Objectives: We investigated the association of the I/D polymorphism of the angiotensin converting enzyme (ACE) gene with essential hypertension (EH) and ischemic stroke in Kyrgyz male subjects.
Study design: The study included a total of 313 Kyrgyz men, including 180 patients with uncomplicated EH, 69 patients with EH complicated by ischemic stroke, and 64 healthy age-matched controls. All the subjects underwent I/D genotyping and determination of serum ACE activity. Ambulatory blood pressure (BP) monitoring and carotid ultrasound (51 patients) were also performed in patients with EH.
Results: The mean ACE concentration was 23.3±0.7 mU/ml/min for II, 32.2±0.9 mU/ml/min for ID, and 38.8±2.3 mU/ml/min for DD genotypes. The ID and DD genotypes were associated with significantly higher ACE levels compared to the II genotype (p<0.01 and p<0.0001, respectively). The frequency of the DD genotype in EH patients with ischemic stroke was more than two-fold greater than those with uncomplicated EH (0.31 vs 0.13, p<0.02), and nearly four-fold greater than the control group (0.31 vs 0.09, p<0.02). Patients with ischemic stroke had the highest frequency of the D allele compared to EH patients without stroke and controls (0.56 vs 0.36 and 0.29 respectively, p<0.001). Patients with the DD genotype differed significantly from those with the II or ID genotypes with greater variability of systolic and diastolic BP, more common abnormal night BP profile, and increased carotid intima-media thickness.
Conclusion: In the Kirghiz population, the presence of the DD genotype is associated with higher ACE levels and increased risk for ischemic stroke as a complication of EH.

Objectives: We assessed endothelial dysfunction, a precursor finding of atherosclerosis, and its severity in relation with aminotransferase levels in patients with nonalcoholic fatty liver disease (NAFLD).
Study design: Fifty-two patients without chronic alcohol ingestion were found to have NAFLD on routine abdominal ultrasonographic examination. Aminotransferase enzyme levels were normal in 26 patients (mean age 47±10 years), and elevated in 26 patients (mean age 48±12 years). The brachial artery was examined with Doppler ultrasonography to determine endothelium-dependent flow-mediated dilation in response to reactive hyperemia. Nonendothelium-dependent vasodilation was assessed following sublingual nitroglycerine administration. The results were compared with those of a control group of 27 age- and sex-matched patients (mean age 52±11 years) without NAFLD.
Results: Patients with NAFLD had significantly higher fasting plasma glucose, HDL-cholesterol and total cholesterol levels, but the two patient groups did not differ in this respect. Baseline brachial diameters were similar in all the groups. Flow-mediated dilatation in response to reactive hyperemia significantly decreased in both patient groups compared to controls, but this decrease was more prominent in patients with an elevated aminotransferase level (p=0.03). No significant differences were found between the three groups following nitroglycerine administration (p>0.05). Multivariate analysis showed NAFLD as an independent determinant of reduced endothelium-dependent vascular relaxation (beta= -0.574, p=0.000).
Conclusion: Our data suggest that elevated aminotransferase enzyme levels in patients with NAFLD may predict endothelial dysfunction and the risk for cardiovascular events.

Objectives: This study, was designed to assess left ventricular systolic and diastolic functions with conventional and tissue Doppler echocardiography in patients with the coronary slow flow phenomenon (CSFP).
Study design: The study included 22 patients (12 males, 10 females; mean age 48±12 years) with angiographically diagnosed CSFP but with otherwise normal epicardial coronary arteries. Twenty-two subjects (14 males, 8 females; mean age 47±11 years) with angiographically normal coronary arteries constituted the control group. Left ventricular systolic and diastolic functions were assessed by conventional and tissue-Doppler echocardiography before angiography. The diagnosis of CSFP was made using the TIMI frame count (TFC) method. TIMI frame counts were determined for the left anterior descending (LAD), circumflex (Cx), and right coronary (RCA) arteries.
Results: Patients with CSFP had significantly higher values of corrected TFC for the LAD, TFC for Cx and RCA, and the mean TFC (p<0.001). There were no significant differences in ejection fraction and mitral annular peak systolic velocity between the two groups. Conventional echocardiography showed significantly lower maximal velocity of early diastolic filling (E), ratio of maximal early to late diastolic filling (E/A), and longer isovolumetric relaxation time (IVRT) in the patient group (p<0.01, p<0.001, and p=0.001, respectively). Maximal velocity of atrial diastolic filling (A) and deceleration time of early diastolic filling (DT) were similar. Among tissue Doppler parameters, Em and Em/Am were significantly lower (p<0.001); IVRTm (p=0.001) and DTm (p=0.02) were significantly higher in the patient group. TIMI frame counts were negatively correlated with E, E/A, Em, and Em/Am, and positively correlated with DT, IVRT, DTm, IVRTm, and E/Em.
Conclusion: Coronary slow flow phenomenon is associated with left ventricular diastolic and systolic dysfunctions, requiring a close follow-up in this patient group.

Objectives: The left internal mammarian artery (LIMA) is the most commonly used arterial graft for coronary artery bypass grafting (CABG) and occlusion of LIMA side branches during surgery is important for avoiding myocardial ischemia. In this study, we investigated the incidence of patent LIMA side branches in patients undergoing CABG and evaluated changes in LIMA flow with the use of TIMI frame count in patients with and without LIMA side branches.
Study design: The study included 38 patients (27 males, 11 females) who underwent coronary angiography due to symptoms and complaints that appeared after CABG. In all the patients, a LIMA graft was used for revascularization of the left anterior descending artery. Coronary angiographies were performed after a mean of four years following CABG. Angiograms were examined with respect to the presence of LIMA side branches and LIMI flow was assessed by the TIMI frame count method.
Results: Patent LIMA side branches were detected in seven patients (18.4%). The mean TIMI frame counts were 27.3±3.4 and 15.7±2.3 in patients with and without a LIMA side branch, respectively (p<0.0001). In all the patients, the side branch was at the level of the proximal third of the LIMA, having the same diameter (3.1±0.2 mm). Fourteen patients were evaluated by myocardial perfusion scintigraphy, six of whom had anterior ischemia. The incidence of anterior ischemia was 30% (3/10) for those without a side branch, and 75% (3/4) for those with a side branch.
Conclusion: We suggest that, in the presence of a LIMA side branch, LIMA flow may be used in assessing myocardial ischemia, and TIMI frame count is an objective means of measuring LIMA flow.

Hemorrhagic complications may occur after thrombolytic therapy. An 80-year-old woman was admitted with acute anteroseptal myocardial infarction (MI) at three hours of onset. Half-dose streptokinase (750,000 U) along with conventional MI agents was initiated. At 15 hours of hospitalization, the patient began to complain of abdominal pain and distention of increasing intensity. Abdominal computed tomography demonstrated a huge intraperitoneal hematoma, 15 x 14 x 12.5 cm in size, located anterior to the bladder, compressing the bladder. There was a dramatic decrease in hemoglobin level from 12.5 gr/dl (before thrombolysis) to 6.6 gr/dl. The anemia was corrected urgently with four units of blood transfusion. During follow-up, the size of the hematoma diminished and surgical intervention was not considered.

Infective endocarditis associated with permanent transvenous pacing is a rare but serious complication. A 64-year-old man was referred to our hospital with fever of unknown origin. Despite repeated antibiotic therapies, he sustained fever for a year without any documented infectious foci, and all blood cultures were negative. He had a history of permanent transvenous pacemaker (PM) implantation 20 years before, followed by two subsequent reimplantation procedures due to lead detachment. After unsuccessful efforts of percutaneous removal, all PM leads and wires were left in place. On admission, he was in sinus rhythm and the PM leads were completely dysfunctional. His temperature was above 38.5 °C. Transthoracic echocardiography findings were normal except for mild to moderate tricuspid insufficiency. Transesophageal echocardiography revealed a large vegetation, 19x13 mm in size, attached to the pacemaker leads, and multiple tiny vegetations over the anterior and septal leaflets. There was also moderate tricuspid insufficiency. Under cardiopulmonary bypass and aortic cross-clamping, infected pacemaker wires were removed and infected anterior and septal leaflets of the tricuspid valve were excised. Cultures from the PM wires and leaflets revealed methicillin-resistant Staphylococcus epidermidis. After 10 days of specific antibiotic therapy, tricuspid valve replacement was performed. During a follow-up of 17 months, the patient remained free of any cardiac events or fever.

Fungal endocarditis is a rare but serious disease with a high mortality rate, affecting mainly young patients. A 46-year-old man underwent emergency thromboembolectomy with a diagnosis of thromboembolism of the right femoral artery. During investigation into cardiologic causes, his fever was 37.8 °C and he had a 2/6 systolic ejection murmur. Echocardiography revealed a vegetation, 1.2 x 0.8 cm in size, on the noncoronary cusp of the aortic valve. The vegetation was removed surgically and the aortic valve was replaced with a mechanical valve. Upon isolation of Candida albicans in the surgical specimens, a diagnosis of fungal endocarditis was made and parenteral fluconazole treatment was instituted. After surgery, the patient’s fever persisted and blood cultures were positive for C. albicans. Abdominal computed tomography performed for abdominal pain showed a pseudoaneurysm in the right iliac artery and a thrombosed aneurysm in the left iliac artery. Peripheral angiography revealed an aneurysm and occlusion in the right external iliac artery, total occlusion in the right common femoral artery, and an occlusion and dissection in the left external iliac artery. There was also an infarct area in the peripheral spleen, measuring 4 cm. The patient’s general condition showed a rapid deterioration and he died before any surgical intervention could be performed.

Obstrüktif uyku apne sendromu (OUAS) toplumda çok sık görülen, birçok kardiyovasküler hastalığın etyopatogenezi ve ilerlemesinde rol oynayan bir hastalıktır. Hastalığın tanınması ve tedavisi ile medikal tedaviye yanıtsız birçok kardiyovasküler hastalık tedavi edilebileceği gibi, nedenini henüz bilmediğimiz birçok hastalığın ortaya çıkması da engellenebilecektir. Bu derlemede, Sağlık Bakanlığı’nın OUAS’yi kardiyologları ilgilendiren hastalıklar arasına alması nedeniyle, konu hakkındaki yayınların gündeme getirilmesi amaçlandı.

We report a 76-year-old woman presented with a 54 x 66 mm multivesicular cardiac hydatid cystic mass located in right heart chambers demonstrated by two-dimensional echocardiography and magnetic resonance imaging. This case stresses the importance of MRI differentiating multivesicular cardiac hydatid cyst with a solid mass image which contains less liquid and more scolexes from cardiac tumours especially angiosarcoma.

A 53-year-old woman with prominent calcific constrictive pericarditis on left lateral telecardiogram was reported as an image.