The Effect of Dobutamine Stress on Left Ventricular Outflow Tract Gradients in Hypertensive Patients with Basal Septal Hypertrophy

Basal septal hypertrophy (BSH), a cause of left ventricular outflow tract (LVOT) obstruction, is thought to occur by increased ventricular dynamics. The aim of the study was to evaluate the effect of pharmacologic stress on LVOT gradients in a group of hypertensive patients with BSH. Dobutamine stress was used in 24 hypertensive patients (mean age 56 ±8 years; 11 women) with BSH and 20 normal controls (mean age 54 ±9 years; 7 women). Ejection fraction and myocardial mass, basal septal dimension, and LVOT diameter were measured with 2-dimensional echocardiography. LVOT velocities and transmitral velocities before and at peak dobutamine infusion were determined by continuous wave Doppler and pulsed Doppler, respectively. There were no differences in mean ejection fraction and myocardial mass between BSH patients (58 ±3%, 204 ±24 g) and normals (56 ±4%, 201 ±32 g). The basal septum was thicker in patients (1.55 ±0.2 cm) than in normals (1.03 ±0.1 cm, p<0.001). Maximum LVOT velocities were similar in BSH (1.2 ±0.4 m/sec) and normals (1.1 ±0.2 m/sec) at rest. At peak stress, maximum LVOT velocities were higher in BSH (3.3 ±0.6 m/sec) than normals (1.7 ±0.4 m/sec, p<0.001). LV rate-pressure product at peak stress was higher in BSH (23,326 ±4,388) than normals (17,592 ±2,409, p<0.001). LV isovolumetric relaxation time was prolonged, and the E/A ratio was decreased in the patients at rest (130 ±14 msec and 0.72 ±0.18, respectively, p<0.001). At peak stress, diastolic function did not significantly change in two groups. The correlations between LVOT velocity change by stress and mean LVOT diameter ( r =-0.668, p<0.001) and mean BS thickness ( r =0.610; p<0.001) were significant in the whole group. High velocities appeared on LVOT at peak pharmacologic stress in the hypertensive patients with BSH compared with control group. This suggests dynamic ventricular ejection by stress may contribute to hypertrophy of the basal segment, which is the closest part of septum to increased afterload.

Measurement of radioactivity levels and assessment of radioactivity hazards of soil samples in Karaman, Turkey

In this study, the levels of the natural and artificial radioactivity in soil samples collected from surrounding of Karaman in Turkey were measured. Activity concentrations of the concerned radionuclides were determined by gamma-ray spectrometry using a high-purity germanium detector with a relative efficiency of 40 % at 1.332 MeV. The results obtained for the (238)U series ((226)Ra, (214)Pb and (214)Bi), (232)Th series ((228)Ac), (40)K and fission product (137)Cs are discussed. To evaluate the radiological hazard of radioactivity in samples, the radium equivalent activity (Raeq), the absorbed dose rate (D), the annual effective dose and the external (Hex) and internal hazard index (Hin) were calculated and presented in comparison with the data collected from different areas in the world and Turkey.

Pravastatin therapy fails to suppress post-PCI inflammatory response measured by serum neopterin and CRP levels

OBJECTIVE

Percutaneous coronary intervention (PCI) is known to induce both local and systemic inflammatory states. In addition to lowering lipid levels, statins exert well-proven anti-inflammatory effects. We investigated the effects of pravastatin on serum C-reactive protein (CRP) and neopterin levels in the short term after elective PCI.

METHODS

In this randomized prospective study, 93 patients undergoing elective PCI were enrolled. Group 1 (n=30) received pravastatin at a dose of 10 mg/day, Group 2 (n=29) was given 40 mg/day, and Group 3 (n=34) served as the control group and received no lipid-lowering drugs. Blood samples were drawn before and after PCI to measure serum CRP and neopterin levels. Differences among the groups for continuous variables were evaluated by the ANOVA and the Kruskal-Wallis test as appropriate. The Chi-square test was used for comparison of categorical variables.

RESULTS

Demographic features and the characteristics of the PCI, including the number of vessels and lesions and the duration and number of inflations, did not differ among groups (p>0.05). Serum CRP and neopterin levels were significantly increased after PCI (p<0.001). Mean serum neopterin levels before and after the PCI were as follows: Group 1: 13.3±5.9 vs 22.8±15.4 nmol/L, Group 2: 16.9±10.2 vs 22.0±14.9 nmol/L, controls: 15.2±11.9 and 18.8±11.5 nmol/L. Prior pravastatin therapy had no significant effect on these inflammatory markers (F=0.5, p=0.6).

CONCLUSION

Percutaneous coronary intervention induces a pronounced inflammatory response. The pre-procedural administration of 2 different doses of pravastatin seems not enough to suppress this inflammation at the short-term follow-up. Further trials are needed to clarify this issue.

The severity of coronary atherosclerosis in diabetic and non-diabetic metabolic syndrome patients diagnosed according to different criteria and undergoing elective angiography

Our aim in this study was to evaluate the relationship between metabolic syndrome (MS) as defined by different criteria and the severity of coronary lesions in a sample of diabetic and non-diabetic patients undergoing elective coronary angiography. All patients had blood and urine tests, physical examinations were performed before angiography, and finally they were classified based on three criteria (World Health Organisation-WHO, Adult Treatment Panel-ATP III and International Diabetes Federation-IDF). Eighty-eight patients were diabetic, and 96 patients were non-diabetic. Among all patients, diabetics had significantly higher Gensini scores (P < 0.001). According to WHO criteria (P = 0.005) and IDF criteria (P = 0.015) metabolic syndrome patients had higher Gensini scores, but for ATP III criteria difference was not significant. When we evaluated diabetics and non-diabetics separately, non-diabetic patients with MS had significantly higher scores with WHO definition (P = 0.015) and mildly higher but not significant values with other MS criteria (P = 0.057 for both IDF and ATP III). Neither any one of MS components nor gender revealed significant relationship with coronary disease severity. In our study with a cohort of Turkish patients undergoing elective coronary angiography; we concluded that MS should be taken into consideration, especially in non-diabetic patients.

Glycoprotein IIIa gene polymorphism and coronary artery disease

OBJECTIVE

Prevalence of glycoprotein IIIa gene polymorphisms (PIA2) has been reported to be elevated in persons who die of sudden death. PIA2 has been suggested as contributing to the development of atherosclerosis via coronary plaque rupture and thrombus formation. In this prospective study, we investigated the correlation between the PIA2 polymorphism, atherosclerotic plaque burden, and its prognostic significance.

METHODS AND RESULTS

One hundred and seventy-eight patients (mean age 51 +/- 9.6 years) suspected to have atherosclerotic coronary artery disease underwent a coronary angiography and were evaluated for gene polymorphisms. Patients were followed up for 4 years for major adverse cardiac events (MACE). Thirty-eight patients (21%) had the PIA2 polymorphism.There was no statistically significant correlation between presence of atherosclerotic plaque burden, severity of coronary artery stenosis, and glycoprotein genotype. During the follow-up there were no significant differences between the 2 groups with regard to MACE. Any cause of death and cardiovascular death were higher in patients with PIA2 polymorphism but these differences were not significant. On univariate analysis, smoking, presence of severe coronary artery disease, and presence of myocardial infarction were correlated with elevated risk of MACE; presence of atypical angina was correlated with fewer MACE. On multivariate analysis, smoking was an independent risk factor for a MACE. On univariate or multivariate analysis, there was no relation between the PIA2 polymorphism and a MACE.

CONCLUSIONS

The glycoprotein IIb/IIIa genotype was not shown to indicate the presence of atherosclerotic plaque. There was no correlation between the genotype and plaque vulnerability.

Persistent atrial standstill and idioventricular rhythm in a patient with thalassemia intermedia

We present a 57-year old male patient with thalassemia intermedia and right heart failure. He had a 30-year history of anemia and short-term iron therapy without blood transfusion. Hemoglobin level was 7.1 g/dl and hematocrit was 22.7%. White blood-cell and platelet counts, and serum ferritin level were normal. Electrocardiography showed irregular narrow QRS bradyarrhythmia, suggesting slow atrial fibrillation at a mean rate of 35 beats/min. Echocardiographic examination revealed dilatation of the right atrium and ventricle, depressed systolic right ventricular function, advanced tricuspid regurgitation, and mild pericardial effusion. In the electrophysiologic study, no electrical activity was recorded in the right atrium. It was inexcitable at multiple sites and no retrograde conduction to the right atrium could be elicited by ventricular pacing. His bundle (HB) recording showed fixed retrograde HB activation with ventricular rhythm originating from different foci. Retrograde V-H conduction time during ventricular rhythm was 95 msec and did not change. There was no retrograde nodal conduction. A VVIR pacemaker was implanted. During a six-month follow-up, he felt well, his functional capacity was NYHA class II, and his basic rhythm was widened QRS arrhythmia with a rate of 20 beats/min. To the best of our knowledge, atrial electrical inactivity together with right-heart failure and pericarditis confined to the right heart chambers has hitherto not been reported in thalassemic disorders.

The effects of prior calcium channel blocker therapy on creatine kinase-MB levels after percutaneous coronary interventions

Background:

Use of intracoronary calcium channel blockers (CCBs) during percutaneous coronary intervention (PCI) has been shown to have favorable effects on coronary blood flow. We aimed to investigate the effects of CCBs administrated perorally on creatine kinase-MB (CK-MB) levels in patients undergoing elective PCI.

Methods:

A total of 570 patients who underwent PCI were evaluated for CK-MB elevation. Patients who were on CCB therapy when admitted to the hospital constituted the CCB group. No CCBs were given to the rest of the patients during the periprocedural period and these patients served as the control group. Blood samples for CK-MB were obtained before and at 6 h, 24 h, and 36 h after the procedure.

Results:

217 patients were in the CCB group (mean age 60.2 ± 9.3 years, 162 males), and 353 were in the control group (mean age 60.0 ± 10.1 years, 262 males). CK-MB levels increased above the normal values in 41 patients (18.9%) of the CCBs group and in 97 patients (27.5%) of the control group (p = 0.02). Median CK-MB levels were significantly higher in the control group for all studied hours (for all p < 0.05).

Conclusions:

Prior oral CCB therapy may have favorable effects in preventing myocyte necrosis after elective PCI.

Reperfusion arrhythmias: are they only a marker of epicardial reperfusion or continuing myocardial ischemia after acute myocardial infarction?

Reperfusion arrhythmias are associated with epicardial reperfusion but may also be a sign of vascular reperfusion injury which can be seen as no-reflow phenomenon on coronary angiography and predicts in-hospital complications and recovery of left ventricular (LV) function. No-reflow phenomenon (thrombolysis in myocardial infarction [TIMI] <or=2 flow) is frequently observed in patients after mechanical or medical reperfusion procedures for acute myocardial infarction (AMI). The authors hypothesized that reperfusion arrhythmias (or peri-infarct arrhythmias) may be related to continuing myocardial ischemia. They documented all arrhythmia episodes in patients with AMI and compared arrhythmia rates in different therapy groups. They also compared arrhythmia rates according to TIMI flow achieved and those after MI. The highest arrhythmia rate was detected in patients to whom thrombolytic therapy was given for AMI (64%). The arrhythmia rate was lower in patients with primary PCI performed for AMI (46.2%) than in those receiving thrombolytic therapy. The arrhythmia rates according to therapy modalities for AMI were significantly different (p < 0.01). The achieved mean TIMI flow with primary PCI (2.46 +/-0.21 ) was higher than the mean flow achieved after thrombolytic therapy (2.12 +/-0.16). When compared to the arrhythmia rate according to TIMI flow, it was shown that the lowest arrhythmia rate was found in patients with TIMI 3 flow (17.2%) achieved with any procedure after AMI. The arrhythmia rate was 84% in patients with TIMI 2 flow and 33.3% with TIMI 0-1 flow (p <0.001). The arrhythmia rate was appreciably lower after 48 hours of MI. This finding suggests that the continuing myocardial ischemia represented by TIMI flow at the coronary angiography after acute myocardial infarction may have an important role in the pathogenesis of reperfusion arrhythmias.

High-pressure pulmonary artery aneurysm and unilateral pulmonary artery agenesis in an adult

The presence of a pulmonary artery aneurysm, major aortopulmonary and coronary-pulmonary collateral vessels, and severe pulmonary hypertension in an adult with unilateral pulmonary artery agenesis and previous patent ductus arteriosus ligation is very rare. A 34-year-old man experienced these conditions. When he was 10 years old, catheterization and angiography revealed right pulmonary artery agenesis, dilation of the main pulmonary artery, multiple collateral vessels extending from the aorta to the right pulmonary system, and a patent ductus arteriosus (shunt ratio, 3.57) that was then ligated; the other conditions were not corrected. This adult patient was in New York Heart Association functional class II; mild central cyanosis was detected only during exercise. The right pulmonary arterial system was seen only at the right hilar area via collateral vessels from the subclavian, bronchial, internal mammary, and intercostal arteries. Angiography revealed collateral vessels from the right and circumflex coronary arteries to the right pulmonary system. The right intraparenchymal pulmonary arterial systems were patent but of small diameter (pulmonary artery pressure, 85 mmHg; ratio of peak right-to-left ventricular pressure, 0.94; peak pulmonary pressure unresponsive to 100% oxygen). Pulmonary vascular resistance was not estimated because of the risk of aneurysmal rupture. We concluded that irreversible pulmonary hypertension had developed (delayed by the patent ductus arteriosus ligation in childhood) and that the patient's only chance for survival was heart-lung transplantation. To sustain the patient until surgery, we administered sildenafil. Herein, we describe the vascular conditions that accompany unilateral absence of the pulmonary artery, and therapeutic methods.

Effect of dobutamine stress on basal septal tissue dynamics in hypertensive patients with basal septal hypertrophy

Left ventricular outflow tract (LVOT) obstruction has been classically observed in hypertrophic cardiomyopathy in which the LVOT obstruction is associated with asymmetric septal hypertrophy producing a systolic pressure gradient across the LVOT. Basal septal hypertrophy (BSH) with hypertension may result in dynamic LVOT obstruction as well. It was suggested that regional hypertrophy may be related to enhanced ventricular dynamics.

Effects of metoprolol therapy on cardiac troponin-I levels after elective percutaneous coronary interventions

AIMS

Beta-blockers (BBs) have been shown to improve survival and reduce the risk of re-infarction in patients following myocardial infarction. There are conflicting data about the effects of BB therapy on cardiac biomarkers after percutaneous coronary interventions (PCIs). The aim of the study was to investigate the effects of BB use on cardiac troponin-I (cTnI) levels in patients who had undergone elective PCI.

METHODS AND RESULTS

In this prospective study, 287 patients with coronary artery disease were included. Patients were randomized either to BB or control groups prior to the intervention. Blood samples for cTnI were obtained before and at 6, 24, and 36 h after the procedure. Of the 287 patients included, 143 received metoprolol succinate 100 mg/day, and 144 received no BB and served as the control group. Baseline clinical characteristics of both groups, except for history of coronary artery bypass graft surgery, were similar. We observed no significant difference in the elevation of cTnI levels between the two groups after PCI (BB group, 17 patients, 11.9%; control group, 10 patients, 6.9%; P=0.2).

CONCLUSION

Metoprolol succinate therapy seems to have no cardioprotective effect in limiting troponin-I rise after PCI.

Clinical and hemodynamic follow-up of a patient after operation for dissection of an ascending aortic aneurysm secondary to coarctation of the aorta

We present clinical follow-up of a 20-year-old male with an aortic aneurysm secondary to aortic coarctation. The diagnosis of aortic aneurysm secondary to aortic coarctation was made in 1997. The patient did not agree to undergo any invasive or therapeutic procedures at that time. He presented to an emergency unit with severe chest pain after chest trauma obtained during judo exercises in 1998. Two-dimensional echocardiography showed bicuspid aortic valves, an ascending aortic aneurysm 6 cm in diameter with an intimal flap and false lumen, aortic coarctation distal to the left subclavian artery, and aortic insufficiency secondary to annular dilatation. Type II aortic dissection was confirmed by transesophageal echocardiography, which showed the dissection was confined to the ascending aorta. The dissection extended to the beginning of the arcus aorta. Following stabilization of the patient's clinical condition, balloon coarctation angioplasty was performed to reduce afterload and hypertension and to facilitate femoral artery cannulation for cardiopulmonary bypass. Surgical procedures included resection of the aortic valve and prosthetic valve implantation, resection of the ascending aorta, and interposition of a 22 mm Hamashied tubular vascular graft. At a follow-up visit 6 years later, the patient reported being easily fatigued and having palpitations. He had been suffering from hemolytic anemia and mild renal function impairment. Cardiac catheterisation and angiography showed a 40 mmHg gradient due to kinking of the aortic graft and no gradient at the coarctation site. We postulated the kinking of the aortic vascular graft may be related to an inappropriate vascular graft length. We also thought that the severe hemolysis was attributable to the disturbance of blood flow by a jet of blood at the site of the kinking aortic vascular graft. A second operation was performed because the renal function of the patient had decreased progressively and hemolysis symptoms increased. After the second operation, hemolysis on peripheral blood smears had disappeared and renal function had shown progressive improvements.

The effects of prior beta-blocker therapy on serum C-reactive protein levels after percutaneous coronary intervention

BACKGROUND

There are no studies in the literature related to the effect of beta blockers (BB) on changes in C-reactive protein (CRP) levels after percutaneous coronary intervention (PCI).

HYPOTHESIS

We designed a prospective randomized study to investigate the impact of BB therapy on CRP in patients who underwent elective PCI.

METHODS

In all, 300 patients with coronary artery disease were included. Patients were randomized to either a metoprolol or to a control group before PCI. Blood samples for CRP levels were obtained before BB treatment, and at the 6th, 24th, and 36th h after PCI.

RESULTS

Of 300 patients, 150 received metoprolol 100 mg/day (mean age, 59.0 +/- 10.2 years; 106 men, 44 women), and 150 received no BB (mean age, 59.8 +/- 9.8 years; 114 men, 36 women) and served as the control group. Baseline clinical characteristics of both groups were similar. Basal CRP levels between the two groups were similar. Of the patients included in the study, 40.8% in the BB group and 39.6% in the control group had elevated basal CRP levels. The CRP levels increased above baseline values in 85% of patients in the BB group and in 89.3% of patients in the control group (p > 0.05) during follow-up. The CRP levels in patients in the BB group at the 6th, 24th, and 36th h were lower than those in the control group; however, this difference did not reach statistical significance.

CONCLUSIONS

Prior BB therapy seems to have no effect on CRP levels after PCI.

Serum levels of cardiac enzymes before and after renal transplantation

BACKGROUND

Cardiac troponins are very sensitive and specific indicators of myocardial damage; however, they are sometimes found to be increased in patients with end-stage renal disease (ESRD).

HYPOTHESIS

The aim of this study was to determine cardiac troponin I (cTpI) and creatine kinase myocardial isoform (CK-MB) levels and to assess their diagnostic and prognostic importance before and after renal transplantation.

METHODS

Thirty-four patients with ESRD (mean age 31.8 +/- 8.6 years, 11 women) were enrolled. Serum levels of cTpI and CK-MB were measured pre- and postoperatively on Days 1, 7, and 30. Patients were followed up for cardiac events, and possible myocardial damage was investigated by exercise thallium-201-labeled myocardial perfusion scintigraphy. Mean cTpI levels were 0.24 +/- 0.11 ng/ml (preoperative), and 0.34 +/- 0.27 ng/ml (Day 1), 0.26 +/- 0.11 ng/ml (Day 7), and 0.28 +/- 0.30 ng/ml (Day 30).

RESULTS

Compared with preoperative levels, cTpI was increased in 16 (47%), decreased in 6 (17.6%), and did not change in 12 (35.4%) patients. However, the increase did not exceed the myocardial infarction reference level of 2.3 ng/ml in any patient. Mean CK-MB levels were 12.6 (8.7U/l (preoperative), and 16.8 +/- 9.2U/l (Day 1), 16.3 +/- 8.1U/l (Day 7), and 13.3 +/- 6.6U/l (Day 30). Creatine kinase-MB was increased to above normal levels of 24 U/l in 13 (38.2%) patients on postoperative Days 1 or 7, and decreased to normal at the end of Month 1. No cardiac events occurred, and there was no abnormality in any patient on thallium scintigraphy.

CONCLUSION

There was no significant difference in the levels of cTpI in patients with ESRD without cardiac events before and after renal transplantation (p > 0.05). Our findings show that cTpI has very high sensitivity and specificity for detecting cardiac damage in patients with ESRD after renal transplantation.

Beta blocker effects on plasma homocysteine levels in patients with hypertension

Recent studies have shown that hyperhomocysteinemia might play a role in the pathogenesis of hypertension. The effects of antihypertensive agents on plasma homocysteine levels have not been tested extensively. We investigated the effects of beta-blocker therapy on homocysteine levels in patients with hypertension. In the study, 120 patients with newly diagnosed hypertension were enrolled. All patients received metoprolol succinate 100 mg/day initially. If blood pressure was above normal on the 15th day of follow-up, the metoprolol dosage was doubled. Before initiation of the antihypertensive medication and after the fourth month of treatment, homocysteine levels were measured. Of the 120 patients enrolled, 39 could not complete the study. Homocysteine levels decreased significantly by the end of the fourth month when compared with basal values (13.5+/-4.5 micromol/l versus 12.4+/-4.9 micromol/l; P = 0.001). There was no relation between homocysteine level and blood pressure control. There was a significant decrease in homocysteine levels in the women treated in this study (P = 0.001); however, this effect was absent in men (P = 0.185). We demonstrate that metoprolol succinate treatment significantly decreases plasma homocysteine levels in patients with hypertension, especially in women.

Comparison of intermittent with continuous simvastatin treatment in hypercholesterolemic patients with end stage renal failure

Coronary artery disease is the most important cause of morbidity and mortality in patients with end-stage renal failure (RF). Hypercholesterolemia is an important risk factor for coronary heart disease. Patients with chronic renal failure (CRF) have difficulties in compliance with their care and treatment. Intermittent simvastatin treatment may help to increase compliance and can be a treatment alternative in patients with CRF at risk of coronary artery disease. We investigated the effects of simvastatin and compared intermittent with continuous simvastatin treatment in hypercholesterolamic patients with CRF. The study group included 40 of 422 CRF patients on dialysis in our clinic. The inclusion criterion was low density lipoprotein cholesterol (LDL-C) of 130 mg/dL or more. Twenty patients received simvastatin 10 mg/day (continuous group) and 20 patients received simvastatin 20 mg three times a week (only dialysis days- intermittent group) for four months. Nineteen patients served as controls and they were given a prescribed diet only. Total cholesterol (TC) and LDL-C decreased markedly in patients receiving intermittent and continuous simvastatin compared to controls. Continuous simvastatin decreased TC by 23% (P < 0.001) and LDL-C by 39% (P < 0.001). Intermittent simvastatin decreased TC by 26% (P < 0.001) and LDL-C by 40% (P < 0.001). The atherogenic index ratios in both the continuous and intermittent groups (TC/High density lipoprotein-cholesterol (HDL-C) and LDL-C/HDL-C) decreased significantly. There was no significant difference in patient compliance between the two groups. Intermittent simvastatin is as effective and reliable as continuous simvastatin treatment and can be an alternative treatment in hypercholesterolemic patients on dialysis.

[The effects of simvastatin combined with different antioxidant vitamin regimens on serum lipid profile in patients with low HDL cholesterol levels]

OBJECTIVE

This study was designed to compare the effects of simvastatin versus a combination of simvastatin with vitamin C or E on serum lipid profile, particularly, high-density lipoprotein (HDL)-cholesterol (C) level, in patients with a low HDL-C level.

METHODS

Fifty-nine women and 49 men, who had a baseline HDL-C level equal to or lower than 40 mg/dl were randomized to one of the following study treatment groups: Group S (n=39) simvastatin 20 mg/day, Group S+C (n=33) simvastatin 20 mg/day + vitamin C 500 mg/day, and Group S+E (n=36) simvastatin 20 mg/day + vitamin E 400 IU/day. The groups' lipid profiles were obtained at baseline, 3rd and 6th months.

RESULTS

Comparing with baseline values, total-C and low-density cholesterol (LDL-C) values significantly reduced (p<0.001) and HDL-C values significantly increased (Group S--33.9+/-3.9 mg/dl vs. 39.8+/-6.9 mg/dl, Group S+C--34.2+/-3.5 mg/dl vs. 38.1+/-6.1 mg/dl, Group S+E--33.1+/-3.6 mg/dl vs. 34.8+/-5.9 mg/dl, p<0.001) on therapy within the groups; however, there were no significant differences among the groups with regards to these parameters. The HDL-C levels increased from baseline by 14.0%, 11.7% and 10.2% in Group S, S+C, and S+E, respectively (p>0.05).

CONCLUSION

A combination of simvastatin with antioxidant vitamins does not offer any beneficial effect over simvastatin alone. Particularly vitamin E seems to blunt the simvastatin induced HDL-C increase.

Characteristics of coronary heart disease in renal transplant recipients

The aim of this study was to identify the characteristics of coronary heart disease (CHD) in renal transplant recipients as well as to assess the impact of coronary angiography on allograft function. The 21 cases including 2 women and 19 men who underwent coronary angiography were retrospectively studied for age at transplantation and at diagnosis of coronary disease; risk factors; angio findings; serum creatinine and blood urea nitrogen (BUN) values before and after angio; and revascularization procedures. The mean ages at transplantation and at diagnosis were 40 +/- 7 years and 44 +/- 7 years, respectively. Eighteen patients (86%) had hypertension, 16 (76%) exhibited hyperlipidemia, and 5 (24%) diabetes mellitus. Coronary angiography revealed three-vessel disease in 10 patients, two-vessel disease in 3 patients, one-vessel disease in 4 patients, ectatic vessels in 2 patients, and normal coronary arteries in 2 patients. The mean serum creatinine and BUN levels after angio were not significantly different from the baseline values (pre creatinine and BUN 1.7 +/- 0.5 mg/dL and 33.8 +/- 8.6 mg/dL versus post 1.8 +/- 0.6 mg/dL and 32.8 +/- 10.0 mg/dL, respectively). Ten patients with three-vessel disease underwent coronary artery bypass surgery; 4 patients, coronary angioplasty. The other patients received medical therapy. The study showed an increased likelihood of three-vessel disease among recipients compared with the general population and confirmed that coronary artery bypass surgery may be performed successfully in these patients. In conclusion coronary angiography is a safe diagnostic procedure with respect to allograft function.

Implantation of submammary implantable cardioverter defibrillators

Implantable cardioverter defibrillators (ICDs) are routinely placed in the left pectoral area using a transvenous approach. This approach may result in poor cosmetic outcome and cause psychological problems, especially in younger patients. To avoid this, several alternative implantation techniques have been developed. For cosmetic reasons, we used a submammary technique to implant ICDs into three young women. Apart from defibrillation threshold testing, the procedures were performed under local anesthesia. Threshold testing was done under general anesthesia. Appropriate defibrillation thresholds were obtained in all three cases, and all the patients tolerated the procedure well. There were no complications in a mean of 22 months of follow-up, and the cosmetic results were very good.

Prevalence of coronary artery disease in patients undergoing valvular operation due to rheumatic involvement

OBJECTIVE

Rheumatic heart disease is still a major health problem in developing countries. The impact of coronary artery disease (CAD) on or its relation to rheumatic fever is not well established. We aimed to evaluate the prevalence of CAD and atherosclerotic risk factors in patients who underwent valvular surgery due to rheumatic heart disease.

METHODS

The records of 346 patients who had undergone rheumatic valvular surgery in a university hospital between 1996 and 2002 were evaluated.

RESULTS

Coronary angiography was performed in 218 (63%) patients, of whom 41 (18.8%) had CAD. The mean age of the patients having CAD and normal coronary arteries were 57.3 and 50.5 years respectively (p<0.001). In the study population patients with CAD had significantly increased prevalence of diabetes mellitus (14.6% vs. 4.5%; p=0.02), hypertension (36.6% vs. 16.4%; p=0.003), smoking (51.2% vs. 23.2%; p=0.001) and family history of CAD (39.5% vs. 20.0%; p=0.01) compared to patients with normal coronary arteries. However, the prevalence of dyslipidemia was similar in both groups (45.9% vs. 36.4%; p=0.1).

CONCLUSION

These findings suggest that coronary artery disease prevalence in rheumatic valvular disease patients is similar to the normal population of same age. In cases where invasive assessment of valvular lesions is not indicated we suggest coronary angiography to be performed only in patients having clinical suspicion of CAD or multiple risk factors.

An unusual case of right ventricular outflow tract tachycardia

In this report, we describe an unusual case of right ventricular outflow tract (RVOT) tachycardia with episodes of repetitive monomorphic ventricular tachycardia (VT), paroxysmal sustained VT and incessant monomorphic VT of the same morphology. Diltiazem, adenosine, or metoprolol failed to interrupt these arrhythmias. However, administration of intravenous propafenone completely eliminated all ventricular ectopic activity. Electrophysiologic study performed off propafenone showed that the ventricular ectopic activity originated from a single locus at the anterior wall of the RVOT. Two radiofrequency applications at this site resulted in complete elimination of ventricular ectopic activity.

[Metabolic syndrome in patients after coronary bypass surgery: prevalence and compliance with treatment]

OBJECTIVE

The aim of this study was to evaluate the prevalence of metabolic syndrome (MS) and its components, to determine the patients' compliance with pharmacological therapy and lifestyle modification, and to clarify the association of demographic and socioeconomic factors with the MS in Turkish patients with prior coronary artery bypass surgery (CABG).

METHODS

Two hundred and seventy-three patients (age range 35-77, 208 men) were interviewed and examined 1.0-2.2 years after CABG.

RESULTS

The prevalence of MS was 44.8% (55.4% among women and 41.3% among men). The most prevalent metabolic risk factor was visceral obesity among females, and elevated blood pressure among males. Rates for regular physical activity were lower in patients with MS, compared with those without MS (36.9% vs. 47.7%, p<0.05). Compared with patients without MS, use of aspirin was lower among patients with MS (84.4% vs. 93.4%, p<0.05). Logistic regression analysis revealed an independent association of age>65 years and low educational level with MS.

CONCLUSION

We found a high prevalence of metabolic syndrome and its components among patients with prior CABG. Patients with MS had lower rate of regular physical activity and aspirin use, compared with those without MS.

Effects of hemodialysis on myocardial performance index

The myocardial performance index (MPI) reflects global ventricular function. Chronic hypervolemia and uremia may negatively affect the myocardium of both ventricles. The aims of this study were to investigate how chronic renal failure (CRF) affects biventricular MPI and to determine whether preload reduction by hemodialysis (HD) affects left ventricular MPI (LVMPI) and right ventricular MPI (RVMPI) in CRF. Twenty-one patients with CRF (group 1) were examined 1 hour before and 1 hour after an HD session and 17 healthy control patients (group 2) were examined once by echocardiography. The MPI for each ventricle was calculated as the sum of isovolumic time intervals divided by the ejection time. Before HD, the LVMPI of group 1 was similar to that in group 2 (P>.05), but the RVMPI of group 1 was significantly higher (P=.007). After the HD session, LVMPI and RVMPI remained unchanged (P>.05 for both). The LVMPI and RVMPI were not correlated either before or after HD in group 1 (P>.05 for both), whereas they were correlated in group 2 (r=0.671, P=.003). Chronic renal failure causes isolated RV dysfunction, as reflected by increased RVMPI values. Preload reduction by HD does not affect LVMPI or RVMPI. Patients with CRF also do not exhibit the correlation of LVMPI and RVMPI that is observed in healthy individuals.

Association between the metabolic syndrome and newly diagnosed coronary artery disease

This case-control study was designed to outline age- and gender-related differences of metabolic risk factors in a group of patients with coronary artery disease (CAD). Accordingly, a total of 366 consecutive patients with a recent diagnosis of CAD (139 women, 41-79 yr; 227 men, 39-78 yr) were screened between October 1999 and April 2001 at Baskent University Adana Medical Center, and 366 age- and gender-matched individuals were selected as a control group. We compared demographics, blood pressure, body mass index, waist circumference, lipid profile, fasting and post-prandial glucose-insulin levels between CAD patients and the control group. Prevalence of metabolic syndrome was 72.6% in females, and 39.0% in males with CAD. Hypertension, obesity and diabetes were more common in female patients; 64.5% of female patients had premature CAD and 83.5% of those had metabolic syndrome. In logistic (OR: 3.57 for women and OR: 1.59 for men) regression analysis, metabolic syndrome was independently associated with CAD in both genders. As a conclusion, prevalence of metabolic syndrome was significantly higher in patients with CAD than the control group, especially in female patients. The metabolic syndrome was independently associated with CAD in both genders.

Do variable age-related secondary factors affect ventricular geometry in hypertrophic cardiomyopathy?

The relationship between cardiac shape and the age of patients with hypertrophic cardiomyopathy (HCM) has been established, and echocardiography has been accepted as the best method to quantitate ventricular cavity geometry. Recently, real-time three-dimensional volumetric data have demonstrated that children and young, middle-aged, and elderly patients with HCM have different morphologic and prognostic characteristics. This review discusses the importance of phenotypic expression and describes secondary factors that may affect ventricular cavity geometry during the progression of HCM.

Carbon coating of stents has no effect on inflammatory response to primary stent deployment

The aim of this study was to investigate the effects of stent carbon coating on inflammatory response. The authors serially measured plasma concentrations of C-reactive protein (CRP), fibrinogen, and several cytokines (tumor necrosis factor, interleukin [IL]-1-beta, IL-6, and IL-8) in patients with single-vessel coronary stenosis who underwent primary stent implantation. None of the subjects had inflammatory or infectious disease at the time of the procedure. Forty-six patients (38 males; mean age 55 +/-9 years) were studied. Blood samples were collected before and at 2, 4, 6, 24, and 48 hours after stent implantation. Patients were randomly assigned 1 of 2 different stent types, an uncoated MAC (AMG Raesfeld-Erle, Germany) (UC-MAC) or a carbon-coated MAC (CC-MAC) stent. Implantations were performed without predilatation, and stents were deployed at a maximum pressure of 6 atmospheres for 90 seconds. Of the 46 patients, 14 had stable, 27 had unstable, and 5 had atypical angina. According to ACC/AHA classification, 35 lesions (76.1%) were type A, 10 (21.7%) were type B, and 1 (2.2%) was type C. Single stenosis of 28 left anterior descending, 12 circumflex, and 6 right coronary arteries were treated. Serum IL-6 increased in both the UC-MAC and CC-MAC groups, with concentrations significantly elevated above baseline at 6 hours, and then decreasing after 24 hours (baseline, 6-hour, and 24-hour values = 3.1 +/-2.3, 5.7 +/-3.8, and 6.3 +/-4.6 pg/mL, respectively, in UC-MAC; 3.7 +/-2.6, 6.2 +/-6.0, and 4.6 +/-3.7 pg/mL, respectively, in CC-MAC [p=0.002]). Plasma fibrinogen, CRP, and leukocyte concentrations also increased in both groups over the 24 hours (p < 0.05). The elevations of IL-6, CRP, and fibrinogen were similar in the 2 groups. The percent increases in IL-6, fibrinogen, and CRP were not associated with stent length, size, or clinical presentation (all p > 0.05). The results showed that stent implantation increases plasma IL-6, fibrinogen, and CRP concentrations, but carbon coating of the stent does not seem to affect this inflammatory response.

Prevalence of modifiable cardiovascular risk factors remain high after coronary bypass graft surgery: a multicentre study among Turkish patients

BACKGROUND

The measures of secondary prevention in patients undergoing coronary bypass graft surgery (CABG) remains largely undetermined in Turkey.

DESIGN

We designed a multicentre cross-sectional study to estimate the prevalence of cardiovascular risk factors in patients after CABG and to evaluate the association of demographic-socio-economic factors with secondary prevention in these patients.

METHODS

A total of 622 patients who underwent CABG between 1 January 1999 and 15 January 2000 at four centres in Adana, Turkey; 273 (ages 35-77, 208 men) were interviewed and examined 1.0-2.2 years after the procedure.

RESULTS

Of 273 patients interviewed, 81.5% were overweight, 65.5% had unhealthy food choices for a lipid-lowering diet, 56.0% were physically inactive, 28.8% were obese and 17.6% were current smokers. Hypercholesterolaemia, elevated blood pressure and fasting blood glucose were found in 65.6, 34.1 and 19.8%, respectively. Of diabetic patients, 63.8% had elevated fasting blood glucose. The use of angiotensin-converting enzyme inhibitors, beta-blockers and statins was low. Women had a higher rate of obesity and physical inactivity; smoking was less prevalent in females. More women were taking antihypertensive and lipid-lowering drugs than men. Logistic regression analysis revealed an association between hypercholesterolaemia and low educational level.

CONCLUSION

Turkish patients have a high prevalence of modifiable risk factors related to unhealthy lifestyle and ineffective prophylactic drug use 1 year or more after CABG. Low educational level has a significant influence in this situation.

Is Doppler tissue velocity during early left ventricular filling preload independent?

BACKGROUND

Transmitral Doppler flow indices are used to evaluate diastolic function. Recently, velocities measured by Doppler tissue imaging have been used as an index of left ventricular relaxation.

OBJECTIVE

To determine whether Doppler tissue velocities are influenced by alterations in preload.

METHODS

Left ventricular preload was altered in 17 patients (all men, mean (SD) age, 49 (8) years) during echocardiographic measurements of left ventricular end diastolic volume, maximum left atrial area, peak early Doppler filling velocity, and left ventricular myocardial velocities during early filling. Preload altering manoeuvres included Trendelenberg (stage 1), reverse Trendelenberg (stage 2), and amyl nitrate (stage 3). Systolic blood pressure was measured at each stage.

RESULTS

In comparison with baseline, left ventricular end diastolic volume (p = 0.001), left atrial area (p = 0.003), peak early mitral Doppler filling velocity (p = 0.01), and systolic blood pressures (p = 0.001) were all changed by preload altering manoeuvres. Only left ventricular myocardial velocity during early filling remained unchanged by these manoeuvres.

CONCLUSIONS

In contrast to standard transmitral Doppler filling indices, Doppler tissue early diastolic velocities are not significantly affected by physiological manoeuvres that alter preload. Thus Doppler tissue velocities during early left ventricular diastole may provide a better index of diastolic function in cardiac patients by providing a preload independent assessment of left ventricular filling.

Effects of spironolactone on heart rate variability and left ventricular systolic function in severe ischemic heart failure

Recent data show that blockade of aldosterone receptors by spironoloctone reduces the risk of morbidity and death among patients with severe heart failure. Heart failure secondary to ischemia is characterized by an imbalance of the autonomic nervous system, which can be assessed by analysis of the heart rate variability (HRV). Spironolactone's effects on HRV are not well defined. If spironolactone has beneficial effects on HRV, this would contribute to favorable results. We therefore measured Holter-derived HRV indexes in a group of 126 patients with heart failure, aged 36 to 83 years, with angiographically proved coronary artery disease, on 3 separate occasions. Patients' sodium intake was restricted; therapy with enalapril, furosemide, and digoxin was begun, and 2 weeks after this standard therapy, spironolactone 50 mg/day was added. Evaluations were done at baseline, and the first and 12th months. After spironolactone, the triangular interpolation of the NN histogram (from 233.0 +/- 98 to 291.7 +/- 74 ms and 340.5 +/- 130 ms, p <0.001) and the percentage of differences between successive normal RR intervals differing >50 ms over a 24-hour electrocardiography (from 2.9 +/- 2.4% to 4.3 +/- 5.2% and 3.9 +/- 2.6%, p <0.002) increased significantly. Ejection fraction and functional classes were also improved. These data imply that in patients with heart failure who are taking conventional drugs, the addition of spironolactone induces a favorable sympathovagal balance. These changes, as assessed by the triangular interpolation of the NN histogram and the percentage of differences between successive normal RR intervals differing >50 ms over a 24-hour electrocardiography, and observed at 1 month after therapy, persisted in the long term.

Loss of nocturnal decline of blood pressure in patients with nasal polyposis

The objective of this study was to assess the blood pressure pattern in patients with nasal polyposis. Twenty-seven patients with nasal polyposis (18 males and 9 females), ranging in age from 15 to 72 years (mean 37.1 years) were eligible for inclusion in the study. All patients were hospitalized overnight before surgery. After the basal blood pressure measurements were taken, non-invasive ambulatory blood pressure monitoring was carried out. Oxygen saturation was measured via a finger probe and venous blood sampling was taken for catecholamine level during the full night. All measurements were repeated 4 months after nasal surgery. Mean values for nocturnal decline in blood pressure and heart rate before surgery were less marked than those measured after surgery. Mean decline values (+/- SD) were; 4.6 +/- 2.4 mmHg for systolic blood pressure, 5.8 +/- 3.8 mmHg for diastolic blood pressure, and 7.9 +/- 3.9 beats/min for heart rate before surgery, 9.3 +/- 2.8 mmHg, 8.5 +/- 4.1 mmHg and 10.4 +/- 4.3 beats/min after surgery (p < 0.01), respectively. Whereas mean and minimum SaO2 (%) significantly increased (p < 0.01), catecholamine levels decreased (p < 0.05 for adrenaline, p < 0.01 for noradrenaline) after surgery. A correlation was found between BMI and blood pressure as well as between duration of obstruction and blood pressure. Patients who snored had higher blood pressure values than those who did not. Our data show that in cases of nasal polyposis, hypoxia, hypercapnia, snoring, and sleep disorders may develop and persons with nasal polyposis and snoring have an increased risk of hypertension and loss of nocturnal decline in blood pressure.

Effect of trimetazidine on late potentials after acute myocardial infarction

The purpose of this study was to evaluate the effect of trimetazidine on late potentials in patients with acute myocardial infarction. A total of 60 patients (52 males, mean age 55 +/- 2 years, and 8 females, mean age 54 +/- 1.8 years) with the diagnosis of acute myocardial infarction were included in this study. The study was designed as a randomized, double-blinded, and placebo-controlled trial. Signal-averaged electrocardiography and echocardiography were performed during the first 2 days of acute myocardial infarction and were repeated between days of 8 and 15 (mean 11). Patients were treated with trimetazidine (n = 30) or placebo (n = 30). In the placebo group, the total filtered QRS duration and low-amplitude terminal signal duration increased (from 102.7 +/- 1.8 ms to 113.3 +/- 1.8 ms, and from 32.2 +/- 0.9 ms to 38.3 +/- 1.1 ms; P < 0.001), the root mean square voltage of the terminal 40 ms of the QRS decreased (from 28.6 +/- 2.1 microV to 21.4 +/- 1.3 microV; P < 0.001), and the incidence of late potentials increased (from 30% to 46%; P < 0.01) significantly. In the trimetazidine group, these measurements were a decrease from 102.9 +/- 1.9 ms to 100 +/- 2.0 ms (NS), an increase from 31.6 +/- 0.9 ms to 32.5 +/- 0.9 ms (NS), a decrease 9.3 +/- 2.0 microV to 27.3 +/- 1.8 microV (P < 0.01), and a decrease from 33% to 30% (NS), respectively. The ejection fraction was 47.1 +/- 1.3% to 50.8 +/- 1.2% in the placebo group (P = 0.05), and 48.1 +/- 1.1% to 53.4 +/- 1.2% (P < 0.01) in the trimetazidine group. It is concluded that trimetazidine reduces late potentials after acute myocardial infarction without changing blood pressure and heart rate.

Bone marrow suppression and klebsiella pneumonia septicemia due to ticlopidine and successful treatment with filgrastim; a case report

In this report we describe an elderly lady, who after 27 days of ticlopidine treatment developed severe pancytopenia and gram (-) septicemia. No clinical response was obtained with an eight days course of empirical broad spectrum antibiotics, after which granulocyte colony stimulating factor (G-CSF, filgrastim) added to her regimen. In a period of seven days her neutrophil count was normal and she had recovered from septicemia. Twelve weeks after discharge she is fine and her blood parameters are all normal.

The effects of hormone replacement therapy on echocardiographic basic cardiac functions in postmenopausal women

This prospective study was designed to investigate the effects of hormone replacement therapy (HRT) on systolic and diastolic functions. Twenty-eight non-smoking, healthy postmenopausal women who had not received any kind of HRT for at least three years within the onset of menopause were included in the study. All patients received 0.625 mg conjugated oestrogens and 2.5 mg medroxyprogesterone acetate as daily HRT regimen. Their basic systolic and diastolic functions were investigated echocardiographically using standard positions and windows before and 6 months after initiation of HRT. The means of age, weight and length of postmenopausal period were 49.3 +/- 5.8 years, 63.5 +/- 8.7 kg and 46.3 +/- 7.1 months, respectively. Heart rate and systolic and diastolic pressures were similar during the pre- and post-treatment periods. After 6 months of HRT, the mean left ventricular end-systolic and end-diastolic volumes were decreased significantly (71.3 +/- 16.4 versus 56.3 +/- 22.8 ml, 144.5 +/- 26.1 versus 111.7 +/- 24.0 ml, respectively, P < 0.05). Left ventricular ejection fraction was increased (45.1 +/- 6.2% versus 54.8 +/- 4.1%, P < 0.05). Improvement in diastolic function was significant compared with the pretreatment period (E/A 0.90 +/- 0.2 versus 1.10 +/- 0.4, deceleration time 238 +/- 36.8 versus 201 +/- 24.2 ms, respectively, P < 0.05). Based on our preliminary results, we conclude that besides the known favourable effects on women's lives, HRT may also improve cardiac performance and age-related dysfunctions. The present results further suggest that oestrogens exert many direct effects on the cardiovascular system, other than the metabolic changes related to lipoproteins.

Acetate hemodialysis does not increase the frequency of arrhythmia in hemodialysis patients

Arrhythmia is one of the most important causes of mortality in patients on hemodialysis and may develop due to cardiovascular diseases or fluid-electrolyte or acid-base abnormalities. Previous studies have shown that acetate hemodialysis (AHD) increased the frequency of arrhythmia. To evaluate the frequency and the causes of arrhythmias during AHD, we studied 33 randomly selected patients (25 male and 8 female, mean age of 45+/-18 years) who were under AHD (4 h, 3 times/week, mean duration of HD of 38+/-29 months) with the same Cuprophan membranes. All patients underwent a detailed echocardiographic evaluation during the interdialytic period. Twenty-four hours of Holter monitoring was performed starting from the onset of HD. Twelve lead electrocardiography (ECG) was obtained, and venous and arterial blood samples were drawn for serum electrolytes, pH, and arterial blood gas measurements before and after HD. Serum magnesium and potassium levels dropped after AHD (from 2.3+/-0.5 to 1.9+/-0.3 mEq/L and from 5+/-0.7 to 3.4 +/-0.4 mEq/L respectively, p < 0.001); on the other hand serum pH, bicarbonate, sodium, and calcium levels were normalized. Electrocardiographic evaluation revealed significant lengthening of the QTc interval (from 433+/-42 to 464+/-43 ms, p < 0.001), which was thought to be related to the decrease in serum magnesium and potassium levels. The frequencies of ventricular premature contractions (VPCs) were not different during AHD and the interdialytic period (8+/-9.1 to 6.5+/-11 contractions/h, p > 0.05). This was also true for supraventricular premature contractions (SVPCs) and supraventricular tachycardia (SVT). Nonsustained ventricular tachycardia was observed in 2 patients during HD and in 1 patient in the interdialytic period. No relation was established between the echocardiographic findings and the frequency of arrhythmia. In our ambulatory electrocardiographic study, the frequencies of VPCs and SVPCs observed during the interdialytic period were only positively correlated with age (r=0.54, p=0.013 and r=0.50, p=0.010, respectively). No relation was found between the frequency of arrhythmia and the gender of the patients; duration of HD; etiology of kidney disease; or serum Na, K, Ca, iCa, Mg, bicarbonate, or pH levels (p > 0.05). In conclusion, the application of AHD does not increase the frequency of arrhythmia in HD patients as had been shown in previous studies.

Management of brucella endocarditis of a prosthetic valve

A case of chronic brucella endocarditis of a prosthetic valve is reported. The diagnosis of this infection was established by positive blood cultures and high brucella agglutination titre. The patient was successfully managed by combination of medical therapy (consisting of streptomycin, trimethoprim-sulphamethoxazole, rifampin and tetracycline) and surgery.

Safety of single-site adenosine thallium-201 scintigraphy

The diagnostic accuracy, safety and tolerance of adenosine thallium scintigraphy have been reported using a 2-site intravenous infusion with either a titrated or fixed-dose protocol. A single-site infusion would considerably simplify the test procedure, but its safety must be established before it can be recommended. Accordingly, 400 consecutive patients who had adenosine and thallium-201 administered through the same intravenous line were classified into 2 groups. Group I (n = 201) patients received a 7-minute titrated intravenous infusion of adenosine, with an initial dose of 50 micrograms/kg/min that increased at 1-minute intervals to a maximum of 140 micrograms/kg/min. Group II (n = 199) patients received a fixed dose of adenosine at 140 micrograms/kg/min for 6 minutes. Adenosine significantly (p < 0.001) increased heart rate and decreased systolic blood pressure by similar amounts in both groups. Adverse effects occurred more often (88 vs 71%, p < 0.001) and started earlier (2.8 vs 3.6 minutes, p < 0.001) in group II. There was no significant difference in the occurrence of second- and third-degree atrioventricular block between the 2 groups (4.0 vs 5.0%); however, chest pain, flushing and nausea were all more frequent in group II. Severe side effects were seldom seen in either group and occurred in 9 group I and 8 group II patients. Scintigraphic findings were similar in both groups. Transient perfusion defects were seen more often in patients with than without second- or third-degree atrioventricular block (42 vs 21%, p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Levels of IgE in the serum of patients with coronary arterial disease

Because previous studies have shown that mast cells can be activated by IgE-mediated mechanisms to release potent mediators which affect coronary blood flow, we measured serum IgE levels in 156 patients with coronary arterial disease and in 53 healthy controls (27 men, 26 women, mean 54 years). Patients were classified into 3 groups according to well established criteria as having stable angina pectoris (28 men, 15 women, mean 58 years), unstable angina pectoris (37 men, 15 women, mean 57 years), and acute myocardial infarction (52 men, 9 women, mean 58 years). In every subject, serum IgE measurement, eosinophil count, and stool examination for parasites were performed. Every subject was interviewed concerning history of allergy, smoking habits and the other risk factors for coronary arterial disease. In a model including the factors that may affect the serum levels of IgE (namely, age, sex, cigarette smoking, parasites, and family and personal history of allergy), IgE levels were found to be significantly higher in the patients with unstable angina and acute myocardial infarction compared to the patients with stable angina pectoris and controls. These data indicate that IgE may play a role in the pathogenesis of unstable angina pectoris and acute myocardial infarction.

Quality of life in patients with rate responsive pacemakers: a randomized, cross-over study

Eleven patients with rate responsive pacemakers (7 men, 4 women, mean age 41 years with a range of 23-60) were randomly assigned to a cross-over study in order to assess their overall exercise capacity and quality-of-life (QOL) scores. All of the pacemakers were implanted for complete AV block or sick sinus syndrome. The pacemakers were randomly programmed into VVI or rate responsive (VVIR) pacing modes for 3-week study periods in each mode. At the end of each period, an exercise test was performed and the QOL was evaluated by the "Hacettepe Quality-of-Life Questionnaire". All patients exercised longer in the VVIR mode (mean 10.54 +/- 0.73 min) than in the VVI mode (mean 7.81 +/- 0.62 min) (P less than 0.05). QOL scores were also found to be significantly higher in the VVIR mode (mean 173.81 +/- 16.22 points) compared to the VVI mode (mean 156.27 +/- 21.22 points) (P less than 0.01). In conclusion, our results suggest that VVIR pacing offers a better QOL in addition to an improved exercise capacity, compared to the single chamber nonrate modulated pacing (VVI).