Ata Kirilmaz

Bisoprolol Improves Echocardiographic Parameters of Left Ventricular Diastolic Function in Patients with Systemic Hypertension

Left ventricular (LV) diastolic dysfunction (LVD) is a common complication secondary to hypertension. It has been reported that bisoprolol is effective in reducing blood pressure and has beneficial cardiac effects in patients with hypertension. However, its effect on LV diastolic function has not been studied in detail. In this study, we sought to determine bisoprolol’s effect on left ventricle diastolic function. Data from 25 patients were statistically analyzed. Peaks E and A wave, E/A ratio, isovolumetric relaxation time and E wave deceleration time were measured echocardiographically. Doppler echocardiography measurements after bisoprolol treatment revealed an improvement in LV diastolic function. In conclusion, our results show that treatment with bisoprolol, improves echocardiographic parameters of LV diastolic function after 3 months of treatment.

Comparison of Electrocardiographic Repolarization Patterns between Hypogonad Males and Normal Subjects

Background: There is a significant difference in repolarization on the surface ECG between men and women. The effect of testosterone on repolarization of myocardium may provide a basis for the physiological and pathophysiological importance of these distinctions between sexes. The purpose of this study is to compare the repolarization characteristics of surface ECG in patients with secondary hypogonadotropic hypogonadism to those of healthy men and women.

Detection of the defibrillation threshold using the upper limit of vulnerability following defibrillator implantation.

Objective: This study was designed to test defibrillation threshold (DFT) with the least number of fibrillation inductions using upper limit of vulnerability (ULV) and to describe the most practical set of ICD during DFT following implantation.

Aortic elastic properties in young pregnant women

This study aimed to investigate the aortic elastic properties of young pregnant women by comparing them with those of age-matched healthy females. The study group consisted of 21 pregnant women at a mean age of 26 ± 1 years; 22 healthy women at a mean age of 25 ± 1 years constituted the control group. Doppler-color echocardiographic variables and serum estradiol (E2) levels were measured from both groups. The blood samples were obtained from the control group in the first week after menstrual bleeding. Diastolic and systolic blood pressure (DBP and SBP, respectively) were measured with a sphygmomanometer. Systolic and diastolic aortic diameters (AOS and AOD, respectively) were measured 3 cm proximal to the aortic valves. Aortic elastic properties were assessed according to the following formulas: 1, Aortic strain = (AOS − AOD)/AOD; 2, Aortic distensibility = 2 × (AOS − AOD)/(PP × AOD); 3, Aortic diameter change = AOS − AOD; 4, Aortic stiffness index = ln(SBP/DBP)/(AOS − AOD)/AOD. The results were expressed as mean ± standard deviation and compared by t-test between groups. P < 0.05 was considered as statistically significant. All women in the study group were in their first pregnancy and second trimester. The height and weight were 160 ± 5 vs 164 ± 6 cm and 60 ± 9 vs 54 ± 3 kg in the study vs control groups, respectively (P < 0.05). The AOD was 26 ± 3 vs 26 ± 4 mm and AOS 29 ± 3 vs 28 ± 4 mm. Pulse pressure was 43 ± 3 vs 45 ± 8 mmHg in the study vs control groups, respectively (P > 0.05). The serum E2 level was significantly higher in pregnant women (21 300 ± 2 300 pg/ml). Derived aortic elastic properties in pregnant women were also increased significantly (P < 0.0005). The indexes of aortic elastic properties are altered and aortic stiffness is decreased among young pregnant women. This may be due to the adaptation mechanisms including high estradiol levels detected in pregnancy.

The value of 64-slice computed tomography in a patient with an anomalous and atherosclerotic coronary artery

We report the case of a 64-year-old male presenting with chest pain with a history of hyperlipidemia and smoking. Coronary angiogram was not successful to visualize the right coronary artery. Contrast enhanced 64-slice computed tomography (CT) identified the origin of the RCA from the aorta and distal stenosis of the vessel. Additionally, it revealed that the nature of the stenosis could be consistent with soft plaque or thrombus. Repeated coronary angiogram confirmed the data obtained by 64-slice CT. The confirmatory value of 64-slice CT in the evaluation of coronary abnormalities and stenoses has been addressed by this case report.

Left atrial functions after myocardial infarction.

Acute myocardial infarction results in not only left ventricular but also left atrial dysfunction. Left atrial function is important for optimal filling of the left ventricle. In this study, we aimed at evaluating left atrial functions 6 months after acute myocardial infarction in three different patient groups (thrombolytic therapy, primary percutaneous intervention, or no reperfusion strategies). Between October 2002 and May 2003, 48 patients with ST elevation myocardial infarction who were either administered thrombolytic therapy (group T, n = 16), underwent primary angioplasty (group A, n = 20), or underwent no reperfusion therapy (group C, n = 12) at our unit were enrolled into the study. Echocardiography was performed in these patients 6 months after acute myocardial infarction. Left atrial contractility was assessed by atrial ejection force. Left atrial contribution was assessed by atrial fractional shortening and left atrial volume was calculated. The left atrial volume was significantly higher in group C (P < 0.05), but there was no significant difference between groups A and T (P > 0.05). Patients in group C had significantly lower atrial ejection force values compared with the other groups (P < 0.05). Atrial fractional shortening was not significantly different among the three groups (P > 0.05). Atrial ejection force, which is an indicator of left atrial contractility, is better with either angioplasty or thrombolysis. Left atrial volume is higher in patients who were not treated with reperfusion strategies. Further studies are needed to explain the mechanism involved.

Effects of chronic alcohol consumption on myocardial ischemia in rats

The effects of chronic alcohol consumption on myocardial ischemia and gas perfusion with 95% O(2)-5% CO(2) were investigated in isolated rat heart. Eighteen adult male Wistar rats were used. Rats were assigned into six groups for each group to contain three rats: normal, alcoholic, normal ischemic, alcoholic ischemic, normal ischemic and 95% O(2)-5% CO(2) perfused, alcoholic ischemic and 95% O(2)-5% CO(2) perfused, respectively. Alcohol (7.2%, v/v) was given to rats by a modified liquid diet for 21 days. Rats were anaesthetized with ketamine (1-2mg kg(-1)). Hearts were quickly isolated. Normal and alcoholic rat hearts were directly sent to the electron microscopic preparation. The other hearts were cut into small pieces and put into Krebs solution. The solution was continuously bubbled using 95% N(2)-5% CO(2) 20 min for ischemia. After removal of normal ischemic and alcoholic ischemic heart specimens for electron microscopic examination, the remaining hearts of the last two groups were bubbled with 95% O(2)-5% CO(2) for another 20 min for the purpose of reperfusion and then were also prepared for electron microscopic examination. The hearts were investigated with a transmission electron microscope (Jeol 100 CXII TEM). Twenty-one days of chronic alcohol consumption was found to have no significant effect on myocardial ischemia determined by transmission electron microscopic examination. Our results suggest that there is no significant relationship between 21 days of alcohol consumption by a liquid diet and myocardial protection.

Papillary fibroelastoma of mitral papillary chordae in a young patient

Our case is a 38-year-old man, admitted to Cardiology Department with shortness of breath. Echocardiography yields a hyperechogenic mass localized to papillary muscle with severe mitral regurgitation. Coronary angiography demonstrated radiopacity localized to the papillary muscle. The excision of the mass was consistent with elastic tumor, which was reported as papillary fibroelastoma attached to the papillary chordae of the mitral valve. A 29 no St-Jude bileaflet mechanical valve was implanted to mitral position. Papillary fibroelastoma (PF) can be found in young age and originate from the papillary muscle, which the radiopaque angiographic appearance of the mass supports the diagnosis.

Impedance cardiographic monitoring during pericardiocentesis: comparison with echocardiography

Objective — Thoracic impedance cardiography (TIC) is a noninvasive method which has proved to be useful in monitoring the haemodynamic status of the patients. In this study, we evaluated the TIC findings in patients with pericardial effusion and cardiac tamponade. Methods and results — The study consisted of patients with pericardial effusion with (group A) or without (group B) cardiac tamponade (CT).The stroke volume, cardiac output and ejection fraction was measured by both echocardiography and TIC.The measurements were done at baseline in both groups and following pericardiocentesis in group A.The variables were compared by linear regression analysis, paired sample’s t test and chi-square test.The study included 32 patients. Group A consisted of 16 patients and group B of 14 patients.Two patients were excluded from comparisons because of insufficient quality of the echocardiographic examination. There were no significant differences between group A and B with regard to demographic features. Both echocardiographic and TIC measurements at baseline revealed decreased cardiac output, EDV and SV in group A and EF was not different. Linear regression analysis revealed that echocardiography and TIC were in significant correlation with regard to cardiac output, enddiastolic volume, stroke volume (p < 0.01) but not ejection fraction (p = 0.8910).The correlation was also present after pericardiocentesis. Conclusions — TIC can be safely used in patients with pericardial effusion. It provides suggestive data for the diagnosis of CT and can be used as a means of monitoring the results of the pericardiocentesis.

A Sudden Change in QRS Morphology

June 2002 PACE, Vol. 25, No. 6 An 80-year-old man with normal left ventricular ejection fraction presented with a wide QRS tachycardia. An electrophysiological study was done following the positioning of two diagnostic quadripolar catheters in the high right atrium and the His-bundle position through the right femoral vein. The intracardiac measurements were remarkable for HV intervals of 175–220 ms and right bundle branch block (RBBB) with QRS duration of 150 ms. Intracardiac electrograms are depicted in Figures 1 and 2 during atrial pacing at a cycle length (CL) of 700 and 600 ms, respectively. Although the surface electrocardiograph (ECG) during sinus rhythm showed RBBB, leftaxis deviation, and PR prolongation (beat 1 in Fig. 3), he had frequent wide QRS complexes (the last 4 beats in Fig. 3) with left bundle branch block (LBBB) pattern and relatively short PR interval. Although PR intervals were not constant, every QRS complex preceded a P wave and this pattern existed for about 10 minutes at a fairly regular sinus rate. What is the differential diagnosis to explain the observed wide QRS tachycardia?