Turhan Akyol

Restenosis after Transluminal Coronary Angioplasty: A Risk Factor Analysis

Background: Restenosis after percutaneous transluminal coronary angioplasty (PTCA) is a major problem limiting the long-term efficacy of the procedure. The purpose of this study was to determine whether risk factors such as cigarette smoking, diabetes mellitus, hypertension or hypercholesterolaemia correlate with restenosis after PTCA. We also studied the relationship between a history of previous myocardial infarction and the extent of coronary artery disease (single-, two- or three-vessel) with restenosis after coronary angioplasty. Methods: A total of 360 patients underwent successful PTCA. Follow-up coronary angiograms were performed in 181 patients after a mean ± SD period of 6 ± 4 months. Results: The restenosis rate was 49%. We divided the patients into two groups: 89 patients with restenosis (8 women and 81 men) and 92 patients with no restenosis (14 women and 78 men). Age, sex, a history of cigarette smoking, diabetes mellitus and a history of previous myocardial infarction were not associated with restenosis. Serum levels of triglyceride were also unrelated to the restenosis rate. Restenosis was associated with hypertension, low levels of high-density-lipoprotein cholesterol, high levels of low-density-lipoprotein cholesterol and high total cholesterol levels (P < 0.001). Patients with two-vessel or multivessel disease had significantly higher restenosis rates than patients with single-vessel disease (P < 0.001). Conclusion: Patients with hyperlipidaemia, hypertension and multi-vessel disease appear to be at higher risk of recurrent restnosis.

Acute Myocardial Infarction and Normal Coronary Arteries in a Pregnant Woman

As it is a rare case, we report a 37-year-old woman who had transmural myocardial infarction in her last trimester. Coronary arteriography done 15 days after her normal delivery showed normal coronary arteries and left ventriculography showed an apical aneurysm. The proposed cause appears to be coronary spasm.

Cardioinhibitory response to carotid sinus massage in patients with coronary artery disease.

The relationship between cardioinhibitory response to the carotid sinus massage and the severity of coronary artery lesions and left ventricular impairment was investigated in 86 patients who underwent coronary angiography. The study group (Group 1) comprised 63 patients who had coronary lesions and the control group (Group 2) comprised 23 patients who had normal coronary arteries. There was no significant relationship between the severity of coronary artery lesions and the cardioinhibitory response to the carotid sinus massage in the study group. However, there was a positive correlation (r = 0.478, P < 0.01) between total left ventricular segment scores and the maximal change in RR interval (%) during the right carotid sinus massage in the study group. During the right carotid sinus massage, maximal change of RR interval (%) was significantly higher in patients who had segmental wall motion abnormalities than in patients who did not (83.0 +/- 72.4% vs. 32.9 +/- 42.5%, P < 0.01, respectively). In the patients who could have echocardiographic measurements there was negative correlation between fractional shortening value and maximal change of RR interval (%) (right massage; r = -0.482, P < 0.01, left massage; r = -0.334, P < 0.05). In conclusion, we found a significant relationship between the cardioinhibitory response to carotid sinus massage and the presence and severity of the segmental wall motion abnormalities and left ventricular impairment in patients with coronary artery disease.

Significance of resting U wave polarity in patients with atherosclerotic heart disease

The aim of this study was to determine the value of U wave polarity in the electrocardiograms of patients with atherosclerotic heart disease. One hundred twelve consecutive patients with U waves were entered into the study. Forty-eight of them had unstable angina pectoris and 64 had prior myocardial infarction (MI) (20 patients had inferior MI, 35 had anterior MI, and 9 had non Q wave MI). Each of these subgroups was divided into two groups with positive (group 1) and negative (group 2) U waves. All patients in this study underwent routine left ventriculography and coronary angiography. The authors examined coronary arteries and calculated ejection fractions. The authors discovered that patients with unstable angina pectoris or anterior MI (group 2) had three-vessel disease more frequently (P < .05). Also, in these patients, there was more than 90% diameter narrowing in the left anterior descending vessel more frequently (P < .001 in unstable angina pectoris and P < .05 in anterior MI). In patients with unstable angina pectoris, inferior MI, or anterior MI, the authors observed that the ejection fraction was lower in group 2 than in group 1 (P < .001 in unstable angina pectoris, P < .05 in inferior MI, and P < .05 in anterior MI). The authors suggest that negative U waves in patients with unstable angina pectoris or anterior MI may indicate multivessel disease with a severe left anterior descending lesion. Also, in patients with unstable angina pectoris, inferior MI, or anterior MI who had negative U waves, ejection fraction was reduced.

Effects of Percutaneous Transluminal Coronary Angioplasty on Late Potentials and High Frequency Mid-QRS Potentials

The high frequency mid-QRS potentials and late potentials are important in coronary artery disease because they are related to the extent of ischemia and prognosis. In this study, the effects of successful percutaneous transluminal coronary angioplasty (PTCA) on these potentials were evaluated. Twenty-four patients with coronary artery disease (aged 34-67 years, 5 women, 19 men) were examined. Eight of these patients had a history of myocardial infarction (4 anterior, 3 inferior, 1 anterior and inferior). Signal averaged ECG was recorded at 40- to 250-Hz frequency ranges for late potentials and 150- to 250-Hz frequency ranges for mid-QRS potentials before PTCA, and they were repeated 1 month later. The QRS duration (107.7 +/- 9.8 to 105.3 +/- 9.3 ms, p < 0.0001) root-mean-square voltage (39.4 +/- 20.1 to 47.7 +/- 22.2 microV, p < 0.00001) and low amplitude signal duration (30.7 +/- 9.9 to 27.7 +/- 9.3 ms, p < 0.001) showed significant changes in 40- to 250-Hz ranges before and after PTCA. The same results were also obtained in the 150- to 250-Hz frequency ranges: the QRS duration decreased (90.9 +/- 9.8 to 86.5 +/- 9.1 ms, p < 0.005) and the root-mean-square voltage increased (5.5 +/- 1.6 to 6.1 +/- 1.8 microV, p < 0.00001). Thus, successful PTCA causes improvement in late potential parameters, so the risk of malign arrhythmia that affects the prognosis can be reduced. Additionally, the increase in high frequency mid-QRS potentials shows the decrease in the ischemia after PTCA.

Evaluation of coronary arterial disease by oral dipyridamole stress testing using 12-lead electrocardiography

We studied the values of oral dipyridamole needed to detect coronary arterial disease using 12-lead electrocardiography. The relationship between dipyridamole-induced ST segment depression and coronary arterial lesions, coronary collaterals and myocardial infarction was investigated. 375 mg oral dipyridamole was given to 31 patients (22 with coronary arterial disease, 9 controls). 12-lead electrocardiogram was recorded before and 45 minutes after the test. The control group and the patients, who had no ST segment depression after dipyridamole, performed isometric contraction (handgrip) for 5 minutes and then the 12-lead electrocardiogram was recorded. All patients had coronary angiography. We also performed treadmill stress testing in 28 patients. Dipyridamole testing was positive (greater than or equal to 1 mm ST depression on electrocardiogram) in 7 of 22 patients with coronary arterial disease, of whom 6 had positive treadmill stress testing. Only 2 patients had previous myocardial infarction in the group with positive dipyridamole tests. Of the 15 in whom dipyridamole testing was negative, 5 had positive treadmill stress testing, while 13 of them had had previous myocardial infarction. All patients in the control group had negative dipyridamole stress testing and normal coronary angiograms. No additional ST segment changes were observed in the group who had performed isometric contraction test (both dipyridamole test negative and control groups). Sensitivity and specificity of the test were 32 and 100%, respectively. Comparison of collateral vessels between the groups positive and negative for dipyridamole revealed no difference. But the number of patients with old myocardial infarction was higher in those testing negative than in those who proved positive.(ABSTRACT TRUNCATED AT 250 WORDS)

Undersensing of the Tiny QRS Complexes That Emerged After the Isolation of the Right Ventricle in a Patient with Ventricular Tachycardia

This article describes a patient who underwent right ventricular disconnection for medically refractory ventricular tachycardia associated with arrhythmogenic right ventricular dysplasia. After the operation there was no ventricular tachycardia recurrence. Two years after the operation, he received a permanent VVI pacemaker for the symptomatic second‐degree AV block. Sensing function of the pacemaker was normal for the normal QRS complexes, but the tiny QRS complexes that appeared after the arrhythmia surgery were not sensed by the pacemaker and therefore caused no problem.