Objectives: Nutritional habits and nutritional patterns of the participants of the Turkish Adult Risk Factor Study 2003-2004 were evaluated together with changing trends within the past 20 years.
Study design: Face–to–face interviews were made with 787 participants (394 men, 393 women; mean age, 53.0 years in men, 52.4 years in women) to inquire into daily energy intake, nutritional constituents, and proportions of carbohydrates, proteins, and fats in daily energy intake. The participants equally represented all geographical regions of Turkey, with 22% living in rural, and 78% in urban settings.
Results: The proportions of carbohydrates, proteins, and fats in daily energy intake were 53.3%, 13.7%, and 33%, respectively. Nutrition components in daily energy intake were as follows: cereals and related products (37%), fat and oil (15%), milk and dairy products (13%), fruits (10%), vegetables (6%), sugar, honey, and jam (7%), and meat and poultry (6%). Carbohydrate was mainly supplied by cereals (56%), followed by fruits and vegetables (24%), and sugar, honey, and jam (13%). Protein intake was from cereals (37%), meat and poultry (20%), milk and dairy products (19%), and fruits and vegetables (15%). Visible fats (fat and oil) and invisible fat accounted for 41% and 59%, respectively. In comparison with previously reported proportions of daily energy, carbohydrates decreased by 9%, cereals decreased from 52% to 32%, whereas proteins, total fat, and invisible fat increased by 2%, 8%, and 14%, respectively.
Conclusion: Our data suggest that nutritional habits of participants of the Turkish Adult Risk Factor Survey 2003-2004 have undergone changes in the past years.

Objectives: We evaluated the effect of successful intracoronary stent implantation on regional and global left ventricular systolic functions and functional capacity in patients with chronic total or subtotal occlusions.
Study design: Thirty-six patients (31 males, 5 females; mean age 52.5 years; range 40 to 65 years) who underwent successful stent implantation were divided into two groups depending on the presence of chronic total (n=24) or subtotal (n=12) occlusion in coronary arteries. Control angiographies were obtained after three to nine months and changes in global ejection fraction and regional wall motion of the left ventricle and functional capacity were assessed. Symptoms were assessed according to the Canadian Cardiovascular Society classification system. The mean follow-up periods were 6.0±3.1 months and 5.8±2.9 months in total and subtotal occlusion groups, respectively.
Results: Following the procedure, coronary restenosis and reocclusion rates were similar in both groups. Patients with restenosis and reocclusion had significantly lower functional capacity than those without restenosis and reocclusion (p<0.001). Left ventricular ejection fraction significantly improved in the total occlusion group (p=0.01), whereas the increase was not significant in patients with subtotal occlusion (p=0.07). The two groups differed significantly in this respect (p=0.04). Although both groups had improved regional systolic functions (total, p=0.008; subtotal, p=0.02) and functional capacity (total, p<0.0001; subtotal, p=0.02) following the procedure, these improvements did not differ significantly between the two groups (p>0.05).
Conclusion: Successful stenting is associated with more pronounced improvements in regional and global left ventricular systolic functions and functional capacity in patients with chronic total occlusion than in those with subtotal occlusion.

Objectives: We evaluated the effect of metoprolol succinate or carvedilol given in addition to conventional treatment on left ventricular systolic functions and effort capacity in patients with heart failure.
Study design: The study included 33 patients (6 females, 27 males; mean age 60±10 years) with mild to moderate heart failure (NYHA functional class II-III). Following six weeks of standard treatment, the patients were randomized to receive carvedilol or metoprolol succinate, whose initial doses were 3.125 mg twice daily and 25 mg daily, with weekly increments to target doses of 50 mg/day and 100 mg/day, respectively. The patients were assessed by the six-minute walk test and transthoracic echocardiography prior to, and after three months of, beta-blocker treatment.
Results: Compared with pretreatment values, resting heart rate and systolic blood pressure showed significant decreases after beta-blocker treatment (carvedilol, p<0.001; metoprolol, p<0.05). Decrease in diastolic pressure was significant only in the metoprolol group (p<0.01). In both groups, systolic and diastolic diameters and end volumes showed significant decreases, and ejection fraction showed a significant increase. There was a dramatic increase in the walking distance in both groups (p<0.001) associated with significantly decreased heart rate and symptom scores which were more notable in the carvedilol group. However, none of the improvements obtained by beta-blocker treatment differed significantly between the two groups (p>0.05).
Conclusion: Our findings show that metoprolol succinate and carvedilol provide similar but significant improvements in left ventricular systolic functions and effort capacity of patients with mild to moderate heart failure.

Objectives: We investigated the relationship between heart rate variability (HRV) and treadmill variables in nonischemic neuropathic patients.
Study design: The study included 38 patients (20 men, 18 women; mean age 50±11 years). All the patients underwent standard tests for cardiovascular autonomic neuropathy (CAN), maximal exercise treadmill testing according to the Bruce protocol, 24-hour Holter ECG monitoring, and time- and frequency-domain analysis of HRV. Time-dependent parameters included SDNN, SDANN, SD, RMSSD, and PNN50, with cut-off values being 100 ms, 25 ms, 92 ms, 35 ms, and 7500, respectively.
Results: MET scores and exercise time reached in exercise test showed varying correlations with the lowest and mean heart rates recorded by Holter ECG monitoring and HRV parameters, in particular with SD and SDNN, whereas they were not correlated with CAN scores. Moderate correlations were found between chronotropic parameters of exercise test (maximal heart rate and percent maximal heart rate) and pressure-rate product associated with CAN severity. Patients with an insufficient treadmill test had significantly higher minimal rates on Holter monitoring (p=0.05) and significantly lower values for SDNN, SD, RMSSD, and PNN50 (p<0.05). Patients with an effort capacity of 5 METs or lower had significantly decreased SDANN values, while those reaching 10 METs or more had above-normal SDANN values (p<0.05).
Conclusion: Autonomic neuropathy is closely related with HRV parameters in patients with nonischemic type II diabetes and is associated with a disturbed exercise response.

Objectives: We evaluated the changes in left ventricular function by means of tissue Doppler imaging (TDI) in patients with mitral stenosis (MS).
Study design: Standard echocardiographic and TDI studies were performed in 26 patients (18 females, mean age 38±7 years) with severe MS [mitral valve area (MVA) <1.2 cm2], in 32 patients (24 females, mean age 35±9 years) with mild to moderate MS (MVA ≥1.2 cm2), and in 25 age-matched healthy volunteers (17 females, mean age 39±6 years). All the patients were in sinus rhythm and none had hypertension or coronary artery disease. Systolic myocardial velocity, early and late diastolic velocities were measured in the basal lateral segment and basal interventricular septum from the apical four-chamber views.
Results: Left ventricular dimensions, ejection fraction, end-diastolic and end-systolic diameters, and fractional shortening of the left ventricle were similar in all the groups. Patients with MS had significantly decreased peak systolic myocardial velocities in both the lateral wall and interventricular septum of the left ventricle. In addition, early diastolic velocity and the ratio of early/late diastolic velocities were significantly lower. E-wave deceleration time and late diastolic myocardial velocities were similar in three groups. Peak systolic myocardial velocities were significantly correlated with mitral valve areas measured at the septum (r=0.57, p<0.01) and the lateral wall (r=0.48, p<0.01) of the left ventricle.
Conclusion: Our results show that, despite the presence of seemingly normal findings on standard echocardiography, TDI may provide evidence for left ventricular systolic dysfunction in patients with MS, representing early signs of myocardial abnormality.

The clinical and diagnostic differentiation between constrictive pericarditis (CP) and restrictive cardiomyopathy is often difficult because of similar hemodynamic features. We present a 22-year-old male patient with CP, whose differential diagnosis was quite challenging. He had received treatment for Wilson’s disease, had a history of lung tuberculosis, and within the past two years, had undergone thoracotomy and decortication twice. He presented with complaints of dyspnea and swelling in the lower extremities. Computed tomography of the thorax showed pericardium of normal thickness, but pericardial calcification close to the right ventricle. On magnetic resonance imaging, pericardial thickness was 2 mm. Transthoracic echocardiography showed dilatation of the right and left atria. Cardiac catheterization revealed the square-root sign on ventricular diastolic pressure tracings, and a “y descent” on right atrial pressure tracings. Endomyocardial biopsy was performed which showed mild hypertrophic changes, without any signs of inflammatory infiltration, granuloma, amyloid deposition, or fibrosis. Biopsy sample from the pericardial tissue was not suggestive of a specific inflammatory process. He underwent pericardiectomy after which right atrium pressure decreased from 30 mmHg to 15 mmHg and his complaint of exertional dyspnea disappeared.

In patients with an accessory pathway (AP), the degree of preexcitation depends upon the intra-atrial conduction time through the AP, atrioventricular node, and the His-Purkinje system, and on the localization of the AP. We presented a 20-year-old male patient whose electrocardiogram exhibited minimal preexcitation due to a left lateral AP. He had tachycardia as the presenting complaint. Electrocardiography (ECG) showed a shortened PR interval, a pattern of right bundle branch block in V1, and a negative delta-wave activity in aVL. On electrophysiologic study, an AP was detected in the left lateral wall and atrioventricular re-entrant tachycardia was induced. After successful radiofrequency ablation of the AP, no apparent change from the baseline ECG findings was observed. However, detailed analysis of the intracardiac and surface ECG showed that the ablation was successful and there was a minimal change in the QRS morphology in aVL derivation.

Some atypical right atrial flutters present as a double-loop reentry. This kind of arrhythmia usually occurs after a cardiac operation leaving behind a right atrial scar tissue, with one reentry loop turning around the tricuspid valve, and the other around the scar tissue. It is extremely difficult to detect the presence and localization of these reentry loops by conventional electrophysiologic studies. Only three-dimensional mapping techniques provide identification of these reentry loops. Herein, we presented a 55-year-old woman who developed persistent atrial flutter after mitral valve surgery. Conventional electrophysiologic study showed macroreentry in the right atrium, but ablation target could not be determined. With the use of a three-dimensional mapping technique, a double-loop reentry was delineated in the right atrium and ablation of the common isthmus resulted in the disappearance of tachycardia.

Measurement of blood pressure in the clinic is the most frequent method in the detection of hypertension. However, this method may at times lead to inappropriate treatment options due to the occurrence of white coat hypertension. Compared to the office blood pressure measurements, the effort test has been shown to be more valuable especially in showing the target organ damage. In addition to its value in evaluating effort capacity and ischemia, it is also important in delineating the blood pressure response. Further research is warranted to validate its value in the indirect evaluation of endothelial dysfunction in both normotensive and hypertensive individuals and to understand the relationship between the development of hypertension and blood pressure response.

Although electrocardiography consists of 12 derivations, aVR is frequently neglected and evaluation is made from only 11 derivations. The study of Aygul et al is a good example of comprehending the importance of aVR.