Cemal Tuncer

Origin and distribution anomalies of the left anterior descending artery in 70,850 adult patients: multicenter data collection.

Objectives To present the clinical and angiographic properties of the left anterior descending artery anomalies. Background Coronary artery anomalies are discovered in less than 1% of angiography series. Since the number of angiographies and coronary bypass operations are increasing significantly every day, these anomalies are of clinical importance. However, data about left anterior descending artery anomalies in literature is still scarce. Methods We reviewed the records of 70,850 patients who had undergone coronary angiographies at 4 different cardiology center from 1999 to 2005 years. Results Major congenital coronary anomalies were discovered in 171 of these cases (0,24%). The mean age of these patients was 61 ± 11 (18–84) years. Ninety nine patients (58%) were male. Left anterior descending artery was involved in 12 patients (0.017%). In nine patients with the anomalous LAD there were concomittant congenital coronary artery anomalies. Concurrent coronary artery anomalies encountered were double left anterior descending artery type 4 (2 cases), double left anterior descending artery type 4 with double right coronary artery (1), double right coronary artery (1), double circumflex artery with anomalous left anterior descending artery (1), circumflex artery from right sinus of Valsalva (1), separate septal perforator and myocardial bridging of posterior descending artery (1), intercoronary communication, and ostial atresia of the left anterior descending artery and anomalous circumflex artery (1). Conclusion Our series is the biggest series where relatively sufficient clinical and angiographic information about the LAD anomalies were provided.

Assessment of Atrial Electromechanical Delay, Diastolic Functions, and Left Atrial Mechanical Functions in Patients with Type 1 Diabetes Mellitus

OBJECTIVE The aim of this study was to evaluate atrial electromechanical coupling obtained by tissue Doppler imaging (TDI), left and right ventricular diastolic functions, and left atrial (LA) mechanical functions in patients with type 1 diabetes mellitus (DM-1). METHODS A total of 43 patients with DM-1 (age 19.6 +/- 6.8 years) and 42 age- and gender-matched controls (age 19.5 +/- 6.4 years) were included. Atrial electromechanical coupling was measured with TDI and corrected for heart rate. P-wave dispersion (Pd) was calculated from the 12-lead electrocardiograms. Systolic and diastolic functions in both ventricles were assessed using conventional echocardiography and TDI. Myocardial performance index was calculated with TDI. LA maximal, minimal, and pre-systolic volumes were measured according to the biplane area-length method. LA mechanical function parameters were calculated. RESULTS Intra- and interatrial electromechanical delays and Pd were significantly higher in patients with DM-1 compared with controls (P = .02, P < .0001, and P = 0.005, respectively). A-wave velocity and isovolumic relaxation time were higher and E/A ratio was lower in patients with DM-1 (P = .03, P = .03, and P = .003, respectively). According to TDI, systolic velocities and myocardial performance index values of both ventricles were comparable. Diastolic filling velocities of the left ventricle, including E(m) global, A(m) global, E(m)/A(m) ratio, and right ventricular A(m), were different between groups (P = .03, P = .02, P < .001, and P = .02, respectively). LA passive emptying fraction was decreased, and LA active emptying volume and LA active emptying fraction were increased in patients with DM-1 (P = .02, P = .001, and P < .0001, respectively). Interatrial electromechanical delay was positively correlated with the presence of DM-1, age, LA active emptying fraction, and Pd (P < .001, P = .007, P < .001, and P = .002, respectively), and was negatively correlated with E(m)/A(m) ratio and LA passive emptying fraction (P < .001 and P = .001, respectively). In multivariate analyses, age and DM-1 were independent predictors of interatrial electromechanical delay (P = .001 and P < .001, respectively). CONCLUSION This study shows that intra- and interatrial electromechanical delays are prolonged diastolic functions of both ventricles and that LA mechanical functions are impaired in patients with DM-1. Age and the presence of DM-1 were independent factors of the interatrial electromechanical delay.

Assessment of Atrial Conduction Time in Patients with Familial Mediterranean Fever

Background: Increased inflammatory activity is known to be a pathophysiologic characteristic of atrial fibrillation. Familial Mediterranean fever (FMF) is a disease characterized by recurrent and sustained increased inflammatory activity. Atrial conduction abnormalities in these patients have not been investigated in terms of P‐wave duration, P‐wave dispersion (Pd), and atrial electromechanical delay measured by tissue Doppler echocardiography (TDE). We aimed to assess atrial conduction time in patients with FMF.

Effects of slow coronary artery flow on P-wave dispersion and atrial electromechanical coupling

AIM Slow coronary flow (SCF) is characterized by angiographically normal coronary arteries with delayed opacification of the distal vasculature. The purpose of this study was to evaluate atrial electromechanical couplings and P-wave dispersion (Pd) reflecting intraatrial and interatrial conduction delays in SCF patients and the relationship between these parameters and Thrombolysis in Myocardial Infarction (TIMI) frame count. METHODS Thirty-four patients with SCF and 40 controls were enrolled. From 12-lead surface electrocardiograms, Pd was calculated. Atrial electromechanical coupling (PA), intraatrial, and interatrial electromechanical delay were measured with tissue Doppler imaging. RESULTS Maximum P-wave duration (Pmax) and Pd were higher in SCF patients than those of controls (109.2 +/- 9.3 vs 92.3 +/- 13.5 milliseconds; P < .0001 and 50.4 +/- 9.4 vs 34.4 +/- 8.9 milliseconds; P < .0001). Atrial electromechanical coupling at the left lateral mitral annulus (lateral PA), septal mitral annulus (septal PA), and right ventricular tricuspid annulus (RV PA) were significantly higher in SCF patients than controls (68.1 +/- 8.1 vs 52.6 +/- 7.3 milliseconds; P < .0001; 49.3 +/- 9.8 vs 38.2 +/- 5.3 milliseconds; P < .0001; 47.5 +/- 9.0 vs 37.6 +/- 4.6 milliseconds, P < .0001, respectively). Interatrial electromechanical delay (lateral PA - RV PA) was significantly longer in SCF patients (20.6 +/- 9.1 vs 15.0 +/- 6.0 milliseconds; P = .0002). A positive correlation was detected between circumflex coronary artery TIMI frame count and interatrial electromechanical delay (r = 0.45; P < .01). CONCLUSIONS Prolongation of interatrial electromechanical delay, Pmax, and Pd suggest that SCF might contribute to development of adverse functional and electrophysiologic atrial characteristics in these patients.

A previously undescribed anomaly of left anterior descending artery: Type V dual left anterior descending artery

Dual left anterior descending coronary artery (LAD) is a group of rare congenital coronary artery anomalies and exhibits 4 different types. The goal of this article is to define a new, previously undescribed type of dual LAD anomaly.

The influence of ambulatory blood pressure profile on global and regional functions of the left and the right ventricles in orderly treated hypertensive patients.

Background: The association between nondipping profile and adverse cardiovascular outcome is still controversial. Tissue Doppler imaging (TDI), a new and useful addition to standard echocardiographic imaging techniques, permits a quantitative assessment of both global and regional function and timing of myocardial velocities. In this study, we aimed to assess whether a reduced nocturnal fall in blood pressure (BP) in orderly treated hypertensive patients with satisfactory BP control is related to more prominent structural and functional alterations of the ventricles. Method and Results: Sixty‐nine hypertensive patients with adequate BP control were divided into two groups with respect to ambulatory BP profiles as dippers and nondippers. In addition to conventional echocardiographic parameters, in septal and lateral segments of left ventricle and free wall of right ventricle, peak systolic velocity (Sm), early (Em), and late (Am) diastolic velocities, isovolumic contraction time (ICTm), isovolumic relaxation time (IRTm), and ejection times (ETm) were measured, and modified myocardial performance index (MPIm) was calculated. Left ventricular (LV) and atrial dimensions, ejection fraction, transmitral early to late diastolic flow ratio, LV mass index, and LV hypertrophy ratio did not differ between groups. Both regional and mean LV Sm, Em/Am, MPIm and right ventricular Sm and MPIm were similar in both groups. Conclusion: In treated hypertensive patients with satisfactory BP control, there was no significant difference in cardiac structural and functional abnormalities among dipper and nondipper subjects.

Aneurysm involving bifurcation of left main coronary artery presenting with transient ischemic attack, paroxysmal atrial fibrillation and ventricular tachycardia

Coronary artery aneurysm, especially left main coronary artery (LMCA) aneurysm is a rare phenomenon. The disease may be congenital or acquired. The most common cause of coronary artery aneurysm is atherosclerosis. We presented a man with a large LMCA aneurysm presenting with unstable angina, transient ischemic attack, ventricular tachycardia and paroxysmal atrial fibrillation.

Effects of Rosiglitazone on Cardiac Function in CAPD Patients: A Tissue Doppler Study

Background. Insulin resistance was an independent predictor of cardiovascular mortality in uremic patients without diabetes. Rosiglitazone (ROS) improves insulin sensitivity in the liver, muscle, and adipose tissue. We prospectively investigated the effects of ROS on cardiac functions by standard (SDE) and tissue Doppler echocardiography (TDI) in continuous ambulatory peritoneal dialysis (CAPD) patients. Methods. A total of 24 CAPD patients (13 males, 11 females; mean age 42.2 ± 14.8 years) were included. Routine blood samples were examined. Left and right ventricular functions were assessed, and myocardial performance index (MPI) was calculated by SDE and TDI at baseline and after 12-month ROS therapy. Left and right atrial volumes were measured and indexed to body surface area. Results. When compared with baseline, after 12 months of ROS treatment, it was shown that early (E) and late (A) diastolic velocities of atrioventricular valves, E/A ratio, mitral E-wave deceleration time (DT), isovolumetric relaxation time (IVRT), and MPI were similar (p > 0.05). Also, no significant changes were detected in LV dimensions, LV mass index, LVEF, LA volume index, or RA volume index measured by SDE before and after ROS therapy (p > 0.05). Left and right ventricular function parameters measured by TDI including Sm, Em, Am, Em/Am ratio, E/Em ratio, and MPI were similar. Conclusion. It was found that there was no negative effect of long-term ROS therapy on cardiac functions measured by SDE and TDI in CAPD patients.