Mustafa Demirtas

Left ventricular systolic and diastolic functions in patients with sickle cell anemia

The aim of this study was to evaluate the left ventricular systolic and diastolic functions in patients with sickle cell anemia. Fifty-four patients (34 male, 20 female, mean age 22.6±7.3 years) and 23 healthy persons (12 male, 11 female, mean age 26.7±6.8 years) were studied. After clinical examination and routine biochemical evaluation by a hematologist, patients with sickle cell anemia were admitted to the study. M-mode and 2-dimensional and Doppler echocardiographic measurements of patients and controls were performed according to criteria of the American Echocardiography Society. The values of the patient groups were compared with the values of normal healthy subjects (controls). Left ventricular systolic and diastolic diameters of sickle cell patients were greater than those of controls (p<0.001). All of the sickle cell anemia patients had reduced systolic cardiac function (EP: 0.57±0.1 vs 0.63±0.06 and FS: 0.30±0.06 vs 0.34±0.04,p<0.02) and abnormal diastolic left ventricular function parameters compared with the control group (IRT: 114±20 msec vs 65±7 msec,p<0.0001; E/A ratio: 1.2±0.5 vs 1.6±0.04,p<0.01). Left ventricular mass (LVM) was greater in patients than in controls (222±78 g vs 177±46 g,p<0.01). Left ventricular systolic and diastolic functions were abnormal in patients with sickle cell anemia, and the left ventricular mass was greater in the patients compared with controls.

The effect of early statin treatment on inflammation and cardiac events in acute coronary syndrome patients with low-density lipoprotein cholesterol.

We investigated the effects of atorvastatin on inflammation and cardiac events during the inpatient period and initial 6-month follow-up in acute coronary syndrome (ACS) patients with low low-density lipoprotein (LDL) cholesterol level. One hundred and twelve consecutive ACS patients with LDL cholesterol less than 100 mg/dl were included in the study (mean 78.2 ± 12.3 mg/dl). While 70 randomly selected patients received a dose of 40 mg atorvastatin within the first 24 h on top of their standard treatment as the atorvastatin group, the remaining 42 patients considered as the control group were given the standard treatment only, i.e., without any lipid-lowering drug therapy. Lipid profile, high-sensitivity C-reactive protein (hsCRP), and plasma amyloid A (SAA) levels were measured in all patients within the first 24 h of chest pain, on the 5th day, and in the 6th month. During the inpatient period and subsequent 6-month follow-up, all episodes of angina, reinfarction, revascularization, heart failure, rehospitalization, cardiac mortality, and total number of cardiac events were recorded. In the atorvastatin group, hsCRP and SAA values on the 5th day and in the 6th month compared to the first 24 h were significantly lower than those of the control group (P < 0.0001). Mean LDL cholesterol level was significantly decreased in the atorvastatin group (55.7 ± 17.7 mg/dl), but there was no significant change in the control group at the 6th month. The frequency of heart failure during the inpatient period and angina, unstable angina pectoris, heart failure, and revascularization in the first 6 months were also significantly reduced in the atorvastatin group. Atorvastatin started in the first 24 h reduces inflammation and improves the prognosis during both the inpatient period and the first 6 months of clinical follow-up in ACS patients with low LDL cholesterol levels.

Cardiac troponin T as a prognostic marker in patients with heart failure : a 3-year outcome study.

Cardiac troponin T (cTnT), a highly sensitive and specific indicator of myocardial cell death, may be elevated in congestive heart failure (CHF). The aims of this study were to test the hypothesis that decompensated CHF may be associated with an increase in cTnT release and to correlate between cTnT levels and patient outcomes. The authors studied 55 patients aged between 38 and 86 years (30 women and 25 men) who were hospitalized for CHF. Left ventricular ejection fraction (EF) was calculated by using modified Simpsons rule by echocardiography. cTnT levels were assessed. Troponin T ≥0.1 ng/mL was considered as positive. All patients were contacted by phone annually during the next 3 years, and their history of subsequent hospital admissions and current health status were recorded. cTnT was negative in 44 (80%) and positive in 11 (20%) patients. EF was significantly lower and NYHA was higher in cTnT-positive patients. During the 3-year follow-up period, 25 patients died from CHF. The mortality rate was 8/11 (72.7%) among cTnT-positive patients, whereas the mortality rate was 17/44 (38.6%) among cTnT-negative patients. There were significant relationships among positivity of cTnT, NYHA, EF, and mortality rate. Multivariate regression analysis yielded an independent relationship between positivity of cTnT, NYHA classification, and mortality rate. The percent of hospital admissions due to CHF was also higher in patients with cTnT positive (63.6% versus, 27.3%, p <0.05). In conclusion, this study shows that cTnT positivity is an independent risk factor in predicting the long-term mortality and morbidity rate in patients with CHF. Patients with worsening CHF may possibly be identified early on the basis of their elevated serum cTnT levels.

The Presence of a Calcific Plaque in the Common Carotid Artery as a Predictor of Coronary Atherosclerosis

Many contradictory reports have been published investigating the relationship between coronary artery disease (CAD) and the increased intima-media thickness (IMT) in the common carotid artery (CCA). However, only a limited number of studies evaluate the relationship between CAD and CCA disease as reflected by both the plaque morphology (fibrous and calcific plaques) and IMT. We have studied the associations between CAD and the wall morphology of CCA by B-mode ultrasound (US). One hundred and forty-four subjects, whose angiography was planned on the basis of suspected CAD, were included into the study. The patients were divided into 4 groups on the basis of B-mode US findings; Group I: normal, Group II: increased IMT (IMT ≥ 0.8 mm and plaque absent), Group III: fibrous plaque, Group IV: calcific plaque. Coronary artery disease was diagnosed in 63 patients. A statistically significant correlation was found between CAD and CCA wall morphology (r =0.42, CI (95%) = 0.30-0.51, p<0.001). Positive predictive values were 45.0%, 48.4%, and 75.0% in patients with increased IMT, fibrous plaque, and calcific plaque, respectively. None of the women with normal CCA wall morphology had significant coronary artery lesion. With respect to the normal group, the risk for CAD increased by 4.3 fold with the existence of fibrous plaque (p=0.02) and by 9.9 fold with the existence of calcific plaque (p<0.001). It has been shown that the CCA wall morphology determined by B-mode US is correlated with CAD in patients with chest pain, and the presence of calcific plaque is a better predictor for CAD than that of fibrous plaque and increased IMT. Women with chest pain and normal CCA wall morphology may not need coronary angiography.

Cardiomyopathy and Atrioventricular Block in Emery-Dreifuss Muscular Dystrophy: A Case Report

A 32-year-old woman is described as having the following characteristics of Emery-Dreifuss muscular dystrophy: humeroperoneal muscular atrophy and weakness, neck and elbow contractures with sinus bradycardia, first-degree atrioventricular block, and dilated cardiomy opathy. The biopsy specimen of skeletal muscle showed dystrophic character; a cardiac endomyocardial biopsy specimen showed adipose tissue infiltration and deposition of antihuman IgG. Emery-Dreifuss muscular dystrophy is an X-linked recessive myopathy. The patient had no familial background of the disease. This patient might have a sporadic inheri tance pattern with severe cardiac involvement.

Comparative Assessment of the Effects of Vasodilators on Peripheral Vascular Reactivity in Patients with Systemic Scleroderma and Raynaud's Phenomenon: Color Doppler Flow Imaging Study

The aim of the present study was assessment of peripheral vascular reactivity during cold test and effects of different types of vasodilators on vascular resistance in patients with progressive systemic sclerosis and Raynauds phenomenon with use of color Doppler flow imaging of upper extremity.

Mobile right atrial hydatid cyst with multiorgan involvement

A 25‐year‐old woman who had hydatid cysts in her lung was referred to our clinic for the hydatid cyst in her cardiac localization. Multiple hydatid cysts of different cardiac localizations were diagnosed by two‐dimensional echocardiography, confirmed by computed tomography and magnetic resonance imaging, supported by enzyme‐linked immunosorbent assay (ELISA) for echinococcosis. Surgical resection was performed for the right atrial cyst and pathology confirmed the diagnosis. Oral albendazole treatment was given postoperatively. Cathet. Cardiovasc. Intervent. 49:204–207, 2000.

Hydatid disease presenting as cardiac tamponade : A case history

Although hydatid disease has been reported in almost all human tissues, cardiac involve ment is uncommon. The authors report a case of cardiac hydatid disease presenting with cardiac tamponade. The diagnostic value of transthoracic and transesophageal echocar diography, computed tomography, and angiography in hydatid heart disease is also discussed.

The relation between serum erythropoietin level and severity of disease and mortality in patients with chronic heart failure

Objective — We evaluated the relation between serum erithropoietin level and the severity of disease and mortality in patients with chronic heart failure (CHF). Methods — We enrolled 96 CHF patients and 50 age- and sex-matched control subjects. Haemoglobin, haemotocrit, N terminal pro-B type natriuretic peptide (NT-proBNP) and erythropoietin levels and echocardiographic parameters were measured. The patients were contacted 1 year after the evaluations to determine survival. Results — The patients had lower haemoglobin and haematocrit but higher serum erythropoietin and NT-proBNP levels than the control subjects. Serum erythropoietin and NT-proBNP levels increased with worsening functional class.The serum erythropoietin level correlated negatively with left ventricular ejection fraction (r = –0.404, P < 0.001), haemoglobin (r = –0.530, P < 0.001) and haematocrit (r = –0.496, P < 0.001) levels. The patients who died (n = 17) had lower haemoglobin and haematocrit levels and significantly higher erythropoietin and NT-proBNP levels. However, multivariate logistic regression analysis showed that only NT-proBNP level was an independent predictor of mortality (P = 0.002). Conclusion — Anaemia and resistance to erythropoietin develop proportionately to disease severity and left ventricular systolic dysfunction in patients with CHF.Although serum erythropoietin level seems related with mortality, this observation needs to be confirmed by studies with more patients and longer follow-up.

Low Blood Pressure and Amyloidosis

Yahya Saḡliker, MD, Professor of Medicine, Head, Department of Medicine, Çukurova University School of Medicine, TR01330 Adana (Turkey) Dear Sir, Amyloidosis is a complex disease entity caused by deposition of amyloid substance in various organs or systems with resultant derangement in bodily functions. The symptomatology of the disease depends on the organ involved. Kidneys are known to be primarily affected and proteinuria due to glomerular permeability increase is usually the leading symptom in the patient with systemic amyloidosis. As the disease progresses renal functions further deteriorate and death is usually caused by renal complications [1-4]. Cardiovascular involvement is another frequent feature and cause of death in amyloidosis patients [1,5,6]. Hypotension is reported to be a common feature of the disease though the exact mechanism is not established. Autonomic neuropathy, suppression of the renin-angiotensin-aldosterone system due to juxtaglomerular apparatus involvement, adrenal insufficiency, low-cardiac output and secondary reasons like dehydration and malnutrition are some factors that are held responsible [ 1 ‚ 7-9]. For elucidating the incidence and etiology of low blood pressure in systemic amyloidosis, we conducted a study on 30 systemic amyloidosis patients diagnosed by renal biopsies. Two of the patients had primary, 16 patients had reactive and 12 patients had FMFrelated heredofamilial amyloidosis. The mean age of the patients was 35.6 ± 15.0 years. Sixteen of the patients were newly diagnosed while 14 had had the disease for an average duration of 42 + 33 months. The presenting symptoms were edema in 26, uremic complications in 2, gastrointestinal bleeding in 1 and restrictive cardiac failure in 1 of the patients. After a complete physical examination, blood pressure and heart rate was taken. Laboratory tests like a hemogram, biochemical tests and urinalysis were performed. Electrocardiographic, echocardiographic, ultrasono-graphic examinations were done. Blood pressure while standing was measured and autonomic tests like Valsalva maneuver, sub-maximal handgrip test were performed for evaluating the autonomic system involvement. The results of cardiac and autonomic tests were compared to those of a control group of 15 subjects. Average mean arterial blood pressure was 80.6 ± 13.7 mm Hg in the patients while it was 89.2 ± 12.7 mm Hg in the control group, the difference being statistically significant (p < O.02).