Ahmet Bilge Sözen

Effect of Valsalva maneuver on surface electrocardiographic P-wave dispersion in paroxysmal atrial fibrillation

The purpose of this study was to investigate the effect of the Valsalva maneuver on P-wave durations and dispersion. After the Valsalva maneuver, we found that maximum P-wave duration increased, minimum P-wave duration decreased, and P-wave dispersion increased in controls, whereas the opposite was true for unselected patients with paroxysmal AF. It was concluded that patients with paroxysmal AF performing the Valsalva maneuver normalized their P-wave dispersion, thereby correcting the inhomogeneous intra-atrial conduction.

Hepatopulmonary syndrome in noncirrhotic portal hypertensive patients.

Hepatopulmonary syndrome has yet not been sufficiently assessed in noncirrhotic portal hypertension. The prevalence of hepatopulmonary syndrome was determined in 31 consecutive patients with noncirrhotic portal hypertension (19 idiopathic portal hypertension, 7 portal vein thrombosis, 5 congenital hepatic fibrosis) and 46 patients with liver cirrhosis. Contrast echocardiography was carried out in all patients. Macroaggregated albumin lung perfusion scans were performed in patients with positive contrast echocardiogram. Hepatopulmonary syndrome was detected in 5 (10.8%) cirrhotic and 3 (9.7%) noncirrhotic portal hypertensive patients (2 idiopathic portal hypertension, 1 portal vein thrombosis). All patients with hepatopulmonary syndrome had an increased shunt fraction (13–62%) and a decreased diffusion capacity of carbon monoxide (40–79%), and 7 of them were hypoxemic (PaO2, 31.6–69.8 mm Hg). These findings show that hepatopulmonary syndrome may occur in both liver cirrhosis and noncirrhotic portal hypertension and that portal hypertension is the predominant etiopathogenic factor related to hepatopulmonary syndrome.

Heart rate variability in diabetes patients.

Diabetes mellitus can cause cardiovascular autonomic neuropathy and is associated with increased cardiovascular deaths. We investigated cardiovascular autonomic neuropathy in diabetics and healthy controls by analysis of heart rate variability. Thirty-one diabetics and 30 age- and sex-matched controls were included. In the time domain we measured the mean R-R interval (NN), the standard deviation of the R-R interval index (SDNN), the standard deviation of the 5-min R - R interval mean (SDANN), the root mean square of successive R - R interval differences (RMSSD) and the percentage of beats with a consecutive R - R interval difference > 50 ms (pNN50). In the frequency domain we measured high-frequency power (HF), low-frequency power (LF) and the LF/HF ratio. Diabetes patients had lower values for time-domain and frequency-domain parameters than controls. Most heart rate variability parameters were lower in diabetes patients with chronic complications than in those without chronic complications.

Autonomic dysfunction in vitamin B12 deficiency: a heart rate variability study.

This study was arranged to examine whether vitamin B12 deficiency may cause autonomic dysfunction. Time-domain and long-term frequency-domain heart rate variability parameters from 12 patients with pernicious anemia were compared to 12 age and sex matched controls. In B12 deficient patient group time-domain parameters; SDNN (100.4 +/- 37.86 vs. 131.91 +/- 26.94, P = 0.05), SDANN (87.00 +/- 37.77 vs. 118.83 +/- 26.22, P = 0.05) SD (39.41 +/- 13.32 vs. 53.41 +/- 15.39, P = 0.0221), rMSSD (21.41 +/- 10.00 vs. 28.5 +/- 8.42, P = 0.046) were significantly lower when compared to controls. Difference in pNN50 between groups were not statistically significant. In B12 deficient patients frequency-domain parameters; total power (23.08 +/- 9.89 vs. 34.75 +/- 9.56, P = 0.0078), low frequency power (13.5 +/- 6.57 vs. 22.75 +/- 7.25, P = 0.0069) and high frequency power (7.58 +/- 4.25 vs. 11.58 +/- 3.80, P = 0.0175) were significantly lower when compared to controls. It was concluded that B12 deficiency may cause autonomic dysfunction.

The role of HLA molecules in susceptibility to chronic rheumatic heart disease

Only a small fraction of the streptococcal pharyngitis progress to rheumatic carditis, which implies that environmental, host and microbial factors interact to cause an aberrant immune response against the antigens of the microorganism that cross‐react with cardiac tissues. Although there are numerous studies and a general consensus on the relation between human leucocyte antigen (HLA) class II antigens and rheumatic heart disease (RHD), the details and the culprit antigens are still controversial. The study was undertaken to examine 100 patients with chronic RHD and 100 controls for HLA class I and class II antigens for differences in prevalence. All samples were typed at the HLA‐DRB1/3/4/5 and DQB1 loci by the sequence‐specific primer (PCR‐SSP) method at low resolution. For HLA class I antigens, HLA‐B13 frequency was marginally increased in patients with RHD compared to controls without reaching statistical significance. For class II antigens, RHD patients had higher frequencies for HLA‐DRB1*01 (RHD 24%, controls 10%), DRB1*04 (RHD 35%, controls 26%), DRB1*07 (RHD 18%, controls 11%) and HLA‐DQB1*02 (RHD 32%, controls 17%) without reaching statistical significance, and significantly lower frequencies for DRB1*13 (Pc < 0.003, OR: 5.69), DRB5* (Pc < 0.003, OR: 33) and DRB3* (Pc = 0.03, OR: 2.66) compared to controls. It was concluded that host, microbial and environmental factors collude to create acute rheumatic fever (RF) and chronic rheumatic valve disease. The HLA‐DRB1*13, DRB5* and DRB3* were protective against the development of rheumatic valve damage.

Comparison of pre- and postoperative pulmonary function in obese and non-obese female patients undergoing coronary artery bypass graft surgery

Objective and background:  Various studies have suggested that body size and in‐hospital mortality are related. However, only a few analysed the effects of obesity on pulmonary complications following coronary artery bypass graft surgery (CABG). The purpose of the present study was to assess early changes in lung volumes, respiratory complications and arterial blood gas tension following CABG in obese women.

Drugs with Blocking Effects on the Renin–Angiotensin–Aldosterone System Do Not Improve Endothelial Dysfunction Long-Term in Hypertensive Patients

In essential hypertension, endothelial dysfunction has been documented many times and correlates with prognosis. The influence of the renin–angiotensin–aldosterone system (RAAS) on endothelial dysfunction has also been studied. The present study investigated the duration of the effects of RAAS-blocking drugs on endothelial function in 44 consecutive, never-treated, outpatients with mild to moderate hypertension. Patients (11 per group) received an angiotensin receptor blocker (ARB; irbesartan 300 mg/day or valsartan 160 mg/day) or an angiotensin-converting enzyme inhibitor (ACEi; fosinopril 10 mg/day or quinapril 20 mg/day). If target blood pressure (< 140/90 mmHg) was not achieved, 12.5 mg/day hydrochlorothiazide was added. Endothelial function, assessed by measuring brachial artery diameter, did not change significantly after 6 weeks, 1 year or 3 years of treatment in any group. Across all groups, endothelium-dependent and-independent vasodilation increased significantly after 6 weeks but, after 1 year, decreased below baseline and was at a similar level after 3 years; groups did not differ significantly. Both ACEi and ARB had similar effects on endothelial function; improvement occurred at the start of treatment but was not maintained. Endothelial dysfunction may be a resistant or irreversible feature of hypertension, requiring high doses of antihypertensive drugs and above-average patient compliance.

Over 14 years of experience with cardiac myxomas

Atrial myxomas are the most commonly encountered tumours of the heart and can present at different ages with different clinical symptoms. They are one of the curable tumours of the heart. Appropriate surgical treatment and surgery must be performed with great precautions in order to prevent fatal systemic embolizations. In this retrospective study we will present our experience of 14∞∞years, between 1990 and 2004, in 27∞∞patients who had been operated for cardiac myxomas. Diagnosis of the myxomas were made by echocardiography in all cases. Surgical approach to the tumour was biatrial in nine, left atrial in 11, and transseptal in seven patients.Associated procedures included coronary artery bypass grafting in one, mitral valve repair with tricuspid annuloplasty in two patients, mitral valve replacement in one and bilateral femoral embolectomy in one patient. One hospital mortality occurred as a result of multiorgan failure in a patient with peripheral embolization. None of the patients required recurrent operation, however, mitral valve insufficiency was surgically corrected in one patient.

An open-label, uncontrolled trial of the angiotensin-converting enzyme inhibitor cilazapril in the treatment of patients with chronic congestive heart failure

Abstract We assessed cilazapril, an angiotensin-converting enzyme (ACE) inhibitor, in the treatment of patients with chronic congestive heart failure. A single 2.5-mg dose of cilazapril was given to 20 patients with chronic congestive heart failure rated as New York Heart Association functional Class II for 15 days according to our protocol. Exercise capacity, breath-by-breath oxygen analysis, and echocardiographic variables were assessed before and after treatment. Cilazapril improved peak exercise time statistically significantly (7.36 ± 3.48 minutes vs 9.45 ± 5.17 minutes), but peak oxygen consumption (17.45 ± 4.19 mL/kg per minute vs 18.65 ± 3.70 mL/kg per minute) and peak heart rate (145.5 ± 23.7 beats/min vs 149.9 ± 27.1 beats/min) did not increase significantly. Anaerobic threshold time (3.31 ± 2.38 minutes vs 4.54 ± 2.99 minutes), anaerobic threshold oxygen consumption (11.03 ± 2.52 mL/kg per minute vs 12.77 ± 2.92 mL/kg per minute), and anaerobic threshold ratio (63.35 ± 7.59% vs 68.10 ± 7.67%) were statistically significant increased with cilazapril treatment without a significant change in anaerobic threshold heart rate (123.3 ± 20.4 beats/min vs 122.1 ± 20.7 beats/min). Cilazapril treatment also decreased statistically significantly the resting heart rate (91.4 ± 20.1 beats/min vs 85.3 ± 17.6 beats/min) during follow-up. No patient decompensated, and diuretic and digoxin doses were not changed during the study. No adverse effects of cilazapril were observed in any patient; however, the effect of cilazapril treatment was not detected on echocardiographic variables. We conclude that the ACE inhibitor cilazapril may be useful in the treatment of patients with chronic congestive heart failure.

Percutaneous transluminal angioplasty for total coronary occlusion: The effect of restenosis on left ventricular function

The study was undertaken to evaluate the effect of restenosis on global and regional left ventricular function after percutaneous transluminal coronary angioplasty (PTCA) for total coronary occlusion. Thirty-one consecutive patients with total coronary occlusion treated successfully with PTCA and had follow-up angiography at 3–6 months formed the study group. Nineteen patients had restenosis (16 males, mean age 48±10 years) and 12 had no restenosis (11 males, mean age 53±10 years). In the LAD group there were increases in anterobasal (35.9±8.5% vs 43.1±5.7%, p=0.05) and apical (24.1±6.8% vs 31.7±2.9%, p=0.03) segment motion scores in patients without restenosis after PTCA. Global ejection fractions (63.1±14.5% vs 68.9±12.4%, p=0.09) and anterolateral (28.7±11.3% vs 39.7±10.2%, p=0.09) segment scores increased, but did not reach statistical significance. In the LAD restenosis group anterobasal (41.5±14.3% vs 34.3±12.6%, p=0.001), apical (21.1±15.0% vs 17.8±10.9%, p=0.05) and anterolateral (32.7±19.6% vs 26.6±13.8%, p=0.03) segment motion scores decreased but the decrease in the global ejection fraction (60.3±18.5% vs 58.6±17.4, p=0.38) was not significant. In the RCA+LCX group there was a significant increases in global ejection fraction (69.0±7.5% vs 74.2±7.6%, p=0.03) and posterobasal (23.8±7.8 vs 34.4±8.0, p=0.04) segment motion scores in patients without restenosis. The wall motion scores were unchanged in patients with restenosis in the RCA+LCX group. It was concluded that restenosis after a successful PTCA for total coronary occlusion may deteriorate segmental wall motion and treatment modalities with increased patency rates should be used for total coronary occlusions.