Objectives: To analyze all-cause and coronary mortality as well as newly diagnosed coronary heart disease (CHD) in the cohort of the Turkish Adult Risk Factor Study which was surveyed in the summer of 2005 and included individuals residing essentially in the regions of Marmara and Central Anatolia.
Study design: Information on the mode of death was obtained from first-degree relatives and/or health personnel of local health offices. Diagnosis of coronary heart disease was based on history, physical examination, and 12-lead electrocardiograms. New coronary events were defined as those that developed after the last survey, including fatal or nonfatal myocardial infarction, stable angina and/or myocardial ischemia.
Results: Of 1646 participants, 1078 subjects (mean age 54.8±11.8 years) were examined; information alone was gathered for 507 subjects; 43 subjects (28 men, 15 women) had died, and 18 subjects were lost to follow-up. Incorporation of 3104 person-years of follow-up raised the total follow-up of the survey to 42,600 person-years. Twenty-three deaths were classified as CHD-related. New coronary events were identified in 37 participants. Annual mortality and coronary mortality rates were 13.9 and 7.4 per 1000 adults, respectively. Overall mortality per 1000 person-years was 16.3 in rural areas and 12.0 in urban areas. The high share of coronary deaths among all deaths persisted. In the age bracket of 45 to 74 years, overall mortality declined to 10.6 (p=0.09) and coronary mortality to 5.5 per 1000 person-years, thus supporting the presence of a consistently decreasing trend of all-cause mortality and coronary mortality. Estimated fatal and nonfatal new coronary events appeared to be high with 18 per 1000 person-years.
Conclusion: A rising trend persists in the incidence of coronary mortality and its share in overall mortality as well as in new coronary events. The occurrence of coronary deaths among women seems to be gradually shifting to older ages.

Objectives: We aimed to investigate the predictive value of lead aVR in the evaluation of electrocardiograms (ECG) for lesions in the proximal portion of the left anterior descending (LAD) coronary artery.
Study design: The study consisted of 361 patients (293 males, 68 females; mean age 58±10 years; range 24 to 84 years) with acute myocardial infarction (AMI), who presented with typical chest pain and ST elevation on ECG. All of the patients underwent coronary angiography (CAG) in order to identify the infarct-related artery (IRA) and its segments. Changes in the ST segment (i.e. elevation or depression) were evaluated in all leads including aVR. The patients were divided into two groups according to the ST elevation recorded in lead aVR, namely as positive (≥0.5 mm) or negative (<0.5 mm).
Results: The IRA segment was in the proximal LAD in 54% of the aVR positive group, and in 9% of the aVR negative group (p<0.001). Multiple vessel coronary artery disease was more common in the aVR positive group (p<0.001). There was a weak correlation between ST segment elevations in lead aVR and the Gensini score (r=0.21, p=0.002). In patients with anterior AMI, ST elevation in lead aVR predicted the IRA segment in the proximal LAD with 47% sensitivity, 91% specificity, 81% negative predictive value, 68% positive predictive value, and 78% diagnostic accuracy.
Conclusion: In patients with anterior AMI, evaluation of aVR lead may be useful in localizing the IRA segment in the proximal LAD and predicting that an increased amount of myocardial tissue is at risk.

Objectives: Saphenous vein grafts have been widely used in coronary bypass operations for many years. We investigated the association between metabolic syndrome (MS) and late saphenous graft disease.
Study design: The study included 193 patients (16 females, 177 males; mean age 62±8 years; range 39 to 86 years) in whom at least one saphenous vein graft had been used during coronary bypass operation of at least 10-year history. All the patients underwent coronary angiography for anginal complaints or preoperative assessment. Patients were classified into two groups. Group 1 was comprised of 72 patients with patent saphenous graft, whereas group 2 included 121 patients without patency or with associated lesions. The two groups were compared in terms of their medications, anthropometric measurements, blood biochemistry, and the presence of hypertension, diabetes mellitus, smoking, and MS.
Results: Metabolic syndrome was less frequent in group 1 than in group 2 (22% vs. 45.6%, p=0.003). Metabolic syndrome score, derived from the sum of MS components, was higher in group 2 than in group 1 (2.3±1 vs. 1.8±1.2, p=0.003). In a multivariate logistic regression analysis, duration from bypass to coronary angiography (beta=0.812, p=0.017) and MS score (beta=0.590, p=0.005) were found to be independent factors related to saphenous graft patency.
Conclusion: Metabolic syndrome score seems to be associated with late saphenous vein graft disease. Early measures for MS may affect the prognosis of patients undergoing coronary bypass operations.

Objectives: We investigated the factors that affect physical activity levels of university students studying health sciences.
Study design: The study included 1097 university students. Age, height, weight, smoking status, alcohol and drug use, and medical conditions that would preclude physical activity were recorded. Physical activity levels were determined using the International Physical Activity Questionnaire and the students were classified as physically inactive, minimally active, and sufficiently active.
Results: The mean weekly energy expenditure from physical activity was 1958±1588 MET-min. Of the study group, 72% did not have vigorous physical activity, 68% lacked moderate physical activity, and 1% did not have a walking activity of sufficient level. Physical activity levels were as follows: 15% physically inactive, 68% minimally active, and 18% sufficiently active. Physical activity levels of male students were significantly higher than those of female students (p<0.05). No statistically significant differences were found between physical activity levels of the subjects having a body mass index of <25 kg/m2 and ≥25 kg/m2 (p>0.05).
Conclusion: University students have significantly low physical activity levels. More physical activity facilities, education, and opportunity should be allocated to university students for maintenance and improvement of health.

Single coronary artery in which all three coronary arteries originate from the right sinus of Valsalva through a single ostium is a rare anomaly and its association with acute myocardial infarction (AMI) is even rarer. A 63-year-old female patient was admitted with severe chest pain of sudden onset, radiating to the neck and the left arm. Electrocardiographic findings were consistent with inferior lateral AMI. Coronary angiography demonstrated that the left anterior descending (LAD), the left circumflex (LCx) and the right coronary (RCA) arteries originated from the right sinus of Valsalva through a single ostium. There was severe discrete stenosis (95%) in the mid-portion of the RCA, and severe segmental stenosis (90%) in the proximal portion of the LCx, without any occlusion in the LAD. The patient refused recommendations for elective percutaneous coronary intervention or coronary bypass surgery and was discharged one week after angiography.

A 70-year-old male patient presented with symptoms of heart failure three years after having myocardial infarction. Transthoracic echocardiography revealed severely compromised left ventricular systolic function (ejection fraction 20%) and a large left ventricular pseudoaneurysm. The diagnosis was confirmed by computed tomography. The size of the pseudoaneurysm sac was 11x9 cm. At surgery, the pseudoaneurysmal sac was resected and a defect of 3.5x4 cm was detected in the anterolateral wall of the left ventricle. The defect was repaired by the remodeling ventriculoplasty method of Dor. The patient whose general condition improved through intensive medical treatment was discharged with medications for heart failure and coronary artery disease on the 15th postoperative day.

Myocardial free wall rupture due to acute myocardial infarction (AMI) is a rare complication with an incidence of 2% to 4%. The patients’ complaints in AMI may not always be typical. In particular, the clinical presentation of inferior myocardial infarction may be confused with gastrointestinal symptoms. A 54-year-old male patient presented with acute abdominal pain, faintness, and sweating. On admission, there was no ST segment elevation related to AMI. Due to the presence of acute abdominal pain and shock symptoms, an urgent abdominal exploration was planned to identify abdominal pathology. Prior to exploration, echocardiography was performed to evaluate cardiac functions and to rule out any cardiac etiology associated with shock symptoms. It demonstrated myocardial free wall rupture and a hematoma compressing the right ventricle. He was referred to an emergency cardiac operation, during which he died due to uncontrolled bleeding through multiple ruptured areas in the myocardium.

Noninvasive imaging techniques play an important role in assessing the efficacy of stem cells in cardiac regenerative medicine. Tissue samples from experimental studies provide detailed information on cellular characteristics, but, similar analyses cannot be performed in humans, necessitating the utilization of noninvasive imaging techniques to evaluate the beneficial effects of cellular cardiomyoplasty on myocardial function and perfusion. The roles of echocardiography in the assessment of left ventricular functions and nuclear diagnostic techniques such as single photon emission computed tomography (SPECT) and positron emission tomography (PET) in determining myocardial viability and perfusion are well established. On the other hand, magnetic resonance imaging (MRI) with the advantage of serial imaging is considered to be the gold standard in the evaluation of cardiac anatomy and is particularly preferred in cellular cardiomyoplasty studies. In addition, further studies are needed to evaluate the utility of noninvasive imaging techniques in assessing the efficacy of labeled stem cells in the myocardium and to monitor their behaviors over time.

Magnetic resonance imaging (MRI) is the most important and developed tool among the new methods of radiologic imaging. Radiofrequency waves used in MRI may interact with biomedical implants and assist devices. With recent developments in cardiology and increasing number of cardiologic devices implanted, MRI-related problems about safety and compatibility of these devices have emerged. The aim of this review was to discuss MRI-related issues and the studies conducted in patients with cardiovascular implants.

Male patient who had LIMA coronary artery by-pass grefting 2 years ago, had left arm claudication, typical angina pectoris triggered with arm movements and a subsequent vertigo. Coronary angiography revealed more than 90% stenosis of the proximal subclavian artery. Saphenous vein angiography showed opacification of LIMA and subclavian artery distal to the stenotic segment,via native coronary arteries.