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    Comparison of P-wave duration and dispersion in patients aged ?65 years with those aged ?45 years
    (Churchill Livingstone Inc Medical Publishers, 2003) Turhan, H; Yetkin, E; Sahin, O; Yasar, AS; Senen, K; Atak, R; Sasmaz, H
    P-wave dispersion (PWD) is a Dew electrocardiographic marker that reflects discontinuous and inhomogeneous propagation of sinus impulses, which has been studied in some cardiac conditions as a useful predictor of paroxysmal atrial fibrillation (AF). The aim of the peresent study was to compare P-wave duration and PWD in patients less than or equal to45 versus greater than or equal to65 years of age. The study consisted of 2 groups. Group I included 118 patients aged greater than or equal to65 years (86 men, 32 women, mean age = 69 +/- 4 years). Group II included 72 patients aged less than or equal to45 years (53 men, 19 women, mean age = 41 +/- 4 years). All patients were selected from those who were undertaken coronary angiography in our hospital with a suspicion of coronary artery disease and detected as having angiographically normal coronary arteries. All patients were undertaken transthoracic echocardiography to evaluate the presence of any structural and functional cardiac abnormality. Maximum and minimum P-wave durations and PWD were calculated from 12-lead surface electrocardiogram. Maximum P-wave duration and PWD were significantly higher in group I patients than in group II patients (P <.00 1). However, there was no statistically significant difference between group I patients and group H patients regarding minimum P-wave duration (p =0.9). Left atrial diameter, left ventricular wall thicknesses, mitral A velocity, deceleration time and isovolumic relaxation time were significantly higher in group I patients than in group 11 patients. However, mitral E velocity were significantly lower in group I patients than in group II patients. A significant positive correlation was detected between PWD and age, left atrial diameter, mitral A velocity, deceleration time and isovolumic relaxation time. in addition, we found a significant negative correlation between PWD and mitral E velocity. PWD, indicating increased risk for paroxysmal AF, was found to be significantly higher in patients greater than or equal to65 years of age than in those less than or equal to45 years of age. Further prospective studies that include larger series and long term follow-up are needed to clarify the clinical utility of PWD as a predictor of increased risk for paroxysmal AF in old patients.
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    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, O
    Background: 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.
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    Elevated level of plasma homocysteine in patients with slow coronary flow
    (Elsevier Ireland Ltd, 2005) Erbay, AR; Turhan, H; Yasar, AS; Ayaz, S; Sahin, O; Senen, K; Sasmaz, H
    Back-ground: Elevated plasma levels of homocysteine are currently considered a major, independent risk factor for cardiovascular diseases. Recently, several investigators have Suggested that even mild elevation in plasma homocysteine level can severely disturb vascular endothelial function and subsequently impair coronary blood flow. Accordingly, we investigated plasma homocysteine level in patients with slow coronary flow. Method: Study population included 53 patients with angiographically proven normal coronary arteries and slow coronary flow in all three coronary vessels (group I, 21 females, 32 males, mean age=48 +/- 9 years), and 50 subjects with angiographically proven normal coronary arteries without associated slow coronary flow (group II, 22 females, 28 males, mean age=50 +/- 8 years). Coronary flow rates of all patients and control subjects were documented by Thrombolysis In Myocardial Infarction frame count (TIMI frame count). All patients in group I had TIMI frame counts greater than two standard deviations above those of control subjects (group II) and, therefore, were accepted as exhibiting slow coronary flow. The mean TIMI frame Count for each patient and control subject was calculated by adding the TIMI frame counts for each major epicardial coronary artery and then dividing the obtained value into 3. Plasma homocysteine level was measured in all patients and control subjects using commercially available homocysteine kits. Results: There was no statistically significant difference between two groups in respect to age, gender, hypertension, diabetes mellitus, hyperlipidemia and cigarette smoking (p > 0.05). Plasma homocysteine level of patients with slow coronary flow were found to be significantly higher than those of control subjects (15.5 +/- 5.7 vs. 8.7 +/- 4.2 mu M/l, respectively, p < 0.001). Moreover, we found a significant positive correlation between plasma homocysteine level and mean TIMI frame count (r=0.660, p < 0.001). Conclusion: We have shown that patients with slow coronary flow have raised level of plasma homocysteme compared to control subjects with normal coronary flow. This data suggests that elevated level of plasma homocysteine may play a role in the pathogenesis of slow coronary flow. (c) 2004 Elsevier Ireland Ltd. All rights reserved.
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    P-wave duration and P-wave dispersion in patients with dilated cardiomyopathy
    (Wiley, 2004) Kubilay, SA; Turhan, H; Erbay, AR; Basar, N; Yasar, AS; Sahin, O; Yetkin, E
    Background: P-wave dispersion (PWD) has been reported to be associated with inhomogeneous and discontinuous propagation of sinus impulses. In the present study, we aimed to investigate PWD in patients with dilated cardiomyopathy. Method: The study population consisted of 72 patients with dilated cardiomyopathy and 72 healthy control subjects. Left atrial diameter, left ventricular end-diastolic and end-systolic diameters and left ventricular ejection fraction of all patients and control subjects were measured by means of transthoracic echocardiography. Maximum P-wave duration (Pmaximum) and minimum P-wave duration (Pminimum) were measured from the 12-lead surface electrocardiogram. PWD was calculated as the difference between Pmaximum and Pminimum. Results: Pmaximum and PWD of patients with dilated cardiomyopathy were significantly higher than those of control subjects (Pmaximum: 126 +/- 12 ms vs. 116 10 ms, PWD: 47 +/- 6 ms vs. 38 +/- 7 ms, respectively, P < 0.001 for all). However, there was no statistically significant difference between patient group and control group regarding Pminimum (79 7 ms vs. 78 6 ms, respectively, P = 0.27). Left atrial diameter was significantly higher in patients with dilated cardiomyopathy compared to control subjects (4.51 +/- 0.62 cm vs. 3.60 +/- 0.43 cm, respectively, P < 0.001). Left ventricular ejection fraction was found to be significantly lower in patients with dilated cardiomyopathy compared to control subjects (33 +/- 5% vs. 63 +/- 7%, respectively, P < 0.001). Conclusion: PWD was found to be significantly higher in patients with dilated cardiomyopathy than in healthy control subjects. (C) 2004 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.
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    Plasma homocysteine levels in patients with isolated coronary artery ectasia
    (Elsevier Ireland Ltd, 2005) Turhan, H; Erbay, AR; Yasar, AS; Bicer, A; Sahin, O; Nurcan, B; Yetkin, E
    Objective: Hyperhomocysteinemia is recognized as an independent risk factor for arterial disease including coronary artery disease, cerebrovascular disease and peripheral vascular disease. Previously, an association between increased plasma homocysteine level and peripheral arterial aneurysms has been reported. However, the relationship between coronary artery ectasia (CAE) and plasma homocysteine level has not been investigated. Accordingly, this study was designed to investigate plasma homocysteine level in patients with isolated CAE. Methods: Thirty-two patients with isolated CAE without significant stenosis and 30 control subjects with angiographically normal coronary arteries were included in this study. Fasting plasma homocysteine concentrations were measured by Florescence Polarization Immunoassay method using homocysteine kids. Hyperhomocysteinemia is defined as plasma homocysteine levels above the 95th percentile of the control subjects (13.6 mu mol/l). Results: According to the definition of hyperhomocysteinemia, 19 (59%) of patients with isolated CAE had elevated levels of plasma hornocysteine compared to 2 (7%) in the control subjects with angiographically normal coronary arteries (p < 0.001). In addition, patients with isolated CAE had significantly higher levels of plasma homocysteine compared to control subjects (14.9 +/- 4.5 mu mol/l vs. 8.6 +/- 1.9 mu mol/l respectively, p < 0.001). Besides, we detected a significant positive correlation between the number of ectasic segment and plasma homocysteine level (r=0.537, p=0.002). Conclusion: We have shown for the first time an association between elevated plasma homocysteine level and isolated CAE. Larger prospective studies are needed to confirm the role of hyperhomocysteinemia in CAE and to evaluate the usefulness of homocysteine-lowering therapies. (c) 2005 Elsevier Ireland Ltd. All rights reserved.
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    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, O
    Determination 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.