Ozan Utuk

QT dispersion in rheumatoid arthritis patients with and without Sjögren's syndrome.

The aim of this study was to assess the effect of secondary Sjögrens syndrome (SjS) on QT dispersion and corrected QT dispersion in patients with rheumatoid arthritis (RA). We performed electrocardiography and Doppler echocardiography on 58 patients with RA whom we divided into two groups according to the presence of secondary SjS, and on 29 healthy controls. All patients revealed significantly longer QT dispersion and corrected QT dispersion values (P < 0.05). Diastolic function variables were significantly different in all patients compared to controls. QT dispersion and corrected QT dispersion values were significantly longer in RA patients with secondary SjS than in those without. We concluded that secondary SjS could be a cardiovascular risk factor contributing to the well documented cardivascular disease in RA patients.

Endothelıal dysfunctıon ın patıents wıth prımary Sjögren’s syndrome

The aim of this study was to determine the endothelial function in patients with primary Sjögren’s syndrome (SS). We also aimed to determine whether endothelial (dys)function correlates with extraglandular manifestations, specific autoantibodies and the severity of salivary gland involvement of SS. Endothelium-dependent vasodilation and endothelium-independent vasodilation of the brachial artery were assessed by a high-resolution ultrasound on 25 patients with primary SS and on 29 healthy controls. Patients with primary SS had significantly less mean endothelium-dependent vasodilation than did controls (3.0±0.4% vs 4.2±0.3%; p=0.012). Endothelium-independent vasodilation induced by sublingual glycerol trinitrate was not different between the two groups (12.9±1.4% vs 14.1±1.2%; p=0.86;). We concluded that endothelium-dependent vasodilation was impaired in primary SS patients, in particular those presenting with Raynaud’s phenomenon, when compared with the healthy controls and this impairment was not associated with the presence of RF, ANA, anti-Ro/SS-A, anti-La/SS-B and with the other extraglandular manifestations of the disease.

Effect of losartan on exercise tolerance and echocardiographic parameters in patients with mitral regurgitation.

Objectives. The aim of this study was to assess the effects of losartan treatment on exercise tolerance and echocardiographic parameters in patients with mitral regurgitation (MR) secondary to mitral valve prolapse or rheumatic heart disease. Methods. Twenty-seven patients (14 males, 13 females, mean age 51±11, range 21—76) with moderate MR due to mitral valve prolapse or rheumatic heart disease were examined by means of Doppler echocardiography.The subjects were submitted to treadmill exercise tests using the modified Bruce protocol at baseline, after six hours and after the six-week treatment period to be evaluated based on their exercise tolerance. Mitral Regurgitant Volume (MRV), effective regurgitant orifice diameter, left atrial volume, left ventricle (LV) end-diastolic volume index, LV end-systolic volume index, LV ejection fraction (LVEF), left ventricle mass index were calculated at baseline and after six weeks of treatment with single dose of losartan (50 mg/day). Results. Total treadmill exercise time increased from 477.7±147.9 to 535.7±149.0 seconds after six hours (p<0.01) and to 559.6±142.8 seconds after six weeks of treatment. Also, metabolic equivalent values increased following six hours of first dose and six weeks of losartan treatment (from 10.9±2.9 to R11.8±3.1, p=0.006 and 12.4±3.1, p=0.002; respectively). However, peak exercise systolic blood pressure (BP) was reduced after six hours and six weeks of treatment, and resting diastolic BP did not change after six hours but reduced at the end of the treatment period. MR volume decreased significantly from 29.3±14.1 ml to 25.1±14.8 ml, (p=0.025) without significant change in regurgitant orifice diameter (0.72±0.37 cm vs. 0.66±0.37 cm, p=NS), left atrium diameter and area while LVEF increased from 51.70±13.37 to 54.11—11.75 (p=0.015) with losartan. Conclusion. We conclude that the angiotensin II receptor antagonist losartan improves exercise tolerance and echocardiographic parameters in patients with moderate MR.

Giant Unruptured Noncoronary Sinus of Valsalva Aneurysm

A 66-year-old woman presented with dyspnea on exertion (NYHA class II), which she had been experiencing for 2 years. An examination revealed normal systolic and diastolic blood pressures and a grade 2/6 continuous murmur on the left side of the sternum. The transthoracic echocardiogram showed serious aortic regurgitation and …

A rare cause of ischemic chest pain: Congenital Ostial Atresia of the right coronary artery

The prevalence of congenital coronary anomalies is reported in about 0.5% to 1.5% of patients undergoing coronary angiography. Tüccar E. And Elhan A. Just reported coronary artery anomalies in adult Turkish population. They analysed 5000 coronary angiograms. Twenty-five (0.5%) coronary arteries with anomalous origins were found. We are presenting an extremely rare right coronary origin abnormality. In this case right coronary artery originates from left anterior descending coronary artery. According to general opinion, coronary segments with an anomalous course are no more susceptible to coronary atherosclerosis than normal segments in the same individual. Only 10.1% of patients with congenital coronary artery anomalies (CCAA) identified during cardiac catherization, had another congenital heart defect. Coronary artery anomalies are very important because coronary artery anomalies rank second as a cardiovascular cause of sudden death in the young, behind hypertrophic cardiomyopathy.

Beyond lowering LDL cholesterol

Compelling evidence from randomized controlled studies demonstrated the crucial role of lowering low-density lipoprotein cholesterol (LDL-C) in the prevention of vascular events. However, not all patients with low LDL-C levels show similar reduction in event rates. The residual risk factors associated with ongoing vascular events despite achieving low LDL-C levels remain to be elucidated. New data suggest that beyond statin therapy, inflammatory mediators, high non-HDL (high-density lipoprotein) cholesterol or apolipoprotein B, small dense LDL-C, type 2 diabetes mellitus, and lifestyle features may have impact on residual vascular risk. In this review, we discussed the significance of identifying these residual risk factors and developing new treatment strategies to further decrease vascular events. The importance of imaging arterial wall to evaluate the effect of various medical therapies has also stated.

Endometrial thickness and the Doppler sonographic parameters of the uterine arteries as discriminators of endometrial status in postmenopausal women receiving anti-hypertensive treatment.

Aim:  The aim of the present study was to establish the Doppler sonographic parameters of the uterine arteries in postmenopausal patients with or without hypertension and to determine the value of their measurement in the prediction of endometrial pathology.