Faruk Erzengin

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.

Cardiac surgery in Belgium. State of the art in 2003.

Preinfarction angina pectoris has been suggested in some studies to have a beneficial effect on left ventricular function after acute myocardial infarction (AMI).The precise mechanisms of this protection have not been fully elucidated.The effect of preinfarction angina on myocardial tissue perfusion also needs to be clarified. In this study, we investigated the influence of preinfarction angina on microvasculatory damage by using ST-segment resolution and pressure-derived collateral flow index (CFIp) as a marker of microcirculatory perfusion. Methods — We studied 41 patients with a first AMI in whom thrombolysis in myocardial infarction (TIMI) grade 3 flow in the infarct-related artery was established by thrombolytic therapy.The percent resolution of ST-segment deviation (DS ST) after thrombolysis was determined. All of the patients had TIMI grade 3 flow in IRA at the coronary angiography, which was done a mean of 4 days after AMI. Intracoronary pressure measurements and stent implantation to the IRA were performed. After angiography, CFIp was calculated as the ratio of simultaneously measured coronary wedge pressure – central venous pressure (Pv) to mean aortic pressure – Pv. Results — Patients with preinfarction angina pectoris had greater percent DS ST than those without PA (67 ± 18% vs. 44 ± 24%, p = 0.03).The mean of the coronary wedge pressure (16.4 ± 7.4 compared with 23.2 ± 9.4, P < 0.03) and the pressure-derived collateral flow index (0.15 ± 0.10 compared with 0.22 ± 0.08, P < 0.03) were significantly lower in patients with preinfarction angina compared to those without. Conclusion — Preinfarction angina is associated with a greater degree of ST-segment resolution and lower CFI-p in patients with TIMI-3 reflow after thrombolysis.These findings suggest that a protective effect of preinfarction angina against reperfusion injury may result in greater ST resolution and lower CFIp after AMI.

Efficacy and tolerability of amlodipine in patients with stable angina pectoris: an open-label, multicenter trial

Abstract This open-label, multicenter study was designed to assess the efficacy and tolerability of once-daily amlodipine treatment and its effects on exercise test variables in patients with stable angina pectoris. A total of 233 patients with this condition (82 women, 151 men; mean age, 57 ± 18 years) treated at 17 medical centers were enrolled in the study; 215 patients (92%) completed the study. A 2-week baseline period in which the patients maintained their existing antianginal therapy was followed by a 10-week treatment period with 5 to 10 mg of amlodipine daily. Maximal treadmill exercise tests using the Bruce protocol were performed at the beginning and end of the amlodipine treatment period. After amlodipine therapy, both the median number and duration of anginal attacks per week and the median number of nitroglycerin tablets consumed per week were reduced significantly when compared with baseline values. During self-assessment, 81% of patients reported excellent or good anginal control, 14% reported moderate control, and 5% reported poor control with the drug. Systolic and diastolic blood pressures, heart rate, resting patterns on electrocardiography, and blood and urine analyses showed no statistically significant changes. Compared with baseline, amlodipine treatment significantly increased exercise duration and maximum workload attained, prolonged the time to onset of angina and ST-segment depression, and decreased the magnitude and duration of ST-segment depression. Maximum heart rate, systolic blood pressure detected during exercise testing, and calculated rate-pressure product did not change significantly with amlodipine treatment. Forty-four patients (19%) experienced adverse events considered to be drug related. The most commonly reported adverse events were headache and ankle edema. In three patients (1%) amlodipine treatment was discontinued due to the severity of the side effects. It is concluded that amlodipine, when added to existing antianginal drug therapy, is well tolerated, significantly reduces the incidence of anginal attacks and the concomitant need for nitroglycerin for relief of symptoms, and improves exercise capacity in patients with stable angina pectoris.

Atherosclerosis in 2015: Hypotheses and Viewpoints. Our Comments, Assertions and the Realities

Formation of atherosclerotic and calcified plaque begins and grows up not only beneath the endothelium (intimae), but also in the adventitial subepithelium on the coronary arteries. A new innovative combined drug (polypill) certainly releases, regresses and prevents of formation of the atherosclerotic and calcified plaque of arteries.

Importance of multislice computed tomography angiography for the diagnosis and evaluation of silent coronary ischemia and asymptomatic acute myocardial infarction: long-term follow-up of three cases.

to predict AF recurrence using parameters that easily applied in daily clinical practice. We therefore preferred AP-Lad that is routinely used in daily electrocardiographic evaluations and more practical than LAVI. Interatrial conduction delays have been implicated in initiating and maintaining AF (6). P-wave dispersion (PWD) shows the prolonged interatrial conduction and can be used to predict the recurrence of AF. We agree with the opinion that PWD can be used as a practical predictor of AF. It could be exciting and interesting study in which NLR and PWD are evaluated together and these parameters are compared. We are in absolutely agreement with authors about the improving effects of antiarrhythmic drug therapy on prognosis in AF. Therefore, amiodarone was given to all patients before cardioversion (CV) and was continued for 1 month following CV in this study. Antihypertensive agents such as angiotensin converting enzyme inhibitors and angiotensin receptor blockers have antifibrillatory and antifibrotic actions via inhibition of angiotensin II. Also, statins have anti-inflammatory and antioxidant action. However, according to the ESC 2012 AF guideline, there is only little reason to consider the use of such therapy for the prevention of AF recurrence in patients with little or no underlying heart disease (7). We agree with authors that bacterial or viral infections, chronic inflammatory disease and drug treatments might affect neutrophil and lymphocyte counts and so the ratio of these parameters might be changed. Therefore, we excluded the patients with chronic obstructive pulmonary disease, malignity and acute infectious disease. It could be considered to evaluate together with other serum inflammatory markers. However, these inflammation markers are not used in daily practice and are only assayed with commercially available kits. Another limitation of commercial kits is those shelf lives are generally short after first use. However, our aim was to find a basic parameter analysis of which is quick, economical and labor free for predicting AF following electrical cardioversion (ECV). For this reason, other serum inflammatory markers were not evaluated. Finally, we support the comments of authors that future large-scale prospective clinical studies are needed to clarify the essential pathophysiological mechanisms in the recurrence of AF after ECV in patients with non-valvular AF.

Adventitial (Erzengin’s) Atherosclerocalcification: Surprise Loca-tion and a New Concept of the Formation of Atherosclero-calcifications in 2013. The Tip of the İceberg and a New İnnovative Current Drugs for Certain Solution with the Erzengin’s Polypill

Formation of atherosclerotic and calcified plaque begins and grows up not only beneath the endothelium (intimae), but also in the adventitial subepithelium on the coronary arteries. A new innovative combined drug (polypill) is certainly releases, regress and prevents of formation of the atherosclerotic and calcified plaque of arteries.

SEMPTOMSUZ MİYOKARD İSKEMİSİ VE İNFARKTÜSÜNÜN ERKEN TANISINDA ÇOK KESİTLİ BİLGİSAYARLI TOMOGRAFİK KORONER ANJİYOGRAFİNİN YERİ VE ÖNEMİ: (UZUN DÖNEM TAKİP EDİLEN İKİ OLGU NEDENİYLE)

Multislice computed tomography (MSCT) is an important tool for the noninvasive evaluation, intervention and cure of coronary disease. We have presented here the assessment of a coronary artery disease in a 85 years old man and another 59 years old man, using a MSCT. First patient was admitted to the Cardiology Department with exercise dispnea, and palpitation from time to time spending for about last one month. His ECG and Exercise ECG were normal (Figure 1). To the patient who is a medical doctor denying directly coronary angiography (CA), so CMST technique was performed (Figure 2); severe coronary artery stenosis (%95) at middle segment of LAD was detected. Single coronary artery lesion (LAD) was detected by CA. (Figure 3). Percutaneous coronary intervention was performed for LAD lesion and drug-eluting stent was implanted after balloon predilatation (Figure 4,5). The patient was examineted routinely and in the three mounthly periods time. He was asymptomatic at the end of the 4 years of the procedure. Second patient was admitted with trivial sore throat together with minimal diaphoresis during rest and with elevated cardiac enzymes. His ECG (Figure 6) was normal. In the MSCT-Fig.7, completely total occlusion in the Cx, critical stenosis of LAD arteries. His invasive CA was completely parallel to the MSCT (Figu8). Drug-eluting stents were implanted these two lesions in the same prosedure. This patient also was asymptomatic at the end of the 3 years of the procedure. We conclude that, MSCT is very important divice for silent ischemia and asymthomatic acute myocardial infarction.

Techniques for Interventional Catheterization Guided by Transesophageal Echocardiography

Transesophageal echocardiography (TEE) was first used clinically by anesthesiologists for intraoperative monitoring of cardiac functions. Later, intraoperative TEE has been accepted by cardiologists, cardiac surgeons, and anesthesiologists as a basic tool to evaluate the immediate hemodynamic results of a surgical procedure.1,2