Objectives: This study aimed to define the risk for stroke in hypertensive patients in Turkey and the differences among geographical regions regarding this risk, and to evaluate risk factors for stroke other than hypertension.
Study design: This hospital-based, cross-sectional, epidemiological questionnaire study was conducted in 39 centers in 22 cities from seven geographical regions in Turkey. Using the algorithm in the Framingham Heart Study, stroke risk for the following 10 years was calculated for 6790 patients (59.3% females; age range, 54 to 74 years for 87.4%). Blood pressure levels were assessed according to the ESC (European Society of Cardiology) and JNC 7 (Seventh Report of the Joint National Committee) classification systems.
Results: Hypertension was rated as mild to severe and grade 1 to 2 in approximately 69% and 70% of patients according to the ESC and JNC 7 classifications, respectively. The mean 10-year stroke risk was 17±15% in the study group, the highest being in the Black Sea region (19±14%), and the lowest in the Marmara region (16±14%), with the odds ratio of 1.62 (95% confidence interval, 1.32-1.99; p<0.001). Risk factors for stroke according to the odds ratios were as follows in decreasing order: left ventricular hypertrophy, increased age, high blood pressure, male gender, coronary heart disease, smoking, diabetes mellitus; high creatinine, low HDL, and high fasting glucose levels; geographical region, and obesity.
Conclusion: There is a considerable stroke risk for Turkish hypertensive patients despite a high antihypertensive treatment ratio among this population.

Objectives: We evaluated the relationship between high sensitivity C-reactive protein (hsCRP), a marker of inflammation, measured on admission and ST-segment resolution, which is a marker of microvascular perfusion.
Study design: Serum hsCRP levels were measured in 113 consecutive patients (96 males, 17 females; mean age 56.9 years; range 35 to 83 years) before coronary angiography for ST-segment elevation acute myocardial infarction (MI). All the patients underwent successful (TIMI III flow) primary percutaneous coronary intervention (PCI) within 12 hours of MI. ST-segment elevation was measured on electrocardiograms obtained before PCI and after 60 minutes of TIMI III flow restoration and the difference was accepted as resolution of the sum of ST-segment elevation (∆STR). The presence and absence of no-reflow phenomenon was determined according to Schroder et al., taking ∆STR<50% (n=23, 20.4%) and ∆STR ≥50% (n=90, 79.6%), respectively.
Results: On admission, patients with no-reflow phenomenon had significantly elevated peak creatine kinase (p<0.001) and hsCRP (p=0.002) levels, and significantly decreased left ventricular ejection fraction (p=0.04). A significant inverse correlation was found between ∆STR and hsCRP (r=-0.281, p=0.003). An ROC (receiver-operating characteristics) analysis showed ≥4.16 mg/l as the threshold for a high hsCRP level (n=71), which was associated with a more frequent no-reflow phenomenon (p=0.02), a higher level of peak creatine kinase (p<0.001) and a lower left ventricular ejection fraction (p=0.03). In a multivariate analysis, a high hsCRP level was found as an independent predictor for no-reflow phenomenon (odds ratio 2.1; 95% confidence interval, 1.001 to 4.4; p=0.04).
Conclusion: High hsCRP levels on admission may predict insufficient myocardial perfusion despite the presence of TIMI III flow following primary PCI.

Objectives: Recent studies suggest that brain natriuretic peptide (BNP) is associated with the prognosis of coronary heart disease. We studied the relationship between BNP and left ventricular (LV) end-diastolic pressure and the number of involved coronary arteries in patients with chronic coronary artery disease.
Study design: The study included 100 patients (30 women, 70 men; mean age 56 years; range 37 to 78 years) who underwent coronary angiography for definite or suspected coronary artery disease. Before angiography, baseline serum samples were obtained for plasma BNP, and LV end-diastolic pressure was measured. The patients were classified in three groups as normal (n=35), one-vessel disease (n=16) and multivessel disease (n=49).
Results: The incidence of diabetes mellitus and the levels of BNP and fasting blood glucose were significantly higher, and LV end-diastolic pressure and the mean heart rate were significantly increased in multivessel disease. Vessel involvement was significantly correlated with BNP (r=0.463, p<0.001), LV end-diastolic pressure (r=0.745, p<0.001), and fasting blood glucose (r=0.235, p<0.05). Correlation between BNP and LV end-diastolic pressure was highly significant (r= 0.72, p<0.001). Multivariate linear regression analysis showed LV end-diastolic pressure as the only independent determinant of increased BNP levels (r=0.762, p<0.001).
Conclusion: Increased plasma BNP levels are associated with increased LV end-diastolic pressure and increased vessel involvement in patients with chronic coronary artery disease.

Objectives: We investigated correlations between regional rest myocardial perfusion and regional systolic and diastolic myocardial velocities assessed by 99mTc MIBI gated single-photon emission computed tomography (G-SPECT) and tissue Doppler echocardiography, respectively, in dilated cardiomyopathy (DCM).
Study design: The study included 32 patients (27 men, 5 women; mean age 63±12 years) with DCM, with NYHA functional capacity II-IV. Twenty-five patients had ischemic, seven patients had nonischemic DCM. G-SPECT and tissue Doppler imaging studies were performed using short axis views of the basal, mid, and apical levels of the left ventricle, which was divided into 16 segments. For each segment, regional 99mTc MIBI uptake and peak systolic (Sm), and early (Em) and late (Am) diastolic velocities were determined.
Results: The mean Sm value (p=0.007) was significantly higher and the mean 99mTc MIBI uptake (p<0.001) was significantly lower in ischemic patients. There was a very good correlation between ejection fractions obtained by the two methods in ischemic (r=0.81, p<0.001) and nonischemic (r=0.76, p=0.05) groups. Regional perfusion levels showed weak but significant correlations with Sm, Em, and Em/Am in the ischemic group. When 99mTc MIBI uptake levels of ischemic patients were assessed in four groups (≥75%, 75% to 50%, 50% to 25%, <25%), Sm values of the first two were significantly higher than that of the group with <25% uptake (p=0.007, p=0.002, respectively). Sm, Em, and Em/Am values were not correlated with 99mTc MIBI uptake in the nonischemic group.
Conclusion: Myocardial flow velocities determined by Doppler echocardiography are correlated with perfusion abnormalities detected by G-SPECT in ischemic DCM.

Objectives: We examined whether pulmonary venous flow parameters by Doppler echocardiography would throw light on the assessment of reperfusion therapy in acute myocardial infarction (AMI) with ST-segment elevation.
Study design: The study included 88 patients who were admitted to intensive care unit with AMI. Data obtained from standard echocardiographic parameters and mitral and pulmonary vein Doppler parameters were evaluated in the following groups: Patients with or without ST-segment resolution on electrocardiograms (n=47, mean age 57±11 years and n=41, mean age 59±11 years, respectively) and patients with (n=53) or without (n=35) fibrinolytic therapy. ST resolution was defined as the disappearance of at least 70% of elevation detected on initial electrocardiograms.
Results: Compared to those without ST resolution, patients with ST resolution had significantly higher mitral E-wave deceleration time (EDT), mitral E-wave pressure half time (E-PHT), pulmonary antegrade systolic flow (PS), and ejection fraction (EF) (p<0.05, p<0.05, p<0.05, p<0.001, respectively), and significantly lower end-systolic volume and left ventricle end-diastolic pressure (p<0.001, p<0.05 respectively). There was a significant correlation between PS and EF (r= 0.41, p<0.01) in patients without ST resolution, whereas PS was not correlated with EF in those with ST resolution (r= 0.21, p>0.05). In both groups with (r= -0.30) and without (r= -0.34) ST resolution, PS exhibited a negative correlation with pulmonary artery systolic pressure (p<0.05). With fibrinolytic therapy, the presence of ST resolution was significantly associated with higher values of EDT, E-PHT, and PS (p<0.05). However, in those who did not receive fibrinolytic therapy, patients with ST resolution had higher EDT, E-PHT, and PS compared to those without ST resolution, but only PS reached significance (p<0.05). Deceleration time of the pulmonary antegrade diastolic flow was significantly lower in patients who did not receive fibrinolytic therapy (p<0.01).
Conclusion: In addition to electrocardiographic ST resolution, early echocardiographic variables such as PS, deceleration time of the pulmonary antegrade diastolic flow, and mitral EDT may contribute to noninvasive assessment of myocardial perfusion.

Three patients with pulmonary atresia with intact ventricular septum (PA-IVS) were treated with different transcatheter perforation techniques. In two patients, one with patent ductus arteriosus- (PDA) dependent pulmonary circulation (age 2 months) and the other with a previous surgical systemic-pulmonary artery shunt in the neonatal period (age 10 months), anterograde perforation of the atretic valves was performed with the use of the stiff-end of a 0.014-inch guide-wire. In the former, the guide-wire was snared in the main pulmonary artery and pulled with the catheter into the pulmonary artery for perforation followed by pulmonary balloon valvuloplasty (PBV). In the latter, prior to PBV, a low-profile coronary artery balloon catheter was advanced over the guide-wire for predilatation. The third (age 14 months) required stabilization by stenting of the PDA because of severe cyanosis. Retrograde perforation was achieved using the guide-wire which was snared and pulled in the right ventricle together with the catheter for PBV. No significant complications occurred during perforation and PBV. Transcatheter guide-wire perforation with different techniques and with complementary ductal stent implantation before or after the procedure is a safe and effective alternative to surgical valvotomy for PA-IVS.

Anatomical complications may occur after surgical repair procedures for congenital heart diseases. A 13-year-old boy presented with progressively decreased effort capacity. He had a history of bilateral Blalock-Taussig pulmonary shunt operation shortly after birth with diagnoses of transposition of the great arteries, pulmonary atresia, ventricular septal defect, and patent ductus arteriosus. In addition, he underwent a Rastelli operation (a left ventricular to aorta and right ventricular to pulmonary artery conduits) and reconstruction of the right ventricle outflow tract at the age of seven years. Right ventriculography showed bilateral stenosis of the pulmonary artery conduit anastomoses. Balloon angioplasty with stent implantation was performed, after which his complaints disappeared and effort capacity increased.

The severity of pulmonary congestion can be assessed by monitoring thoracic impedance (TI). In patients with congestive heart failure (CHF), TI monitoring provides a unique opportunity to foresee decompensation before clinical signs and symptoms ensue. Some biventricular defibrillators (BiV-ICD) have TI monitoring capability, providing hemodynamic data as well as treatment of CHF and arrhythmias. We present an 80-year-old male patient in whom TI monitoring by BiV-ICD was utilized for clinical decision making. He had undergone coronary artery bypass graft surgery and BiV-ICD implantation, and had decompensated CHF on admission. Interrogation of BiV-ICD revealed a substantial decrease in TI compatible with volume overload. Shortly after treatment for CHF, a steady increase was noted in TI parallel to effective diuresis. However, after discharge, a decrease in TI was again noted without any signs and symptoms of decompensation. Treatment was tailored and TI values became normal. No need for hospitalization occurred and he showed a steady decrease in the ventricular rate in parallel to increases in TI and heart rate variability.

Renal artery stenosis (RAS) leads to hypertension and renal dysfunction. The most common causes of RAS are fibromuscular dysplasia at younger ages, and atherosclerosis after 55 years of age. Coronary artery and lower extremity vascular diseases are frequently associated with atherosclerotic RAS. Flash pulmonary edema, deterioration in blood pressure control and renal function point to RAS. Duplex ultrasonography enables diagnosis without difficulty. Treatment consists of medical therapy and percutaneous or surgical revascularization. In the presence of refractory hypertension and/or renal dysfunction, mechanical revascularization is recommended. Percutaneous method is preferred to surgery due to high success and low complication rates. Revascularization therapy improves blood pressure control, renal function, and survival.