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Öğe Changes in antibody titers against chlamydia pneumoniae after percutaneous transluminal coronary angioplasty(W B Saunders Co Ltd, 2002) Yetkin, G; Yetkin, E; Aksoy, Y; Ileri, M; Mert, A; Cehreli, S[Abstract Not Available]Öğe Changes in plasma levels of adhesion molecules after percutaneous mitral balloon valvuloplasty(Elsevier Science Inc, 2004) Yetkin, E; Erbay, AR; Turhan, H; Balci, M; Yetkin, F; Yetkin, G; Ileri, MBackground: Adhesion molecules are expressed on vascular endothelium and on immune and inflammatory cells. Recently increased levels of adhesion molecules have been shown in patients with rheumatic mitral stenosis. This study examined the serum levels of the adhesion molecules intercellular adhesion molecule I (ICAM-1), vascular cell adhesion molecule I (VCAM-1), and E-selectin in patients with rheumatic mitral stenosis and the effects of percutaneous mitral balloon valvuloplasty (PMBV) on these adhesion molecules. Materials and methods: Thirty five patients (3 men, 32 women, mean age 39 5 years) with severe rheumatic mitral stenosis who underwent percutaneous balloon mitral valvuloplasty, and 35 age and sex matched healthy control subjects were included in the study. Serum levels of ICAM-1, VCAM-I, and E-selectin were measured in all patients who underwent PMBV and in all control subjects. Blood samples were taken for measurement of adhesion molecules immediately before and 24 h after the mitral balloon valvuloplasty. Results: The plasma levels of soluble adhesion molecules E-selectin, ICAM-I and VCAM-I were significantly elevated in patients with mitral stenosis compared to control subjects: E-selectin, 97 +/- 59 vs. 45 +/- 24 ng/ml (P=.001), sICAM-1, 874 +/- 301 ng/ml vs. 238 82 ng/ml (P<.0001); sVCAM-1, 3056 +/- 763 ng/ml vs. 985 +/- 298 ng/ml (P<.0001). Plasma levels of VCAM-1 significantly increased 24 h after the valvuloplasty procedure (3056 +/- 763 ng/ml vs. 3570 +/- 1225 ng/ml P=.013). Plasma levels of E-selectin showed a significant decrease after PMBV (97 +/- 59 vs. 70 +/- 58 ng/ml, P=.043) and plasma levels of ICAM-I did not show any change after PMBV (874 +/- 301 vs. 944 +/- 3 77 ng/ml, P=.356). Conclusion: Cellular adhesion molecules, sICAM-1, E-selectin, sVCAM-1 have shown changes in different directions in response to PMBV These results necessitate further studies to clarify the mechanism underlying the association between adhesion molecules and PMBV as well as rheumatic mitral stenosis. (C) 2004 Elsevier Inc. All rights reserved.Öğe Comparison of low dose DSE and echocardiography during GIK infusion for the detection of myocardial viability after anterior myocardial infarction(W B Saunders Co Ltd, 2002) Yetkin, E; Kubilay, S; Atak, R; Ileri, M; Tandogan, I; Turhan, H; Kosar, F[Abstract Not Available]Öğe Comparison of low-dose dobutamine stress echocardiography and echocardiography during glucose-insulin-potassium infusion for detection of myocardial viability after anterior myocardial infarction(Lippincott Williams & Wilkins, 2002) Yetkin, E; Senen, K; Ileri, M; Atak, R; Tandogan, I; Yetkin, Ö; Kosar, FBackground Low-dose dobutamine stress echocardiography (LDDSE) is one of the methods most used to assess myocardial viability. Glucose-insulin-potassium (GIK) infusion has been shown to increase contraction of the ischemic zone. The aim of this study was to compare LDDSE and echocardiography during GIK infusion for detection of myocardial viability. Methods Thirty-two patients who had first anterior myocardial infarction (MI) without previous MI were included in the study. Echocardiographic evaluation was carried out on the 7th +/- 2 days after MI. During continuous electrocardiographic, blood pressure and echocardiographic monitoring, an intravenous infusion of dobutamine (3 mug/kg body weight/min) was started with an infusion pump, continued for 5 min and then increased to 5 mug/kg/min and 10 mug/kg/min for another 5 min. The GIK protocol consisted of a fixed dose of insulin (100 muU/kg/h intravenously) and a variable glucose/potassium infusion rate. GIK echocardiography was done at baseline and after 60 min of GIK. The detected viable myocardium was defined as one or two scores decreasing in at least two adjacent abnormal segments during LDDSE and GIK echocardiography. Results Under resting conditions 225 segments (44%) were normokinetic, 21 segments (4%) dyskinetic, 117 segments (23%) akinetic and 149 segments (29%) hypokinetic. Viability was detected in 20% (57 segments) of the asynergic segments at baseline with GIK echocardiography and in 22% (62 segments) of those segments with LDDSE (P < 0.05). Left ventricular wall motion score index at baseline was 1.87 and it decreased significantly indicating improvement in left ventricular systolic function during both LDDSE and GIK echocardiography (P < 0.001, versus 1.75 and 1.76 respectively). The agreement between LDDSE and GIK echocardiography for detection of myocardial viability was 96%. Conclusion We have shown that GIK echocardiography is similar to LDDSE for detection of myocardial viability. With the support of further clinical studies GIK echocardiography could be used to detect myocardial viability after acute MI.Öğe Comparison of TIMI frame counts of patients with and without coronary artery ectasia(W B Saunders Co Ltd, 2002) Yetkin, E; Atak, R; Turhan, H; Sivri, N; Ileri, M; Kosar, F; Ozdemir, R[Abstract Not Available]Öğe Correlation between infarct-related coronary artery patency and predischarge electrocardiographic patterns in patients with first anterior myocardial infarction who received thrombolytic therapy(Springer-Verlag, 2004) Atak, R; Ileri, M; Senen, K; Turhan, H; Erbay, AR; Basar, N; Yetkin, EThe aim of this study was to investigate the correlation between the ST-segment and T-wave patterns in pre-discharge electrocardiogram and patency of left anterior descending coronary artery in patients with a first anterior myocardial infarction (AMI). One hundred and fifty-six of 175 consecutive patients who were admitted to our clinic between January 2000 and September 2002 due to a first episode of transmural AMI and who received thrombolytic therapy were enrolled. Coronary angiography was performed by the Judkins method on the 6th-10th day after the acute infarction. The corrected TIMI frame count (CTFC) was estimated according to the previously described method. According to the combination of the ST-segment and T-wave morphology on the day (6-10) of cardiac catheterization, patients were classified into four groups: group A, ST elevation <0.1 mV and negative T waves; group B, ST elevation ?0.1 mV and negative T waves; group C, ST elevation <0.1 mV and positive T waves; and group D, ST elevation greater than or equal to0.1 mV and positive T waves. Of the 99 patients with negative T waves, 47 (48%) had CTFCless than or equal to27,32 (32%) CTFC between 27 and 40,15 (15%) CTFCgreater than or equal to40-100, and 5 (5%) CTFC>100. Of the 57 patients with positive T waves, CTFC was less than or equal to27 in 14 (25%), between 27 and 40 in 17 (30%), greater than or equal to40-100 in 11 (19%), and >100 in 15 (26%) (P<0.001). From the 76 patients with an isoelectric ST segment, 38 (50%) had CTFC?27, 29 (38%) CTFC between 27 and 40, 8 (11%) CTFC?40-100, and 1 (1%) CTFC >100. Of the 80 patients with an elevated ST segment, 23 (29%) had CTFCless than or equal to27, 20 (25%) CTFC between 27 and 40,18 (23%) CTFCgreater than or equal to40-100, and 19 (23%) CTFC>100(P<0.001). Use of the combination of two electrocardiographic parameters (ST segment and T waves) also indicated that there were significant differences between groups A and D, and groups B and D (P<0.001 and P<0.05, respectively). Development of an isoelectric ST segment with negative T waves may indicate a better degree of reperfusion after AML In contrast, patients in whom ST-segment elevation and positive T waves remain at discharge from the coronary care unit have a higher probability of a nonpatent left anterior descending artery.Öğe Decreased platelet activation and endothelial dysfunction after percutaneous mitral balloon valvuloplasty(Elsevier Ireland Ltd, 2003) Yetkin, E; Erbay, AR; Turhan, H; Ileri, M; Ayaz, S; Atak, R; Senen, KObjective: This study was conducted to assess the changes in platelet activation and endothelial dysfunction in patients with mitral stenosis (MS) and sinus rhythm (SR) following percutaneous mitral balloon valvuloplasty (PMBV). Background: Systemic thromboembolism is a serious complication in patients with valvular heart disease, and its incidence is highest in those with mitral stenosis. A hypercoagulable state has also been reported in patients with mitral stenosis and sinus rhythm. A recent study has shown that patients with previous PMBV had a lower incidence of thromboembolism. Methods and results: The study was conducted in 21 patients (two men, 19 women, mean age=34+/-6 years) with mitral stenosis and sinus rhythm (SR) who underwent percutaneous mitral balloon valvuloplasty and 17 healthy control subjects (two men, 15 women, mean age=33+/-6 years). Biochemical markers of platelet activity (beta thromboglobulin, BTG, and soluble P-selectin, sPsel) and endothelial dysfunction (von Willebrand Factor, vWF) were measured in both control subjects' and patients' serum samples taken immediately before PMBV and 24 h after PMBV procedure. All patients underwent successful PMBV Significant improvement of mitral valve area, pulmonary artery pressure, mean mitral gradients, and left atrial diameter were achieved in all patients after PMBV Compared with control subjects, patients with MS had higher plasma levels of BTG (66+/-26 ng/ml vs. 14+/-6 ng/ml, P<0.001), vWF (177+/-67 units/dl vs. 99+/-37 units/dl, P<0.0001), sPsel (226+/-74 ng/ml vs. 155+/-66 ng/ml, P<0.001). There was a significant reduction of plasma levels of BTG (66 +/- 26 ng/ml vs. 48 +/- 20 ng/ml, P=0.002), vWF (177 +/- 67 units/dl vs. 134 +/- 60 units/dl, P=0.001) and P-selectin (226 +/- 74 ng/ml vs. 173 +/- 71 ng/ml, P=0.008,) 24 h after PMBV Conclusion: We have shown that patients with severe MS and SR have increased platelet activation and endothelial dysfunction compared with control subjects and PMBV results in decreased platelet activity and improvement of endothelial injury. (c) 2003 Elsevier Ireland Ltd. All rights reserved.Öğe Detection of Chlamydia pneumoniae deoxyribonucleic acid in blood samples taken from coronary sinus after coronary angioplasty(Excerpta Medica Inc-Elsevier Science Inc, 2002) Yetkin, E; Yetkin, G; Tandogan, I; Kocabas, NA; Ileri, M; Ozdemir, R; Kosar, FChlamydia pneumoniae deoxyribonucleic acid was not found in blood samples (0%) taken from the coronary sinus immediately before coronary angioplasty, but C. pneumoniae deoxyribonucleic acid was detected in 4 of 14 patients' blood samples (29%) taken after coronary angioplasty. This finding suggests that coronary angioplasty can cause C. pneumoniae bacteremia.Öğe Detection of Chlamydia pneumoniae DNA in blood samples taken from coronary sinus after coronary angioplasty(W B Saunders Co Ltd, 2001) Yetkin, E; Yetkin, G; Tandogan, I; Aygun, N; Ileri, M; Cehreli, S; Mert, A[Abstract Not Available]Öğe Diagnostic value of aVL derivation for right ventricular involvement in patients with acute inferior myocardial infarction(Wiley, 2003) Turhan, H; Yilmaz, MB; Yetkin, E; Atak, R; Biyikoglu, SF; Senen, K; Ileri, MBackground: Right ventricular (RV) involvement is associated with increased morbidity and mortality in patients with acute inferior myocardial infarction (MI). Although electrocardiography is probably the most useful, simple, and objective tool for the diagnosis of acute MI, there are no well-defined criteria in the standard 12-lead electrocardiogram to properly identify RV involvement in patients with acute inferior MI. Our objective was to evaluate the value of ST-segment depression in lead aVL in diagnosing RV involvement in patients with acute inferior MI. Materials and Methods: Sixty-seven patients, hospitalized with acute inferior myocardial infarction, were included in this study. The diagnosis of acute inferior myocardial infarction was based on the clinical history, characteristic enzyme pattern of CK-MB values, and the appearance of ST-segment elevation greater than or equal to 1 mm in at least two of the leads (leads II, III, aVF). RV infarction was defined by ST segment elevation greater than or equal to 1 mm in lead V4R. ST-segment depression in lead aVL that is more than 1 mm was accepted as a diagnostic criterion for RV involvement in patients with acute inferior MI. Results: Thirty-one patients had >1 mm ST-segment depression and 28 of them had right ventricular infarction according to lead V4R. Thirthy-six patients showed less than or equal to1 mm ST-segment depression indicating no right ventricular involvement but four of them also had right ventricular infarction according to V4R. Conclusion: More than 1 mm ST-segment depression in lead aVL was found to have high sensitivity (87%), specificity (91%), high positive and negative predictive value (90%, 88%, respectively), and high diagnostic accuracy (89%) in diagnosing RV involvement in patients with acute inferior MI. Therefore, by using a simple 12-lead electrocardiographic sign, ST-segment depression >1 mm in lead aVL, obtained on admission, it is possible to identify RV involvement in patients with acute inferior MI.Öğe Documentation of slow coronary flow by the TIMI frame count in habitual smokers with normal coronary arteries(W B Saunders Co Ltd, 2002) Yetkin, E; Turhan, H; Atak, R; Ileri, M; Senen, K; Yetkin, O; Tandogan, I[Abstract Not Available]Öğe Effects of slow coronary artery flow on QT interval duration and dispersion(Blackwell Futura Publishing, Inc, 2003) Atak, R; Turhan, H; Sezgin, AT; Yetkin, O; Senen, K; Ileri, M; Sahin, OBackground: The coronary slow-flow phenomenon is an angiographic phenomenon characterized by delayed opacification of vessels in the absence of any evidence of obstructive epicardial coronary disease. Several studies have demonstrated myocardial ischemia in patients with slow coronary artery flow. In the present study, we aimed at evaluating the effects of slow coronary artery flow on QT interval duration and QT dispersion as a possible indicator of increased risk for ventricular arrhythmias and sudden cardiac death. Methods: The study population included 49 patients with angiographically proven normal coronary arteries and slow coronary flow in all three coronary vessels (group 1, 33 males, 16 females, mean age = 48 9 years), and 71 patients with angiographically proven normal coronary arteries without associated slow coronary flow (group 11, 47 males, 24 females, mean age = 50 8 years). Coronary flow rates of all subjects were documented by thrombolysis in myocardial infarction frame count (TIMI frame count). QT interval duration and QT dispersion of all subjects were measured on the standard 12-lead electrocardiogram. Results: There was no statistically significant difference between the two groups in respect to age, gender, presence of hypertension, and diabetes mellitus. There was a significant difference between the two groups in respect to the presence of cigarette smoking, typical angina, and positive exercise test results. TIMI frame counts of group I patients were significantly higher than those of group II patients for all three coronary arteries (P < 0.001). Maximum corrected QT interval (QTcmax) of group I did not differ from the QTcmax of group II (P > 0.05). However, minimum corrected QT interval (QTcmin) of group I was significantly lower than that for group II (P = 0.008). Consequently, corrected QT dispersion (QTcd) in group I was found to be significantly higher than in group II (P < 0.001). Conclusion: QTcd, indicating increased risk for ventricular arrhythmias and cardiovascular mortality, was found to be significantly higher in patients with slow coronary artery flow. However, further long-term prospective studies should be carried out to establish the significance of QTcd as a risk factor for ventricular arrhythmias and subsequent sudden cardiac death in patients with slow coronary artery flow.Öğe Identification of viable myocardium after anterior myocardial infarction: Comparison of combined low dose dobutamine-nitrate echocardiography and low dose dobutamine stress echocardiography(Lippincott Williams & Wilkins, 2002) Senen, K; Yetkin, E; Ileri, M; Atak, R; Turhan, H; Tandogan, I; Cehreli, S[Abstract Not Available]Öğe Identification of viable myocardium in patients with chronic coronary artery disease and myocardial dysfunction: Comparison of low-dose dobutamine stress echocardiography and echocardiography during glucose-insulin-potassium infusion(Sage Publications Inc, 2002) Yetkin, E; Senen, K; Ileri, M; Atak, R; Battaoglu, B; Yetkin, O; Tandogan, ILow-dose dobutamine stress echocardiography (LDDSE) is one of the methods most used to assess myocardial viability. Glucose-insulin-potassium (GIK) has been shown to increase contraction of the ischernic zone. The aim of this study was to compare LDDSE and echocardiography during GIK infusion for detection of myocardial viability in patients with chronic coronary artery disease (CAD) and myocardial dysfunction. Twenty-one patients who had chronic CAD and myocardial dysfunction were included in the study. Glucose-insulin-potassium protocol consisted of a fixed dose of insulin (100 muU/kg/hour IV) and a variable glucose/potassium infusion rate. GIK echocardiography was made at baseline and after 60 minutes of GIK infusion. During continuous electrocardiographic, blood pressure, and echocardiographic monitoring, an intravenous infusion of dobutamine (3 mug/kg body weight/min) was started with an infusion pump and continued for 5 minutes and then increased to 5 mug/kg/min and 10 mug/kg/min for another 5 minutes. The detected viable myocardium was defined as I or 2 scores decreasing in at least 2 adjacent abnormal segments during LDDSE and GIK echocardiography. Viability was detected in 19% (52 segments) of the asynergic segments at baseline with GIK echocardiography and 16% (44 segments) of those segments with LDDSE (p > 0.05). Left ventricular wall motion score index at baseline was 2.24 +/- 0.35 and it decreased significantly during both LDDSE (p=0.004 vs 2.11 +/- 0.36) and GIK echocardiography (p=0.001 vs 2.09 +/- 0.32). The agreement between LDDSE and GIK echocardiography for detection of myocardial viability was 95%. This study shows that GIK echocardiography is similar to LDDSE for detection of myocardial viability. With the support of further clinical studies GIK echocardiography can be used to detect myocardial viability in patients with chronic CAD.Öğe Increased P-wave duration and P-wave dispersion in patients with aortic stenosis(Blackwell Futura Publishing, Inc, 2003) Turhan, H; Yetkin, E; Atak, R; Altinok, T; Senen, K; Ileri, M; Sasmaz, HBackground: P-wave dispersion (PWD), defined as the difference between the maximum and minimum P-wave duration, has been proposed as being useful for the prediction of paroxysmal atrial fibrillation (AF). AF is the most common arrhythmia and an important prognostic indicator for clinical deterioration in patients with aortic stenosis (AS). The,aim of the present study was to evaluate PWD in patients with AS. Methods: The study population consisted of two groups: Group I consisted of 98 patients with AS (76 men, 22 women; aged 63 8 years) and group II consisted of 98 healthy subjects (same age and sex) without any cardiovascular disease. A 12-lead electrocardiogram was recorded for each subject. The P-wave duration was calculated in all leads of the surface electrocardiogram. The difference between the maximum and minimum P-wave duration was calculated and was defined as the PWD. All patients and control subjects were also evaluated by echocardiography to measure the left atrial diameter, left ventricular ejection fraction, left ventricular wall thicknesses, and the maximum and mean aortic gradients. Patients were also evaluated for the presence of paroxysmal AF. Results: Maximum P-wave duration and PWD of group I were found to be significantly higher than those of group II. In addition, patients with paroxysmal AF had significantly higher PWD than those without paroxysmal AF. There was no significant difference between the two groups regarding minimum P-wave duration. In addition, there was no significant correlation between echocardiographic variables and PWD. Conclusion: PWD, indicating increased risk for paroxysmal AF, was found to be significantly higher in patients with AS than in those without it. Further assessment of the clinical utility of PWD for the prediction of paroxysmal AF in patients with severe AS will require longer prospective studies.Öğe Increased systemic and regional coagulation activity in patients with mitral stenosis and sinus rhythm(Westminster Publ Inc, 2003) Atak, R; Yetkin, E; Yetkin, O; Ayaz, S; Ileri, M; Senen, K; Turhan, HA hypercoagulable state has been reported in patients with mitral stenosis (MS) and sinus rhythm (SR). However it has been suggested that the coagulation activity may be increased only within the left atrium in MS, with normal peripheral blood levels. The aim of the present study was to assess regional left atrial and systemic coagulation activities by measuring PF1+2 in patients with severe mitral stenosis and sinus rhythm, normal blood clotting times, and no left atrial thrombus. The study was conducted in 25 consecutive patients with moderate-to-severe MS and sinus rhythm who underwent percutaneous balloon mitral valvuloplasty. Transesophageal echocardiography was performed before the valvuloplasty procedure in all patients to exclude the presence of left atrial thrombus and left atrial spontaneous echo contrast (LASEC). There were no statistically significant differences between LASEC-positive and LASEC-negative patients with respect to age, gender, fibrinogen levels, prothrombin time, mitral valve area, mean mitral gradient, pulmonary artery pressure (in all p > 0.05). Regional (left atrial) PF1+2 levels of both LASEC-positive and LASEC-negative patients were significantly elevated when compared to control subjects (p < 0.01). Statistically significant elevated systemic level of PF1+2 was observed only in LASEC-positive patients when compared to control subjects (p < 0.01, p > 0.05, respectively). In conclusion patients with severe mitral stenosis and SR have increased regional coagulation activity in both LASEC-negative and LASEC-positive groups. Although this increased regional coagulation activity has been reflected in peripheral blood of LASEC-positive patients, it has not been reflected in peripheral blood of LASEC-negative patients.Öğe Myocardial viability in patients with chronic coronary artery disease and myocardial dysfuncton: Dobutamine stress echocardiography and echocardiography during glucose-insulin-potassium infusion(Lippincott Williams & Wilkins, 2002) Turhan, H; Yetkin, E; Senen, K; Atak, R; Ileri, M; Aksoy, Y; Cehreli, S[Abstract Not Available]Öğe Permanent myocardial dysfunction caused by high-voltage electrical injury - A case report(Sage Publications Inc, 2004) Atak, R; Turhan, H; Erbay, AR; Yetkin, E; Ileri, MElectrical injury, particularly alternating current, may lead to disease of conducting tissue or to myocardial damage, or even may cause sudden death. In the present case, the authors report a 22-year-old man who sustained extensive upper extremity trauma from a high-voltage electrical injury and manifested clinical signs of left ventricular heart failure.Öğe QTc dispersion measurement for risk of syncope in patients with aortic stenosis(Westminster Publ Inc, 2001) Kosar, F; Hisar, I; Durmaz, T; Ileri, M; Tandogan, IThe purposes of this study are to evaluate the clinical usefulness of maximum QTc and QTc dispersion determination in aortic stenosis, and to compare the effects of maximum QTc and QTc dispersion on the risk of syncope in aortic stenosis. The QT interval dispersion has long been known to be a marker of dispersion of ventricular repolarization and, hence, electrical instability. Additionally, it has been shown that these patients have a propensity to ventricular tachyarrhythmic syncope. The study included 86 patients with aortic stenosis who underwent left-heart catheterization and coronary angiography during investigation of syncope and 30 healthy subjects. The patients were characterized with regard to the presence or absence of a history of syncope and the severity of aortic stenosis (the degree of peak transvalvular gradient). In addition, QT max and QT dispersion measurements were corrected for heart rate according to Bazett's formula. The QTc max and QTc dispersion were greater in patients with aortic stenosis than in the healthy subjects (477 +/- 49 ms vs 370 +/- 22 ms, p<0.001; 60 +/- 13 ms vs 38 +/- 1 ms, p < 0.001). Similarly, the QTc max and QTc dispersion were greater in the patients with a history of syncope than in the patients with no history of syncope (493 +/- 48 ms vs 459 +/- 4 ms, p < 0.001; 68 +/- 12 ms vs 53 +/- 10 ms, p < 0.001). In addition, both parameters were greater in the patients with a high transvalvular gradient than in the patients with a low transvalvular gradient (489 +/- 49 ms vs 451 +/- 39 ms, p < 0.001; 65 +/- 12 ms vs 50 +/- 9 ms, p < 0.001). Multivariate logistic regression analysis showed that only a increased QTc dispersion had significant value for the risk of syncope in aortic stenosis. An increased QTc dispersion caused a 10.4% increase in the occurrence of syncope in aortic stenosis. These results suggest that high values of QTc dispersion are sensitive noninvasive markers to determine the risk for syncope in aortic stenosis.Öğe The role of valvular and thoracic aortic calcifications in distinction between ischemic and nonischemic cardiomyopathy(Sage Publications Inc, 2004) Atak, R; Ileri, M; Yetkin, O; Yetkin, E; Turhan, H; Senen, K; Sahin, ODetermination of underlying etiology in patients with dilated and globally hypokinetic left ventricles may sometimes be difficult even after detailed history and complete clinical evaluation. Cardiac valvular and thoracic aortic calcifications have previously been reported to be used as a window to diffuse atherosclerosis of the vascular system. The authors prospectively examined the predictive value of mitral annular calcification (MAC), aortic valve calcification (AVC), and thoracic aortic calcification (TAC) in diagnosis of coronary artery disease as the underlying cause of diffuse left ventricular dilatation and systolic dysfunction. The study included 98 consecutive patients (male/female = 76/22, mean age = 58.9 +/- 10.7 years, range: 33 to 75 years) over the age of 30 years admitted to their clinics between October 1999 and December 2001 with signs and symptoms of congestive heart failure associated with documented cardiomegaly. Transthoracic echocardiography and coronary angiography were performed in all patients for the evaluation of valvular calcifications and coronary status. Although there was no significant difference between the groups with and without coronary artery stenosis (CAS), with regard to presence of MAC, patients with CAS tended to have MAC more frequently (12/61, 20% vs 4/37, 11%, p > 0.05). AVC and TAC were found to be significantly more frequent in patients with CAS compared to those without CAS (AVC, 35/61, 57% vs 4/37, 11%, p < 0.001 and TAC, 28/61, 46% vs 2/37, 5%, p < 0.001). While all 3 calcifications had sensitivity under 60%, and specificity and positive predictive value over 75% individually, the presence of any of them had a sensitivity of 80%, specificity of 86%, positive predictive value of 91%, and negative predictive value of 73%. Thus the presence of any of these calcifications distinguished patients with coronary artery disease with a sensitivity of 80% and specificity of 86%. The presence of aortic valvular valve and thoracic aortic calcifications seems to be associated with significant coronary arterial stenosis; however, with relatively low negative predictive values these cannot be used in clinical practice for diagnosis of underlying coronary artery disease in patients with dilatated left ventricles and impaired systolic functions.
