Ferit Akgül

Effects of Trimetazidine on Heart Rate Variability and Left Ventricular Systolic Performance in Patients with Coronary Artery Disease After Percutaneous Transluminal Angioplasty

Fifty-one patients (mean age 51.6 ± 7.1 years) with angiographically proven coronary artery disease (CAD) entered the study. In 26 patients (Group I), trimetazidine treatment started twenty-four hours after percutaneous transluminal coronary angioplasty (PTCA). Another 25 patients (Group II) without trimetazidine treatment were kept as controls. The groups were comparable by age, gender, risk factors of CAD, coronary anatomy, left ventricular performance, and heart rate variability indices at baseline state. Power spectral analysis of heart rate variability and two-dimensional and Doppler echocardiographic examinations were performed before PTCA, and twenty-four hours, ten days, thirty days, and three months after PTCA. A statistically significant improvement of left ventricular systolic performance (P<0.001), augmentation of the parasympathetic band of heart rate variability (P<0.001), and decline of P1/P2 ratio (P<0.01) were evident in patients treated with trimetazidine, while no apparent changes were observed in controls. The intergroup analysis also showed marked difference between groups as recorded on the day 30 and month 3 of observation (P<0.001). During follow-up period recurrences of angina pectoris and ischemia were registered in Group II, while no evidence of ischemia was discerned in Group I patients. In conclusion, trimetazidine modulates the autonomic control of heart rate, ie, reduces sympathetic overactivity and augments vagal influences, improves left ventricular contractility, and diminishes the clinical manifestations of ischemia in patients with CAD after PTCA.

Relationship between components of heart rate variability and Doppler echocardiographic indices of left ventricular systolic performance in patients with coronary artery disease

Decreased heart rate variability (HRV) has been reported as prognostic predictor in coronary artery disease population. The aim of the study was to assess the relationship between cardiac autonomic tone disturbances and the degree of left ventricular dysfunction, estimated by 2-dimensional and Doppler echocardiography, in patients with coronary artery disease. Forty patients with angiographically proven coronary artery disease and 15 age-and sexmatched healthy subjects were included into the study (Group I and II, respectively). Routine clinical examinations, electrocardiography, coronary angiography, and 2-dimensional and Doppler echocardiography with assessment of LV systolic performance were done in all the patients and control subjects. Cardiac autonomic function was assessed by means of frequency-domain analysis of heart rate variability. The powers of LF and HF bands (P1 and P2), their ratio (P1/P2), and the logarithmic expression of powers were measured. The patients (Group I) had lower values of parasympathetic band of HRV and higher sympathetic activity than the healthy population (Group II) (p<0.0002 for P2 andp<0.04 for P1/P2 ratio). A positive significant correlation was seen between parasympathetic band of HRV and ejection fraction (r=0.61,p<0.0001), and mean acceleration of aortal flow (r=0.56,p<0.0001), whereas P1/P2 ratio inversely and significantly correlated with the same parameters (r=−0.46,p<0.002 and r=−0.41,p<0.008).

Current role of laser angioplasty of restenotic coronary stents

Treatment of in-stent restenosis (ISR) with conventional percutaneous transluminal coronary angioplasty (PTCA) causes significant recurrent neointimal tissue growth in 30-85%. Therefore, laser ablation of intrastent neointimal hyperplasia before balloon dilation can be an attractive alternative. However, the long-term outcomes of such treatment have not been studied thoroughly enough. This prospective case-control study evaluated angiographic and clinical outcomes of PTCA alone and a combination of excimer laser coronary angioplasty (ELCA) and adjunct PTCA in 125 patients with ISR. ELCA was performed before balloon dilation in 67 patients, PTCA alone was performed in 58 patients. Basic demographic and clinical data were comparable in both groups. Lesions included in ELCA group were longer (17.1 ±9.9 vs 13.6 ±9.1 mm; p=0.034), more complex (36.5% type C stenoses vs 14.3%; p=0.006), and more frequently had reduced distal blood flow (TIMI <3: 18.9% vs 4.8%; p=0.025) compared to lesions in the PTCA group. Immediate angiographic results of PTCA and ELCA + PTCA appeared to be comparable. PTCA alone was successful in 57 patients (98.3%), ELCA + PTCA, in 66 patients (98.5%). The rates of hospital complications were comparable (3.0% in ELCA group vs 8.6% in PTCA group). The 1-year follow-up showed that the rates of major adverse cardiac events (MACE) were comparable in the 2 groups (37.3% in ELCA group vs 46.6% in PTCA group). The rates of target vessel revascularization (TVR) within 1 year after the intervention were also similar in the 2 groups (32.8% vs 34.5%). The data mean that ELCA in patients with complex ISR is efficient and safe. Despite a higher complexity of lesions in the ELCA group, no increase in the rate of complications was registered.

Effects of the hypoxic test on left and right ventricular contractility in progressive systemic sclerosis with pulmonary arterial hypertension

AbstractThe purpose of this investigation was to assess hypoxic test effects on left and right ventricular contractility in patients with progressive systemic sclerosis (PSS) and pulmonary arterial hypertension (PAH). Ten patients (mean age 48.8±13.2 years) who were diagnosed with PSS and PAH were included in the study. All the patients underwent left and right heart catheterization. Right ventricular (RV) contractility was measured according to the method of Ferlinz [1] and left ventricular (LV) contractility according to the method of Kennedy et al. [2] using indirect digital substraction angiography. The mean pulmonary artery pressures (

Thromboembolism Risk in Patients with Mitral Stenosis

\bar P

Effects of acute hypoxia on left and right ventricular contractility in chronic obstructive pulmonary disease

PA) and oxygen saturation of the pulmonary artery (SaO2) were registered at each stage of graded hypoxic exposure 14%, 12%, and 10% of O2. Right atrial pressures (PRA,syst, PRA,diast,

Kalıcı kalp pili elektrotu enfeksiyonunda elektrot kalıntısının nadir bir komplikasyonu : Göğüs duvarına migrasyon

\bar P