and obesity increased with increasing levels of economical status. In women, central obesity was found to be inversely related with the economic status. CONCLUSION: Our data show a higher risk factor profile in men with higher income level, while in women central obesity was inversely related to the income and educational level. These data should be considered in secondary prevention efforts.