Nusret Acikgoz

Behçet's disease is characterized by increased inflammatory activity, and there there might be an increased risk of atrial arrhythmia in patients with this disease. Our study is aimed to evaluate a novel method of measuring atrial electromechanical features expressed as interatrial and intraatrial electromechanical delay by tissue Doppler echocardiography in patients with Behçet's disease. We evaluated 57 patients (mean age: 36.3±12.1 years) with Behçet's disease and 34 sex and age matched healthy volunteers (mean age: 38.4±8.6 years) as control group. P-wave dispersion (PWD) was calculated from the 12-lead surface ECG, interatrial and intraatrial electromechanical delay were measured by tissue Doppler imaging and conventional echocardiography. Interatrial electromechanical delay and intraatrial electromechanical delay were prolonged in patients with active Behçet's disease compared with the patients with inactive disease and the controls (p<0.0001, p<0.0001, p=0.013 and p=0.001, respectively). Erythrocyte sedimentation rate and high-sensitivity C-reactive protein values of of patients with active Behçet's were significantly higher than those with inactive Behçet's disease and the controls (p<0.0001 and p<0.0001, respectively). High-sensitivity C-reactive protein and erythrocyte sedimentation rate were correlated with interatrial electromechanical delay in patients with Behçet's disease (r=0.44, p=0.001 and r=0.64, p<0.0001, respectively). The prolongation of atrial electromechanical conduction might be related with changes in structure and electrophysiological properties of the atrial myocardium or the conduction system in patients with active Behçet's disease.

We are reporting the case of a 64-year-old woman with acute inferior ST elevation myocardial infarction with right ventricular infarction. She underwent primary angiography which revealed total occlusion of distal right coronary artery (RCA) by thrombus. Three runs of aspiration were performed and the thrombus was aspirated from RCA without additional ballooning or stenting. Postaspiration angiography revealed normal TIMI-3 flow down with the resolution of the thrombus and a residual noncritical trombus was seen also. She was started on glycoprotein (GP) IIb-IIIa inhibitor tirofiban for 48 h. A new angiography performed on the 4th post-intervention day and TIMI-3 flow down was seen in RCA with complete disappearance of the residual thrombus. Key words: Intracoronary thrombus, acute myocardial infarction, thrombus aspiration.

The aim of this study was to evaluate the relationship between cigarette smoking and atrial rhythm disorders with the use of noninvasive methods. The study population consisted of 50 healthy volunteer smokers and 40 healthy volunteer non-smokers who had normal echocardiographic parameters and similar sex and age profiles. P-wave dispersion (PWD) was calculated from the 12-lead surface ECG. Left ventricle (LV) end-systolic and end-diastolic diameters, LV ejection fraction, and interatrial and intraatrial electromechanical delay were measured by tissue Doppler imaging and conventional echocardiography. Isovolumetric relaxation time and deceleration time were significantly higher (91.5 ± 11 vs. 82.35 ± 8.6, p < 0.0001; 215.7 ± 37.1 vs. 175.3 ± 17.7, p < 0.0001, respectively), and HDL cholesterol was significantly lower in smokers (39.34 ± 7.5 vs.44.3 ± 8.07, p = 0.003). There were no significant differences between the groups with respect to Sm and Em values, Am value, and E/A and E/Em ratios. However, the Em/Am ratio was significantly lower in smokers (1.28 ± 0.21 vs. 1.44 ± 0.33, p < 0.006). Inter- and intraatrial electromechanical delay were significantly higher in smokers when compared with non-smokers (51.11 ± 1.54 vs. 27.30 ± 3.36, p < 0.0001, and 30.63 ± 3.2 vs. 12.24 ± 3.26, p < 0.0001, respectively). The amount of smoking was strongly correlated with interatrial electromechanical delay (r = 0.567, p < 0.0001), and a significant correlation was detected between PWD and interatrial electromechanical delay (r = 0.653, p = 0.001). We have demonstrated the relationship between inter- and intraatrial electromechanical delay and PWD. These parameters may be useful predictive markers for the development of AF in the asymptomatic period before cardiac rhythm disturbances occur. This finding may indicate that smokers have an increased risk of developing atrial rhythm disturbances.

The urocortin (Ucn) hormones have many important roles in the cardiovascular system. Apart from systolic dysfunction (SD), there is no sufficient data on the relationship between serum Ucn-2 and diastolic dysfunction (DD), or coronary artery disease (CAD). We investigated serum Ucn-2 levels in SD, DD, and CAD. In this observational cross-sectional study, study population was enrolled among outpatients who underwent coronary angiography with the pre-diagnosis of CAD. By examining the echocardiography 86 subjects were selected to study after coronary angiography. The subjects distributed over three groups to investigate the relationship between serum Ucn-2 and SD according to their ejection fraction (EF): subjects with moderate to severe SD (Group A, EF=33.6%), subjects with mild to moderate SD (Group B, EF=46.1%), and those without SD (Group C, EF=64.5%). Apart from these groups, the serum Ucn-2 levels were compared between subjects with and without DD (EF≥45%), and also compared between subjects with and without CAD (EF≥55%). Statistical analyses were performed using one-way ANOVA, Kruskal-Wallis, Chi-square, Mann-Whitney U, Spearman correlation and multiple regression analyses tests. Serum Ucn-2 levels were decreased in Group A and were increased in Group B compared to Group C (9.4±3.4, 12.8±3.6 vs. 10.4±3.9 pg/mL, respectively, p=0.003). Unlike SD; there was no significant difference in serum Ucn-2 levels between subjects with and without DD (11.4±4.1 vs 11.7±3.9 pg/mL, p=0.8) or CAD (10.7±4.7 vs 10.2±3.2 pg/mL, p=0.7). Ucn-2 is elevated in mild to moderate SD. But, DD (impaired relaxation pattern), or CAD (without myocardial infarction) seems to have no effect on Ucn-2 hormone levels.

Objective: The aim of our study was to evaluate serum uric acid level and its relationship with carotid intima-media thickness (CIMT) in patients with cardiac syndrome X (CSX). Subjects and Methods: A total of 50 patients with CSX (28 females/22 males, 51.0 ± 10.9 years) and 40 controls (27 females/13 males, 53.0 ± 10.2 years) were included in the study. All subjects underwent a noninvasive stress test and conventional coronary angiography. Serum uric acid levels were measured and B mode ultrasonography was performed to assess CIMT in all subjects. Results: Serum uric acid levels were higher in patients with CSX than in the control subjects (5.1 ± 1.8 vs. 3.9 ± 1.3 mg/dl; p = 0.002). The CIMT was higher in patients with CSX than in the control subjects (0.75 ± 0.18 vs. 0.63 ± 0.09 mm; p < 0.001). A significant correlation was found between serum uric acid values and CIMT measurements in patients with CSX (r = 0.666, p < 0.001). Conclusions: Serum uric acid levels were higher in patients with CSX and elevated serum uric acid levels were associated with carotid atherosclerosis, thereby indicating that elevated serum uric acid levels might contribute to the development of subclinical atherosclerosis in CSX patients.

Cardiomyopathy (CMP) is a disorder associated with an increased risk of thromboembolism due to blood stasis, platelet activation and altered coagulation status. In this study, we aimed to investigate mean platelet volume (MPV) in patients with idiopathic CMP and ischemic CMP and to compare with those of the controls, and aimed to determine whether there is a relationship between MVP and echocardiographic parameters in patients with CMP. This study was designed as an observational cross-sectional study. A total of 100 subjects with idiopathic CMP (n=35), ischemic CMP (n=35) and controls (n=30) were included in the study. The MPV values were measured in all participants. All subjects underwent transthoracic echocardiography and angiographic evaluation. We used Chi-square test, one-way ANOVA and Pearson correlation tests for statistical analysis. The MPV values were significantly higher in patients with idiopathic CMP and ischemic CMP than those of the controls (9.03±1.3 and 8.77±0.9 vs. 7.95±1.0 fl, respectively, p<0.001). The MPV values were although not statistically significant also tend to be higher in patients with idiopathic CMP than in patients with ischemic CMP (p=0.328). The MPV values were found to be positively correlated with left ventricular end-diastolic and end-systolic diameters (r=0.369, p<0.0001; r=0.325, p=0.001, respectively), and left atrial diameter (r=0.403, p<0.0001), but inversely correlated with left ventricular ejection fraction (r=-0.392, p<0.0001). Patients with idiopathic or ischemic CMP have higher MPV values indicating tendency to platelet aggregation regardless of the etiology, when compared to controls and an enlarged dysfunctional left ventricle may also be associated with higher MPV values.

Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common form of paroxysmal supraventricular tachycardia and is usually treated successfully by radiofrequency catheter ablation. We report on a 38-year-old woman whose AVNRT attacks occasionally degenerated into polymorphic ventricular tachycardia (VT). The patient presented with a complaint of palpitations. The electrocardiogram was in sinus rhythm with a normal corrected QT interval. During Holter monitoring, narrow QRS complex tachycardia with a heart rate of 220 beats/min was noted at nighttime, that lasted for 90 minutes, during which two episodes of polymorphic VT were also seen. The diagnosis of AVNRT was confirmed on an electrophysiologic study and AVNRT was successfully treated by radiofrequency catheter ablation. The patient had no complaint during a follow-up of eight months, with no signs of arrhythmia on repeat Holter monitoring.

Objectives —We aimed to evaluate serum gamma-glutamyl transferase (GGT) activity and its relationship with carotid intima media thickness (CIMT) in patients with cardiac syndrome X (CSX). Methods — The study population consisted of 40 patients with CSX, 35 controls and 40 patients with coronary artery disease (CAD). All patients underwent a noninvasive stress test and conventional coronary angiography. Serum GGT and C-reactive protein (CRP) levels were measured and CIMT was assessed in all subjects. Results — Serum GGT activity was higher in the CSX and the CAD groups than in the control group (32.6 ± 16.0 and 30.4 ± 15.3 U/L, respectively, vs. 17.9 ± 4.2 U/L; P < 0.001). There was no statistically significant difference in serum GGT activity between the CSX and the CAD groups. When compared to the control group, serum CRP levels were significantly increased in both the CSX and the CAD groups (4.1 ± 2.0 and 4.7 ± 2.6 mg/L, respectively, vs. 2.2 ± 1.8 mg/L; P < 0.001). Patients with CSX and CAD had significantly higher CIMT values than the controls (0.74 ± 0.17 and 0.94 ± 0.12 mm, respectively, vs. 0.62 ± 0.08 mm; P < 0.001). A significant correlation was found between GGT activity and CIMT measurements (r = 0.640, P < 0.001), but serum GGT activity did not correlate with serum CRP levels in patients with CSX (r = 0.277, P > 0.05). Conclusions — The present study showed that serum GGT activity in patients with CSX was as high as those in patients with CAD. Increased GGT levels may play a role in the pathogenesis of the microvascular atherosclerotic process of CSX.