Objective: Ultrasonic tissue characterization, based on the measurements of integrated backscatter (IBS) analysis, has the potential to provide quantitative information which could characterize the functional and structural state of cardiac muscle. In this study we aimed to determine whether the integrated backscatter is measurable and quantifiable in left ventricular walls in patients with dilated cardiomyopathy (DCMP) and can be used to identify changes in myocardial structure and contractility. Methods: We studied 32 subjects: 16 patients with idiopathic dilated cardiomyopathy who were free of atrial fibrillation, bundle branch block and valvular heart disease (12 male, 4 female, mean age 48±18) and 16 healthy volunteers (10 male, 6 female, mean age 46±8). Left ventricular diastolic and systolic diameters, septum and posterior wall (PW) systolic and diastolic thickness were measured in the parasternal long axis view with M-mode echocardiography. Ejection fraction (EF), fractional shortening (FS), septum and posterior percent wall thickening (WT%) were calculated in the parasternal long axis view with M-mode echocardiography. Real time IBS was measured from the parasternal long axis view of the left ventricle at the level of basal posterior and septal walls. Mean IBS was expressed as averaged IBS values and cyclic variation of IBS (CVIBS) was expressed as the difference between end-diastolic (peak) and end-systolic (nadir) IBS values averaged over all cardiac cycles. Results: CVIBS values obtained from septum and PW in idiopathic DCMP group were statistically different from control group (p=0,003, p<0,001, respectively). Septal and PW mean IBS values in idiopathic DCMP group were greater and statistically different from control group (p<0,05). Septum and PW CVIBS values correlated with WT%, EF and FS positively. But, septum and PW mean IBS values did not correlate with WT%, EF and FS. Conclusion: CVIBS and mean IBS values which were obtained with IBS method may be useful to determine myocardial contractile performance and myocardial structural properties, respectively.
Objective: The determination of high risk patients for sudden death and sustained ventricular tachycardia after acute myocardial infarction constitutes the main goal to decrease morbidity and mortality. Every attempt that decreases the frequency of late potentials (LPs) on signal averaged ECG (SAECG) and corrected QT dispersion (QTc-d) may improve prognosis of patients. In this study, the effect of metoprolol on frequency of LPs and QTc-d was investigated. Methods: Thirty-five patients (mean age 53±9 years) with acute myocardial infarction who were not given thrombolytic therapy were enrolled. Patients in whom metoprolol was not administered formed group I (n=20) and patients who were given metoprolol constituted group II (n=15). Metoprolol was administered as an initial dose of 15 mg intravenously, following 6-8 hours 100 mg/d orally. To determine the frequency of LPs, SAECG records were performed on admission and at the end of the first week. At the same time, resting ECG recordings (12 leads, 50 mm/s) were obtained to calculate QTc-d. Variance analysis was used for statistical analysis. Results: In group I; frequency of LPs were found 30% on admission and at the end of the first week. In group II; frequency of LPs were 6% on admission and at the end of the first week there was no LPs. There was no statistically significant difference between two groups according to TQRS, RMS-40, LAS40 and QTc-d. Conclusion: Metoprolol decreases the frequency of LPs. It has no effect on cQT-d.
Kenan Sönmez, Mustafa Akçakoyun, Durmuş Demir, Orhan Hakan Elönü, Özgür Onat, Nilüfer Ekşi Duran PMID: 12101790Sayfalar 18 - 23
Objective: The aims of our study were to assess the distribution of interventional and other therapeutic procedures performed on subjects who had proven CAD by angiography in our clinic; to determine the groups of therapeutic agents prescribed at the time of discharge; and to compare these with the results of EUROASPIRE II, which examined the prophylactic drug therapy upon discharge of CAD patients in 15 European countries. Methods: Our patients comprises of 617 subjects (516 male, 101 female; mean age 57.2 ± 10.8 years) who underwent coronary angiography for the first time in our clinic and who were found to have a ≥50% lesion in at least one of the coronary arteries. In all patients distribution of risk factors on admission, distribution of therapeutic procedures and the use of drug therapies at the hospital discharge were recorded. Results: We found that, 68% of our cases were considered to be eligible for a percutaneous or surgical intervention, while 27% were assessed not as requiring such an intervention and consequently were discharged being prescribed appropriate medications. For the remaining 5% of the subjects, tests for detection of viable myocardium were advised, before selecting the proper type of management. At discharge, prescription rates for antiplatelets, beta-blockers, nitrates, statins, angiotensin-converting enzyme inhibitors (ACE-I), calcium channel blockers and anticoagulants were detected to be %99, 86%, 86%, 63%, 40%, 16%, and 2% respectively. Conclusion: Compared with the results of EUROASPIRE II study, these data show that, antiplatelet, beta-blocker, ACE-I and lipid-lowering treatments our subjects received upon discharge were higher, whereas anticoagulant treatment was lower than the averages of the fifteen European countries consisting the EUROASPIRE II study.
Fatih İslamoğlu, Anıl Z. Apaydın, Mustafa Özbaran, Münevver Yüksel, Ali Telli, İsa Durmaz PMID: 12101791Sayfalar 26 - 34
Objective: The aim of this study was to determine the risk factors affecting the mortality and morbidity after coronary artery bypass grafting (CABG) in patients with LV dysfunction and without any viability assessment. Methods: The preoperative, perioperative, and postoperative early and mid-term follow-up data of 252 patients with left ventricular ejection fraction (LVEF) of £30% who underwent isolated CABG from 1995 through 2000, were evaluated. No preoperative viability study was performed for patient selection. Preoperative echocardiography and cardiac catheterization, and postoperative control echocardiography were performed in all patients. Follow-up data after the discharge of these patients were obtained via monthly periodical examinations in the first 6 months, and thereafter via telephone interviews. As preoperatively, 229 (90.87%) patients were in NYHA class III or IV, and the mean LVEF was 26.58±3.66%. Results: Overall mortality and late mortality rates were 16.27% and 5.16%, respectively. Postoperative complications were observed in 61 (24.21%) patients. During 49.06±15.17 months of follow-up, 185 (93.43%) of 198 (78.57%) survived patients were in NYHA class I or II and the mean LVEF was 39.64%±5.68%. Advanced age, diabetes, hypertension, cross-clamp time >60 min, bypass time>120 min, severity of angina and functional classes (class III-IV of NYHA and CCS) were found to be the determinants of mortality. However, by multivariate analysis only older age and class III-IV of NYHA and CCS were detected as predictors of mortality. Conclusion: The low mortality and morbidity rates as well as postoperative improvements in functional capacity and in LVEF support the use of CABG without the need of any viability assessment in patients with left ventricular dysfunction. Advanced age, severe angina and functional symptom status seem to be the predictors of poor prognosis in these patients after CABG.
Emin Özyurt, Şöhret Ali Oğuzoğlu, Ahmet Hilmi Kaya, Taner Tanrıverdi, Rasim Enar, Dinçer Uçak PMID: 12101793Sayfalar 40 - 44
Objective: To demonstrate that microvascular decompression of the left medulla oblongata is a safe and effective treatment modality in the treatment of essential hypertension. Methods: Two patients with medically refractory hypertension underwent microvascular decompression of the left rostral ventrolateral medulla oblongata. Causes such as renal diseases, carcinoid syndrome, pheochromocytoma were ruled out before surgery. Indications for surgery included mainly systolic blood pressures greater than 180 mm Hg or uncontrolled blood pressures under three or more medications. Results: Both patients experienced more than 20 mm Hg reduction in systolic blood pressure although the number of medications was decreased after surgery. Conclusion: Microvascular decompression of the left rostral ventrolateral medulla oblongata may be an effective modality in the treatment of essential hypertension.
İzzet Tandoğan, Mehmet İleri, Ertan Yetkin, Ahmet Temizhan, Dursun Aras, Alpay Turan Sezgin, Funda Bıyıkoğlu, Ali Şaşmaz PMID: 12101794Sayfalar 45 - 48
Objective: The aim of this study was to investigate the effects of widely used mobile telephones on the functions of implantable cardioverter-defibrillators (ICD). Methods: The study included 9 patients (2 women, 7 men, mean age 65.5±6) with coronary artery disease who had underwent transvenous ICD implantation due to sustained ventricular tachycardia and/or fibrillation. First the test was performed on the basal conditions of ICD. Then, spontaneous heart rate of the patient was programmed to 10 beats/minute on VVI mode and the test was repeated. Two mobile telephones were located symmetrically 50 cm, 30 cm, 20 cm and 10 cm away from the ICD pocket in the pectoralis muscle and finally the mobile telephones antennas were touched to the pockets. On these different distances, the test was repeated during opening, standby, calling, talking and closing of the telephones. Possible ICD dysfunctions such as improper antitachycardic shock, inhibition of pacemaker functions, conversion to ventricular asynchronous mode (VOO) and development of ventricular trigger in devices with two chamber pacemaker functions were tested. The changes were observed on intracardiac and surface ECGs. Results: There were no changes in the basal and pacemaker functions of ICDs and no symptoms in any patients. Conclusion: We have concluded that mobile telephones have no adverse effects on the functions of types of ICD assessed in the study.
Turhan Yavuz, Ali Kutsal PMID: 12101795Sayfalar 50 - 54
Graft occlusions are the main problems that may arise during long-term follow-up period after coronary artery bypass surgery. Knowledge of pathologies developed in saphenous grafts and attempts to reduce their frequency are important for reduction of the incidence of saphenous graft vein occlusions. For today the patency rate for 10 years saphenous vein grafts are about 60%. Along with intraoperative technical factors, there are a lot of factors contributed to the development occlusion during long-term follow-up period. In this review we aimed to analyze the factors affecting saphenous vein pathologies and propose preventive measures.
Atrial fibrillation (AF) is a common clinical problem, particularly in the elderly, and in patients with organic heart disease. A small percentage of patients, have a potentially reversible cause. Atrial fibrillation is in most patients (approximately 70%) associated with chronic organic heart disease including valvular heart disease, coronary artery disease, hypertension, particularly if left ventricular hypertrophy is present, hypertrophic cardiomyopathy, dilated cardiomyopathy and congenital heart disease and most commonly in adults, atrial septal defect. As in many chronic conditions, determining whether AF is the result or is unrelated to the underlying heart disease, remains unclear. The list of possible etiologies also include cardiac amyloidosis, hemochromatosis and endomyocardial fibrosis. Other heart diseases, such as mitral valve prolapse (with or without mitral regurgitation), calcification of the mitral annulus, atrial myxoma, pheochomocytoma and idiopathic dilated right atrium, present a higher incidence of AF. The relationship between these findings and the arrhythmia are still unclear. Atrial fibrillation may occur in the absence of detectable organic heart disease, the so-called "lone AF", in about 30% of cases. The term lone AF or "idiopathic AF" implies the absence of any detectable etiology including hyperthyroidism, chronic obstructive lung disease, overt sinus node dysfunction, and overt or concealed preexcitation (Wolf-Parkinson-White syndrome), only to mention a few of other rare causes of AF. In every instance of recently discovered AF, thyrotoxicosis should be ruled out. The autonomous nervous system may contribute to the occurrence of AF in some patients. Atrial fibrillation occurs commonly in patients with valvular heart disease, particularly when it involves the mitral valve. The occurrence of AF is unrelated to the severity of mitral stenosis but is more common in patients with enlarged left atrium and congestive heart failure. In patients with coronary artery disease, AF occurs predominantly in older patients, males and patients with left ventricular dysfunction. Important predictive factors of AF include hypertension, left ventricular hypertrophy and diabetes. However, the relation between AF and hypertension remains unclear. The risk of the development of AF, in an individual patient, is often difficult to assess but increasing age, presence of valvular heart disease and congestive heart failure, increase the risk of AF.
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