ISSN 1016-5169 | E-ISSN 1308-4488
Archives of the Turkish Society of Cardiology - Turk Kardiyol Dern Ars: 29 (5)
Volume: 29  Issue: 5 - May 2001
1. Summaries of Articles

Pages 264 - 267
Abstract |Full Text PDF

2. Diabetes and Glucose Intolerance in Turkey: Rise in Prevalence and Prospective Evaluation of Impact on Coronary Mortality and Morbidity
Altan ONAT, Beytullah YILDIRIM, Köksal CEYHAN, İbrahim KELEŞ, Ömer BAŞAR, Vedat SANSOY, Ali ÇETİNKAYA, Burak ERER, Ömer UYSAL
Pages 268 - 273
This study aimed to evaluate the prevalences of diabetes mellitus and of glucose intolerance and their trends among Turkish adults as well as to assess prospectively their independent effect on coronary mortality and morbidity. The population randoru sample of the Turkish Adult Risk Factor Study surveyed in year 2000 comprising 2455 participants aged 30 or over were evaluated by diabetes criteria of the World Health Organization. Criteria for the diagnosis of coronary heart disease (CHD) and death from CHD conforıned to those previously described. The overall prevalence of diabetes was 8. 1% in men and 8.9% in women, while that of glucose intolerance (Gl) was 2.2% and 2.7%, respectively. These rates allowed to estimate the presence of 1.92m cases of diabetes and 620.000 persons with Gl in Turkish adults. Among subjects <50 years of age, diabetes was more frequent in women than in men. It was furthermore estimated that the prevalence of diabetes rose at a mean annual rate of 6.7%, i.e. roughly 130.000 persons each year. Concentrations of both plasına apolipoprotein B and C-reactive protein were significantly elevated in diabetic men or women, being in line with an atherogenic dyslipidemia. When only the apparently "healthy" participants of the survey in 1990 were followed up for 1 O years, presence of diabetes at baseline was a predictor of the composite endpoint of fatal and nonfatal CHD on multiple regression analysis independent of I O other variables. The relative risk was 1.52 in women and 1.43 in women and men combined. Relative risk for newly developed CHD was approximately 1.6-fold in diabetic men or women. It was concluded that diabetes - independently from its action on systolic blood pressure, central obesity and dyslipidemia - significantly elevated the risk of cardiac events among Turkish adults, notably in women. The rapid rise of the prevalence of diabetes in Turkish adults is highly concerning, and much more organized effort is needed to ınake large sections of the comın unity adopt a healthy life-sty le.

3. Classification of Turkish Adults Based on Dyslipidemia and on Lipoprotein Phenotype
Altan ONAT, Köksal CEYHAN, Vedat SANSOY, İbrahim KELEŞ, Burak ERER, Ömer UYSAL
Pages 274 - 285
Since total/HDL cholesterol ratio (TC/HDL-C) was shown to be one of the best predictors of fatal and nonfatal coronary events among Turks, adu lts as represented in the cohort surveyed in 2000 in the Turkish Adults Risk Factor Study were attempted to be classified herein on the basis of a) dyslipidemia, and b) lipoprotein phenotype. Based on dyslipidemia, for which TC/HDL-C ratio was used, three groups were separated: 1) normoli pideın i c (ratio ~5.0 in men, ~4.5 in women), 2) dyslipideın ic (ratio >5.0 in men, >4.5 in women), of which 3) metabolic syndrome (MS) was differentiated by the concomitant presence of a waist circumference ;:>:94 cm in men, ;:>:80 cm in women, systolic blood pressure ;:>:130 mmHg and of diabetes mellitus or glucose intolerance. As evidence was gathered in the course of the study that the upper normal tirnit for plasma triglycerides would most suitably be 100 mg/di, this limit was used to identify individuals with isolated hypertriglyceridemia and combined h y p erlipide ınia , along with LDL-C >130 ıng/d !. Five categories of lipoprotein phenotype were constructed: a) combined hyperl ipidemia (CHL), b) isolated hypertrig l ycerideınia, c) isolated hyper-LDLcholesteroleınia, d) isolated lo w HDL-C levels ( <35 ıng/di in men, <40 ıng/d i in women), and e) normolipid eınia. In the total cohort of 2414 participants aged 30 years or over, MS and d yslipideınia formed 1.8% and 53% of men and 4.6% and 38% of women, respectively. Dys lip i deınia represented a metabolic defect inasmuch as it d istingu ished itself from the normolipidemic group by a clustering of salient risk factors, namely by an excess of a mean of 2 kg/m2 body mass index (BMI), 3 mmHg of diastolic pressure, 89 mg/di triglycerides, by a reversal of apo Al/apo B ratio whereby apo B value exceeded that of apo AI by 35 mg/di, and in men by an excess of blood fibrinogen (all s ignificant). Though the TC/HDL-C ratio was virtually identical (6.5 vs 6.4), subjects with MS were distinct from dyslipidemia by significantly further elevated levels of triglycerides, BMI and diastolic pressure, in addition to the definition criteria. It was observed that, from a level of I 00 mg/di on w ards, concentrations of HDL-C exhibited clearly inverse trends as triglyceride levels rose, so that the number of individuals with low HDL-C more than doubled, as the limit for triglycerides was shifted upwards from 100 to 140 mg/di. In logistic regression analysis for prevalent coronary heart disease (CHD), dyslipidemia which may largely be considered an incomplete form of MS, did not prove to confer excess risk when compared to normolipidemia, whereas MS doubled the relative risk, even after age adjustment. In the classification by lipoprotein phenotype, CHL was the prominent one, with a prevalence of 22%, underlying 35% of cases with CHD, and being the only independently and significantly associated category with CHD (relative ri sk 1.56, CI 1.05- 2.33). Prevalences in percent of the remaining categories were: isolared hypertriglyceridemia 40%, · isolated hyper-LDL-cholesterolemia 7.3%, isolared low HDL-C levels 2.7%, and normolipidemia 28%. Plasma concentrations of C-reactive protein and apo B were significantly elevated and highest in CHL. It may thus be concluded that, contrasted to Western populations, possessing predominantly high levels of LDL-C, Turkish adults are mainly subjected to the risk arising from atherogenic dyslipidemia.

4. Four years Follow-up Results of Patients Who Had Wiktor Stents and No Restenosis in the First Six Months
Kenan SÖNMEZ, Muzaffer DEĞERTEKİN, Murat GENÇBAY, Ahmet YILMAZ, Nilüfer Ekşi DURAN, Fikret TURAN
Pages 286 - 291
Restenosis after conventional percu taneo us transluminal coronary angioplasty (PTCA) occurs mainly in the first six months. Data are sparse about the time course of restenosis after Wiktor coronary stent implantations. Some studies reported that restenosis after coronary stenting occurs in the same period of time when compared to that of PTCA. There are also contradictory opinions suggesting coronary stenting could defer the time course of restenosis. Studies reporting long term outcomes of coronary stenting with Wiktor stents are laking. The aim of our study was to find the long term elinical and angiographical outcomes (4-5 years) of Wiktor coronary stents which had no restenosis in the first six months after coronary stenting. Our study enrolled 66 patients (59 male, average age 54 ± ll years) with Wiktor coronary stents which were implanted between June 1995 and December I 996 in our institute and had no restenosis in the sixmonths' follow-up coronary angiography. In these cases performed a second angiography was after a duration of 44±14 months and in-stent restenosis was examined. A new restenosis rate and targer lesion revascularisation rate were 6.1% and 4.5%, respectively. A new lesion (>50% diameter stenosis) different than the target Iesion was found in 25.8% of cases. A PTCA and CABG procedures were performed in 13.6% and 7.6% of cases, respectively. Revascularisation rate for the non-target lesion was 21.2%. There was no new significant stenotic coronary lesions in patients who developed restenosis beyond 6 months period. Our data showed that restenosis occurs essentially in the first 6 months in patients with Wiktor coronary stents. Due to progression of atherosclerosis, nontarger lesion revascularisation rate was considerably high (2 1.2%).

5. Transcatheter Patent Ductus Arteriosus Occlusion with Release Control Coils: Application in the Small Child
Ümrah AYDOĞAN
Pages 292 - 297
We evaluated the immediare and intermediate follow-up results of transcatheter closure of patent ductus artericsus (PDA) using release control coils in 16 consecutive patients weighing < 10 kg (median 7.6 kg, range 4.5 to 10). Single coil was used in 10 (62.5 %) patients and two coils in the others. No coil embolization occurred and procedure-related complications were seen in 3 (18.7%) patients: massive femoral hemorrhage in one in whom no medicine was used, femoral artery thrombosis in the other two, which was responsive to streptokinase treatment. But, the PDA was re-canalized in one and mechanical hemolysis started. This was the only patient in whom second occlusion procedure was performed. Complete occlusion was achieved in 7 patients (43.7%) by angiography. Colored Doppler echocardiography demonstrated 81.2 % (13 patients) complete occlusion the next day, and ı 00 o/o (15 patients) after 6-months follow-up. Flow velocities in left pulmonary artery (LPA) and descending aorta (DAo) were measured every six months. LPA velocity was compared to main pulmonary artery and DAo velocity was compared to ascending aorta at their fina! follow-up and no statistical difference found between them. But, it was found > 2 m/see in three patients in the LPA and in one patient in the DAo during follow-up. Two-diın e n s ion a l echocardiography demonstrated protrusion of the device just in three of these patients. Flow velocity was also high in the last patient. In conclusion, transeatbeter closure of PDA with release control coils is feasible in the smail child. But soıne technical aspects must be taken account during implantation procedure and high f low velocity in the LPA or DAo does not always mean obstruction of the vessel.

6. Technetium-99m Gated SPECT Imaging for Evaluation of Global and Regional Left Ventricular Function: Comparison to Quantitative Echocardiography
Metin GÜRSÜRER, Ayşe EMRE, Mehmet AKSOY, Hakan GERÇEKOĞLU, Selçuk GÖRMEZ, Kemal YEŞİLÇİMEN, Birsen ERSEK
Pages 298 - 301
We studied 35 patients with gated SPECT imaging and echocardiography on the same day to compare the two methods in evaluation of global and regional left ventricular function. Fourteen patients had prior myocardial infarction. Echocardiographic examination of wall motion was visually scored on a 4-point scale; us ing 16 segments; corresponding 16 segments on gated SPECT were also analyzed for comparison of wall motion and systolic thickening (3=norına l , O=akinesia; and 3=normal, O=absent thickening respectively). Horizontal long axis images were taken on a video caın era and subsequently displayed on echocardiography. Planiınetric tracing was performed for all patients and ejection fraction was calculated using the S impson method. There was high segmental score agreement between gated SPECT iınaging and echocardiography for wall motion (74%, kappa=0.43, p

7. Short and Long-Term Results of Surgical Treatment of Left Ventricular Aneurysm
Y.Ertan URAL, Hüsniye YÜKSEL, Seçkin PEHLİVANOĞLU, Cihat BAKAY, Rüstem OLGA
Pages 302 - 307
Although surgical treatment of left ventricular aneurysms has being performed for a long time, it is stili apoint of debate. In this study, we investigated hundred and fifty-nine patients who had been treated with surgery fo r left ventricular aneurysm in our clinic between years ı 985 to 1994. Perioperatuar mortality, long term survival ra tes and parameters which probably affect those ratios were evaluated. Eighty-five patients had three (53.5% ), 50 patients had two (3 1.4%), 20 patients had single (12.6%) vessel disease. In four patients, there were not any critica! lesion in coronary arteries. Classic linear repair in ı ı 1 cases, pıication in 46 cases and Dor plasty in two patients were performed. Revascularisation procedure was also performed in 140 (88%) cases. Average number of distal anastomosis was 2.6. Twenty cases (12.6%) died in perioperatuar period. The most important parameter which affect early mortality was the requirement of intra aortic balloon pump in the postoperative period. Mean duration time for follow-up was 47 months. Fourty-two Iate deaths occurred in this period. The overall 5-year survival rate was 71%. Predictors for long terın mortality were related to left ventricular function preoperatively; presence of congestive heart failure (p=0.02), poor functional capacity (p=0.036). Types of surgery (linear repair or plication) did not affect short and long term survival. Functional capacity of the survivors was improved. In conclusion, surgical treatment of left ventricul ar aneurysms with dassic linear repair and plication has acceptable short and long term survival rates and improves functional capacity. Either for early or for Iate postoperative period the most important predictor of survival is preoperative left ventricular function.

EDITORYAL YORUM
8. Upper Normal Limit for Plasma Triglycerides
İnan SOYDAN
Pages 308 - 312
Abstract |Full Text PDF

9. Is Hypertriglyceridemia an Independent Risk Factor for Coronary Heart Disease?
Hüsniye YÜKSEL, Ayşe ÖZDER
Pages 313 - 320
It is s tili controvers ia l whether isolated hypertriglyceridemia is a risk factor for coronary heart disease (CHD) in the absence of high lowdensity lipoprotein cholesterol (LDL-c) or low highdensity lipoprotein cholesterol (HDL-c) levels. In unvariate analyses hypertriglyceridemia was found to be a risk factor. However, in multivariate analysis, in which all the risk factors are included, it has been shown that hypertriglyceridemia acts as a weaker ri sk factor especially due to the inverse ınetabol ic relationship between HDL-c and triglyceride-rich lipoproteins (TRLP). Hypertrigliyceridemia is increasingly recognized as an independent risk factor for CHD according to the evidences from various epidemiologic and angiographic studies. An epidemiologic study conducted in Turkey in 2000 also showed that hypertrigliyceridemia is an independent risk factor for CHD in women. It has been suggested that TRLPs by forming monocyte- macrophage derived, lipid-filled "foaın cells" just like oxid ized LDL cholesterol and caus ing endothe li a l eel ! dy sfunction initiate atherothrombos is . Furthermore, trig lyceride increases the CHD ri s k by e nh anc ing the atherogenicity of other lipoproteins. The definition of hypertriglyceridemia is important since it appeats to be a risk factor for CHD. In this review, we focused on the pathophysiological role of hypertriglyceridemia, and e linical and epidemiologic studies investigating whether it is a risk factor for CHD and triglyceride threshold levels.

10. Noncompaction of the Myocardium, A Rare Cardiomyopathy: A case report
Yüksel ÇAVUŞOĞLU, Necmi ATA, Bilgin TİMURALP, Bülent GÖRENEK, Ömer GÖKTEKİN, Gulmira KUDAİBERDİEVA, Ahmet ÜNALIR
Pages 321 - 324
Noncompaction of the myoc ardiuın (NM) is a rare cardiomyopathy due to an arrest of in trauterine ın yocardial morphogenesis. The c haracteris tic echocardiographic findings are multiple, proıninent myocardial trabeculations and deep intertrabecular recesses. The clinic manifestations ineJude heart failure, arrhythmias and embolic events. It has been deseribed in association with presence of some genetic abnorınal ities . We deseribe a case of NM with bicuspid aorta in a 19-year-old male with typical elinical and echocardiographic fea tures of the disease. Clinically, the patient had s igns of progressive worsening of heart failure. ECG demostrated left anterior hemiblock. Cardiomegaly was found in teleradiography. Echocardiography revealed a markedly dilated left ventricle with severely impaired systolic function (ejection fraction; 0.27), characteristic, multiple, prominent trabeculations in the left ventricular apex, bicuspid aorta and moderate degrees of aortic regurgitation. Despite aggressive medical treatment, patient died on the 14th day of hospitalization. This is the first reported case of NM in Turkey, and it is considered as cardiomyopathy.

11. 
Çocuklarda Radyonüklid Yöntemler İçin Etik Kurul Onayı
Vedat ŞANSOY
Page 325
Abstract |Full Text PDF

12. Selected Forthcoming Meetings

Page 326
Abstract |Full Text PDF



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