Tiirk Kardiyol Dem

Tiirk Kardiyol Dem

2000; 28: 466-469

Summaries of Articles

Clinical l nvestigations

Effect of Weight Loss I nduced by Physica l Exercise on Blood Pressure in H ypertensive Patients

N. Güler , M . Bilge, B. Eryonucu , L. Demiralp, Ü. Güntekin

Exercise in tervention studie s ha ve show n tha t moderate intens ity lo ng-term aerobic exercise lowers blood pressure in pati ents with mild , mode rate and severe hy pertens ion . Howeve r, it is not clear whether the reduction in blood pressure is caused independently by a weight loss or an inc rease in physical activity, or the combination of the two. In this study, we examined the efficacy of weight loss induced by a n increased physica l exercise in the treatme nt of hypertens ion in hypertens ive patie nts.

To eletermine this, overweig ht or obese 33 patients with s tage I-III essentia l hyperte ns ion were studied throughout a 7-week of moderate intens ity aerob ic exercise. The exercise

inc luded

exercise, 3 days a week fo r 45-60 nıinutes at an intens ity of 60% to 85% of maxima l heart rate (220- age). After 7-week exerc ise program, participan ts were div idcd into two g roups: the weight-loss group (n= 13) and group II (n=20 ) w ith no weig ht loss.

After 7 weeks, ılıere was a sign ifica nt reduction in systol i c press uı·es both in group I ( 167± 19 ının I-lg vs 146±8 nııni-I g, P<O.OO I) and group II (173± 14

ınıni-lg vs 165±2 1 mmHg, p<O,OI ). Significant reduction in di astolic blood pressures also were observed in group I (1 16±8 mmHg vs 93±1 1 mmHg, p<O.OOI ) and group II ( 1 1 4± 12 mmHg vs 1 04±13

ınınHg , p<O.O 1 ). After 7 week s, systo lic and dias tolic blood pressures were s ig ni fica ntly different, for comparis on o f changes from basel ine, between the two groups (P< 0.001 ). A fter 7-weeks exercise, a lthough it was not statistically sig nificant, blood pressures we re ınore found at normal ranges in group I (5/ 1 3 (39%)) than in group II (5/20 (25%), p=0.4) .

In conc lus ion , 7-10% weight loss caused by moderate exerc ise inc reased the positive effect of exercise induced decrease in blood pressure.

Key words : Exerci se, we ight loss, essentia l hyperte ns ion

466

Efeect of Verapaınil, Trandolapril a nd Fixed-Do- se Combination of the Two on Ambulatory Blood Pressure Valuesin Essential Hypertension

O. Gençosmanoğlu, T. Timurkaynak, B. Boyaci, R. Yalçm, A. Çe ngel, Ö. Dörrlemez, H. Dörrlemez

Thi s study was conduc ted to investigate the therape- utic effect of

trandolapril and a fixed-do- se combination of the two on blood press uı·e in es- senti al hypertension (HT). 65 patients with essent ial hypertrension (33F, 32M) (nı ean age 50. 3±8. I) wcre evaluated w ith 24-hour ambulatory b lood pressuı·e

values . Patients were ra ndomized to one of the 3 tre- atme nt protocols : verap aınil SR 240 ıng, trandolapril 2 mg, verapaınil SR 1 80 mg + trandolapril 2 mg.

Both eli nical and

BP

we- re re peated on the 8th week of therapy.

With trando lapril , verapanı il SR and combination treatment elini cal systolic and dias tolic blood pres- s ure (S/DBP) va lu es decrcased by 17.4/10.5 ,

15.0/9.3 , 19.0/14.3 mmHg and 24-hour mean S/DBP by 14.4/11.5, 1 3.3/9.5 , !7.4/12. 1 mmHg. All three protocols were observed to be effecti ve in mild to

ınoder ate HT treatmen t. Although ılıere was no statistically s ignificant difference betwcen the res ults of the trea tment protocols, a greater dec rease in elinical and 24-hour mea n BP values was observed in the combination treatment g roup.

Hence, all th ree treatment protocols provecl to be ef- fccti ve, and randoın i sed studies with larger patient populations s hould be con duc ted to eva luate the e ffect of fi xed-dose combination therapy in mild to moderate HT.

Key words : Essential hype rtens ion, a mbula tory blood p ress ure moni to ring, cal c iuın ch a nne l blockers, angiatensin converting enzyme inhibitors

Plasma Homocyste ine, Folate and Vitamin Bıı

Levels as Risk Factors for Coronary Artery Disease in a Turkish Cohort

M. Aksoy, M . Öç, Ş.N. Aksoy, M. Koldaş.

M.B. Mihm an!I, V. YaZiciOğlu, M. Gürsürer, A. Emre, A. Er , i. Öz, B. Ersek

Eleva ted levels of pl asın a h onıocyste ine has

enıerged to be a new independe nt ri s k fac tor for

coronary a rtery disease (CAD) , but its iınportance in

Tiirk Kardiyol Dem

2000; 28; 466-469

Turkish population is not well known. The present case-con trol s tudy was des igneel to examine the re la tion between p!asma homocysteine and CAD;

and to establish whether the blood le ve ls of folate and vitamin B 1 2 that modul ate plasma ho mocys te ine levels relate to CAD. We compa re el 168 patients with CAD with 126 age- and sex-ma tc hed control s.

Con ventiona l ris k fac tors and le vels of plasma homocyste ine , fol a te and v ita min B 12 we re documented. Conce ntrations of ho mocysteine levels were sig nificantly higher in cases than in con trols (geometri c mean 12.6 [95% cı ı 2.4- ı 2.8] vs ı ı. ı [ı 0.8-1 1 .3 ] pmol/L; p=O.OO ı ) . W ith in the group of cases, there was a graded inc rease in the relative risk of CAD in the s econd , third , fourth and fifth

quintiıes of the homocys te ine di stribution (age- adjusted odds ratios 1.43, 1.87, 2.15 , 2.37; p=0.05) relative to the firs t

In addition, the odds

r a ıio for CAD in s ubjects with a homoc ys tein e

concenıration above the 90

percentile o f the control group , as com pareel with those whose homocyste ine levels were at or below tha t value, was 2.35 (95% CI 1.2 1-4.74, p=0.009). On multi variate ana lys is when a ll oth er convention al ris k factors were accounted fo r, pl as ma homocyste in e levels rema ined a n inde pe nde nt significant predictor of CAD (p=0.02).

Me an fo late levels were similar in both case and control subjec ts (8. 1 ±3 .5 vs 8.8±4.1 ng/ml ; p=O.l).

However, a ] eve! of fo Iate below the I oııı percentile for control s ubjects conferred an odds ra tio o f 2.05 (95% CI 1.02-4.11 , p=0.03) for CA D. Vitamin B 1 2 levels were no t different in cases (341 ± 1 37 pmoi/L) and conırols (357± 1 63 pmol/L) (p=0.3), a nd vitamin B 1 2 defi ciency ( < 1 Qıh perce ntile for control subjects) was not associated with an in creased odds ratio for CA D ( 1.1 9; [95% CI 0.5 1-2.80], p=0 .6) . Furth erm ore,

folate a nd vi ta m in B 12 concentra tions were in vers ely associated with homocyste ine !eve! s (r=-0.37 , p<O.OOO ı ; r=-0 .29, p=O.OO ı , respectively). In co nclus ion, hi gh plasma homoc ys teine leveı s are assoc iated with an increased risk of CAD in Turkish popul ation.

Key wo rds: Homocyste ine, foıate, vitamin B 12, coronary artery disease

Relationship Between QT Disper sion and C oronary Angiography Findings in Coronary Artery Disease

M. Kanadaşı, Ş. Demircan, M. D emir, F. Akgül, E. Acart iirk

The a im of this stud y was to eva luat e the

re lationship between severity of coronary artery les ions, left ventric uıar wall motion abno rmaıi ties

and QT di spers ion in patie nts with ischemic hearl di sease. Two h undre d and e ighteen patients ( 144 males, 74 females), age between 33-73 years ( mean : 52.9±9.9) were inc luded in the study. A ll pa tients had co ro nary angiograp hy because of sus pected coron ary arte ry d isease. Standard e lectrocardiogra m (ECG) with s imultaneo us ı 2 Jead acquisition were recorded at 50 mm/see. QT interva1 was manually meas ured from the o nset of QT t il! the end of T wave at each ıead. The QT di spersion was defi ned as the diffe re m .:c:: be tween the ma ximum and minimum QT interval, occuning in any of the eıectrocardiog­

raphi c leads. Using t he B azett' s formul a we corrected QT (QTc) a nd us ing this data, fo und out the corrected QT dispers ion (QTcd). Afte r coronary angiography, we div ided the subgroups according to their coronary les io ns and left ve ntric ul ar wall moti on a bnormalities. Th e patients hav ing 50% o r more ste nosis were ta ken as the group with coro nary lesions. Wall motion score (WMS) was calc ulated and recorded fo r each pa tie nt cons ider in g contractilit y deg ree of wa ll segments on left ve ntricu lo gra phy. QTcd was fou nd to be signifi cantly hi ghe r in patients with ı eft anterio r deseeneling ( LAD) artery stenosis in the group with one coronary artery lesion compareel with the group with normal coronary arteries (p<O.OOI). QTcd was significantly higher in the groups with 2 and 3 corona ry lesions compareel to the norma l group (p<O.O O I). W e di d not fi nd a s ignificant difference between circumfl ex (CX) and right coronary arte ry (RCA) lesions together or isolated CX and RCA. Pa- tients with coronary artery disease were divided into two subgroups e ithe r having left ventricu lar wa ll motio n abnormalities or not. W e also compareel the differences of QTd between these groups. QTcd was ro und to be significantly higher in the gro up with wall motion ab normalities.

O ur study s hows that QTcd is increased significantly in LAD artery lesio ns and/or coronary patho logies accompanying L AD a rtery les io ns, especially in patients wi th le ft ventricu la r wa ll motion abnormalities due to ischemia or necrosis.

Key wo rds : C oro nary art ery disease, coronary angiography, QT dispersion

Electrocardiographic Abnorınalities Occurrin g After Radiofrequency C atheter Ablation of

467

Tiirk Kardiyol Dem

2000: 28: 466-469

M a nifest Accessory Pathways in t he Wolff-

Paı·kinson- White Syndı·ome

İ. Erdinler, E. Öknıen, A. Akyol, E. Oğuz, K. Gürkan, A. Emre, T. U lu fer

Electrical abnormalities such as negative and abnorm ally ta ll-peaked T waves are seen in ECGS after radiofrequency (RF) catheter ablation of manifest accessoı·y path ways in th e Wol ff- Parki nson-White syndrome . The ai m of the study was to evaluate the ECG changes w hich occurred after

and concealed accessory pathway ablation in patie nts with WPW sy ndrom e and ablation of slow pathway in atrioventricular (AV) nodal reentra nt tachycardi a. Twenty-five patie nts with mani fest accessory pathway were included in group 1, and 12 patients with concealed acce ssoı·y

AV connec tion plus 15 patients hav in g AV n oda!

modi fication were included in group 2. Successful RF ablalion was achieved in all patients ECG samples were recorded before abla tio n, after 2 hours and afte r 5 weeks T wave changes, T wave axes, QRS-T angle, numbers of ablation les ions and peak creatin kinase (CK-MB) values were compared between the t wo g roups. R epo lari sation abnormal ities were seen in 24 of 25 patients (%96) with manifest accessoı·y pathways. There were no repolarisation abnormalities in g roup 2 (p<O.OO 1 ).

Abno rnıa l T wave axis , QRS-T an gle and repolarisation abnornıalities re turned to normal in group 1. These parameters did not change in group 2. The pre-excited QRS duration was s ign ificantly lon ger in patien ts h av in g re po larisation abno rma lities after RF ablation. Because of the numbers of ablat ion lesions and peak CK-MB values were not s ignifican tly different between the two g roups, we co ns idered th a t repolari sati on abnormalitie s were not a res u lt of myocardial injury.

According to the "T wave memory" w hich had been conupt was proposed to deseribe the mechanis m of repolarisation a bnormaliti es, the, myocardium can remember its normal repo larisation pattern after es- tabli shing. Normal depo larisation cascacle in patients w ith WPW. W e conclude that this phe nomenon may also be the cause of repolarisation abn ornı al ities that occurred in our patients with WPN syndis ul

Key words: E lectrocardiograph y, radiofrequency catheter ablation , Wolff-Parkinson-White syndrome.

Estimation of Left Ve ntricular end -diastolic Pre ss ure by color M -mode Doppl e r Echocardiography a nd Tissue Doppler lın ag ing

468

S. Dağdelen, N. Eren, H. Karabulut, İ. Akdemir, M. Ergelen, M_

M _ Yiir :e. C Alhan, N. Cağ/ar

The a im of thi s s tudy is to estimate the left ventri cu la r e nd d ias to lic press ure (LVEDP ) noninvasively by tissue Doppler imaging and color M-mode echocardiography.

Material an d method: Th ree group o f patie nts a ngiograp hically proven to be free of s ign ificanı

coro nary artery le sions (<40 % stenos is) with LVEDP < 10 mmHg (Gro up A: n: 24 , J 6 males, mean age ± SD: 55 ± 13 years); LVEDP= 10-15 mmHg (G roup B: n:21 , 1 7 males, mean age± SO:

56 ± 1 1 years); and L VEDP > 15 mmHg (Group:C:

n:35 , 20 mal es mean age ± SD: 58 ± 9 years) we re stud ied . Using a n A loka SSD 22 00 echocardiography device tissue Doppler inıagin g of the lateral mi tra l annu lus a nd co lor M-mode imagings of the mitral valve in apical 4-chamber view were obtained. Early and Iate d iasto li c veloc ities (E m, Anı), Em dece lcra ti on tim e (EmDT), A nı time (Anı -ı) , mi tral propagation veloc ity time dela y (VpDT) were nıeas ured in every patient.

Results: In gro up A sensitivity and specificity for

EınDT being ~ 1 00 nısec, Aın-t~90 msec, Em/Anı~ ı .

and V pOT~ 45nı sec we re found to be 0.57 and 0 .89, 0.66 and 0.88, 0.86 and 0.92, O. 73 and 0 .89;

respectively. In Group B sensitivicity and specificity fo r EmDT being between 1 00-120 nı sec, Am-t bet- ween 90- 1 1 O msec, E m/ Anı between 1-0.5 and VpDT between 45-60 msec were fo und to be 0. 57 and 0.84, 0.69 a nd 0.82, 0.66 and 0.75, 0.55 and 0.83, respecti vely. In Group C sen s iıiv icity and s pecifity for Em DT being > 120 m see, Am-t > 1 1 O msec, Em/Anı <0.5 and V pDT >60 msec were found to be 0.88 and 0.8 1, 0.71 and 0.80, 0.86 and 0.72, 0.78 and 0.86; respecti vely.

Conclusion: EınDT, Am-t. Em/Am and VpDT

me as ure nıe n ts obtained noninvasively by l e fı venıri cul a r tissue Do pple r inı aging and mitral flow propagation velocity were fou nd meaningful in esı i­

matiny LVEDP.

Key words : ıissue Dopple r i ınaging, color M-Mode, diastolic fuııcti on

Case Reports

Warm Heart Surgery in a Case with Cold

Agglutinins

Tiirk Kardiyol Dem Ar

2000; 28: 466-469

B.H. Şirin, A. Keskin , A. Baltalm·lt

Cald-reactive antibodies may cause complications such as hemolysis and myocard ial damage due to their activ ity at low te mpara tures du ring cardiac surgery. The detection of cold aggluti nins in a patient before the ope ration may change the operative strategy. Th is report deseribes a case with coronary artery disease in which cold aggluti nins with high-t iter and high-thermal amplitude were detec ted preope ratively. The o peratio n was conducted with normothermic ca rdiopulmonary bypa ss and warm blood ca rci iopleg ia. The management of this ra re s ituati o n remains controvers ial but currently , warm he art surgery appears to be the most expedient method.

Key words : Cold aglutin in, cardiac s urgery;

cardiopulmonary bypass, hypothermia.

A New App roach in the T r eatme nt of Refractory Angina: Spinal Cord Stiınulator

Y. Çavu şoğlu, A. Ünalt r, B. T imuralp, A. Aslantaş, B. Görenek, N. Ata, E. Tel

Angina pectoris is an important sy ınpto ın of coronar y heart disease. Anti ische mic drugs, interve ntional cardiolog ic procedures and by-pass o pe rations are usuall y he lpful in the re lief of angin a.

In som e pa tient s who had previously revascularisati on proced ures or not s uitable for revascularisation procedure, it may be diffic ult to control angi na pectoris. In these patie nts new treatment stra teg ies are necessary. Sp i nal c ord

stiınulation

is a n alternative way of con trolling angina. Dorsal sp inal cord could be stimu lated by high frequency e lec trica l waves w ith the use of spinal cord s timulato r (SCS). Thi s device inhibits the delivery of pain orig inating from myocardial

ischeınia to thalamu s and brain coı-ıex and inhibits

the sympa the tic activ ity. Thus, pa in , oxygen

consunı pti on o f myocardiunı and coronary vasanıo­

tor tonus decrease. We inıplanted a SCS to a patient who had chest pain desp ite maxim a l med ical treatment afte r by-pass ope ration. His co rona ry arteries were not s uitable for a new revascul arisation procedure. Af ter inıpl antati on of SCS, the freq uency, duration and severity of anginal episodes decreased and his quality of life was inıproved . Th is is the first case report of SCS appl ication in Turkey and it opens a new perspective in the ma nageme nt of patients with re fractory angina pectoris .

Key words: Spinal cord s timulator, angina pectoris

An Un us u a t Compli catio n Afte r Aortic Coarctation Repair: Spinal Cor d lnjury

T. T. E!mact, A. Dindar, Ü. Aydoğan, E. Onursal Spinal cord ischemia after coarctation repai r is a rare complication in the pediatric population. In this report, we deseribed a 5-year-o ld boy wi th aortic

coaı·cıation who becaıne paraplegic a fter repair.

Key words: Aortic coarctation, s pinal ischemia, pa- raplegia

Transvenous Antegra d e Balloon Angiop lasty fo r Coarctation of the Aorta in a Newborn

Ü. Aydoğan, F. Meriç, T. Ertuğrul

The nıajor coıııplications encountered in heart catheterization via the arterial pathway are fenıoral

artery injury and blood loss in newborn bab ies. T he ineid ence of these complications wou ld increase if angioplasty/va lv ulop lasty via arterial route is

perfo rnıed. We report a 2900-gr baby wi th coarctat ion of the aorta and ventricular septal defect in who m balloon a ng ioplasty was performed transvenously.

Key words: Balloon ang ioplasty, coarctation of the aorta, newbom

Review

General Pı-inciples of Transv enous Lead Extraction of Permanent Pacemake r and Internal Cardioverter Defibrillator Systeıns

O. Erdoğan

Technol og ical i nıpro ve nıe n ts and e nl arg ing indicatio ns during the last decade resulred in increased inıplantation rate of pacenıakers and

inıplantable ca rdioverter defib rilla tors. Despite the proven benefits of these dev ices in certain med ical conditions, the patients who unde rwent implantation of pacemakers and inte rn al defibrillators are

sonı etiınes prone to develop coınp lications such as infection or lead problenıs. In such ci rcumstances it

nıi g ht be nı a nd atory to extract the who le system fro m the body and replace a new system at a later date. W ith the advent of new techn iques and tools, extraction of infected leads and pacemakers bccaıne

much easie r than prev iously thou ght. This article compre hensive ly deseribes general pri nc ipl es and indications as well as the current technique how to perform lead ex lraction.

Key words: pacemake r, lead extraction

469