In a representative sample of Turkish adults comprising 2573 participants of the or i gina! and new cohorts of the Turkish Risk Factor Survey, plasma concentrations of high-density lipoprotein cholesterol (HDL-C), apolipoprotein Al (apoAI) and B were determined and low-density lipoprotein cholesterol (LDL-C) computed. Participants were aged ?:.27 (mean 48 ± ı 2) years. Plasma apolipoprotein AI (apoAI) and apo B values were determined in one-third of the cohort by utilizing radial immunodifusion plates (Behring) concerning antisera of immunized sheep, and total and HDLcholesterol in over 96% by enzyınatic technique utilizing a Reflotron apparatus. A random sample of lipid and lipoprotein values were validated in a reference laboratory. Obtained findings were evaluated after stratification for sex and age groups. Overall mean valuesfor HDL-C were 37 ± 12, and 45 ± ı 3 mg/di in men and women, respectively, for LDL-C 113 ± 30 and 121 ± 34 mg/di, respectively. HDL-C levels were 20% lower in both genders than those of the U.S. white population; they were inversely correlated in women with plasma triglycerides, body mass index, and waist cicumference, in addition to proving to be an independent determinant of coronary heart disease in women alone (p<0.04), odds ratio between lowest and highest quintiles be ing ı .54, after age adjustment. Mean levels for apoAI were 15% lower in men than in women (122 ± 30 and 141 ± 35 mg/d!, respectively). Remarkably, apoB levels in women (127 ± 54 mg/di) were also higher than in men (122 ± 36 mg/dl). These implied slightly low levels of apoAI in both genders and conspicuously high levels of apoB in women. A significant though mild rise of apoAI concentrations with age was noted in both genders, while a steep rise with age was observed in mean apoB levels in women. Mean apoB values remained above -not substantially below - the levels of LDL-cholesterol in both sexes. In conclusion, Turkish men and women possess low levels of HDL-C and apoAI, and men medium to high, women distinctly high levels of LDL-C and apoB -an adverse setting in regard to coronary risk. An independent contribution by low HDL-C levels to the previously observed high coronary risk in women was in fact demonstrated for the first time.

Cardiac invasive procedures have been performed in rapidly increasing numbers in recent years, in Turkey. White 31.4 79 cardiac catheterization and coronary angiographies and 4.704 PTCA were registered in ı 994, 73.294 coronary angiography and 12.098 PTCA procedures were performed in ı 997. This represents an astonishing mean annual increase by about 35%. Of the figure related to PTCA, coronary stents were inserted in 5518 patients in 1997 in 38 cardiac centers. Balloon angioplasties had the following rates of major complications in the last year of the survey: acute obstruction in 2.5%, Q-wave and non-Q myocardial infaretion in 3%, emergency bypass surgery in 0.7% anddeathin 0.33%. On the other hand, stent complications were noted with the following incidences: acute and subacute thrombosis in 2.4%, Qwave and non-Q myocardial infaretion in 1.5%, emergency bypass surgery in 0.7% and death in o.ı 8%. In ı 994, 403 mitral valvuloplasty, 90 pulmonary, 18 aortic and 6 tricuspid valvuloplasty were carried out. In 1997,509 mitral valvuloplasty, 51 pulmonary, ı4 aortic and 5 tricuspid valvuloplasty were applied. The cost of all cardiac invasive prodecures in ı997 was estimated as US$ 119 mi11ion. Key Words:

It is rather difficult to diagnose left ventricular diastolic dysfunction in such cases as atrial fibrillation, or pseudonormalized or restrictive patterns of mitral flow. In our study, we aimed to investigate the value of intraventricular alteration of early diastolic flow velocity in determining the diastolic function, particularly in this type of patients. To that end, a total of 20 patients with hypertensive heart disease (HHD), 30 cases with ischemic cardiomyopathy (ICMP) and a control group, 33 cases with normal left ventricular function were included in the study. Intraventricular regional flow velocity patterns were obtained from Doppler echocardiography by placing guide point at distances of O, ı, 2, 3 cm away from mitral valve towards the apex. The regional E velocity in HHD and ICMP was seen to decrease more progressively with respect to that in the control group (p

Abstract |Full Text PDF

Exercise-induced changes in Q, R and S wave amplitudes and their incorporation into a composite index (Athens QRS score) have been reported to increase the diagnostic value of exercise ECG. The aim of this study was to compare this score with findings on exercise myocardial perfusion scintigraphy (MPS). One-lıundred and eighteen consecutive patients (65 men, 53 women; mean age 56 ± 7) who underwent coronary angiography (CA) and exercise SPECT MPS were prospectively included in the study. Patients with previous myocardial infarction, left ventricular hyperthrophy and left bundle branch block were excluded. Athens QRS score was calculated based on the exercise induced changes of the Q, R and S wav es in derivations a VF and V5. Considering QRS score <0 mm as a marker of ischemia on exercise ECG, sensitivity and specificity of exercise ECG for the diagnosis of CAD were found to be 82% and 84%, respectively. Patients were divided into three groups according to the findings of CA and MPS. Group I consisted of patients who had at least one ischemic segment on MPS and significant coronary artery disease (CAD) in CA. Group II included patients with CAD in angiography, but without any ischemic segment on MPS, Group III consisted of patients with both normal CA and MPS. The mean QRS score of Groups I, II and III were fo und to be -4.5 ± 4.1 mm, 0.4 ± 2.5 and 0.8 ± 4.4 mm, respectively" The mean QRS score of Group I patients was significantly lower than those of Group II and III patients (p

Abstract |Full Text PDF

The aim of the study is to compare the diagnostic efficacy of qualitative (ql) and quantitative (qn) troponin T (TnT) analyses in diagnosis of acute myocardial infaretion (AMI) and to determine the correlation of ql-TnT and qn-TnT assays. The study group was consisted of 146 patients (100 men, 46 women; m ean age: 57. 9± ll. 7 years) consequtively admitted to coronary care unit because of chest pain and/or AMI suspicion. Criteria of World Health Organization was approved for diagnosis of AMI. ql-TnT analysis was performed by using bedside disposible systems (TROPT Rapid Assay, Boehringer Mannheim). The cut-off value of this system was 0.2 ng/ml for positivity. qn-TnT analysis was realized with "ELOSA Troponin-T" (Boehringer Mannheim) kids by using automatic analysor (ES-300 Boehringer Mannheim). Test principle of qn assay was based on one-step sandwich enzyme immunassay. Mean admission time of patients was 26.7±40.5 hours (min-max: 1-240 hours). AMI was diagnosed in 77 of total 146 patients. qn-TnT values were 0.2 ng/ml or higher in 72 of 75 (96%) patients with qlTnT (+). Values of qn-TnT were measured below 0.2 ng/ml in 65 of (91.5%) of 71 patients w ith qlTnT (-). There w as a moderate in verse correlation 70 between time to positivity of ql test and quantitative values (r: -0.58). The mean TnT values of strong positive (positivity a first 10 minutes) and weak positive (positivity after first 10 minutes) groups were significantly different (7.1 I ±6.62 ng/ml and 0.83±0.73 mg/ml, respectively; p

Abstract |Full Text PDF

The Turkish Adult Risk Factor Study, initiated in 1990 in order to examine cardiovascular risk factors, prevalence of coronary heart disease and death in a representative sample of the adult population, had sustained a loss of over 30% of its original cohort due to death and loss of follow-up over the past 8 years. In 1997/98 surveys, a total of 736 men and women were newly included in the study. This time participants were confined to the ages 30-70 years. Agreement of the new and old cohorts with respect to sex, age, risk parameters and prevalence of coronary heart disease (CHD) was examined. The new cohort, comprising 52% women and having a mean age of 49 ±10 years, was tested statistically with the old sample in regard to 16 parameters. Age, systolic blood pressure, smoking, HDL-cholesterol, blood glucose, and body mass index exhibited no significant difference among the two samples in both genders. No difference was observed also with respect to several other parameters either in men or in women. Women in the new cohort had slightly higher LDL-cholesterol and apo B concentrations, while men disclosed an increase in mean values of several parameters suggesting higher insulin resistance. Nonetheless, overall cardiovascular risk burden was estimated to be similar in both cohorts. The prevalence of CHD in the new sample population was detected as 6.2% and that of hypertensive hyart disease as 1.8%. The age-specific prevalence of CHD was considered to be similar to that of the original cohort.

There are two dimensions of the ventricular repolarization abnormality. One of them known as QT dispersion which reflects spatial dimension of the ventricular repolarization. Recently dynamic dimension of the ventricular repolarization has been deseribed as T wave alternans (TWA) which is an infrequently-detected ECG abnormality consisting of transient beat-to-beat changes in the morphology of ventricular repolarization. The purpose of this review is to assemble the widely dispersed information about TW A and to reveal mechanisms, elinical manifestations, in association with ınyocardial ischemia, and methodological problems.

Activation of sympathetic nervous system results in myocardial ischemia by· increasing the oxygen requirement of the myocardium and altering the vasoruotor tonus of coronary arteries. Myocardial ischemia, in return, augments the activation of adrenergic activity. Thus, the bidirectional interaction between myocardial ischemia and adrenergic activation results in an irreversible myocardial destruction, modulating left ventricular remodelling and augmenting its dysfunction. On the other hand when adrenergic activity of the heart suppresses the vagal activity, the possibility of sudden death due to malign arrhythmias increases.

Holt-Oraın syndrome is an autosomal dominant disorder, manifesting skeletal malforınation in the upper extreınities, congenital heart defects and cardiac dysrhytmias. A 15-month-old ınale was admitted to pediatric clinic with cyanotic spells. On physical examination, there was radial aplasia of the right arın and aplasia of the right thumb, hypoplasia of the left thumb with hypoplastic thenar eminences. Echocardiography revealed double outlet right ventricle with pulmonary stenosis. Altough multiple forrus of congenital heart diseases and skeletal malformations associated with the HaltOram syndrome have been documented, double outlet right ventricle is rare. Therefore, this case is presented and discussed. Key words