There are limited number of studies evaluating right ventricular functions in patients with essential hypertension. Standard echocardiographic parameters have been used in all those studies, and data on effects of left ventricular hypertrophy (LVH) on right ventricular functions are lacking. This paper seeks the effect of LVH on the right ventricular functions with standard echocardiography (echo) and pulsed wave tissue Doppler imaging (TDI) in 114 patients with essential hypertension. Findings were compared to 34 healthy subjects who had no systemic disease and negative exercise test, according to the Bruce protocol (group 1). Patients were classified as no LVH in electrocardiography (ECG) and echo (group-2), LVH by echo but not by ECG (group-3) and those who had LVH both by ECG and echo (group-4). None of the standard echocardiographic parameters could detect an abnormality in right vetricular functions due to LVH. However; right ventricular TDI parameters of IVRa speed and Ea deceleration time were higher than in patients with LVH. IVRa speed data collected in right ventricular myocardium (group 4) were greater than in other groups (p 0.01, 0.02 and <0,001, respectively). The Ea deceleration time in group 4 was also prolonged compared to the healthy group and essential hypertensie group which had no LVH (P:0.020 and p:0.037). Assuming these changes reflect right ventricular diastolic disfunction, following results can be concluded: right ventricular functions were influenced by left ventricular hypertrophy and these changes could not be detected by standard echo parameters, and thus it is concluded that LVH in ECG indicates right ventricular diastolic dysfunction.

A simple, reproducible, noninvasive myocardial performance index (MPI) for the assessment of overall cardiac function has been described previously. The purpose of this study was to compare the MPI obtained by pulsed Doppler method with the MPI obtained by tissue Doppler echocardiography (TDE) in normal subjects. Twenty-eight healthy subjects were included. In order to calculate MPI by TDE, isovolumetric contraction (IVCT), relaxation time (IVRT) and ejection time (ET) were measured at two different sites of mitral annulus: septum and lateral. MPI was calculated by dividing the sum of IVCT and IVRT by ET at each site of measurement. The mean MPI value was found by dividing the sum of these MPI values into two. The same parameters were measured using the mitral inflow and left ventricular outflow velocity time intervals in pulsed Doppler method. At all sites measured, MPI by TDE correlated well with conventional MPI (at septal site r=0.82, p<0.0001; at lateral site r=0.86, p<0.0001). The highest correlation was observed in mean value of MPI by TDE; r=0.94, p<0.0001. This study demonstrated that MPI may be measured by TDE and correlated well with conventional MPI in normal subjects. The mean of MPI by TDE values measured at two different mitral annular sites may be a more reliable way of assessing global LV function.

Slow coronary flow (SCF) is a phenomenon characterized by delayed opacification of coronary arteries in the absence of epicardial occlusive disease, in which many etiological factors such as microvascular and endothelial dysfunction, and small vessel disease have been implicated. We aimed to investigate the epicardial resistance in relation to SCF by using fractional flow reserve (FFR) and intravascular ultrasound (IVUS). Both have been combined to disclose the related epicardial flow resistance and the arterial anatomy. The study population consisted of 19 [8 (42.1%) male, 11 (57.9%) female; age=55.9±9.4 years] patients with SCF. As compared to expected normal values (1.0), FFR values (0.83±0.13) were significantly lower (p=0.0001). In patients with SCF, a strong negative correlation was seen between TIMI frame count and FFR (r=0.551, p<0.05). On IVUS investigation, the common finding was longitudinally extended massive calcification throughout the epicardial arteries and increased intimal thickness (0.59±0.18mm). A negative correlation between intimal thickness and FFR was determined (r=0.467, p<0.05). In conclusion, we demonstrated decreased FFR in patients with SCF. Decreased FFR levels have been attributed to increased resistance in epicardial coronary arteries due to diffuse atherosclerotic disease which has been demonstrated by IVUS.

Focusing on coronary heart disease (CHD), this article reviews the impact of obesity on cardiovascular disease among Turks, based primarily on the data obtained in the Turkish Adult Risk Factor Study, a prospective study ongoing since 1990 on a representative sample of Turkish adults. After summarizing basic knowledge on obesity and abdominal obesity and adipocyte metabolism, the prevalences in this population were estimated (2.8 milllion men and 7.7 milllion women with abdominal obesity). Waist circumference revealed significant correlations with dyslipidemia, fasting glucose and physical activity and, above all, with blood pressure and C-reactive protein. The two good surrogates of visceral adiposity among Turkish adults, examined by computed tomography, were waist girth and body mass index (BMI), while waist-to-hip ratio was clearly inferior. In men, waist girth is the parameter of choice due to a closer relationship with visceral adipose tissue area, whereas in women BMI approached it. Best cutoff values for waist circumference were 96 cm in men and >88 cm in women, thus pointing to a lower action level of waist circumference in men than hitherto recommended. A 4-year prospective analysis disclosed that the age-adjusted relative CHD risk in men with a waist 96 cm was 1.65-fold the risk in men having a waist less than 96 cm. Waist girth significantly predicted nonfatal and/or fatal CHD risk, independent of salient risk factors, imparting a 34% excess risk for each increment of 12 cm (=1 SD). In contrast to the prevalence of abdominal obesity in men being similar to Western populations, it is a standard in peri- and postmenopausal Turkish women. Though abdominal obesity in Turkish adults is a main determinant of dyslipidemia as well, compared to Western adults (in particular among women), it affects to a greater extent (systolic) blood pressure, which appears the main determinant of coronary risk among Turks. It is concluded that the attributable risk for the population - estimated as 25,000 of the new cases of CHD that develop each year - highlights abdominal obesity in 3rd rank among the risk factors in Turkish adults, after hypertension and smoking, jointly with low HDL-cholesterol, namely, before elevated LDL-cholesterol and diabetes.

Right ventricular myocardial infarction accompanies inferior myocardial infarction in 30 to 50 percent of cases. However isolated right ventricular myocardial infarction has rarely been diagnosed, and is seen in fewer than 3 percent of all cases of acute miyocardial infarction. Because right ventricular infarction is associated with increased rates of morbidity and mortality, successful reperfusion has gained importance in treatment. Herein we present two separate cases of isolated right ventricular myocardial infarction successfully treated by primary angioplasty. (Arch Turk Soc Cardiol 2003;31:290-3)

Bilateral coronary artery fistulas, which drain into the systemic high-pressure arterial system, are rare anomalies. This article will report an unusual case of multiple, bilateral coronary artery to left ventricle fistulas causing myocardial ischaemia and angina pectoris that did not respond well to pharmacological treatment

An unusual case of aortico-right atrial tunnel is presented. The patient was referred to our institution for evaluation of a continuous heart murmur best heard along the right upper sternal border. Ascending aortography showed the tunnel taking its origin from the aortic root and entering the right atrium through a tortuous link. The patient underwent sugical repair because of a large left to right shunt. (Arch Turk Soc Cardiol 2003;31:298-302)