Role of incremental doses of intracoronary adenosine
in the assessment of fractional flow reserve
Barçın C, İyisoy A,
Kurşaklıoğlu H, Köse S, Aslan N, Töre H.F, Işık E.
The achivement of maximal
vasodilation is mandatory for the accurate assessment of fractional flow
reserve (FFR). We examined the role of incremental doses of intracoronary
adenosine instead of predetermined fixed doses in FFR studies. A total of 31
intermediate (56±16 %) lesions in the left coronary system were examined.
Incremental doses of intracoronary adenosine of 24, 48, 72 and 96 µg were
administered in all of the patients. Mean FFR values decreased gradually as
the dose of adenosine increased (0.79±0.07, 0.76±0.09, 0.75±0.07 ve
0.74±0.08 respectively, p<0.05). Of 17 patients whose FFRs were <0.75 after
96 µg adenosine, these values were >0.75 in 10 (59%) patients after 24 µg,
in 6 (35%) patients after 48 µg and in 2 (12%) patients after 72 µg of
adenosine. This study suggests that: 1)use of incremental doses of
intracoronary adenosine in FFR measurement is very important in order to
prevent underestimation of significant lesions; 2)administration of up to 96
µg of adenosine is safe for the left coronary system.
Key Words:
Adenosine, fractional flow reserve
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Effect of carvedilol on left ventricular
systolic and diastolic function in patients with dipper and nondipper
hypertensives and evaluation of the antihypertensive effect of carvedilol,
determined by the ambulatory blood pressure
Şentürk T, Güllülü S,
Baran İ, Kaderli A. A, Özdemir B, Yuvanç U, Aydınlar A, Cordan J, Özkaya G.
The purpose of this study
was to investigate the antihypertensive effect of carvedilol, on left
ventricular function and the effects of carvedilol, in the treatment of
essential hypertension between patients with a dipper and those with
nondipper profile by means of 24 hour ambulatuary blood pressure monitoring
(ABPM).
Newly diagnosed, untreated
38 patients who had stage I hypertension based on Seventh Report of the
Joint National Committee criteria were enrollled to the study. 24 hours
ambulatory blood pressure recording were perfomed. These patients were
divided into 2 groups according to the presence (dipper, n=16) or absence (nondipper,
n=22) of reduction of both systolic (SBP) and diastolic blood pressure (DBP)
during nightime by an average of more than 10% of daytime blood pressure.
Two dimensional and M-mode echocardiograms of good quality were recorded in
all patients. LV morphologic characteristics, LV systolic and diastolic
functional parameters, mitral Doppler-derived diastolic indexes were
evaluated. Echocardiographies were repeated and ABPM was measured again
after 3 month of the active treatment phase with carvedilol.
Reduced MSBP (p<0.001), MDBP
(p<0.01), nMSBP (p<0.01), nMDBP (p<0.001), dMSBP (p<0.001), dMDBP
(p<0.001), isovolumetrik relaxation time (IVRT) (p<0.05), diastolic (D)
pulmonary venous flow velocity (p<0.01), and increased ejection fraction (EF)
(p<0.01), sistolic/diastolic (S/D) pulmonary venous flow velocity ratio
(p<0.05) after 3 month of carvedilol treatment have been shown in dipper
hypertensives. Compared to the baseline at third month between two groups,
EF (p<0.05) was greater in dippers and MSBP (p<0.05), MDBP (p<0.01), nMSBP
(p<0.01), nMDBP (p<0.001) were lower in dippers than nondippers.
Carvedilol, which can be
dosed once daily, is an effective antihypertensive agent which effectively
lowers blood pressure during the day while reducing daytime, nighttime, and
24 hours average blood pressure more in dippers than nondippers. Carvedilol
therapy can prevent or partially reverse these diastolic changes and improve
left ventricular systolic function.
Key Words: Ambulatory
blood pressure monitoring, hypertension, carvedilol
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The efficiacy and safety of Ephesos stents in
primary PTCA
Çelik T, Kurşaklıoğlu H,
İyisoy A, Amasyalı B, Köse S, Işık E.
Primary PTCA has emerged as
the first choice therapy in the management of acute myocardial infarction in
recent years. One of the issues determining the success of the intervention
is stent related factors. In this study we tried to find out the
efficiacy and safety of Ephesos stents produced in our country.
67 consecutive patients were
enrolled in the study ( men 64,2%, mean age: 64,4+-11,3). Coronary stenting
was successfully performed in all the patients. TIMI 3 flow was achieved in
65 patients ( %97). No reflow phenomenon was seen in two patients (%2,9).
TIMI 2 flow was attained after vigorous flushing and intracoronary verapamil
use in the two cases. No in-hospital death case was seen. One patient was
taken back to the laboratory for acute stent thrombosis and TIMI 3 flow was
accomplished after thrombectomy and angioplasty in this case. Left
ventricular ejection fractions of patients were improved significantly after
the procedure (43,3+-7,8 vs 58,6+-7,1 p<0,01)
Ephesos stents can be used
in primary PTCA effectively and safely according to our data.
Key Words: Primary
PTCA, coronary stent, acute myocardial infarction, Ephesos stents
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Outcome of significant functional tricuspid
regurgitation after percutaneous mitral valvuloplasty
Boyacı A, Güray Ü, Şaşmaz
H, Korkmaz Ş.
Significant tricuspid
regurgitation (TR) can contribute to increased morbidity and mortality in
patients under-going mitral valve surgery for mitral stenosis. This study
examined the impact of significant functional TR on immediate and late
outcomes of patients undergoing percutaneous mitral valvuloplasty (PMV).
We studied 79 consecutive
patients (64 women, 15 men; mean age 37.4±7.1 years) who underwent PMV
retrospectively and had a complete color-Doppler echocardiographic study
before and after the procedure. The severity of TR was assessed
echocardiograpically using color-Doppler flow images and flow direction in
the inferior vena cava or hepatic veins. Patients were classified into two
groups; 60 with mild (77%) and 19 with significant (23%) TR.
Patients with significant TR
showed more severe pulmonary hypertension, more atrial fibrillation and
poorer baseline clinical status than patients with mild TR. Mitral valve
area, pulmonary artery pressure, functional capacity and NYHA class of the
patients in both groups survived significantly after balloon valvuloplasty.
TR was resolved in 6 of the 19 patients (31%) with significant TR.
Patients with mitral
stenosis and significant functional TR have advanced pulmonary vascular
disease and poorer late outcome although transmitral pressure gradient was
sufficiently relieved with PMV.
Key words: Tricuspid
regurtation, percutaneous mitral valvuloplasty
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Cardiac troponins
Arınç H, Gündüz H, Tamer
A, Uyan C.
Troponins are complex
structures proteins which are found in the thick filaments of striated
muscles. They have three forms called troponin T, troponin I and troponin
C. While the cardiac isoforms are not found in the blood normally,
following a myocardial damage their plasma concentrations start to elevate
in 4-12 hours, and depending on the reperfusion, duration of the ischemia
they become maximum in between 12-48 hours and can be detected for a long
time.
In Emergency Rooms, it is
important to make a differential diagnosis of the patients who are suspected
to have acute coronary syndrome. In acute coronary syndrome, there is the
risk of cardiac complications and death which can be eliminated by
appropriate treatment. The troponins are the first choice cardiac markers
for differential diagnosis of unstable angina and non-ST elevation
myocardial infarction in the international guidelines, CK-MB is the second
choice. Troponins are the gold standard markers of cardiac damage.
Cardiac troponin I and T are
not very sensitive at early hours of damage but sensitivities increase in
time and they are highly specific. In acute coronary syndrome troponin
levels are correlated with the amount of the damage and they have prognostic
value. Troponins can be detected in severe heart failure, Duchenne muscular
dystrophy, pulmonary thromboembolism and pericardial effusion. The
diagnostic and prognostic values and the source of the troponins in chronic
renal insufficiency and dialysis patients are still not obvious.
Key words: Cardiac troponin, acute coronary syndrome,
myocardial infarction go to up
Coronary massive air embolism - a case report
Soydinç S, Davutoğlu V,
Akdemir İ, Sezen Y, Aksoy M.
Coronary air embolism is a
rare complication of percutaneous coronary intervention (PCI). The
consequences of this complication depend on the amount of air which is
introduced in the coronary vessels in advertently and appropriate management
is uncertain. We report a 65-year old man complicated with massive coronary
air embolism during PCI and successfully treated with intracoronary
administration of verapamil and forcefully injection of saline.
Key Words: Percutaneous coronary intervention, massive air embolismgo to up
An unusual case with coronary artery-left
ventricular fistulas presented with typical angina pectoris
Durmaz T, Murat S.N,
Yavuz B, Özer N, Hıdıroğlu M, Keleş T, Atalar E, Övünç K, Aksöyek S, Özmen
F.
Visualization of the left
ventricular cavity from coronary arterio-ventricular communications is
rarely encountered in routine coronary angiography. Congenital coronary
arterial fistulas are the most prevalent hemodynamically significant
congenital malformations of the coronary arterial circulation. We report a
53 year-old man who presented with typical stable angina pectoris because
of multiple and extensive coronary artery-left ventricular microfistulas.
Key words:
Coronary artery fistulas, angina pectoris go to up
Familial homozygous hypercholesterolemia
Boyacı A, Sezgin Ö,
Yıldız A, Şaşmaz A.
A 39-year old man with
familial homozygous hypercholesterolemia who had a coronary bypass operation
eleven years ago and relapsing effort angina since three months was
presented here with his signs and symptoms, physical examination and
laboratory findings and also familial hypercholesterolemias were summarized.
Key words:
Familial, homozygous, hypercholesterolemia
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