Usefulness of Maximal Exercise- Corrected QT as a Predictor of Coronary Artery Disease: A Comparison of Simpler Heart Rate Corrections

29th Turkish Cardiology Congress of the Turkish-Society-of-Cardiology (TSC) with International Participation -- OCT 26-29, 2013 -- Antalya, TURKEY[No Abstract Available]Turkish Soc Cardio

Heart rate recovery may predict the presence of coronary artery disease

Objective: We investigated whether post-exercise first minute abnormal heart rate recovery (HRR1) helps to predict the presence and severity of CAD, because of some confounding data. Methods: A cross-sectional, retrospective study was performed. Two hundred individuals were included. Gensini scores and the number of coronary artery involvements were used to evaluate the severity of CAD. Student's t-test, Mann-Whitney U test and chi-square test were used for the analysis continuous and categorical data. Spearman's correlation analysis was used to determine whether there is correlation between Gensini scoring and HRR1. Univariate and multivariate logistic regression were used to determine predictors for abnormal HRR1. ROC curve analysis was performed to detect the best sensitivity and specificity value of HRR1 in predicting CAD presence. Results: Seventy subjects (35%) did not have CAD, and CAD was present in 130 patients (65%). HRR1 0.05), there was relationship CAD presence and abnormal HRR1 (OR=2.1, 95% CI: 1.1-3.9, p=0.02), but not between CAD severity and HRR1 (r=-0.13, p=0.112). The sensitivity, specificity, and the positive and negative predictive values of abnormal HRR1 <= 21 beats at first minute for predicting CAD presence were 76.1%, 41.3% (AUC=0.588, CI 95%: 0.517-0,657, p=0.039), 70.7% and 48.3%, respectively. Conclusion: In the study abnormal HRR1 predicted the presence of CAD, but not the severity of it

Maximal Exercise-Corrected QT as a Predictor of Coronary Artery Disease: Comparison of Simpler Heart Rate Corrections

Background and Objectives: The relationship between QT prolongation and myocardial ischemia is widely known. Due to the limited value of ST depression, we aimed to evaluate, by using four simpler heart rate corrections (Bazett, Framingham, Fridericia and Hodges), the value of maximal exercise-QTc prolongation in the diagnosis of coronary artery disease (CAD) presence and severity. Subjects and Methods: We enrolled 234 subjects (mean age 57.3 +/- 9 years, 143 men) who had undergone exercise testing and coronary angiography due to a suspicion of CAD in the study. Evaluating CAD severity with Gensini scoring, the CAD group (n=122) and controls with non-CAD were compared in terms of corrected QT duration at maximal exercise. Results: Age, gender, hypertension, dyslipidemia, smoking, exercise duration, resting, and peak heart rate were similar between the two groups (all p>0.05). The CAD group had higher raw QT values than the controls {268 (169-438) vs. 240 (168-348), p= 350 ms and Fridericia QTc of >= 340 ms were seen to be useful for the diagnosis of CAD, there was no additive diagnostic value of exercise QTc in addition to ST depression. Maximal exercise-QTc Bazett (r=0.163, p=0.01), Framingham (r=0.239, p=0.001), and Fridericia (r=0.206, p=0.001) equations were weakly positively correlated with Gensini scoring. Conclusion: The patients with CAD have longer QTc intervals at peak heart rates during exercise. This finding provides insufficient evidence to support routine incorporation of QTc at peak heart rates into exercise test interpretation

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Role of sympathetic cotransmitter galanin on autonomic balance in heart failure: an active player or a bystander?

Objective: Galanin, a cotransmitter similar to neuropeptide Y (NPY), aggravates autonomic imbalance in systolic heart failure (HF) by attenuating vagal tonus after burst sympathetic activity. In animal HF models, galanin antagonists have improved cardiac function. To determine whether galanin is a promising therapeutic target in HF, we studied its concentrations in HF patients and evaluated its correlation with NPY, markers of humoral activity such as pro-BNP and copeptin, and echocardiographic parameters of HF severity. Methods: After recording demographic and echocardiographic characteristics of 87 individuals (57 HF patients and 30 control subjects), fasting serum concentrations of galanin, NPY, copeptin, and pro-BNP were determined. Results: Unlike pro-BNP, copeptin, and NPY, which were significantly elevated in HF patients (p<0.001, p<0.001, and p=0.001, respectively), galanin was similar in HF patients and control subjects (p=0.9). NPY correlated with the echocardiographic parameters of HF severity (r=-0.22, p=0.03 for EF; r=0.3, p=0.005 for Tei index of RV; r=-0.23, p=0.03 for TAPSE; and r=0.24, p=0.024 for E/e') and pro-BNP (r=0.22, p=0.046). NPY levels were also associated with beta blocker (BB) use, wherein BB significantly decreased NPY in both HF patients and control subjects. Galanin correlated with humoral biomarkers, pro-BNP and copeptin (r=0.39, p<0.001 and r=0.41, p<0.001, respectively). Although current smoking, BB therapy, pro-BNP, copeptin, and body mass index were associated with galanin in univariate analyses, the multiple linear regression model revealed that pro-BNP was the only significant determinant of galanin levels in HF patients. Conclusion: Our findings confirmed the role of NPY in autonomic balance and suggest that galanin is associated with the proadrenergic state, but its role in HF in humans remains unclear.Scientific Research Projects Fund of Namik Kemal University [NKUBAP.02.YL.16.046]This research was supported by the Scientific Research Projects Fund of Namik Kemal University (NKUBAP.02.YL.16.046)

Can the development of atrial fibrillation in patients with ischemic heart failure with low ejection fraction be predicted?

OBJECTIVE: Our aim is to determine the triggering factors of paroxysmal atrial fibrillation (PAF) in ischemic heart failure (HF) patients with low ejection fraction (EF). METHODS: Sixty patients were included in this study. Echocardiography and 24-hours Holter monitoring were performed after measurement of serum NT-pro BNP concentration. The patients were classified into two groups concerning the occurrence of PAF on Holter recordings. Biochemical and echocardiographic parameters of patients with and without PAF were compared. RESULTS: PAF was detected in 28 (46%) patients. Patients with PAF demonstrated higher NT-pro BNP levels, mitral and aortic regurgitation velocities, E/A, E/E', pulmonary capillary wedge pressure, pulmonary artery systolic pressure, left atrial volume and volume indices. NT-pro BNP was established as the predictor of PAF (OR=1.23, 95% CI: 1.08-1.42; p=0.001).ROC analysis showed an NT-pro BNP value of 2188 pg/mL as cut-off value with 68% sensitivity and 84% specificity [Area under the ROC curve (AUC)=0.826, CI 95%: 0.724-0.927; p<0.001]. CONCLUSION: The triggering factors for AF are increased intracardiac pressures, left atrial dilatation and increased wall tension. As an indicator of increased wall tension, elevated levels of NT-pro BNP predict the development of PAF

Evaluation of the Coronary Angiography Results Performed at the Namık Kemal University Medical Faculty

Aim:In this study, we have tried to elucidate the influence of major cardiovascular risk factors such as age and gender on the prevalence of occlusive coronary artery disease (CAD) and define the prevalence of patients presenting with acute myocardial infarction(MI) or post-procedural MI in patients undergoing coronary angiography(CAG) at our center.Material and Methods:Five hundred consecutive CAG procedures carried out between may 2015 and july 2015 were retrospectively analysed in terms of demographic data (age, gender, prior sten tor coronary bypass procedure), angiographic characteristics (extense of CAD,number of occluded vessels, treatment and stent number),occurence of MI before or after the procedure.Results:In our study population (mean age 62.06±11.18 and 63% male) the rate of normal coronary arteries (NCA) was 14,6%, of nonocclusive CAD was 21,8%, of slow flow phenomenon was 3,8% and occlusive CAD was 59,8%. The mean age of patients with NCA was 56,1±10,5 years which was significantly lower than that of the patients with occlusive CAD (mean age 64±11,3) and nonocclusive CAD (mean age61±10) (p=0,000 and p=0,006 respectively). The patients with occlusive CAD were significantly older when patients with CAD were analysed.(p=0,026). Patients with NCA were more likely to be female (%74) while male gender was more common in patients with occlusive (71,2%) and nonocclusive(64,8%) CAD. Age did not effect the prevalence of presentation with MI. (p=0,11). There was no statisticaly significant difference in presentation with MI in terms of gender (p=0,287) but older women more commonly presented with MI when compared to men(p=0,015) and men experienced more thromboembolic complications after procedure when compared to women (p=0,011).Conclusion:The analysis of the KAG results showed that the prevalence of occlusive CAD is high among our patients. In the light of these data, more emphasis should be given to the primary prevention of cardiovascular diseases in our region

Büyük Menderes Havzasında Organik Pamuk Üretim Olanaklarının Araştırılması

Bu araştırma Büyük Menderes Havzasında Organik Pamuk Üretim Olanaklarının araştırılması amacıyla 2003-2007 yıllarında, Nazilli Pamuk Araştırma Enstitüsünde, tesadüf blokları deneme deseninde, 4 tekrarlamalı yürütülmüştür. Deneme Konuları organik yeşil gübre bitkisi A-arpa, B-arpa+fiğ, C-fiğ(konvansiyonel ekim), D-fiğ(son sulamada ekim) ve E-Kontrol (konvansiyonel pamuk üretim), olarak ele alınmıştır. Araştırmada 2003-2004 yıllarında deneme alanını sömürtmede mısır, 2005-2007 yıllarında organik pamuk üretiminde Nazilli 84-S çeşidi yetiştirilmiştir. Parseller 67,2m² alınmıştır. Deneme parsellerine organik yeşil gübreleme amacıyla Sonbaharda arpa ve fiğ ekilmiş, İlkbaharda pamuk ekim öncesi parçalanıp toprağa karıştırılmıştır. Pamuğa konusuna göre mineral veya organik gübre ve 3-4 sulama uygulanmıştır. Hasat bir defada elle yapılmıştır. Ekim ve hasat dönemlerinde toprağın su ile doymuşluk, toplam tuz%, pH, kireç%, yarayışlı fosfor, yarayışlı potasyum, organik madde %, toplam azot ve Fe,Cu,Zn, Mn,Pb,Cr,Cd,Ni analizleri yapılmıştır. Pamuk parsellerinde fide, koza olgunlaşma, hasat dönemlerinde zararlı ve yabancı ot; %5-10, %50-%60 koza açma döneminde yapraktan; hasattan sonra gövde kesitinde solgunluk hastalık sayımları yapılmıştır. Pamukta verim, çırçır randımanı, uzunluk, incelik, mukavemet analizleri yapılmıştır. Pamuk verim varyans analizinde, konular 2005-2006 yıllarında %99 güvenle farklı, 2007 yılında farksız bulunmuştur. Verimde C-D-E konuları ön sıralarda yer almış, 3 yıllık ortalama verimler sırasıyla 285,4-309,5-293,1 Kg/da olmuştur. Organik pamuk yetiştiriciliğinde organik pamuk verimi ile konvansiyonel pamuk verimi ayni grupta yer almıştır. Sonuçlar Büyük Menderes havzasında organik pamuk yetiştiriciliğinin yapılabilir olduğunu göstermektedir. Bu durum organik tarım ve çevre sağlı açısından büyük önem arz etmektedir

Akut Miyokard İnfarktüsünde Hastaneye Başvuru Süresi ve Yaşam Biçimi Davranışlarının Etkisi

Amaç: Akut Miyokard İnfarktüsü (AMI) tanısı almış hastalarda hastaneye başvuru süresini belirleyerek, yaşam biçimi davranışlarının başvuru gecikmelerindeki rolünü saptamaktır. Yöntem: Çalışma, kesitsel türde tanımlayıcı bir çalışmadır. Çalışma, bir üniversite hastanesinde Aralık 2016–Haziran 2017 tarihleri arasında yürütülmüştür. MI ön tanısı kesinleşen 229 hastaya ilişkin veriler “Hasta Tanılama Formu” ve “Sağlıklı Yaşam Biçimi Davranışları Ölçeği II” (SYBDÖ-II) kullanılarak elde edilmiştir. Bulgular: Hastaların hastaneye başvuru süresi 2,9 ± 1,9 saat olup, %42,4’ünün hastaneye başvuru süresi iki saat ve daha uzundu. Erkek cinsiyet, el ve kola yayılan ağrı, şikayetler başladığında hava şartlarının elverişli olması hastaneye başvuru süresini kısaltırken (P < ,05); ağrıya güçsüzlüğün eşlik etmesi, hasta yakını tarafından yardım arama davranışında bulunulması başvuru süresini uzatmıştır (P < ,05). Şikayetlerin başlangıcından itibaren iki saatten kısa sürede hastaneye başvuranlar SYBDÖ-II’den daha yüksek puan almışlardır (P < ,05). Sonuç: Bulgularımız sonucunda MI sonrası hastanın karar verme sürecini hızlandırarak hastaneye başvuru süresini kısaltmanın yollarınd

INTERPOLATED BIGEMINY VENTRICULAR PREMATURE CONTRACTIONS DUE TO CARDIAC COMPRESSION OF LEFT PLEURAL EFFUSION: A CASE REPORT

We described interpolated bigeminy ventricular premature contractions due to cardiac compression by a large left pleural effusion during exercise test. A 68-year-old man was admitted to the hospital for further examination of chest oppression. His history included a rheumatoid arthritis for more than 20 years and multiple admissions to the hospital. He had been on indomethacin (75 mg/daily) in partial remission for more than 1 year. Laboratory findings of thoracentesis fluid revealed that the cause of pleural effusion was rheumatoid arthritis. He had no diabetes mellitus, thyrotoxicosis, myopericarditis, ischemic or valvular heart disease