[The importance of lipoprotein(a) in pathogenesis of the high risk unstable angina]. / Yüksek riskli kararsiz anginanin patogenezinde lipoprotein(a)'nin önemi.

OBJECTIVE: The aim of this study is to compare lipoprotein (a) [Lp(a)] levels in patients with low and high risk unstable angina pectoris, which is defined according to the cardiac troponin-I (Tn-I) levels and to investigate their relation with myocardial damage. METHODS: From patients with chest pain; venous blood samples were collected for measuring serum Lp(a) and C-reactive protein (CRP) levels on admission and serum cTn-I levels 12 and 24 hours after admission. Fifty-nine patients with serum cTn-I levels <1.0 ng/ml were assigned as negative unstable angina group and 53 patients with serum cTn-I levels >or=1.0 ng/ml were assigned as positive unstable angina groups, respectively. Severity of coronary artery disease was determined by angiography in all patients. RESULTS: Compared with cTn-I negative group, Lp(a) levels were significantly higher in cTn-I positive group (52.9+/-6.0 mg/dl vs 15.7+/-2.5 mg/dl, p<0.0001). There was a significant correlation between Lp(a) and cTn-I levels (r=0.870, p=0.0001). We could not establish any correlation between Lp(a) levels and Gensini score or between multiple vessel disease and low density lipoprotein cholesterol levels (p>0.05). Also, there was no significant difference between cTn-I positive and negative groups with respect to Gensini score (p>0.05). CONCLUSION: Increased Lp(a) levels and significant relation between Lp(a) and cTn-I levels support the opinion that Lp(a) can be a risk factor for plaque destabilization and thrombosis rather than severity of coronary artery disease in patients with high risk unstable angina. Furthermore, high levels of Lp(a) may be related with myocardial injury in patients with unstable angina.

Effect of irbesartan monotherapy compared with ACE inhibitors and calcium-channel blockers on patient compliance in essential hypertension patients: a multicenter, open-labeled, three-armed study.

OBJECTIVES: This multicenter, three-armed, open-labeled study investigated patient compliance of patients receiving irbesartan, angiotensin-converting enzyme (ACE) inhibitors or calcium-channel blockers (CCB) for essential hypertension for a 6-month period. Patients were either newly diagnosed or switched from existing antihypertensive medication due to lack of efficacy or side-effects. METHODS: Patients were started monotherapy with irbesartan (n=377), ACE inhibitors (n=298) or CCB (n=308) and were reevaluated on 1st, 3rd, and 6th months of the treatment. The primary endpoint was patient compliance, assessed by proportion of patients who had taken their study medication every day. Efficacy was recorded as mean reductions in blood pressure and the proportion of patients whose blood pressure normalized. Tolerability was assessed by reported adverse events. RESULTS: Significantly more patients receiving irbesartan had complied with study medication after 3 and 6 months of treatment than ACE inhibitors or CCB. Significantly fewer patients receiving irbesartan needed to change their antihypertensive medication. All three study treatments exhibited similar efficacy profiles, but irbesartan had significantly less adverse events. CONCLUSIONS: This study demonstrated that patient compliance to irbesartan was significantly superior to other study treatments. Irbesartan is therefore a suitable first-line therapy for essential hypertension in everyday clinical practice.

Bacterial endocarditis of systemic atrioventricular valve (tricuspid valve) in corrected transposition and its surgical treatment.

We describe a case of congenitally corrected transposition of great arteries (CCTGA). Tricuspid valve replacement was performed due to valve dysfunction following bacterial endocarditis. After two weeks' antibiotic therapy haemodynamic stabilisation was obtained and the patient was operated in the third week. On cardiopulmonary bypass with 28 degrees C degree systemic hypothermia, the left atrium was approached transeptally. At exploration, the systemic atrioventricular valve was tricuspid valve and pulmonary atrioventricular valve was in shape of a mitral valve. The posterior leaflet of the tricuspid valve was ruptured and vegetations above it were observed. The valve was excised and a 29 mm St-Jude mechanical heart valve prosthesis implanted using a teflon reinforced separated suture technique. After operation the patient recovered rapidly and following six weeks' antibiotic therapy, the patient was discharged.

[Is slow coronary flow related with inflammation and procoagulant state?]. / Koroner yavas akim inflamasyonla ve prokoagülan durumla iliskili midir.

OBJECTIVE: To investigate the pathogenesis of coronary slow flow (CSF), C-reactive protein (CRP) levels as indicator of inflammation and procoagulant activity were studied in patients with CSF. METHODS: Fifty-one patients (22 female, mean age; 53+/-10 years) who were admitted to our clinic with chest pain and had the diagnosis of CSF established by TIMI frame count method and coronary angiography, and 44 healthy subjects (18 female, mean age; 546 years) with normal coronary flow (NCF) were included in the study. Subjects with any infectious and systemic immune disease were excluded from the study. The CRP levels were measured from venous blood samples during admission, at 24th hour and after 3 months in all subjects. Additionally; fibrinogen, plasminogen, plasminogen activator inhibitor (PAI-1), tissue plasminogen activator (t-PA) and von Willebrand factor (vWF) levels were measured to determine the procoagulant activity. RESULTS: There was no significant difference between CRP levels of patients with CSF and healthy subjects during admission (7.26+/-4.2 ng/dl vs. 6.43+/-2.8 ng/dl, p>0.05), at 24th hour (7.84+/-1.3 ng/dl vs. 6.32+/-2.5 ng/dl, p>0.05) and after 3 months (6.37+/-2.4 ng/dl vs. 6.18+/-3.3 ng/dl, p>0.05). There were no differences between levels of CRP when compared according to the TIMI frame count, number of vessels with CSF and artery in which CSF was dominant. Additionally; procoagulant activity assessed by fibrinogen, plasminogen, PAI-1, t-PA and vWF levels was similar in both groups. CONCLUSION: Our findings on normal levels of CRP and procoagulant activity, and lack of relation with TIMI frame count made us to think that inflammatory and procoagulant activity did not play a role in the pathogenesis of CSF.

Hypertrophic cardiomyopathy: a case of symptomatic Japanese type apical hypertrophic cardiomyopathy.

A 61-year-old male patient was hospitalized due to the exertional angina pectoris. A diagnosis of apical hypertrophic cardiomyopathy was made by ECG (electrocardiography), echocardiographic, and coronary angiographic findings. This case was reported and related literature was reviewed because of its similarity to Japanese type apical hypertrophic cardiomyopathy (AHCMP) cases rarely seen outside Asia.

[Plasma insulin, glucose and lipid levels, and their relations with corrected TIMI frame count in patients with slow coronary flow]. / Yavas Koroner Akimli Hastalarda Plazma Insülin, Glükoz, Lipid Düzeyleri ve Düzeltilmis TIMI Kare Sayisi ile Iliskisi.

OBJECTIVE: High baseline insulin and glucose levels and presence of accompanying dyslipidemia, which are considered in the pathogenesis of metabolic syndrome X, were also observed in patients with cardiac syndrome X, which is similar to metabolic syndrome X in many aspects. In this study we aimed to compare serum insulin, glucose and lipid levels in patients with coronary slow flow which is hypothesized as a subgroup of cardiac syndrome X with those of healthy subjects and determine the relation of corrected TIMI frame count (cTFC) with these levels. METHODS: Forty-six patients with normal epicardial coronary arteries but determined as coronary slow flow in coronary angiography performed because of chest pain and 16 healthy subjects having normal coronary arteries but without coronary slow flow were included in this study. Maximal exercise stress test according to Bruce protocol was performed in all patients. Baseline serum insulin, glucose and lipid levels were measured from venous blood samples of patients in both groups. TIMI 'frame count' method was used for diagnosis of coronary slow flow. The relationship between the degree of coronary slow flow and serum insulin, glucose and lipid levels was investigated. RESULTS: Exercise stress test results of both groups were considered as negative regarding ischemia. There were no differences between 2 groups in serum insulin, glucose and lipid levels. (p>0.05). No relationship were determined by correlations analysis between serum insulin, glucose and lipid levels and corrected TIMI frame count. CONCLUSION: Normal values of insulin, glucose and lipid levels in patients with coronary slow flow and lack of their relation with cTFC support the opinion that coronary slow flow is a separate from the cardiac syndrome X clinical entity.

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.