Fuat Gundogdu

The evaluation of myocardial damage in 83 young adults with carbon monoxide poisoning in the East Anatolia region in Turkey

Carbon monoxide (CO) poisoning is the leading cause of death from intoxication. In CO poisoning, it is important to know if there are any symptoms regarding myocardial damage, which are usually unobserved as a result of hypoxia. This study was planned to assess myocardial damage in young healthy patients with CO poisoning. Eighty-three young healthy cases who had been exposed to CO were included in this study. The demographic and clinical characteristics, the origin of CO gas and smoking habits of the patients were recorded. The evaluation of ECG, peripheral ABG, complete blood count and serial cardiac biomarkers (creatine kinase, creatine kinasemyocardial band and troponin I) measurements were performed in all cases. Additionally, echocardiogram (ECHO) and myocardial perfusion single-photon emission computed tomography (SPECT) were performed at the appropriate times in all cases. The mean age of the patients was 27.39 /10.9 years. The main complaint of the patients was loss of consciousness with a 62.7% rate. The average carboxyhaemoglobin level of the patients was 34.49 /15.9%. Sinus tachycardia was present in 26.5% of patients. Diagnostic ischaemic ECG changes were present in 14.4% of patients. In myocardial SPECT, myocardial ischaemic damage was observed in 9 cases, in 6 of whom ECHO findings were also confirmed. Myocar-dial damage due to CO poisoning should not be ignored. If patients are at risk in terms of myocardial damage, further studies, such as ECHO and scintigraphy are needed to determine myocardial damage resulting from CO poisoning. However, in the young adults of the risk group, if the baseline ECG and serial cardiac biomarkers are normal, further studies such as ECHO and scintigraphy, considering the length of exposure and the severity of poisoning, may not be necessary for the evaluation of myocardial damage due to CO poisoning.

Right ventricular strain and strain rate properties in patients with right ventricular myocardial infarction.

Background: This study was planned to assess strain and strain rate properties of right ventricle in patients with RV myocardial infarction. Material and Method: Thirty patients with acute inferior myocardial infarction were included in this study. The presence of right ventricular infarction in association with an inferior myocardial infarction was defined by an ST‐segment elevation 0.1 mV in lead V4 R. According to this definition, 15 patients had electrocardiographic signs of inferior myocardial infarction without right ventricular infarction (group I), and 15 patients had electrocardiographic signs of inferior myocardial infarction with right ventricular infarction (group II). Echocardiography was performed using a Vivid 5 System (GE Ultrasound; Horten, Norway) and a 2.5‐MHz transducer. 2‐dimensional color doppler myocardial imaging (CDMI) data for longitudinal function were recorded from the RV free wall using standard apical view. Offline analysis of the myocardial color Doppler data for regional velocity (V), strain rate (Sr), and strain (S) curves was performed using a special software program (EchoPac 6.4 Vingmed, Horten, Norway). They were assessed in basal, middle and apical segments of the RV. The differences between different groups were assessed with the Mann‐Whitney U‐test. A value of P < 0.05 was considered statistically significant. Results: Systolic tissue velocity, strain, strain rate of basal (4.8 ± 0.8 cm/s vs 6.5 ± 1.2 cm/s, −12 ± 3% vs −24 ± 5%, 1.28 ± 0.3/s vs −1.9 ± 0.4/s; P < 0.001, <0.001, <0.001, respectively) and mid (4.2 ± 0.5 cm/s vs 5.4 ± 0.5 cm/s, −16 ±3% vs −26 ± 4%, −1.2 ± 0.3/s vs −2.1 ± 0.3/s; P < 0.001, <0.001, <0.001, respectively) segments of right ventricle were significantly lower in patients with RV infarction than in patients without RV infarction. There were no differences between groups for apical strain, strain rate, and systolic tissue velocity. Conclusion: This study demonstrates that right ventricular strain and strain rate were lower in patients with left ventricular inferior wall myocardial infarction with, compared to without, right ventricular infarction.

Comparison of serum levels of inflammatory markers and allelic variant of interleukin-6 in patients with acute coronary syndrome and stable angina pectoris.

ObjectivesAlthough the relationship between atherosclerosis and inflammatory cells has been recognized in recent years, the effect of interleukin-6 (IL-6) genetic variants associated with atherosclerosis is still controversial. Therefore, we investigated the association between IL-6 polymorphism and levels of IL-6 in patients with coronary artery disease (CAD). MethodsWe conducted a case–control study on 294 unrelated participants who were referred to the cardiology department of the university hospital for coronary angiography because of suspected ischemic heart disease. Group I comprised patients with clinically acute coronary syndrome, and group II comprised patients (individuals matched for age and sex) with clinically stable angina pectoris; both groups were categorized, based on their angiographic findings, as either having angiographically documented less extensive CAD (1 vessel narrowed) or extensive CAD (≥2 vessels narrowed). They were studied to examine effect of the IL-6 gene variants in CAD. Genotyping was determined by polymerase chain reaction. ResultsThe IL-6 G/C-174 polymorphism was found in 19 of 106 (18%) in group I and in four of 188 (2%) in group II (P<0.001). Median IL-6 levels were significantly higher in group I (6.7±13.6 pg/ml) than in group II (4.1±3.8 pg/ml) (P<0.05). In addition, high sensitivity C-reactive protein levels were significantly higher in group I (8.2±6.2 mg/dl) than in group II (4.6±3.4 mg/dl) (P<0.001). ConclusionThese results demonstrated that the presence of the IL-6 G/C-174 polymorphism and increased IL-6 and high sensitivity C-reactive protein levels are strongly associated with the inflammatory system and the course of clinical and hemodynamically significant CAD.

A Rare Congenital Anomaly: Biatrial Appendage Aneurysm with Atrial and Ventricular Septal Defect

Atrial appendage aneurysms are extremely rare entities in cardiology practice. There are reports of solitary left and right atrial appendage aneurysms in the literature. A case of biatrial appendages aneurysms is reported here. This is the first report of such an anomaly.

Congenitally corrected transposition of the great arteries: MDCT angiography findings and interpretation of complex coronary anatomy

A 56-year-old male patient was admitted to our hospital because of dyspne and chest pain. A chest radiograph showed mild cardiomegaly. Echocardiography revealed unusual chamber in the heart. The chamber beneath the left atrium was morphologically right ventricle. To evaluate the precise complex anatomy of this abnormality, multidetector computed tomography (MDCT) angiography was performed. MDCT clearly revealed complex intracardiac and vascular anatomy, including typical imaging findings of a patient with congenitally corrected transposition of the great arteries (CCTGA). We described both imaging findings of MDCT angiography and interpretation of complex vascular anatomy in a patient with CCTGA.

Left atrial mechanical functions in pre‐eclampsia

Aim: To assess the effect of short‐term pressure overload on left atrial (LA) mechanical function in pre‐eclampsia.

Strain and Strain Rate Imaging in Evaluating Left Atrial Appendage Function by Transesophageal Echocardiography

Background: This study was planned to assess whether strain rate (Sr) and strain (S) echocardiography is a useful method for functional assessment of the left atrial appendage (LAA). Material and Methods: Fifty‐seven consecutive patients underwent a clinically indicated study. LAA late empty velocity (LAAEV) was calculated as a gold standard for left atrial appendage function. Real‐time 2‐dimensional color Doppler myocardial imaging data were recorded from the LAA at a high frame rate. Analysis was performed for LAA longitudinal strain rate and strain from midsegment of lateral wall of LAA. LAA strain determines regional lengthening expressed as a positive value or shortening expressed as a negative value. Peak systolic values were calculated from the extracted curve. Results: Spearman correlation test results showed a statistically significant positive correlation was between the S, Sr variables and LAAEV (LAAEV vs S; r = 0.886, P < 0.001; LAAEV vs Sr: r = 0.897, P < 0.001, respectively). Strain and strain rate values were also significantly lower in patients with spontaneous echocardiographic contrast when compared with those without (strain; 2.42 ± 0.98 vs 13.1 ± 5.9, P < 0.001 and strain rate: 0.97 ± 0.54 vs 3.34 ± 1.15, P < 0.001, respectively). In addition, LAA strain and strain rate values were significantly lower in the patients with LAA thrombus (strain; 2.15 ± 0.96 vs 8.35 ± 6.9, P < 0.001, strain rate; 0.79 ± 0.46 vs 2.30 ± 1.48, P < 0.001, respectively). Conclusion: S and Sr imaging can be considered a robust technique for the assessment of the LAA systolic deformation.

Assessment of regional left ventricular functions by strain and strain rate echocardiography in type II diabetes mellitus patients without microvascular complications

OBJECTIVES We evaluated regional left ventricular myocardial functions by strain (S) and strain rate (Sr) echocardiography in patients with type II diabetes mellitus (DM) without microvascular complications. STUDY DESIGN The study included 40 DM patients (20 women, 20 men; mean age 52.4 ± 7.9 years) without microvascular complications, and 40 healthy controls (20 women, 20 men; mean age 52.8 ± 10.1 years). Left ventricular functions were evaluated by conventional Doppler, tissue Doppler, and S-Sr echocardiography. Longitudinal peak systolic S and Sr were measured from the basal, mid and apical segments of the left ventricle walls. Patients with DM duration of >3 years (n=24) and receiving medical therapy for DM (n=30) were also evaluated. RESULTS Conventional Doppler findings were similar in the patient and control groups. Among tissue Doppler variables, only early diastolic mitral annular velocity (Em) was significantly decreased (10 ± 2.9 vs. 11.4 ± 3.2 cm/sec, p<0.05), and accordingly, mitral inflow E/Em ratio was significantly increased (7.3 ± 2.5 vs. 6.3 ± 2, p<0.05) in patients with DM. The two groups were similar with respect to systolic S and Sr values, except for apical-lateral S, mid-anterior S, basal-anteroseptal S, apical-anterior Sr, and mid-anteroseptal Sr (p<0.05, for all). Patients with DM duration of >3 years and receiving medical therapy showed similar changes as the overall patient group. CONCLUSION The frequency of left ventricular diastolic dysfunction was higher in patients with DM. Irregular distribution of systolic S and Sr indices in the left ventricular segments may indicate that DM leads to heterogeneous myocardial involvement also in the early period.

Follow-up of coronary artery bypass graft patency: diagnostic efficiency of high-pitch dual-source 256-slice MDCT findings.

Objectives Our aim was to evaluate the diagnostic accuracy of 256-slice, high-pitch mode multidetector computed tomography (MDCT) for coronary artery bypass graft (CABG) patency. Methods Eighty-eight patients underwent 256-slice MDCT angiography to evaluate their graft patency after CABG surgery using a prospectively synchronized electrocardiogram in the high-pitch spiral acquisition mode. Effective radiation doses were calculated. We investigated the diagnostic accuracy of high-pitch, low-dose, prospective, electrocardiogram-triggering, dual-source MDCT for CABG patency compared with catheter coronary angiography imaging findings. Results A total of 215 grafts and 645 vessel segments were analyzed. All graft segments had diagnostic image quality. The proximal and middle graft segments had significantly (P < 0.05) better mean image quality scores (1.18 ± 0.4) than the distal segments (1.31 ± 0.5). Using catheter coronary angiography as the reference standard, high-pitch MDCT had the following sensitivity, specificity, positive predictive value, and negative predictive value of per-segment analysis for detecting graft patency: 97.1%, 99.6%, 94.4%, and 99.8%, respectively. Conclusions In conclusion, MDCT can be used noninvasively with a lower radiation dose for the assessment of restenosis in CABG patients.

The Impact of Trimetazidine Treatment on Left Ventricular Functions and Plasma Brain Natriuretic Peptide Levels in Patients with Non-ST Segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention.

Background and Objectives The aim of this study was to investigate the impact of treatment with oral trimetazidine (TMZ) applied before and after percutaneous coronary interventions (PCI) on short-term left ventricular functions and plasma brain natriuretic peptide (BNP) levels in patients with non-ST segment elevation myocardial infarction (NSTEMI) undergoing PCI. Subjects and Methods The study included 45 patients who were undergoing PCI with the diagnosis of NSTEMI. The patients were randomized into two groups. The first group (n=22) of the patients hospitalized with the diagnosis of NSTEMI was given conventional therapy plus 60 mg TMZ just prior to PCI. Treatment with TMZ was continued for one month after the procedure. TMZ treatment was not given to the second group (n=23). Echocardiography images were recorded and plasma BNP levels were measured just prior to the PCI and on the 1st and 30th days after PCI. Results The myocardial performance index (MPI) was greater in the second group (p=0.02). In the comparison of BNP levels, they significantly decreased in both of the groups during the 30-day follow-up period (29.0±8 and 50.6±33, p<0.01 respectively). However, decreasing of BNP levels was higher in the group administered with TMZ. The decrease of left ventriclular end-diastolic volume was observed in all groups at 30 days after intervention, but was higher in the group administered with TMZ (p=0.01). Conclusion Trimetazidine treatment commencing prior to PCI and continued after PCI in patients with NSTEMI provides improvements in MPI, left ventricular end diastolic volume and a decrease in BNP levels.