Kursad Erinc

A simple different method to use proximal isovelocity surface area (PISA) for measuring mitral valve area.

AbstractBackground Angle-correction is an important limiting factor for using proximal isovelocity surface area (PISA) method in measuring mitral valve area (MVA). In this study, we derived a novel formula, which simplifies the angle-correction, and tested its use in patients with mitral stenosis (MS). MethodsThe study included 30 MS patients without concomitant aortic or mitral regurgitation. We used mathematical equations and established a relation between the angle and its corresponding border, ‘a’, by using linear regression analysis. It was found that MVA is equal to [(1.11*a2 + 0.95)* r2 (Val/Vmax)]. We compared this formula with plain angle-corrected and solid angle-corrected PISA methods, planimetry (reference method) and pressure-half time method by linear regression analysis. Results All methods were in significant relation with the reference method, two-dimensional planimetry. We found that there is a good relation between our method and planimetry (r = 0.79, p < 0.001), pressure half-time method (r = 0.85, p < 0.001), angle-corrected PISA method (r = 0.99, p < 0.001), and solid angle-corrected PISA method (r = 0.88, p < 0.001). The time duration of the new method was shorter (p < 0.001). ConclusionOur method is an easy way for applying angle-corrected PISA method to mitral valve area measurement in patients with mitral stenosis. Absence of the need for estimating the angle is the major advantage.

Comparison of Electrocardiographic Repolarization Patterns between Hypogonad Males and Normal Subjects

Background: There is a significant difference in repolarization on the surface ECG between men and women. The effect of testosterone on repolarization of myocardium may provide a basis for the physiological and pathophysiological importance of these distinctions between sexes. The purpose of this study is to compare the repolarization characteristics of surface ECG in patients with secondary hypogonadotropic hypogonadism to those of healthy men and women.

Evaluation of plasma adiponectin levels in young men with coronary artery disease

Objective — In this study, we investigated the relation between plasma adiponectin levels and other risk factors in a young patient population. Material and results — We enrolled consecutively 69 young patients (<45years) with coronary artery disease in the study group. The patient enrollment period was between February 2003 and November 2004.The control group consisted of 42 age- and sex-matched healthy subjects.Anthropometric, lipid and other variables including adiponectin, fasting glucose and plasma insulin levels were measured in all subjects. Appropriate statistical analyses were performed to determine the differences between the groups, the relation between adiponectin and other parameters and independent factors that predict CAD. There was a statistically significant difference between the groups in terms of lipid parameters (triglycerides, total cholesterol, HDL and LDL cholesterol). Mean plasma adiponectin levels were significantly lower in the patients (P<0.05).Among the risk factors adiponectin had a significant negative association with the plasma triglyceride level (P<0.01). Logistic regression analysis revealed triglycerides and adiponectin as independent predictors of CAD.The areas under the ROC curves of adiponectin and triglycerides were not different (P>0.05). Conclusion — We found a decreased plasma adiponectin level in young male patients with coronary artery disease. It may be a novel marker of atherosclerosis in young men.

Brain natriuretic peptide and the severity of aortic regurgitation: is there any correlation?

We aimed to evaluate the correlation between aortic regurgitation severity and brain natriuretic (BNP) levels as a marker for left ventricular dysfunction. Sixty consecutive male patients (mean age 22 ± 3 years) with isolated chronic aortic regurgitation were enrolled in the study together with a control group of 30 age-matched healthy volunteers (group A). Patients were classified with regard to aortic regurgitation vena contracta width as follows: group B, < 3 mm, mild (n = 16); group C, ≥ 3 and < 6 mm, moderate (n = 26); group D, ≥ 6 mm, severe (n = 18). BNP measurements were performed with a fluorescence immunoassay kit. BNP levels were increased in patients with aortic regurgitation, and severity of regurgitation had a significant influence on BNP levels. This effect can be explained by the volume loading effect of aortic regurgitation.

Univentricular heart and supramitral ring: an unusual association.

Univentricular heart, which is rarely seen cardiac anomaly, is associated with various cardiac anomalies. The presence of supramitral ring and univentricular heart in the same patient is very interesting association which, to the best of our knowledge, was not reported previously.

Left atrial functions after myocardial infarction.

Acute myocardial infarction results in not only left ventricular but also left atrial dysfunction. Left atrial function is important for optimal filling of the left ventricle. In this study, we aimed at evaluating left atrial functions 6 months after acute myocardial infarction in three different patient groups (thrombolytic therapy, primary percutaneous intervention, or no reperfusion strategies). Between October 2002 and May 2003, 48 patients with ST elevation myocardial infarction who were either administered thrombolytic therapy (group T, n = 16), underwent primary angioplasty (group A, n = 20), or underwent no reperfusion therapy (group C, n = 12) at our unit were enrolled into the study. Echocardiography was performed in these patients 6 months after acute myocardial infarction. Left atrial contractility was assessed by atrial ejection force. Left atrial contribution was assessed by atrial fractional shortening and left atrial volume was calculated. The left atrial volume was significantly higher in group C (P < 0.05), but there was no significant difference between groups A and T (P > 0.05). Patients in group C had significantly lower atrial ejection force values compared with the other groups (P < 0.05). Atrial fractional shortening was not significantly different among the three groups (P > 0.05). Atrial ejection force, which is an indicator of left atrial contractility, is better with either angioplasty or thrombolysis. Left atrial volume is higher in patients who were not treated with reperfusion strategies. Further studies are needed to explain the mechanism involved.

Elongation index as a new index determining the severity of left ventricular systolic dysfunction and mitral regurgitation in patients with congestive heart failure.

The shape of the left ventricle is an important echocardiographic feature of left ventricular dysfunction. Progression of the mitral regurgitation and consequent left ventricular remodeling is unpredictable in heart failure. Elongation index is an index of left ventricular sphericity. The surface area of the elongated ventricle is larger than that of a spherical one. The objective of this study was to assess the relation between elongation index and the degree of mitral regurgitation along with noninvasive indices of left ventricular function. Thirty‐two patients (21 male, 11 female, mean age: 57 ± 6 yrs) with congestive heart failure and mitral regurgitation were included. Patients were stratified into three groups according to vena contracta width as having mild (n = 11), moderate (n = 11) and severe mitral regurgitation (n = 10). The elongation index (EI) was considered as equal to {[(left ventricular internal area‐measured) − (theoretical area of the sphere with measured left ventricular volume)]/(theoretical area of the sphere with measured left ventricular volume)}. Ejection fractions by the modified Simpson rule, dP/dt and sphericity index (SI) were also recorded. The relationship between (EI), ejection fraction, dP/dt and SI reached modest statistical significance (p < 0.05). When the EI and SI were compared, the correlation was also significant (p < 0.01). The areas under the receiver operator curve of EI and SI for discriminating dP/dt < 1000 mm Hg/s were 0.833 and 0.733, respectively. In conclusion, the elongation, which defines the shape of the left ventricle, might be related to the systolic function of the left ventricle and the degree of the mitral regurgitation. Further studies are needed to demonstrate its use in other clinical entities.

Effects of chronic alcohol consumption on myocardial ischemia in rats

The effects of chronic alcohol consumption on myocardial ischemia and gas perfusion with 95% O(2)-5% CO(2) were investigated in isolated rat heart. Eighteen adult male Wistar rats were used. Rats were assigned into six groups for each group to contain three rats: normal, alcoholic, normal ischemic, alcoholic ischemic, normal ischemic and 95% O(2)-5% CO(2) perfused, alcoholic ischemic and 95% O(2)-5% CO(2) perfused, respectively. Alcohol (7.2%, v/v) was given to rats by a modified liquid diet for 21 days. Rats were anaesthetized with ketamine (1-2mg kg(-1)). Hearts were quickly isolated. Normal and alcoholic rat hearts were directly sent to the electron microscopic preparation. The other hearts were cut into small pieces and put into Krebs solution. The solution was continuously bubbled using 95% N(2)-5% CO(2) 20 min for ischemia. After removal of normal ischemic and alcoholic ischemic heart specimens for electron microscopic examination, the remaining hearts of the last two groups were bubbled with 95% O(2)-5% CO(2) for another 20 min for the purpose of reperfusion and then were also prepared for electron microscopic examination. The hearts were investigated with a transmission electron microscope (Jeol 100 CXII TEM). Twenty-one days of chronic alcohol consumption was found to have no significant effect on myocardial ischemia determined by transmission electron microscopic examination. Our results suggest that there is no significant relationship between 21 days of alcohol consumption by a liquid diet and myocardial protection.

A Diffusely Aneurysmal, Giant Right Coronary Artery

A 55-year-old woman was admitted to our clinic with the complaint of atypical chest pain. Physical examination was normal except for a low-pitched systolic murmur at the apical region. The history revealed no cardiovascular risk factors. The whole blood, routine biochemical analysis, and erythrocyte sedimentation analysis were within normal limits. Transthoracic echocardiography (TTE) was performed to rule out mitral valve prolapse. It revealed that mitral valve was normal; however there was a round structure adjacent to the aorta which was 0.5 cm in diameter and showed a biphasic e ow. The right ventricle was slightly large. Although we could not e nd any e ow turbulence in the right ventricle, the patient had transesophageal echocardiography (TEE) with the suspicion of coronary artery e stula. On TEE, the origin of the right coronary artery was wide (Fig. 1) and a 32 mmHg gradient was measured with the continuous-wave Doppler. We thought there should be a stenosis at the origin of the artery because of the color Doppler e ndings (Fig. 2). As in TTE, there was no e ow turbulence in the right ventricle. Coronary arteriogram was performed to cone rm the diagnosis. It revealed that the left main, left anterior descending, and left circume ex arteries were normal. Right coronary artery was diffusely aneurysmal (Fig. 3). Its width was 20.4 mm at the proximal region. The patient was given acetyl salicylate 100 mg/day and warfarin (dose to be adjusted so as to keep the international normalized ratio between 2.5 and 3.5). Aneurysm formation of the coronary arteries may result from congenital or acquired conditions. Congenital coronary artery aneurysms are found most often in the right coronary artery. 1 Abnormal e ow patterns within the aneurysm may lead to thrombus formation, with subsequent vessel occlusion, distal thromboembolization, and myocardial infarction. 2 Coronary artery aneurysms are found in about 1.5% of patients studied at necropsy or by coronary arteriography. 3 Acquired coronary artery aneurysms, which may be multiple, can be the result of atherosclerosis, trauma, angioplasty, atherectomy, laser procedures, arteritis (including syphilis), mycotic emboli, mucocutaneous lymph node syndrome (Kawasaki disease), systemic lupus erythematosus, 4 or dissection (spontaneous or secondary). Atherosclerosis-induced aneurysms are thought to result from primary thinning and/or destruction of the media, and may represent up to 50% of the cases. Angioplasty, atherectomy, and arteritis may also damage the arterial wall (media) and lead to coronary aneurysms. This aneurysm is probably congenital because:

A Giant Dissecting Aneurysm of Ascending Aorta

Aortic aneurysm is a serious clinical challenge for the cardiologist. Aneurysm expansion frequently associated with significant dissection and rupture risk. Currently available diagnostic modalities make earlier diagnosis and therapy possible hence giant aneurysm with dissection is relatively rare. In this case report, we present a patient with giant aortic aneurysm with dissection.