The value of measured partial oxygen pressure during pulmonary vein closure and the relationship with the diameter of the closed vein in patients with cryoablation.

AIM: The aim of this study was to investigate the value of partial oxygen pressure (PO2) changes measured in the left atrium (LA) during transient pulmonary vein (PV) closure in patients undergoing cryoablation and its relationship with the diameter of the closed PV. METHODS: The study was carried out on a total of 25 cases. The grouping of PVs was made separately as the left superior, left inferior, left common, right superior, right inferior, right common and total PVs. PV measurement was made from angiographic images obtained after the cryoablation balloon was inflated and opaque. From the LA, the difference between the PO2 values in the blood gases obtained before and during the temporary closure of each PV was evaluated as the PO2 change. The difference of the lowest temperature reached during the closing of each PV from -36°C was termed the heat difference. The relationship of PO2 change with PV diameter and the heat difference were investigated. RESULTS: There was no significant relationship between any of the PV diameters and PO2 changes (p > 0.05). There was a significant relationship between heat differences and PO2 changes in the left superior (p = 0.011), right superior (p = 0.049), right 'common' (p = 0.037) and total PVs (p = 0.001), but there was no significant relationship between heat differences and PO2 changes in the left inferior, left 'common' and right inferior PVs (p > 0.05). CONCLUSION: In the light of these data, PO2 change could demonstrate the success of cryoablation, and was related with the cooling degree, but not with the PV diameter.

The effect of prophylactic migraine treatment on arterial stiffness.

BACKGROUND: Migraine is a common type of primary headache predominantly seen in women. This study aimed to evaluate endothelial function in patients with migraine using pulse wave velocity (PWV). METHODS: The study included 73 patients with newly diagnosed migraine and 80 healthy subjects. All patients and controls underwent baseline transthoracic echocardiography and PWV measurements. Patients were randomized to three groups to receive propranolol, flunarizine or topiramate, and the measurements were repeated at the end of 1 month. RESULTS: The newly diagnosed migraine patients and the control group exhibited no differences in baseline clinical characteristics, and the measurements showed that PWV was 7.4 ± 1.0 m/s in the patient group and 6.0 ± 1.0 m/s in the control group (p < 0.001). The same measurements were repeated during a control visit at the end of 1 month. Following treatment, a significant decrease was observed in PWV in all patient groups compared to baseline (p < 0.001). Subgroup analysis showed significantly decreased PWV in all drug groups, with the most prominent decrease in the topiramate group. CONCLUSIONS: The increased PWV demonstrated in migraine patients in this study stands out as an additional parameter elucidating endothelial dysfunction in these patients. Decreasing the number of migraine attacks with prophylactic treatment may reduce PWV and decrease cardiovascular risk in long-term follow-up.

Cardiac effects of chronic graft-versus-host disease after stem cell transplantation.

Chronic graft-versus-host disease (GVHD) develops as a result of the immunologic response that donor T-lymphocytes generate against host tissue after allogeneic stem cell transplantation. We tried to elucidate the contribution of cardiac dysfunction to the high morbidity and mortality rates observed after GVHD. Forty patients who had undergone bone marrow transplantation were enrolled in this prospective study: 14 patients who had been diagnosed with chronic GVHD (manifestations beyond day 100 after hemopoietic cell transplantation) and 26 patients who had not. All patients had undergone baseline echocardiography before bone marrow transplantation and were monitored. After the expected period of time had elapsed for GVHD after transplantation, these patients were divided into 2 groups in accordance with whether or not they developed chronic GVHD. No significant differences were observed before bone marrow transplantation in the 2 groups' broad attributes or in their laboratory and echocardiographic findings (P >0.05). After transplantation, high-sensitivity C-reactive protein levels and erythrocyte sedimentation rates were significantly higher in the chronic GVHD group (P < 0.001 and P=0.01, respectively). Mean left ventricular mass was 227 ± 32.3 g in the GVHD group and 149.3 ± 27.4 g in the non-GVHD group (P < 0.001). The E/A flow rate was significantly higher in the non-GVHD group. This study shows that chronic GVHD increases left ventricular mass and impairs left ventricular diastolic function in patients who have developed chronic GVHD. In addition, it shows that inflammatory markers increase to higher levels in these patients. Comprehensive studies with larger samples are needed to more fully elucidate the cardiac effects of this disease.

Increased red cell distribution width level is associated with absence of coronary collateral vessels in patients with acute coronary syndromes.

OBJECTIVES: Several studies have evaluated a relationship between increased red cell distribution width (RDW) and morbidity and mortality of acute coronary syndrome (ACS). In this study, we aimed to investigate the association of serum RDW levels and development of coronary collateral vessel (CCV) in patients with ACS. STUDY DESIGN: We evaluated 226 patients with ACS in this prospective and cross-sectional study. Traditional laboratory and clinical parameters and serum RDW levels were measured on admission. All patients underwent coronary angiography on the first day after admission and patients with >80% stenosis were included in the study. The CCV was graded according to the Rentrop scoring system, and a Rentrop grade 0 was accepted as no CCV development (Group 1), while Rentrop grades 1-2-3 were accepted as presence of CCV development (Group 2). RESULTS: Only levels of RDW were significantly higher in Group 1 than in Group 2 (Group 1 RDW 14.6±1.9, Group 2 RDW 14.1±1.4, p=0.02). The predictive value of serum RDW level for absence of collaterals (sensitivity of 58% and specificity of 54%, area under the receiver operating characteristic (ROC) curve = 0.573) was 13.90. CONCLUSION: We found that high levels of RDW were associated with absence of CCV in patients with ACS.

Serum gamma-glutamyltransferase and the burden of atherosclerosis in patients with acute coronary syndrome.

OBJECTIVES: We evaluated the relationship between serum gamma-glutamyltransferase (GGT) levels and the burden of atherosclerosis in patients with acute coronary syndrome (ACS). STUDY DESIGN: This study involved 180 patients (139 male, 41 female; mean age 63±11 years) with the diagnosis of ACS (non-ST elevation myocardial infarction and unstable angina) who underwent coronary angiography on the first day after hospital admission. The burden of atherosclerosis was assessed by the number of involved vessels, and the Gensini and Syntax scores. Serum GGT levels were measured by enzymatic caloric test. RESULTS: Patients with high Syntax scores (>=33) were more frequently diabetic, hypertensive, and had higher GGT and creatinine levels compared to the patients with low Syntax scores (<=23). Similarly, patients with >=3 diseased vessels were more frequently diabetic, hypertensive, and smokers. In addition, these patients were older and had higher serum glucose, urea and GGT levels. Correlation analysis revealed that the level of GGT was significantly associated with Gensini and Syntax scores, number of diseased vessels, and the number of critical lesions (r=0.378 p<0.001, r=0.301 p<0.001, r=0.159 p=0.036, r=0.355 p<0.001, respectively). Multivariate linear regression analysis demonstrated that increased GGT level was an independent risk factor for high Gensini and Syntax scores (p=0.029 and p=0.035, respectively), together with age (p=0.001 and p=0.002, respectively) and serum glucose levels (p=0.017 and p=0.012, respectively). CONCLUSION: Serum GGT levels on admission are associated with increased burden of atherosclerosis in patients with ACS. This may account for the cardiovascular outcomes associated with increased GGT levels.

Red blood cell distribution width in 'non-dippers' versus 'dippers'.

OBJECTIVES: Because both high red cell distribution width (RDW) and non-dipping hypertension are closely related to adverse cardiovascular outcomes and higher inflammatory status, we aimed to investigate whether there is any relationship between RDW and dipping/non-dipping hypertension status. METHODS: The present study involved 123 hypertensive patients and 65 age- and gender-matched healthy, normotensive subjects. Hypertensive patients were divided into two groups: 56 dipper patients (20 males, mean age 51.9 ± 15.3 years) and 67 non-dipper patients (27 males, mean age 55.6 ± 15.0 years). If the systolic daytime blood pressure (BP) of the patients decreased by at least 10% during the nighttime, these subjects were 'dippers', and all other subjects were 'non-dippers'. RESULTS: Both dipper patients and non-dipper patients had higher levels of RDW compared to normotensives (13.5 ± 0.89 and 14.1 ± 1.33 vs. 13.0 ± 1.42%, p = 0.027 and p < 0.001, respectively). Also RDW values in non-dippers were statistically higher compared to those in dippers (p = 0.008). Although there were negative correlations between RDW values and nocturnal systolic BP fall (p = 0.027, r = -0.199) and diastolic BP fall (p = 0.383, r = -0.079) in all hypertensive patients, these correlations did not reach a statistically significant level. CONCLUSION: Our study demonstrates that non-dippers have high RDW levels compared to both dippers and controls.

Increased gamma-glutamyl transferase level is associated with absence of coronary collateral vessels in patients with acute coronary syndrome: an observational study.

OBJECTIVE: Elevated serum gamma-glutamyl transferase (GGT) level has been proposed as a risk factor for coronary artery disease and is associated with poor clinical outcome in acute coronary syndrome (ACS). We aimed to evaluate the relationship between GGT level and presence of coronary collateral vessels (CCV) patients with ACS. METHODS: We evaluated 178 patients with ACS in this cross-sectional-observational study. Traditional laboratory and clinical parameters and serum GGT levels were measured. All patients underwent coronary angiography on the first day after admission and patients who had >80% stenosis of coronary artery were included in the study. The CCVs graded according to the Rentrop scoring system and Rentrop 0, 1, 2 and 3 were determined in respectively 76 (42.7%), 32 (18.0%), 33 (18.5%), and 37 (20.8%) patients. Rentrop grade 0 was accepted as no CCV development (Group 1), Rentrop grades 1-2-3 were accepted as presence of CCV development (Group 2). Statistical analysis was performed using independent-samples t , Mann-Whitney U and Chi-squared tests, logistic regression and receiver operator curve analyses. RESULTS: Mean age was 62 ± 10 years and 134 (75.3%) of patients were male. Group 1 consisted of 76 (42.7%) patients and Group 2 consisted of 102 (57.3%) patients. The median and minimum-maximum values of serum GGT were 33.5 (8-128) U/L for Group 1 and 23 (2-83) U/L for Group 2. Absence of CCV was significantly associated with high levels of GGT (p<0.001), alanine-aminotransferase (p=0.001), glucose (p=0.011) and low levels of total protein (p=0.020). At multivariate analysis, high levels of GGT were independent predictors of absence of CCV (OR=0.953, 95%CI 0.912-0.996, p=0.031). CONCLUSION: High levels of GGT on admission were associated with absence of CCV in patients with ACS.

Impaired aortic elastic properties in patients with chronic graft-versus-host disease.

OBJECTIVES: Graft-versus-host disease (GVHD), which develops as a result of the immunologic response that donor T-lymphocytes generate against host tissue following hematopoietic stem cell transplantation (HSCT), is the leading cause of morbidity and mortality in these patients. The aim of this study is the investigate relation between aortic wall stiffness and duration of the disease in patients with chronic GVHD. METHODS: The study population included 32 patients (18 men; mean age, 36.9±12.5 years, and mean disease duration=14.7±2.9 months) who received HSCT and was diagnosed with GVHD and 44 patients (23 men; mean age, 35.2±9.6 years, and mean disease duration=13.5±2.4 months) who did not develop GVHD following HSCT. All patients underwent baseline echocardiography before HSCT and were followed. After approximately 10-14 months following HSCT, these patients were divided into two groups based on whether they had developed chronic GVHD, and were compared to aortic stiffness parameters and cardiac functions. RESULTS: There was no change in basal characteristics, laboratory and echocardiographic findings, and aortic stiffness parameters in both groups before HSCT (P>0.05). After HSCT, the mean aortic strain and distensibility values of the chronic GVHD patients were significantly lower, compared with the non-GVHD patients (9.8±3.2% vs. 12.9±5.0%, P=0.002 and 4.1±1.5×10(-6) cm2/dyn vs. 5.3±2.1×10(-6) cm2/dyn; P=0.005, respectively). In addition, aortic stiffness index was increased in the chronic GVHD group compared with non-GVHD group (2.7±1.7 vs. 2.0±0.8, P=0.03). CONCLUSION: Aortic stiffness measurements were significantly different in chronic GVHD group compared to non-GVHD group and these findings suggested useful explanation for the potential mechanism about the development of disease.

Acute effects of passive smoking on left ventricular systolic and diastolic function in healthy volunteers.

BACKGROUND: The aim of this study was to investigate the acute effects of passive smoking on left ventricular (LV) function in healthy volunteers. METHODS: Sixty-one healthy nonsmoking volunteers were enrolled in this study. LV M-mode, two-dimensional, conventional Doppler, and color tissue Doppler echocardiography were performed, and carboxyhemoglobin (COHb) levels were obtained from subjects before and immediately after exposure to passive smoking for 30 min in a smoking room. The differences between baseline and post-smoke exposure measurements of transmitral E and mitral annular Em velocities, heart rate, systolic blood pressure, diastolic blood pressure, and COHb levels were assessed. RESULTS: Mean COHb levels were statistically higher after exposure. There were no changes in LV systolic function and volumes. LV diastolic function changed significantly immediately after passive smoking. The transmitral E wave (0.89 ± 0.12 vs 0.70 ± 0.14 m/sec, P = .001), the pulmonary venous D wave (0.52 ± 0.12 vs 0.49 ± 0.13 m/sec, P = .01), and the transmitral E/A ratio 1.79 ± 0.48 vs 1.47 ± 0.32, P = .001) decreased, while the transmitral A wave did not change. The mitral annular Em velocity decreased (12.5 ± 2.1 vs 11.7 ± 1.9 cm/sec, P = .001), the Am velocity increased (6.3 ± 2.1 vs 6.8 ± 1.6 cm/sec, P = .001), and the Em/Am ratio decreased (2.28 ± 0.82 vs 1.78 ± 0.42, P = .001). Color Doppler echocardiography determined diastolic impairment in only women, whereas color tissue Doppler echocardiography demonstrated diastolic dysfunction in both genders. Acute deleterious effects of passive smoking on color Doppler echocardiographic parameters were more prominent in women. Change in E was related to changes in heart rate and systolic blood pressure and with COHb levels, while change in Em was related only to COHb levels. CONCLUSIONS: Acute exposure to passive smoking impairs LV diastolic function in healthy volunteers. The mechanism whereby passive smoking affects diastolic function is probably complex; however, carbon monoxide exposure and an increment in COHb level may be among the causes.

Acute effects of passive smoking on endothelial function.

Impairment of endothelial functions has been shown to occur after acute and chronic exposure to passive smoking (PS), as assessed by flow-mediated dilatation (FMD) of the brachial artery. A total of 61 participants, 30 male and 31 female, mean ages 26 (18-36) were enrolled in the study. All were clinically well and nonsmokers. All participants stayed for 30 minutes in the smoking room. Carbon monoxide (CO) level was 7.42 ± 0.98 ppm (4.71-10.50). Mean carboxyhemoglobin (COHb) levels of participants were significantly elevated after PS. Mean FMD was 18.6% ± 9% and decreased to 12.4% ± 7% after PS (P < .001). In the current study, with more number of participants at lower CO concentrations (7.42 ppm) and with smaller increase in COHb (51%) significant reduction (33%, P < .001) in FMD was observed.

[Catheter ablation of accessory pathway tachycardias in three patients with Ebstein's anomaly]. / Ebstein anomalisi olan üç olguda aksesuvar yol tasikardisinin kateter ablasyonu.

Ebstein's anomaly (EA) is a malformation of the tricuspid valve characterized by a downward displacement of the septal and often the posterior tricuspid valve leaflets to the atrialized right ventricle. Among all congenital anomalies, EA is the most related malformation with accessory pathways. In 5%-25% of patients with EA, accessory atrioventricular pathways may present on the surface electrocardiogram. Radiofrequency catheter ablation is the first-line treatment of EA patients having supraventricular tachyarrhythmias. The presence of a dysplastic tricuspid annulus and electrically distinguishable atrioventricular activity may complicate radiofrequency catheter ablation of accessory pathway tachycardia in these patients. We present three cases of EA in which accessory pathway tachycardias were successfully ablated, with emphasis on technical difficulties in electrophysiological diagnosis and during radiofrequency ablation.

The deletion polymorphism of the angiotensin-converting enzyme gene is associated with acute aortic dissection.

Aortic dissection (AD) is a disease characterized by tear of the aortic intimal layer and separation of the arterial wall. Some risk factor such as hypertension and Marfan syndrome is well known in AD. However, the role of genetic factors in AD is largely unknown. Insertion/deletion (I/D) polymorphism of the angiotensin-converting enzyme (ACE) gene is associated with cardiovascular diseases; patients with D allele have higher serum and tissue ACE levels. We investigated the relationship between the I/D polymorphism of the ACE gene and non-syndromic acute AD. Sixteen patients diagnosed with AD were included in the study (mean age: 60.1 +/- 6.2 years). The diagnosis was established by clinical evaluation and imaging techniques. The control group consisted of 22 age-matched patients without AD (60.9 +/- 7.3 years), who suffered from chest pain. Incidence of hypertension was similar in dissection and control groups (62% vs. 59%). The I/D polymorphism was investigated in both groups by PCR analysis. Dissection types according to the DeBakey classification were identified as type 1 (proximal + distal) in 7 patients (43%), type 2 (proximal) in 5 patients (31%), and type 3 (distal) in 4 patients (25%). The D/D and D/I polymorphisms are present in 13 and 3 AD patients, respectively. None of patients with AD have the II polymorphism. The frequencies of the D allele (DD + ID) are significantly higher in dissection group than control (100% vs. 68%, P < 0001). These results indicate that the D allele of ACE gene is a risk factor for AD.

[Transcatheter closure of secundum atrial septal defects using the Amplatzer septal occluder in adult patients: our first clinical experiences]. / Eriskin hastalarda sekundum atriyal septal defektlerin Amplatzer cihazi ile kapatilmasi: Ilk klinik deneyimlerimiz.

OBJECTIVES: We evaluated short-term results of transcatheter closure of secundum atrial septal defects (ASD) with the Amplatzer septal occluder (ASO) in adults. STUDY DESIGN: The study included 12 patients (6 males, 6 females; mean age 31+/-9 years; range 17 to 54 years) who underwent transcatheter ASD closure with the ASO device. Prior to the procedure, the mean pulmonary to systemic flow ratio was 1.9+/-0.3 (range 1.5 to 2.6). The mean ASD diameter measured by transesophageal echocardiography was 13.9+/-2.8 mm, the mean stretched diameter of ASD measured by balloon sizing was 15.8+/-3.4 mm, and the mean ASO device diameter was 17.3+/-4.7 mm. The patients were evaluated before and six months after the procedure by echocardiography, electrocardiography, and the New York Heart Association (NYHA) functional classification. RESULTS: Transcatheter ASD closure was successfully performed in 11 patients (91.7%). The mean procedure time was 72 minutes. There was no residual shunt at six months after closure. No serious complications occurred during the procedure and within a mean follow-up of 11.6+/-2.3 months. Echocardiographic examination at six months showed significant decreases in right ventricular end-diastolic diameter (VEDD) (p=0.007), right/left VEDD ratio (0.003), systolic pulmonary artery pressure (p=0.017), and significant increases in left ventricular ejection fraction (p=0.014) and left VEDD (p=0.005). There were significant decreases in maximum (p=0.003) and minimum (p=0.006) P-wave durations, and P-wave dispersion (p=0.028). The NYHA functional capacity improved significantly from 1.8+/-0.8 to 1.3+/-0.5 (p=0.014). CONCLUSION: Transcatheter closure of secundum ASD with the ASO device is a safe and effective method in adult patients, resulting in significant improvement in clinical symptoms and cardiac dimensions.

The relationship between Chlamydophila pneumoniae IgG titer and coronary atherosclerosis.

BACKGROUND: The role of Chlamydophila pneumoniae (CP) in the progression of atherosclerosis is controversial. Also no sufficient angiographic study is available about the impact of CP infection on severity and intensity of coronary atherosclerosis. We investigated the relation between CP IgG antibody titers and severity and intensity of coronary atherosclerosis METHODS: The study population consisted of 516 consecutive patients who underwent a coronary angiography. The group included 353 patients who had coronary artery disease; a control group included 163 subjects with angiographically proven normal coronary arteries. Chlamydophila pneumoniae IgG antibody titers were measured by an enzyme immunoassay method in all patients. Gensini scores and extent scores were used to evaluate the angiographic extent and severity of atherosclerosis. RESULTS: The mean value of IgG antibody titer was 44.3 +/- 28.8 IU/mL in the patients and 39.8 +/- 27.4 IU/mL in the control group (p = 0.14). There was no statistically significant correlation between the Gensini scores, extent scores and CP IgG titers (Gensini score: r = +0.103, p = 0.07, extent score: r = +0.110, p = 0.31). When we grouped the patients as high (> 50 IU/mL) and low (< 50 IU/mL) IgG antibody titers, the number of diseased coronary arteries was higher in patients with high IgG antibody titers (respectively: 2.6 +/- 1.1 vs. 2.2 +/- 0.8, p = 0.01). While the Gensini score was significantly higher in patients with high IgG antibody titers (7.5 +/- 4.0 vs. 6.17 +/- 4.0, p = 0.01), the extent score did not change with IgG titers (29.8 +/- 15.9 vs. 25.8 +/- 15.4, p = 0.08). CONCLUSIONS: In our study, we investigated the relation between CP infection and coronary atherosclerosis and found that CP IgG antibody titers are associated with the severity of coronary stenosis at higher antibody levels. However, there is no association between CP antibody titers and clinical presentation of coronary artery disease. We suggest that CP has limited effect on coronary atherosclerosis.

Conservative management of the perforation of a side branch of the left main coronary artery during coronary angiography.

We report perforation of a side branch of left main coronary artery during coronary angiography. We suppose that the engaging of the catheter into a small side branch caused this complication. Furthermore, we observed that the conservative approach might be successful in the restoration of such coronary artery perforations. To the best of our knowledge this is the first reported case of left main side branch coronary artery perforation during angiography.

Coronary ischemia induced Wolf Parkinson White syndrome.

A 60-year-old woman was admitted to cardiology clinic because of typical chest pain. The presenting electrocardiography (ECG) revealed sinus rhythm and T wave inversion on inferolateral wall. Her chest pain relapsed at second day of admission and electrocardiogram recorded during chest pain had ECG changes consistent with Wolf Parkinson White (WPW) syndrome. She underwent cardiac catheterization and borderline lesion was detected in proximal of left anterior descending artery and direct stent implantation was performed. This is the first case report in which acute ischemia may induce typical ECG changes of WPW in a patient with concealed WPW syndrome. We concluded that acute coronary ischemia may manifest concealed WPW syndrome.

Use of ischemia-modified albumin in diagnosis of coronary artery disease.

OBJECTIVE: The diagnosis of coronary artery disease (CAD) is an important clinical problem. Ischemia-modified albumin (IMA) has been demonstrated to be a helpful marker in detecting myocardial ischemia. In this study, we have investigated the diagnostic importance of IMA in CAD. METHOD AND RESULTS: Fifty patients with chest pain were enrolled in the study. IMA levels were measured on admission and within 30-60 min after exercise by albumin cobalt-binding test. Coronary angiography was performed in all patients after the exercise test. The mean preexercise IMA level was 83+/-27 U/ml in the patient group. IMA levels before the exercise test were similar in both patient and control groups (P>0.05). The mean IMA level in the patient group was, however, higher than in the control group after the exercise test (P=0.001). The sensitivity, specificity and positive and negative predictive values of the postexercise IMA levels >85 in diagnosis of CAD were 78, 73, 0.81 and 0.73%; respectively. Postexercise IMA levels were higher in patients with chest pain, ST depression and downsloping and horizontal ST depression of 2 mm or more. CONCLUSION: IMA levels after the exercise test increased in patients with CAD. Our study results indicate that postexercise IMA levels can be helpful markers in the diagnosis of stable CAD in clinical practice.

Cardiovascular effects of carbon monoxide poisoning.

Carbon monoxide (CO) poisoning is an important health problem. Cardiac abnormalities may occur in patients with CO poisoning; however, the severity and duration of cardiac abnormalities are not well known. In this study, cardiac structures and function in CO poisoning were evaluated prospectively. Twenty patients were enrolled in the study. Echocardiographic examination was performed in all patients on admission, at 24 hours, and within the first week. B-type natriuretic peptide and carboxyhemoglobin levels were measured. Patients with increased cardiac markers underwent coronary angiography. Cardiac markers were high in 6 patients. Patients with high cardiac markers had significantly higher carboxyhemoglobin levels and longer exposure to CO. Left ventricular ejection fraction (LVEF) was <45% in 8 patients (group I) on admission and >55% in 7 patients in group I 24 hours after echocardiography. A significant negative correlation was found between B-type natriuretic peptide and LVEF on admission (r = -0.586, p <0.01). The decrease in LVEF was also negatively correlated with carboxyhemoglobin level and CO exposure duration. All angiograms showed normal coronary arteries. In conclusion, despite normal coronary arteries, myocardial dysfunction may occur in patients with CO poisoning. LV systolic function might be normal or mildly to severely impaired. However, most of the myocardial dysfunction dissipates at 24 hours in patients with CO poisoning.

The relationship between the level of plasma B-type natriuretic peptide and mitral stenosis.

B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) are both secreted primarily from the ventricle myocardium in response to the increase in volume and pressure. We aimed to investigate the relationship between the severity of mitral stenosis (MS) and the level of plasma BNP. A total of 56 patients (50 female, 6 male) were included in the study. Mitral stenosis and its related parameters were evaluated by echocardiographic methods. Patients were divided into three groups as with mild, moderate and severe MS according to their planimetric valvular area. Plasma BNP levels were measured using "Triage-B-type natriuretic peptide test" method (Biosite Diagnostics, San Diego). The relationship of BNP with mitral stenosis and other echocardiographic parameters were studied. The comparison of the 3 groups with one another revealed that the BNP level in the group with moderate MS was higher than that in the group with mild MS, however it was statistically insignificant (74.9 +/- 49.7 versus 49.9 +/- 40.5 pg/ml, p > 0.05). BNP level in the group with severe MS was significantly higher than that in the mild MS (144.3 +/- 83.9 versus 49.9 +/- 40.5 pg/ml, p < 0.001) and that in the moderate MS group (144.3 +/- 83.9 versus. 74.9 +/- 49.7 pg/ml, p < 0.05). When patients were taken together, as the area of the mitral valve decreased, the level of BNP underwent a corresponding increase (r:-0.48, p < 0.001). We have ascertained that the level of plasma BNP and the degree of MS are significantly correlated, and as MS becomes more serious, the plasma BNP level rises.