Ercüment Yilmaz

Depression and Anxiety Status of Patients with Implantable Cardioverter Defibrillator and Precipitating Factors

Background: Implantable cardioverter defibrillators (ICDs) are life‐saving devices in treatment of life‐threatening arrhythmia. We evaluate the emotional status of Turkish patients with ICD and try to explain factors that affect emotional status of the patients.

The use of human heart-type fatty acid-binding protein as an early diagnostic biochemical marker of myocardial necrosis in patients with acute coronary syndrome, and its comparison with troponin-T and creatine kinase–myocardial band

Heart-type fatty acid-binding protein (H-FABP), a new biochemical marker of sarcolemmal injury due to acute myocardial ischemia, can be used as a tool in early diagnosis and management of patients at high risk. The aim of this study was to determine the early diagnostic value of H-FABP in acute coronary syndrome (within 6–24 h of chest pain) and to compare it with troponin-T (TnT) and creatine kinase–myocardial band (CK-MB) for accuracy. The study consisted of 40 consecutive patients with chest pain admitted to the coronary care unit with the diagnosis of suspected acute coronary syndrome. The patient population consisted of two groups according to the time of admission; the first group (26 patients) included patients admitted within 6 h of chest pain, and the second group (14 patients) included patients admitted within 6–24 h of chest pain. The blood samples for H-FABP, TnT, and CK-MB were obtained at admittance, at the 6th, and at the 24th hours for the first group, and at admittance and at the 24th hours for the second. Statistical analysis was performed among the 26 patients for the first 6 h values, and among all 40 patients for the values obtained within 6–24 h and at the 24th hour. The patients were then divided into groups according to the changes in the electrocardiogram (ECG) and cardiac enzymes as unstable angina pectoris, non-ST elevation myocardial infarction (MI), and ST-elevation MI. Coronary angiography was performed in 38 (95%) patients. Sensitivity of TnT, CK-MB, and H-FABP in the first group (within 6 h of chest pain) were 38%, 76%, and 95% respectively. The sensitivity of H-FABP was significantly higher than TnT (P = 0.014). Sensitivity of TnT, CK-MB, and H-FABP tests in the second time period (within 6–24 h of chest pain) were 100%, 90%, and 91% respectively. In this time period, the sensitivity of TnT was higher than H-FABP, but it was statistically insignificant. At the 24th hour, sensitivity of TnT was 100%, CK-MB 90%, and H-FABP 27.3%, and TnT and CK-MB were more sensitive than H-FABP for the whole group (P = 0.002). In the first group (within 6 h of chest pain) H-FABP positivity was slightly but insignificantly higher in patients with two- and three-vessel disease compared with those with one-vessel disease (60.7% and 33.3%, P = 0.19) and in the same group, patients who underwent primary coronary intervention had a significantly higher H-FABP positivity than others (80%, 32%, P = 0.02). Within 6–24 h of chest pain, H-FABP positivity was 80% in patients with one-vessel disease and 71.4% in patients with two- and three-vessel disease (P = 0.69). Within 6–24 h, positivity of H-FABP reached a peak value of 100% in patients who underwent primary coronary intervention, while H-FABP was positive in 60% of the others (P < 0.001). We conclude that within the 6 h of acute coronary syndrome, H-FABP seems to be a more sensitive biochemical marker than TnT in the early detection of ischemic myocardial necrosis. But after the first 6 h of the onset of chest pain the sensitivity of H-FABP decreases, and this marker should not be used alone in patients admitted 24 h after the onset of chest pain.

Left ventricular geometric patterns and QT dispersion in untreated essential hypertension.

The spectrum of left ventricular adaptation to hypertension, different types of hypertrophy patterns, and QT dispersion in different types of hypertrophy was investigated in 107 patients with untreated essential hypertension and 30 age- and gender-matched normal adults studied by 12-derivation electrocardiogram (ECG), two-dimensional, and M-mode echocardiography. Left ventricular mass (LVM), body mass index, total peripheral resistance (TPR), relative wall thickness (RWT), and QT dispersion were found to be statistically significantly higher in the hypertension group (P < .001 for all). Among hypertensive patients, 41.1% had both normal LVM and RWT, here called normal left ventricle in hypertension; 10.3% had concentric hypertrophy with increased LVM and RWT; 14.95% had eccentric hypertrophy with increased LVM and normal RWT; and 32.7% had concentric remodeling with normal LVM and increased RWT. Echocardiographically derived cardiac index was higher in the concentric hypertrophy and eccentric hypertrophy patterns (P = .002 and P < .0001, respectively), whereas TPR was higher in the concentric hypertrophy and concentric remodeling patterns (P = .017 and .02, respectively). QT dispersion values were found to be increased in the hypertensive group (P = .001), whereas similar values were calculated for different types of hypertrophy patterns. We conclude that the more common types of ventricular adaptation to essential hypertension are eccentric hypertrophy and concentric remodeling. Concentric hypertrophy is found to be associated with both volume and pressure overload, whereas eccentric hypertrophy is associated with volume overload only and concentric remodeling is associated with pressure overload. But different left ventricular geometric patterns seem to have similar effects on QT dispersion.

Predominant Tricuspid Stenosis Secondary to Bacterial Endocarditis in a Patient With Permanent Pacemaker and Balloon Dilatation of the Stenosis

In a 49‐year‐old woman with sick sinus syndrome and a pemanent VVI pacemaker, severe tricuspid stenosis and its clinical consequences developed 4 years after the attack of endocarditis. Besides the quite unusual occurrence of lead related tricuspid stenosis, successful treatment with balloon dilatation is the unique feature of this case.

Angiotensin-converting enzyme gene polymorphism in arrhythmogenic right ventricular dysplasia: is DD genotype helpful in predicting syncope risk?

Introduction. Arrhythmogenic right ventricular dysplasia (ARVD) is a heritable disorder characterised by fibrofatty replacement of right ventricular myocytes and increased risk of ventricular arrhythmias and sudden cardiac death. Angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism affects myocardialACE levels. DD genotype favours myocardial fibrosis and is associated with malignant ventricular tachycardia.The aim of this study was to explore ACE gene polymorphism inARVD patients. Methods. Twenty-nine patients with ARVD and 24 controls were included.AllARVD patients had documented sustained ventricular tachycardia. Thirteen patients had syncopal episodes. Six patients were resuscitated from sudden cardiac death.ACE gene polymorphism was identified by polymerase chain reaction technique. Results. There was no significant difference in DD genotype frequency between ARVD patients and controls (44.8% vs. 45.8%, p=0.94). However, DD genotype frequency was significantly higher in ARVD patients with syncopal episodes compared to those without syncope (69.2% vs. 25.0%, p=0.017, odds ratio:6.750,95% confidence interval: 1.318—34.565). DD genotype was detected in higher frequency also in patients with a family history of sudden cardiac death (66.7% vs. 39.1%,p=0.36). Conclusion. High prevalence of DD genotype in ARVD patients with syncope suggests that ACE I/D polymorphism might be useful in identifying high-risk patients for syncope.

Using GIS to Analyze Acute Myocardial Infarction in Turkey

Approximately 3.5 million people have cardiologic problems and the number increases by 100 thousand every year in Turkey. Annually, approximately 400 thousand myocardial infarctions (MI) occur and fifty percent of deaths occur due to myocardial infarctions. These deaths occur due to lack of coordination and unconsciousness. It is well known that eighty percent of these incidents can be prevented if they can reach the hospital or health care providers on time. This study is part of a proposal project submitted to TUBITAK (The Scientific And Technical Council of Turkey) and BAP-ITU (Science and Research Projects - Technical University of Istanbul) in order to develop an emergency management model on Myocardial Infarction and, analyze concentration of MIs with respect to location, proximity to health care providers, public transportation routes, and arrange new locations for ambulances. This project will also help the determination of locations of new hospitals or ambulances and/or restoration centers.

Effects of Percutaneous Coronary Thrombectomywith the X-Sizer Catheter on Epicardial Flow and Microvascular Function in Acute Coronary Syndromes

During percutaneous coronary intervention, slow coronary flow and distal embolization are still important problems, especially in cases with intracoronary thrombus. The aim of this study was to learn the effectiveness and early term results of thrombectomy with the X-SIZER catheter system in acute coronary syndrome. Twenty-nine patients (22 [76%] men; 55.9 ± 11.1 years) with acute coronary syndrome and intracoronary thrombus detected in coronary angiography were included into the study. X-sizer thrombectomy was applied to 14 of the patients, and conventional percutaneous transluminal coronary angioplasty (PTCA) was applied to the others. Baseline characteristics were similar in both groups. Mean thrombolysis in myocardial infarction (TIMI) flow increased from 0.8 ± 0.9 to 2.4 ± 0.6 in X-sizer-treated patients (p<0.001) and TIMI 3 flow was maintained in 71.4% of the patients. Similary, mean TIMI flow increased from 0.36 ± 0.81 to 2.73 ± 0.47 in conventional PTCA-treated patients (p<0.001) and TIMI 3 flow was maintained in 73% of the patients (NS). Mean myocardial blush grade (MBG) increased from 0.7 ± 0.7 to 2.6 ± 0.6 in X-sizer-treated patients (p<0.001) and from 0.27 ± 0.65 to 2.36 ± 0.67 in the conventional PTCA-treated patients (p<0.001). Postprocedural MBG 3 was obtained in 64.3% of X-Sizer-treated patients and in 45% of controls. Although microvascular function in the thrombectomy-applied patients was found better, there was no significant difference between the two groups. Furthermore it was detected that the use of tirofiban yielded no additional improvement in epicardial and microvascular flow. In acute coronary syndromes, use of X-sizer in addition to primary percutaneous coronary interventions is a safe and relatively effective method in the prevention of distal embolization.

Can thrombolytic therapy provide beneficial effects additional to epicardial coronary artery recanalization? A study based on coronary pressure measurement.

BackgroundCollaterals provide significant blood supply to the myocardium at risk and the presence of a preserved and adequate collateral network may limit microvascular damage during the occlusion of an epicardial coronary artery. The aim of this study was to evaluate whether thrombolytic therapy (TT) may produce beneficial effects at the level of microvascular circulation in addition to epicardial coronary artery recanalization by using quantitative intracoronary pressure measurement techniques in patients with recent acute myocardial infarction (AMI). Materials and methodsThirty-six patients who presented with AMI and had preinfarction angina pectoris, more than 60% stenosis and thrombolysis in myocardial infarction (TIMI) grade II flow in the infarct-related artery and who underwent a stent implantation procedure within 10 days of AMI were included in this study. Seventeen of 36 patients had received TT (group 1) and 19 had not received TT due to presence of contraindications or late admission (group 2). Quantitative coronary angiography, TIMI frame count (TFC) assessment and intracoronary pressure measurements were performed before and after stent implantation for all patients. Myocardial fractional flow reserve (FFRmyo) was calculated as the ratio of mean distal coronary pressure to mean aortic pressure. During total occlusion with balloon inflation, distal pressure was recorded as coronary wedge pressure (CWP). Collateral flow index (CFI) was determined by the ratio of simultaneously measured CWP to mean aortic pressure. ResultsThere were no differences between the two groups with respect to mean per cent stenosis and mean FFRmyo both before and after stent implantation. The mean CWP (25.1 ± 8.6 mmHg compared with 17.2 ± 6.2 mmHg, P  < 0.01) and CFI (0.24 ± 0.10 compared with 0.16 ± 0.11, P  < 0.01) were significantly higher and mean post-stent corrected TFC (18.8 ± 3.7 compared with 22.4 ± 3.1, P  < 0.01) was significantly faster in the group of patients who had received TT compared to those who had not. ConclusionsWe concluded that destruction degree of collateral circulation and distal microvasculature is lower in patients who had received TT, compared to patients who could not be treated with TT. Besides protective effect on collateral vessels, TT provides even more reperfusion and less destruction of the microvasculature.