Guliz Erdem Yazici

Duplication of the right coronary artery in a patient with hypertrophic cardiomyopathy and myocardial bridging.

Hypertrophic cardiomyopathy is a genetic myocardial disorder. In such patients, myocardial bridging is the most frequent encountered coronary arterial anomaly. Patients may, however, on occasion, present with other much rarer malformations of the coronary arteries. Duplication of the right coronary artery is a very rare anomaly. We have now encountered a patient with hypertrophic cardiomyopathy in whom we found myocardial bridging of the anterior interventricular coronary artery and duplication of the right coronary artery. To the best of our knowledge, this association has not previously been described.

Heart rate variability in neurally mediated reflex syncope

Objective — The aim of this study was to investigate the heart rate variability (HRV) parameters in patients with neurally mediated reflex syncope. Methods — Thirty-three patients (10men, age range 16-50years) who were scheduled to undergo head-upright tilt test (HUTT) with a typical history of vasovagal syncope (VVS) underwent 24-hour Holter monitoring in an attempt to study HRV parameters. Sixteen individuals without syncope and similar baseline characteristics made up the control group. Results — Seventeen of the 33syncopal patients showed HUTT positivity. All the time domain HRV parameters except the mean RR interval were higher in the HUTT (+) syncopal patients than in the negative responders. Although not statistically significant, the positive responders had higher NN50, pNN50, RMSSD and SDNNi values than the control group. HUTT (-) VVS patients had lower SDNN and SDANN values when compared with the control group.The other HRV parameters did not differ significantly between the HUTT (-) patients and the control group. Conclusion — Increased parasympathetic tonus as reflected by significantly higher HRV parameters is associated with a greater frequency of HUTT positivity in patients with syncope and no organic heart disease.

The comparison of early and late outcome of direct and conventional stenting of patients with st elevation myocardial infarction

Background: The aim of this study was to compare direct and conventional stenting procedure in the subacute stable phase on short- and long-term results in patients with ST elevation myocardial infarction. Methods: Eighty-eight clinically stable ST-segment elevation myocardial infarction (STEMI) patients were enrolled into the study. The patients were classified as group I (direct stenting) and group II (conventional stenting — stenting after balloon dilatation). Baseline characteristics of patients were scanned from hospital records. Coronary angiograms before and after the revascularization procedure were evaluated with the quantitative coronary angiogram technique. Patients were followed for 5 years for clinical outcomes. The study population consisted of 58 patients (65%) in group I and 30 patients (35%) in group II. Mean ages were 55.8 ± 10.8 and 57.3 ± 9.8, respectively. Results: There were no significant differences between the two groups regarding clinical characteristics (hypertension, diabetes mellitus, family history of cardiovascular disease, smoking and dyslipidemia). The thrombus score was similar in both groups. Diameter stenosis was lower in group I (54.8 ± 12.7 versus 61.4 ± 12.6; p = 0.023) and TFC (Thrombolysis in Myocardial Infarction frame count) was higher in group II (30.7 ± 14.5 versus 40.8 ± 26.7; p = 0.02) before the percutaneous coronary intervention (PCI). Other quantitative angiographic parameters were not different. For all angiographic criteria, the difference between pre- and post-PCI parameters was significantly different in both groups. However, the change in TFC was higher within the group II compared to pre-PCI TFC rates. This difference was statistically significant (p = 0.002). Procedural success was statistically different between groups (69% in group I, 43% in group II; p50.01). Immediate clinical and angiographic results were similar. At 5-year follow-up the incidence of major adverse cardiac events including death, angina pectoris and myocardial infarction were similar for direct stenting versus conventional angioplasty. Conclusions: Direct stenting is safe and feasible for the treatment in patients with STEMI at the subacute phase. Immediate clinic, angiographic and late clinical results are similar for direct stenting and conventional stenting following balloon angioplasty. Although conventional stenting improved TFC better than direct stenting, this did not translate to better clinical outcomes.

The Optimal Time of Elective Percutaneous Coronary Intervention for Stable Patients After ST Elevation Myocardial Infarction

Objective: To find the optimal time (early: ≤3 days; late: >3 days) for revascularization in ST elevation myocardial infarction (STEMI) patients in the subacute phase. Methods: Ninety-nine STEMI patients who were admitted to Gazi University Faculty of Medicine between 2000 and 2004 were enrolled into this study. Patients were divided into 2 groups according to time from the beginning of symptoms to the percutaneous coronary intervention. Coronary angiograms before and after the revascularization were evaluated using the quantitative coronary angiogram technique. Results: 45 early (group I) and 54 late (group II) revascularized patients were evaluated. There were no significant differences between the 2 groups regarding demographic properties, thrombus score, success of the procedure, quantitative angiographic parameters, and clinical results of the procedure. Conclusions: Waiting for the development of stable phase in STEMI to apply PCI has no obvious benefit for angiographic and clinical results.