Evaluation of beta-blockers on left ventricular dyssynchrony and reverse remodeling in idiopathic dilated cardiomyopathy: A randomized trial of carvedilol and metoprolol

Background: The effect of b-blockage on cardiac dyssynchrony in idiopathic dilated cardio­myopathy (IDC) is unknown. This study evaluated the impact of carvedilol and metoprolol succinate on left ventricular (LV) dyssynchrony and reverse remodeling in IDC. Methods: In this small, prospective, double-blind study, we randomly assigned 81 IDC pa­tients to receive carvedilol or metoprolol succinate. Echocardiographic measurements (dyssyn­chrony, LV volumes and ejection fraction [EF]) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were obtained at baseline and at first and sixth month of therapy. Results: A total of 74 (91%) patients completed all investigations at sixth month (38 and 36 taking carvedilol and metoprolol succinate, respectively). In the carvedilol group, reduction in LV end diastolic volume (D LVEDV at 6 months, 50 ± 15 mL to 40 ± 17 mL, p = 0.03) and increase in LVEF (D LVEF, 7 ± 2% to 5 ± 3%, p = 0.02) was higher compared to the meto­prolol group. Also improvement in inter-ventricular dyssynchrony achieved with carvedilol was higher than metoprolol (D interventricular delay at 6 months, 11 ± 8 ms to 6 ± 7 ms, p = 0.03). However, improvement in intraventricular dyssynchrony was similar in the two groups (D intraventricular delay, 9 ± 7 ms to 9 ± 6 ms, p = 0.91). Improvements in LV mechanical dyssynchrony and reverse remodeling achieved with both drugs were accompanied by reduction in NT-proBNP levels in both carvedilol and metoprolol groups (1614 ± 685 pg/mL to 654 ± ± 488 pg/mL and 1686 ± 730 pg/mL to 583 ± 396 pg/mL, respectively, p < 0.001 for both). Conclusions: Although reduction in LVEDV and increase in LVEF was higher with carvedilol, improvement in intraventricular dyssynchrony was similar in carvedilol and metoprolol groups.

Improved arterial stiffness in mitral stenosis after successful percutaneous balloon valvuloplasty

Background: Rheumatic mitral stenosis (MS) is still a common disease in developing countries with high morbidity and mortality rates. The purpose of the study was to evaluate arterial stiffness in severe MS before and after percutaneous mitral balloon valvuloplasty (PMBV). Methods: Thirty patients with MS in sinus rhythm requiring PMBV and 20 age-gender matched healthy volunteers. The analyze of pulse wave velocities (PWV) were performed using of the carotid artery at the femoral by PWV technique on patients at baseline and a week after PMBV. Results: The values of PWV were significantly decreased after successful PMBW in MS patients. Mitral mean gradients and systolic pulmonary artery pressures (sPAP) both on echocardiography and catheterization also had a significant decrease after PMBW. The mitral valve areas were significantly increased after PMBW. There was a highly significant negative correlation between mitral valve areas and PWV values. A highly significant positive correlation was seen between mitral mean gradient on catheterization and PWV (r = 0.830, p < 0.001). There was also a significant correlation between sPAP on catheterization and PWV values (r = 0.639, p < 0.001). Echocardiographic mitral mean gradients and PWV were highly positive correlated with each other (r = 0.841, p < 0.001). The sPAP on echocardiography had also a highly positive correlation with PWV (r = 0.681, p < 0.001). Conclusions: Mitral stenosis is a cause of impaired arterial stiffness and after the enlargened mitral valve area arterial stiffness improved in patients with MS

Aort Kapak Hastalıkları ve Tedavisi

Enfektif endokardit nadir görülen bir hastalık olsa da, son zamanlarda artan girişimsel işlem sayısı sebebi ile progresyonun da artış olan bir hastalıktır. Tedavisinde iyileşmeler olmasına rağmen kısa ve uzun dönemde mortalite ve morbiditesi yüksek bir hastalıkdır. Tanısı nonspesifik semptomlar yüzünden gecikebilir ve mortal seyredebilir.</p

Aortailiak Anevrizma İçin İnternal İliak Arter Oklüzyonu İle Endovasküler Aort Onarımı

Endovasküler aort onarımı (EVAR) yapılan aorto iliak anevrizma hastaları, endogra ı external iliak artereuzattıktan sonra tip II endoleak oluşumunu önlemekiçin vaskuler plak ile internal iliak arter tıkanması vestent gre le kaplanmasını gerektirir.Bununla birlikteinternal iliak arter oklüzyonu pelvik iskemi nedeniylekalça kaldikasyonuna ve diğer çeşitli sekellere nedenolmaktadır.A.iliaca externa ve A.iliaca interna arasında anastomazoluşturan arterler A. gluteainferior,a.circum exa femoris medialis,A.perforans ve A.iliaca externanın A.epigastrıca inferior dalı ile A. iliaca internanın A.obturatarıos dalı arasındadır.Özellikle A. glutea superıor ve a.glutea inferior arterarasında ki bağlantının herhangi bir nedenle tıkanmasıpelvik kladikasyona neden olmaktadır.Kliniğimize de bilinen ht+ astım + mevcut 75 yaşındahasta epigastrik ağrı nedeniyle başvurdu. Çekilen Bt anjiyogra de abdominal arter en geniş yerinde 57 mm, SolA. iliaca en geniş yerinde 59 mm anevrizma mevcuttu.Tip 2 endoleak gelişmemesi açısından endovaskülergre imizi yerleştirmeden önce sol internal iliac artervaskuler plak ile kapatıldı.Daha sonra bifükarsyonlumoduler endovaskuler gre imiz implante edidi. Komplikasyon gelişmedi. Kontrollerinde herhangi bir şikayetiolmadı</p

Technetium-99m-tetrofosmin imaging with incremental nitroglycerin infusion to detect severely ischaemic but viable myocardium: a comparative study with thallium-201

The aim of this study was to assess the influence of incremental nitroglycerin infusion (NTG+Inf) on the myocardial uptake of Tc-99m-tetrofosmin (TF) in order to determine whether nitrates enhance the detection of viable myocardium with TF in patients with coronary artery disease (CAD) and left ventricular dysfunction. Fifty patients (39 males, 11 females; 54+/-11 years) with previous myocardial infarction and left ventricular dysfunction, who had been referred for coronary revascularization procedures, were studied. Myocardial single-photon emission tomography (SPET) images were obtained I h after injection of 750 MBq TF at baseline and after NTG+Inf, using a 2 day protocol. NTG+Inf was performed starting at 0.4 mug.kg(-1).min(-1), with equal increments every 5 min up to 2 mug.kg(-1)-min(-1). Within 1 week of the TF study, rest-redistribution (R-RD) Tl-201 SPET was performed after the injection of 111 MBq Tl-201. For each study, quantitative analysis was performed in 17 segments. Viability was defined as the presence of tracer uptake of >50% of the peak activity on baseline studies or reversibility. There was significant correlation between quantitative regional RD Tl-201 activity and TF activity after NTG+Inf (r = 0.90, P < 0.001). Of the 131 segments with severely reduced tracer uptake on resting TF images, 34 (26%) were reversible, showing increased tracer uptake after NTG+Inf (from 41%+/-7% to 57%+/-12% of peak activity; P < 0.001). All reversible segments after NTG+Inf had viability criteria on Tl-201 studies. There was 95% concordance between TF with NTG+Inf and RD Tl-201 imaging with regard to the presence of myocardial viability. We conclude that TF imaging with incremental NTG+Inf improves the detection of ischaemic but viable myocardium, correlating with the viability criteria observed on Tl-201 studies. When the advantages of TF imaging are considered, rest TF imaging with NTG+Inf may be a practical diagnostic protocol in patients with CAD and left ventricular dysfunction who are being considered for revascularization. ((C) 2003 Lippincott Williams Wilkins)

High levels of catecholamines cause premature ventricular complex

Ventriküler ekstrasistollerin meydana geliş mekanizmasıbilinsede etyolojisinde rol oynayan ve tetikleyen sebepler tam olarak ortayakonulamamıştır. Ventriküler ekstrasistoller bazı hastalarda asemptomatikseyretsede birçok hastada sıklığına ve kaynaklandığı bölgeye bağlı olaraksemptomatik seyredebilmektedir. Yapılan çalışmalarda uzun süre devam eden sıkVES’in yapısal kalp hastalığı olmadan sol ventrikül sistolik disfonksiyonunaneden olabileceği gösterilmiştir. Norepinefrinin aksiyon potansiyelinin faz-4 kısmındatetiklenmiş aktivite ile ekstra atımlara neden olduğu in vitro çalışmalardagösterilmiştir. Fakat norepinefrinin bu etkisini gösteren insan çalışmasıyapılmamıştır. Aksiyon potansiyelinin faz 3 ve faz 4 aşamasında hücremembranındaki dalgalanmalar eşik değeri aşarsa ekstra uyarı çıkmasına nedenolur.&nbsp; Daha önce yapılan bir çalışmada invitro ortamda ki miyositlere norepinefrin verilince aksiyon potansiyelinin faz4’ünde ekstra uyarılar çıktığı gösterilmiştir. Bu çalışmanın planlanmasındabazı insanların vücudunda endojen olarak fizyolojik miktardan daha fazlakatekolamin sentezlenebileceği ve bu fazla miktarda üretilen katekolaminlerinVES’e neden olabileceği fikri etkili oldu.Katekolaminlerin yarı ömürlerinin çok kısadır ve güniçerisinde salınımları anlık olarak değişim göstermektedir. Bu nedenle fazlakatekolaminin salınımının tespiti için idrarda metanefrin ve normetanefrindüzeylerine bakılmaktadır. Çalışmaya Erciyes Üniversitesi Kardiyoloji kliniğinebaşvuran hastalardan sık ventriküler ekstrasistolü olan 40 hasta çalışmagrubuna, 40 sağlıklı gönüllü kontrol grubu alındı. Hasta grubunda istatikselolarak kontrol grubuna göre idrar normetanefrin ve metanefrin düzeyi kontrolgrubuna göre istatiksel olarak anlamlı fark olduğu izlendi. (p&lt;0,001). Hastagrubunda idrar metanefrin &nbsp;venormetanefrin düzeyi ile ves sıklığı arasında pozitif yönlü orta dereceliistatiksel olarak anlamlı korelasyon izlendi.</p

Fistula between left internal mammary artery graft and pulmonary vasculature after coronary bypass grafting Koroner baypas sonrasi sol i̇ç meme arter grefti ve akciǧer damarlari arasinda fistül oluşumu

Left internal mammary artery (LIMA) is very commonly used conduit for coronary artery bypass grafting (CABG) due to its proven long term patency. The development of fistula between LIMA and pulmonary vasculature is a rare complication of this operation. Recurrent angina pectoris developed in a 73-year-old man 3 years after CABG. Coronary angiography revealed a fistulous connection between LIMA graft and the left pulmonary vasculature. Our patient was managed conservatively with acetylsalicylic acid, statin, nitrate, and angiotensin converting enzyme inhibitor. We report herein a case who developed LIMA to pulmonary vasculature fistula after the CABG