Men with coronary artery disease have lower levels of androgens than men with normal coronary angiograms.
Explore the source record for details and available documents.
Androgens↗
Biomedical subjects
G Kabakci
Publications and source records attributed to G Kabakci.
Left ventricular septal aneurysm in association with bicuspid aortic valve--a case report.
Diverticula of the left ventricle are rare cardiac anomalies. Most cases arise from the apex of the left ventricle and are usually found in children. Only a few cases have been documented in adults. The authors report a case of a 38-year-old woman who presented with dyspnea and chest pain. She was found to have a septal left ventricular diverticulum associated with bicuspid aortic valve, aortic stenosis, and aortic regurgitation. The aortic valve was replaced with the resection of the diverticulum. Pathologic examination confirmed the diagnosis of fibrous diverticulum.
Adult↗
A huge mitral valve tumor and its vascularity--a case report.
Primary cardiac tumors of the mitral valve are extremely rare; however, they present a major risk of embolization. Therefore, prompt diagnosis and urgent treatment is obligatory. The authors report the case of a 60-year-old man with a huge mitral valve mass and its vascularity, which was diagnosed by transthoracic echocardiography and selective coronary arteriography. Our patient's mitral valve tumor had a size of 5.9 x 2.9 cm, which was the largest size reported up to this time in this location. The patient died from a major cerebrovascular event before surgical excision could be performed.
Fatal Outcome↗
Plasma big-endothelin levels, cardiac autonomic neuropathy, and cardiac functions in patients with insulin-dependent diabetes mellitus.
BACKGROUND: The alteration of endothelin (ET) levels in diabetic patients with cardiac autonomic neuropathy (CAN) has not been studied extensively and its correlation with cardiac function parameters has not been discussed. HYPOTHESIS: The aim of the present study was to discuss the correlation between the degree of cardiac autonomic neuropathy, plasma big-ET levels, and cardiac functions in diabetic patients who were clinically free of cardiovascular disease. METHODS: Twenty subjects (32.1 +/- 7.8 years, 11 men, 9 women) with insulin-dependent diabetes mellitus (IDDM) were studied to evaluate the relationship between circulating big-endothelin (big-ET1) levels, CAN, and cardiac functions. The severity of CAN was scored according to Ewing's criteria. Cardiac functions were assessed using Doppler echocardiography. RESULTS: Left ventricular systolic function in the patient group was within normal limits and comparable with the values of the control group (n = 10). The mean E/A values of diabetics with CAN (1.15 +/- 0.33, p = 0.004) and without CAN (1.34 +/- 0.17) were significantly lower than those of controls (1.57 +/- 0.27). Diabetics with CAN had significantly higher big-ET1 values (81.1 +/- 94 pg/ml) compared with others (12.4 +/- 5.9 and 21.1 +/- 17.7 pg/ml, p = 0.04). Circulating big-ET1 levels showed a significant correlation with E/A values in the control group (p = 0.01, r = -0.7) and with peak A values (p = 0.003, r = 0.64) in diabetics. The CAN score correlated negatively with E/A values (p = 0.01, r = 0.54). CONCLUSIONS: High big-ET levels might have an important role in the pathogenesis or consequences of diastolic dysfunction in diabetics with CAN. Their role in cardiac autonomic neuropathy and diastolic dysfunction should be investigated further.
Adult↗
Is ventricular repolarization heterogeneity a cause of serious ventricular tachyarrhythmias in aortic valve stenosis?
BACKGROUND: It is well known that there is a close relation between sudden cardiac death and serious ventricular tachyarrhythmias in patients with aortic valve stenosis (AS). QT dispersion (QTd) reflects the ventricular repolarization heterogeneity and has been proposed as an indicator for ventricular arrhythmias. HYPOTHESIS: This study investigated the QTd and its relevance to the clinical and echocardiographic variables. METHODS: In all, 51 patients (33 men, 18 women, mean age 56 +/- 12) with isolated AS and 51 age- and gender-matched healthy controls comprised the study group. Left ventricular mass index (LVMI) was calculated by the Devereux formula, and we used continuous-wave Doppler (n = 15) and cardiac catheterization (n = 36) for the determination of the maximum aortic valve pressure gradient (PG). RESULTS: Corrected QTd (QTcd) (89 +/- 39 vs. 49 +/- 15 ms, p < 0.001) and LVMI (176 +/- 69 g/m2 vs. 101 +/- 28 g/m2, p < 0.001) in patients with AS were significantly different from those in the control group. The group of 21 patients had a significantly greater number of 24-h mean ventricular premature beats (VPB) and mean number of couplet VT episodes than did the control group (p < 0.05). QTcd also correlated significantly well with LVMI (r = 0.58, p < 0.001), PG (r = 0.41, p = 0.003), and number of 24-h VPB (r = 0.56, p = 0.008). With respect to symptoms (e.g., angina, syncope, and dyspnea) patients without symptoms (n = 19) displayed less QTcd (71 +/- 31 vs. 100 +/- 39 ms, p = 0.007) and less LVMI (144 +/- 80 g/m2 vs. 195 +/- 57 g/m2, p = 0.01) than patients with symptoms. Statistical analysis was similar for all variables with uncorrected QTd values. CONCLUSION: We found that ventricular repolarization heterogeneity was greater in patients with AS than in controls. Our findings also showed that QTd in the patient group correlates well with LVMI, severity of AS, and PG. The present results suggest that serious ventricular arrhythmias in patients with AS may be due to spatial ventricular repolarization abnormality.
Aged↗
QT dispersion as a predictor of arrhythmic events in patients with ankylosing spondylitis.
OBJECTIVE: The aim of the study was to evaluate QT dispersion (QTd), an indicator of repolarization heterogeneity, and its relation to ventricular arrhythmias in patients with ankylosing spondylitis (AS). METHODS: A full history, clinical examination, electrocardiograms and 24-h Holter monitoring were performed in 88 AS patients and 31 volunteers of similar age and sex. Groups were compared based on electrocardiographic abnormality, QTd, arrhythmias and heart blocks. RESULTS: QTd and corrected QTd (QTcd) were significantly greater in AS patients than controls (QTd, 52.8 +/- 15.1 vs 35.5 +/- 8.9 ms, P: < 0.0001; QTcd, 60.3 +/- 16.1 vs 39.4 +/- 10.7 ms, P: < 0.0001). The magnitudes of these parameters were associated with the duration of the disease (QTd, r = 0.56, P: < 0.01; QTcd, r = 0.60, P: < 0.001). The frequency of ventricular extrasystoles was found to be correlated with QTd (r = 0.35, P: < 0.01) and QTcd (r = 0.33, P: < 0. 01). CONCLUSION: Involvement of the heart may be seen in AS during the early clinical course of the disease. QTd may give clues about the presence of arrhythmias and can be used as a new technique for the evaluation of asymptomatic patients. Earlier detection of cardiac involvement could alter the prognosis of the patients.
Adult↗
Ruptured aneurysm of the sinus of Valsalva in association with persistent left superior vena cava--a case report.
A 58-year-old man presenting with chest pain and dyspnea was diagnosed by transesophageal echocardiography and cardiac catheterization to have the rare combination of ruptured aneurysm of noncoronary sinus of Valsalva into the right ventricle in association with persistent left superior vena cava. These defects were confirmed at cardiac surgery. This case shows the importance of complementary use of invasive and noninvasive methods together in the diagnosis of rare combinations of lesions.
Aortic Rupture↗
Inappropriate shocks diagnosed by stored electrograms of implantable cardioverter defibrillators--two case reports.
An implantable cardioverter defibrillator is an important therapeutic option for patients with high risk of life-threatening ventricular arrhythmias. However, their use is also associated with several complications including inappropriate shock. Although the most frequent cause of inappropriate shock is supraventricular tachyarrhythmias, lead fracture can also be associated with inappropriate shock. Diagnosis of lead fracture can be made by chest x-ray radiography, fluoroscopic examination, interrogation of the device, and intracardiac electrograms. In this report, the authors present two cases of inappropriate shock due to lead fractures in the costoclavicular region that could only be diagnosed by the help of stored intracardiac electrograms. Methods for diagnosis of lead fractures and modalities to avoid recurrences are also discussed.
Artifacts↗
T wave alternans can decrease after coronary revascularization.
Clinical observations and animal experiments indicate that T wave alternans (TWA) is associated with an increased propensity for ventricular fibrillation, and thus it may be considered as a noninvasive marker of life-threatening ventricular arrhythmias. There is substantial evidence indicating that TWA is an intrinsic property of ischemic myocardium. This study was performed to determine the role of percutaneous transluminal coronary angioplasty (PTCA)-induced myocardial ischemia in the development of TWA and the effects of revascularization. The authors recorded bipolar X, Y, and Z leads of 111 consecutive patients (mean age: 56 years) undergoing PTCA before, during, and 24 hours after the procedure. T wave alternans signal was calculated in 97 patients (43 left anterior descending, 26 right coronary artery, and 28 circumflex or major obtuse margin branch) by fast Fourier transformation technique after signal processing. Twenty-four hours after the procedure, the mean and peak X, Y, and Z values for TWA had all been significantly reduced from baseline and during balloon inflation (p<0.01). The findings point out that induced ischemia could be a trigger for T wave alternans, and successful revascularization can reduce alternans.
Angioplasty, Balloon, Coronary↗
Circadian variations of QTc dispersion: is it a clue to morning increase of sudden cardiac death?
BACKGROUND: Several studies related to cardiac events including sudden death have shown a peak incidence in the early morning hours. It has also been known that acute ischemia is a potent stimulus to increased dispersion of repolarization and development of malignant arrhythmias. HYPOTHESIS: The purpose of the present study was to investigate diurnal variations of corrected QT dispersion (QTcD) in patients with coronary artery disease (CAD) (Group 1) compared with controls with normal coronary angiograms (Group 2). METHODS: We investigated a total of 110 patients who had been referred for coronary angiography, of whom 62 (42 men, 20 women; age 55 +/- 7 years) had double- or triple-vessel disease, and of whom 48 (31 men, 17 women; age 54 +/- 9 years) had normal coronary angiograms. QTcD measurements were calculated from a 12-lead resting electrocardiogram (ECG) during sinus rhythm. These ECGs were obtained for each patient in the morning, at noon, in the evening, and at night on the day after performance of coronary angiography. QTcD was significantly greater in patients with abnormal coronary angiograms (Group 1) than in patients with angiographically documented normal coronary arteries (Group 2). This difference appeared to be more prominent in the morning hours (p < 0.001) than at other times. QTcD in the evening and night hours was not statistically different (p > 0.05) between both groups. We also compared intragroup QTcD values: QTcD values were significantly increased in the morning hours and were more prominent in Group 1 than in Group 2. CONCLUSIONS: Our data suggest that QTcD has a circadian variation with an increase in the morning hours, especially in patients with coronary artery disease. This finding was thought to be an explanation for the role played by sympathetic nervous system in the occurrence of acute cardiac events and sudden death during these hours.
Acute Disease↗
Relationship between endogenous sex hormone levels, lipoproteins and coronary atherosclerosis in men undergoing coronary angiography.
This study was carried out in order to investigate the relationship between endogenous sex steroid hormones and coronary artery disease (CAD). Three hundred and thirty-seven men undergoing coronary angiography were enrolled in the study. Total testosterone, estradiol, free testosterone levels in men with CAD (n = 213) were compared to those of men without CAD (n = 124). No significant differences were found in the serum concentrations of estradiol, total and free testosterone and serum lipid profile between the two groups. Total and free testosterone were negatively (p < 0.05 to p < 0.001) and estradiol was positively (p < 0.05) correlated with age in both groups. Total cholesterol and low-density-lipoprotein levels were positively correlated with the level of free testosterone (r = 0.221, p < 0.01; r = 0.173, p < 0.05, respectively), and high-density-lipoprotein levels were negatively correlated with total testosterone in patients with CAD (r = -0.166, p < 0.05). The results of this study do not support the role of sex steroid hormones in CAD. However, the relationship between sex steroids and serum lipids needs further clarification.
Adult↗
Increased QT dispersion in the absence of QT prolongation in patients with Behcet's disease and ventricular arrhythmias.
In Behcet's disease, prominent clinical manifestations include involvement of mucocutaneous, ocular, gastrointestinal, respiratory, neurologic, urogenital, articular and cardiovascular systems. Patients with Behcet's disease have higher incidence of ventricular arrhythmia than healthy subjects. However there is a little information about the mechanism of ventricular arrhythmias in Behcet's disease. The aim of the study was to investigate whether dispersion of ventricular repolarisation was an arrhythmogenic mechanism. QT dispersion parameters were measured in 73 Behcet patients and QT dispersion was defined as the difference between the maximum and minimum QT interval in any of the 12 leads of surface electrocardiogram. Corrected QT dispersion for heart rate was calculated by Bazett's formula. The results were compared with the data from 51 matched controls without a history of cardiac disease. We found QT dispersion was greater in Behcet patients (58+/-12 vs. 37+/-8 ms, P=0.001) as was corrected QT dispersion (81+/-14 vs. 52+/-11 ms, P=0.001). There was no significant difference in minimum or maximum QT intervals between Behcet patients and controls (P>0.05). We found a correlation between QT dispersion and grade of premature ventricular complexes (r=0.7, P=0.002). Our findings suggest that increased dispersion of repolarisation may account for the development of ventricular arrhythmias in Behcet's disease.
Adult↗
Transient cerebral ischemic attack and left atrial free-floating thrombus: a case report.
A patient with rheumatic mitral stenosis was found to have a free-floating thrombus in the left atrium during echocardiography. Subsequently, the patient underwent surgical treatment. At surgery, a free thrombus was found within the left atrium. The postoperative course of the patient was satisfactory.
Adult↗
Interferon-alpha does not cause significant cardiac dysfunction in patients with chronic active hepatitis.
The cardiac adverse effects of interferon (INF) treatment have been reported recently in various clinical trials of INF. In this study, the cardiac effects of recombinant INF-alpha treatment were evaluated prospectively in a group of patients with chronic active viral hepatitis (CAH). Sixteen patients with CAH type B, 14 patients with CAH type C and one patients with CAH type D were included in this study, and 4.5, 3 and 9 MU of recombinant INF-alpha-2a was administrated three times a week to these patients, respectively. The durations of treatment were 6 months for CAH type B and C, and 12 months for type D. The cardiac status of all patients was evaluated and monitored with a detailed medical history, physical examination, electrocardiography (ECG), telecardiography, echocardiography and heart rate variability tests at the beginning of the study and at the first and sixth months of INF therapy and also 6 months after ceasing the therapy. The clinical evaluation of patients before the treatment revealed that three had hypertension, one had a past medical history of myocardial infarction, one had a prosthetic mitral valve replacement and another had left hemiblock in her ECG record. No significant changes and adverse effects were detected in clinical examination and cardiovascular tests of all patients, either in pre-existing cardiovascular diseases, during therapy and after stopping the treatment. The cardiac adverse effects of INF reported in previous studies are questionable and we conclude that it can be used safely in CAH patients. Therefore, it should be kept in mind that fever and tachycardia may occur during the first and second weeks of INF therapy and patients with high risk for cardiac disease should be monitored closely in this period of treatment.
Adult↗
Is there any association between dissection after successful percutaneous transluminal coronary angioplasty and late restenosis? An angiographic study.
Restenosis continues to be the most important limitation of percutaneous transluminal coronary angioplasty (PTCA). Many clinical, angiographic, and procedural variables are thought to be related to the development of restenosis. This study was aimed at investigating the effects of no dissection, minor dissections, and major dissections on the long-term outcome of lesions after successful PTCA. The study group comprised 91 patients with 100 lesions who underwent successful PTCA and in whom follow-up coronary angiography was performed at 8.8 +/- 7.2 (two to twenty-three) months after dilation. Dissections were classified according to the National Heart, Lung, and Blood Institute criteria. Restenosis was defined as more than 50% stenosis at follow-up angiography. Restenosis rates were found to be 22% in the no-dissection group (10 restenoses in 46 patients), 27% in the minor dissection group (11 restenoses in 40 patients), and 36% in the major dissection group (5 restenoses in 14 patients). The authors applied corrected Yates Chi-square test and no difference was observed in the restenosis rate between the group without any dissections and that with minor dissections (P > 0.05). However, a statistically significant difference was observed in the restenosis rate between the major dissection group and the other two groups (P < 0.05). The authors conclude that the occurrence of major dissections after successful PTCA may adversely affect the long-term outcome and may increase the restenosis rate.
Angioplasty, Balloon, Coronary↗
Dobutamine thallium-201 myocardial SPECT in patients with left bundle branch block and normal coronary arteries.
UNLABELLED: Dobutamine is a positive inotropic and chronotropic agent and is being widely used as a pharmacologic stress agent in patients unable to achieve maximal dynamic exercise test. The purpose of the current study was to document the dobutamine induced false-positive septal defect in terms of its frequency and extent on 201Tl myocardial SPECT in patient with left bundle branch block (LBBB). METHODS: Twenty-five symptomatic patients with LBBB underwent dobutamine and redistribution 201Tl myocardial SPECT studies. Coronary angiographies were also performed. Only those patients with normal coronaries (n = 19) were included in the study. For each study, tomograms were divided into 19 segments, and each segment was analyzed qualitatively as to presence and type of perfusion defect (reversible or fixed). In addition, septal perfusion was scored in each patient (1 = markedly, 2 = moderately reduced, 3 = normal uptake). RESULTS: Sixteen of 19 patients (84.21%) had false-positive septal reversible perfusion defect, and the remaining 3 had normal images. Perfusion defects were confined to only the septum in 5 of 16 patients (31.25%), whereas a greater proportion of patients had septal defect extending to the contiguous myocardial areas, mainly to the anterior wall. Five of 16 patients with false-positive defects had a septal perfusion score of 1, while the remaining 11 had a score of 2. CONCLUSION: Dobutamine myocardial scintigraphy in patients with LBBB was misleading for the diagnosis of coronary artery disease, since up to 84.21% of patients had false-positive septal perfusion defects.
Adult↗
Late percutaneous extraction of an intracardiac catheter fragment.
A patient was found to have a mobile catheter fragment in the right atrium incidentally during echocardiography. On further investigation, it was learned that the catheter had been inserted 9 years earlier during surgery and had probably been broken during removal. The patient did not experience any symptoms during this period. The catheter was removed percutaneously without any complications using a system similar to the loopsnare catheter.
Catheterization, Central Venous↗