ISSN 1016-5169 | E-ISSN 1308-4488
Archives of the Turkish Society of Cardiology - Turk Kardiyol Dern Ars: 33 (7)
Volume: 33  Issue: 7 - October 2005
1. Low HDL-C in Turks: genetic/lifestyle interactions modulate plasma levels
Robert W.Mahley, Guy M.Pépin, Thomas P.Bersot, Zümrüt Algan, Erhan Palaoğlu
Pages 381 - 391
Objectives: Many studies have shown that extremely low high density lipoprotein cholesterol (HDL-C) levels (mean ~36 mg/dl in men; ~42 mg/dl in women) constitute a prime coronary heart disease (CHD) risk factor in Turks. We reviewed three separate cohorts of Istanbul residents surveyed over the past 14 years and evaluated trends in risk factors for CHD in men and women during this period. Study design: The study subjects were healthy Turkish residents of Istanbul ?20 years of age. Subjects recruited in 1996-2000 (n=828) and in 2003 (n=1100) were compared with the original Istanbul cohort (n=2686) of the Turkish Heart Study, recruited in 1990-1993. Results: The mean HDL-C level increased from 45.3±9.5 mg/dl in 1990-1993 to 49.7±12.0 mg/dl in 2003 in women (p<0.0001). In 2003, university-educated women had markedly higher mean HDL-C levels than women with a primary school or less education (56±9 mg/dl versus 48±12 mg/dl, p<0.0001). Consistent with this difference, highly educated women with higher HDL-C levels had a lower body mass index (mean 25.6±4.9 kg/m2 versus 29.7±5.1 kg/m2), smaller waist circumference, smoked less, and exercised more. Among men, the HDL-C distributions were very similar in both the 1990-1993 and 2003 cohorts (38.3±8.3 mg/dl versus 39.3±9.8 mg/dl, respectively). There was no significant difference in terms of HDL-C distribution between men with higher and lower levels of education. Conclusion: Data from the three cohorts show that, although genetically determined to a great extent, low HDL-C levels can be modulated by lifestyle factors. Higher levels of education are associated with a 10% to 15% increase in the HDL-C levels of women. However, the lack of an association between educational level and HDL-C in men remains to be explained.

ORIJINAL ARAŞTIRMA
2. The relationship between prehospital delays of patients with ST-elevation acute myocardial infarction and clinical, demographic, and socioeconomic factors: importance of patient education
Tuğrul Norgaz, Gültekin Hobikoğlu, Hüseyin Aksu, Aycan Esen, Mehmet Gül, Hasan Orhan Özer, Abdurrahman Eksik, Ahmet Narin
Pages 392 - 397
Objectives: It is of vital importance for patients with acute myocardial infarction (AMI) to receive medical supervision as early as possible. However, the time taken between the onset of symptoms and delivery of care is quite long for many patients. In this study, we evaluated the time from the onset of symptoms to presentation and the factors associated with prehospital delays in patients who were admitted to our hospital with the diagnosis of AMI. Study design: A structured interview was conducted with 147 consecutive patients (84 men, 63 women; mean age 56.7±11.6 years) with ST-elevation AMI. Prehospital delay, acute and prodromal symptoms of AMI, demographic features, clinical risk factors, history of coronary artery disease, and socioeconomic factors were questioned. Patients were classified as early or late arrivers according to the time of presentation within the first three hours or beyond. Results: The mean prehospital delay was 4.2±5.2 hours. Seventy-nine patients (53.7%) were early arrivers and 68 patients (46.3%) were late arrivers. Multivariate logistic regression analysis showed that older age (p<0.001), the number of offsprings (p=0.049), and preexisting stable angina pectoris (p=0.046) were significant independent factors associated with late arrivals. Conclusion: Our data show that nearly half of the patients with AMI reach a reperfusion center with a prehospital delay of more than three hours. Education programs should be developed and implemented focusing on AMI symptoms and importance of early presentation, aiming to reduce prehospital delays, and targeting especially patients with coronary artery disease and general community at large.

3. Long-term results of cardioverter defibrillator implantation in patients with malignant ventricular tachyarrhythmias
Abdurrahman Eksik, Ahmet Akyol, Tuğrul Norgaz, İzzet Erdinler, Nazmiye Çakmak, Ahmet Taha Alper, Hakan Hasdemir, Kadir Gürkan, Tanju Ulufer
Pages 398 - 403
Objectives: Implantable cardioverter defibrillator (ICD) is the most effective treatment for the prevention of sudden death in patients with ventricular tachycardia (VT) or ventricular fibrillation (VF). We retrospectively evaluated the long-term results of patients who had undergone cardioverter defibrillator implantation during the past six years. Study design: The study included 70 consecutive patients (63 men, 7 women; mean age 64.6±8.5 years) who received treatment with a dual-chamber (n=6) or single-chamber (n=64) ICD. Data on demographic and clinical features, echocardiographic left ventricular ejection fractions, ICD indications, clinical course, ICD performance, and medications were derived from the records of our electrophysiology laboratory. The mean follow-up period was 3.1±1.3 years. Results: Mortality occurred in 10 (14.3%) patients due to sudden arrhythmic death (n=2), noncardiac (cerebrovascular accident, respiratory arrest) causes (n=2), and cardiac (congestive heart failure) causes (n=6). No tachycardiac episodes were detected in 20 patients (28.6%). Forty-two patients had 631 spontaneous sustained VT episodes, for which 1,188 attempts of antitachycardia pacing (ATP) were made (mean 1.9 ATP). The large majority of sustained VT episodes (n=535, 84.8%) were successfully terminated by ATP, while the rest (n=96, 15.2%) required cardioversion. Defibrillation was successful in all the VF episodes (n=160). There were 11 inappropriate interventions in five patients (7.1%), all of whom had a single-chamber ICD. Eleven patients (15.7%) required replacement. According to the New York Heart Association (NYHA) functional class assessment, 12 patients with NYHA III had a significantly greater number of episodes (p=0.019). Conclusion: Our results show that ICD is successful in terminating ventricular tachyarrhythmias either by ATP or shock treatment with high efficacy and safety.

4. The incidence of congenital coronary artery anomalies in the Southeast Anatolia Region
Aziz Karabulut, Kenan İltümür, A.Samet Gülsüm, Nizamettin Toprak
Pages 404 - 408
Objectives: We retrospectively reviewed patients who underwent routine coronary angiography in our catheterization laboratory in order to determine the incidence of congenital coronary artery anomalies in the Southeast Anatolia Region of Turkey. Study design: Catheterization reports of 5,018 patients who underwent coronary angiography from January 1998 to April 2005 were reviewed. Cineangiographies and records of patients in whom anomalous coronary arteries were detected were further analyzed. The anomalies were evaluated according to the recommendations of Serota et al. Patients were classified according to the origin of the anomalous coronary artery and accompanying coronary artery stenosis of greater than 50%. Results: Congenital coronary artery anomalies were documented in 19 patients (0.4%; 13 men, 6 women; mean age 48.2 years; range 32 to 74 years). The most frequent anomaly was that of the left circumflex artery in 11 patients (57.9%), all of which originated from the right coronary sinus. Six patients (31.6%) had an anomalous right coronary artery originating from the left coronary sinus. In two patients (10.5%), the left anterior descending and the left circumflex arteries originated from the right coronary sinus with separate ostia. Ten patients (52.6%) were found to have coronary artery disease including single-, two-, and three-vessel disease in seven patients (36.8%), two patients (10.5%), and one patient (5.3%), respectively. Atherosclerosis was present in the anomalous coronary artery in eight patients (42.1%). Conclusion: The incidence of congenital coronary artery anomalies shows geographical variations in individual populations. In our population, it is slightly lower than those reported in the literature. For appropriate and complete treatment, congenital coronary artery anomalies should be identified with their origin and course.

OLGU
5. Bioprosthetic valve dysfunction due to leaflet rupture
Bahar Pirat, Aylin Yıldırır, L.Elif Sade, Bülent Özin
Pages 409 - 412
Patients with bioprosthetic heart valves have low rates of thrombosis and hemorrhagic complications. However, bioprostheses have limited long-term durability due to structural deterioration. A 74-year-old woman was admitted with resting dyspnea, orthopnea, palpitation, and hemoptysis of three days' duration. She had undergone closed and open mitral commissurotomies due to rheumatic mitral stenosis in 1962 and 1988, respectively, and mitral valve replacement (MVR) with a bioprosthetic valve at the age of 66 years. Electrocardiography revealed atrial fibrillation. Transthoracic echocardiography demonstrated a massively enlarged left atrium and severe eccentric mitral regurgitation (MR) with valvular and paravalvular components. Transesophageal echocardiography showed primary valve degeneration, leaflet rupture, and severe MR. Coronary angiography showed normal coronary arteries and third-degree MR. The patient was reoperated and a 29-mm porcine bioprosthesis was implanted. The operative material confirmed rupture of one leaflet.

DERLEME
6. Echocardiographic evaluation of regional mechanical dyssynchrony and candidates for cardiac resynchronization therapy
L.Elif Sade, Bülent Özin, Haldun Müderrisoğlu
Pages 413 - 422
Biventricular pacemaker is a novel alternative approach in the management of patients with end-stage refractory heart failure. The fact that regional mechanical dyssynchrony is the major determinant in the selection of candidates for cardiac resynchronization therapy and that QRS duration is not a reliable marker of the regional mechanical dyssynchrony has expanded the role of echocardiography in this field. Echocardiography enables non-invasive quantification of both the hemodynamic status and regional left ventricular contractile function. Conventional echocardiography combined with two-dimensional and tissue Doppler modalities proved to be useful in the assessment of regional mechanical dyssynchrony and atrioventricular, interventricular, and intraventricular delays. Hence, echocardiography has become an indispensable imaging guide to cardiac resynchronization therapy for patient selection, evaluation of the response to resynchronization, and optimal lead localization.

7. Chronic thromboembolic pulmonary hypertension
Meral Kayıkçıoğlu, Lewis J Rubin
Pages 423 - 432
Although chronic thromboembolic pulmonary hypertension (CTEPH) is a serious disease with high mortality, it is potentially a curable form of pulmonary hypertension. It is thought to develop from organized pulmonary arterial obstructions by single and recurrent pulmonary thromboemboli or from in situ thrombosis. Definitive treatment requires surgical resection of the thromboembolic material. Early diagnosis and pulmonary thromboendarterectomy may improve hemodynamics and functional capacity, and thus survival. Without treatment, progressive pulmonary hypertension, right heart failure, and death will ensue. The purpose of this article is to provide a brief overview of CTEPH, to review current methods of diagnosis, and to summarize the effects of drug therapy and interventions on CTEPH, together with a detailed account on the effects of pulmonary endarterectomy.

OLGU
8. Case images
Cemil Gürgün, Oğuz Yavuzgil, Can Hasdemir, Sanem Nalbantgil
Page 433
Abstract |Full Text PDF

9. Answers of specialist
Ömer Kozan, Serdar Küçükoğlu, Necmi Değer, Oktay Ergene
Pages 434 - 436
Abstract |Full Text PDF

10. Letters to the Editor
Tuğrul Okay
Page 437
Abstract |Full Text PDF

11. Comment on cardiology publications
Ertan Ural
Pages 438 - 439
Abstract |Full Text PDF



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Journal Citation Indicator: 0.18
CiteScore: 1.1
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SCImago Journal Rank: 0.348

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