Mustafa Yazici

The Importance of Gamma‐Glutamyltransferase Activity in Patients with Coronary Artery Disease

In this study, we sought to investigate the relation of gamma‐glutamyltransferase (GGT) levels with the significance of coronary artery disease (CAD), clinical presentation, left ventricular (LV) function, and inflammatory activity.

Intracoronary guidewire emboli: a unique complication and retrieval of the wire.

The breakdown of the guidewire during percutaneous coronary intervention (PCI) and the retention of the broken part inside the coronary or systemic vascular system is a rare complication. With the use of a flexible guidewire, the incidence of these complications has markedly decreased. In this case report, we report the withdrawal of a broken guidewire from the distal coronary during PCI.

Longitudinal Diastolic Myocardial Functions Are Affected by Chronic Smoking in Young Healthy People: A Study of Color Tissue Doppler Imaging

Aims: Many cardiac and hemodynamic alterations occur after acute consumption of cigarettes. The aim of this study is to evaluate the effect of chronic smoking on longitudinal myocardial functions of left ventricle in young, healthy people by using color tissue Doppler imaging modalities. Methods and Results: Ninety‐nine healthy participants were studied. There were 65 smokers and 34 nonsmokers. All subjects were between 20 and 35 years old. Sample volumes were placed on the mid left ventricle in the inner half of the myocardium at the septum, lateral, inferior, and anterior walls. The peak systolic strain (S‐S), peak systolic strain rate (S‐SR), peak early diastolic SR (E‐SR), peak late diastolic SR (A‐SR), peak systolic tissue velocity (S‐TV), peak early diastolic TV (E‐TV), and peak late diastolic TV (A‐TV) values were measured. For the systolic parameters S‐S, S‐SR, and S‐TV values were not different between the groups. For the diastolic parameters smokers had lower E‐SR and E‐TV values than nonsmokers (P = 0.03 for both). Although there was a trend toward higher A‐SR and A‐TV values in the smokers, they were not reaching the statistical significance. Conclusion: Chronic smoking in young, healthy people causes significant alterations in the longitudinal diastolic myocardial function parameters as assessed by color tissue Doppler imaging.

The Role of Adrenergic Activity in Slow Coronary Flow and Its Relationship to TIMI Frame Count

The aim of this study was to investigate the role of adrenergic activity in patients with slow coronary flow (SCF) and its relationship to TIMI frame count on the pathogenesis of SCF. Plasma noradrenalin and adrenalin concentrations at rest were compared in 51 patients diagnosed with SCF through coronary angiography and TIMI frame count; and 44 healthy controls with normal coronary flow (NCF). Furthermore, the relationship between TIMI frame count and noradrenalin and adrenalin levels was investigated. Plasma noradrenalin (127.9 ±9.2 and 79.3 ± 7.3 ng/mL, p < 0.0001) and adrenalin levels (63.9 ± 2.6 and 44.7 ± 2.8 ng/mL, p < 0.0001) were higher in patients with SCF when compared to patients with NCF. Noradrenalin and adrenalin levels were effected with SCF-dominant vessels with respect to TIMI frame count (p = 0.012 and p < 0.0001). Patients with SCF in 1, 2, or 3 vessels had different noradrenalin and adrenalin levels (p <0.003 and p < 0.0001). Patients with TIMI frame count above the 75th percentile had significantly higher noradrenalin and adrenalin levels when compared with those between the 25th—50th percentiles and below (p < 0.001 and p = 0.011, respectively). Correlation analysis established that both adrenalin and noradrenalin levels were correlated with TIMI frame counts of left anterior descending (LAD) and circumflex (Cx) arteries. Exercise testing revealed ischemia in 6 patients. Their TIMI frame counts were above the 75th percentile, and they had higher noradrenalin and adrenalin levels when compared with those without ischemia (p = 0.029, p = 0.045). Higher noradrenalin and adrenalin levels and correlation between TIMI frame count and ischemia in patients with SCF suggest that increased adrenergic activity may be the manifestation of slow coronary flow.

The effect of glucose-insulin-potassium treatment on myocardial oxidative stress in patients with acute coronary syndromes undergoing percutaneous coronary intervention.

ObjectivesIn this study, we sought to examine the effect of glucose–insulin–potassium (GIK) treatment on oxidative stress in patients with acute coronary syndromes (ACSs) undergoing percutaneous coronary interventions (PCIs). MethodsPatients with ACSs who had been electively treated with a stent implantation into the culprit vessel were included in this study. Patients were divided into two groups and were randomly administered either the GIK treatment (GIK group; n=28) or isotonic NaCl (control group; n=19) infusion during PCI. Blood samples from the coronary artery ostium (CO) were collected through the femoral artery and from the coronary sinus (CS) through the femoral vein, before and immediately after PCI. Superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GSH-Px) activities were measured. ResultsA total of 47 patients were included in the study. SOD, CAT, and GSH-Px activities, whether in the CO or the CS, were similar in both the GIK and control groups before the intervention (P>0.05). In the control group, SOD (in both the CO and the CS), CAT (in the CS), and GSH-Px (in the CS) activities were higher compared with baseline values (P<0.05). Such increases were, however, not seen in the GIK group (P>0.05). Although the CS–CO activity differences (venous–arterial) of SOD, CAT, and GSH-Px, which are parameters of myocardial reactive antioxidant enzyme production, were increased in the control group, there was no increase in the GIK group. ConclusionsIn patients with ACSs, reactive local enzyme activity increases for the scavenging to myocardial-free radicals during PCI. Administration of a solution of GIK as a metabolic support agent might prevent oxidative stress in the myocardial level, in these patients.

Is there a relationship between the blood cholinesterase and QTc interval in the patients with acute organophosphate poisoning

Organophosphates cause poisoning as a result of the excessive accumulation of acetylcholine at the cholinergic synapses due to inhibition of acetylcholinesterase (ChE). In the literature, it has been reported that there have been electrocardiographic abnormalities, including QT‐interval prolongation in most patients with acute organophosphate poisoning (OPP), and a relation between blood ChE level and clinical severity in acute OPP. The aim of this study is to assess the relationship between blood ChE level and QTc interval in the patients with acute OPP. This retrospective study consists of 20 patients admitted to the emergency intensive care unit. A total of 93 QTc interval and blood ChE measures obtained on the same day from 20 cases were compared for their correlation. There were prolonged QTc intervals in 35.4% of the ECGs. There was a negative correlation between QTc interval and blood ChE measures. In following up the patients with acute OPP, QTc interval may be useful when blood ChE levels are low and may provide complementary information concerning the severity of poisoning. However, further prospective studies, supporting the present results, are needed.

The relation between endothelin-1 levels and myocardial injury in chronic ischemic heart failure.

We evaluated whether there was any relation between myocardial injury and endothelin-1 (ET-1) levels, which has been suggested as a contributor to the progression of ischemic heart failure. One hundred and twenty-one patients with chronic ischemic heart failure and 37 healthy individuals were included in the study. Cardiac troponin-I (cTn-I) and ET-1 levels of all subjects were measured on admission. Echocardiographic evaluations were also performed. The positivity of cTn-I increased significantly as the severity changed from New York Heart Association (NHYA) Class I to IV (P < 0.01). This was also true for quantitative cTn-I levels (P < 0.05). The ET-1 levels of patients were higher than controls on admission (P < 0.001). The ET-1 levels increased significantly upon the progression from NHYA Class I to IV (P < 0.001). Moreover, patients with cTn-I positivity had higher ET-1 levels (P < 0.05) and a lower ejection fraction (P < 0.001). A negative correlation was found between ejection fraction and the ET-1 levels (r = −0.312, P = 0.019). In patients with cTn-I positivity, the cTn-I levels showed a positive correlation with the ET-1 levels (r = 0.328, P = 0.014) and a negative correlation with ejection fraction (r = −0.671, P < 0.001). In chronic ischemic heart failure, an increase in ET-1 may exert an influence on the progression of cardiac failure by leading to myocardial injury which may be demonstrated by higher cTn-I levels.

Paroxysmal ventricular tachycardia due to interventricular hydatid cyst.

A 35‐year‐old male patient with palpitations and mild lightheadedness was admitted to our clinic. Short‐lasting paroxysmal ventricular tachycardia was diagnosed following 12‐lead electrocardiography (ECG). A mass that included two‐thirds of the interventricular septum and the left ventricular cavity was seen by two‐dimensional echocardiography and magnetic resonance imaging (MRI). Specific hemagglutination tests for hydatid cyst were positive. The mass was excised, and the patient had a septoplasty operation to repair the remaining septal defect. He is currently being followed and reports no complaints. No evidence of arrhythmia was noted in 24‐hour ambulatory ECG monitoring.

Apical hypertrophic cardiomyopathy: a case of slow flow in lad and malign ventricular arrhythmia

The coronary slow flow phenomenon is an angiographic finding characterized by delayed distal vessel opacification in the absence of epicardial coronary artery disease. Patients often present with acute coronary syndrome. Histopathologic studies have revealed the existence of fibromuscular hyperplasia and myofibrilar hypertrophy. Apical hypertrophic cardiomyopathy is a benign progressive form of hypertrophic cardiomyopathy, that is rarely observed in western communities. It remains commonly asymptomatic until advanced ages. Syncope, arrhythmia or sudden death may be the first symptom. We report a case of slow coronary arterial flow in a 71-year-old male patient with apical hypertrophic cardiomyopathy who experienced chest pain and sudden cardiac arrest due to ventricular arrhythmia.

Cardiovocal Syndrome Associated With Huge Left Atrium

A 46-year-old woman was admitted to our cardiology department because of dyspnea with exertion and hoarseness lasting for a long time. She had irregular medical follow-ups because of rheumatic mitral valve disease. Atrial fibrillation with a ventricular rate of 90/min was present in her electrocardiography. Chest teleradiography showed an increased cardiothoracic ratio. Transthoracic echocardiography revealed normal left ventricle systolic function (ejection fraction=60%) …