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ABSTRACT: Data on the correlation of coronary artery disease (CAD) and electrocardiographic findings are, except for Q waves, still controversial. The purpose of this study was to determine whether QRS complex notching and slurring (N&S) is of significant value as a diagnostic discriminator in the detection of CAD. This study comprised 500 consecutive patients aged between 24 and 81 years (mean, 53.4 years) who underwent coronary angiography because of chest pain. Patients were evaluated for CAD, angiographic evidence of myocardial infarction (MI), N&S, and abnormal Q waves. Of these 500 patients, 418 had CAD, and 370 of these had significant (> or = 70%) coronary artery obstruction. The remaining 82 patients had normal coronary arteries. The data revealed that the distribution of N&S in the patients with or without CAD was similar in both the inferior and limb leads (P > .05). But the percentage of N&S in more than two contiguous limb leads was higher in the patients with CAD than in the patients without CAD. Notching and slurring in at least one limb lead was found to be of no value in the diagnosis of MI, of wall motion abnormalities, and of significant obstruction. Notching and slurring in the anterior leads is more sensitive but less specific than abnormal Q waves in the same leads in the detection of significant obstruction, anterior MI, and anterior wall motion abnormalities. Notching and slurring in the anterior leads has as much importance as abnormal anterior Q waves in the detection of angiographic evidence of anterior infarct, of anterior wall motion abnormalities, and of significant coronary artery obstruction.(ABSTRACT TRUNCATED AT 250 WORDS)
Journal of Electrocardiology 08/1995; 28(3):199-208. · 1.14 Impact Factor
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ABSTRACT: Restenosis after percutaneous transluminal coronary angioplasty (PTCA) is a major problem limiting the long-term efficacy of the procedure. The purpose of this study was to determine whether risk factors such as cigarette smoking, diabetes mellitus, hypertension or hypercholesterolaemia correlate with restenosis after PTCA. We also studied the relationship between a history of previous myocardial infarction and the extent of coronary artery disease (single-, two- or three-vessel) with restenosis after coronary angioplasty.
A total of 360 patients underwent successful PTCA. Follow-up coronary angiograms were performed in 181 patients after a mean +/- SD period of 6 +/- 4 months.
The restenosis rate was 49%. We divided the patients into two groups: 89 patients with restenosis (8 women and 81 men) and 92 patients with no restenosis (14 women and 78 men). Age, sex, a history of cigarette smoking, diabetes mellitus and a history of previous myocardial infarction were not associated with restenosis. Serum levels of triglyceride were also unrelated to the restenosis rate. Restenosis was associated with hypertension, low levels of high-density-lipoprotein cholesterol, high levels of low-density-lipoprotein cholesterol and high total cholesterol levels (P < 0.001). Patients with two-vessel or multivessel disease had significantly higher restenosis rates than patients with single-vessel disease (P < 0.001).
Patients with hyperlipidaemia, hypertension and multi-vessel disease appear to be higher risk of recurrent restenosis.
Journal of Cardiovascular Risk 03/1995; 2(1):51-5.
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ABSTRACT: In this study 24-h Holter electrocardiographic recordings were used to measure the effects of an angiotensin converting enzyme inhibitor, enalapril given for 4 weeks, on the frequency of cardiac arrhythmias in 24 patients (14 patients had enalapril, 30 patients had placebo) with congestive heart failure (New York Heart Association Functional Class 3) receiving maintenance therapy with digoxin and furosemide. Although the placebo group had no change in the frequence of arrhythmias, enalapril-treated patients showed significant decrease in the frequency of premature ventricular complexes couplet, bigemine VPS and ventricular tachycardia. Moreover, it was observed that six cases of atrial fibrillation returned to sinus rhythm. During enalapril treatment, some patients experienced increased serum potassium levels, but there was no change in serum digoxin levels. We also observed echocardiographic improvement in left ventricular function as well as clinical symptoms of congestive heart failure. Finally we observed that there was an antiarrhythmic effect of enalapril in congestive heart failure. We thought that the antiarrhythmic effect of enalapril in congestive heart failure was probably due to hemodynamic improvement.
International Journal of Cardiology 04/1994; 43(3):315-8. · 7.08 Impact Factor
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ABSTRACT: The high frequency mid-QRS potentials and late potentials are important in coronary artery disease because they are related to the extent of ischemia and prognosis. In this study, the effects of successful percutaneous transluminal coronary angioplasty (PTCA) on these potentials were evaluated. Twenty-four patients with coronary artery disease (aged 34-67 years, 5 women, 19 men) were examined. Eight of these patients had a history of myocardial infarction (4 anterior, 3 inferior, 1 anterior and inferior). Signal averaged ECG was recorded at 40- to 250-Hz frequency ranges for late potentials and 150- to 250-Hz frequency ranges for mid-QRS potentials before PTCA, and they were repeated 1 month later. The QRS duration (107.7 +/- 9.8 to 105.3 +/- 9.3 ms, p < 0.0001) root-mean-square voltage (39.4 +/- 20.1 to 47.7 +/- 22.2 microV, p < 0.00001) and low amplitude signal duration (30.7 +/- 9.9 to 27.7 +/- 9.3 ms, p < 0.001) showed significant changes in 40- to 250-Hz ranges before and after PTCA. The same results were also obtained in the 150- to 250-Hz frequency ranges: the QRS duration decreased (90.9 +/- 9.8 to 86.5 +/- 9.1 ms, p < 0.005) and the root-mean-square voltage increased (5.5 +/- 1.6 to 6.1 +/- 1.8 microV, p < 0.00001). Thus, successful PTCA causes improvement in late potential parameters, so the risk of malign arrhythmia that affects the prognosis can be reduced. Additionally, the increase in high frequency mid-QRS potentials shows the decrease in the ischemia after PTCA.
Cardiology 01/1994; 85(3-4):216-21. · 1.71 Impact Factor
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ABSTRACT: The relationship between cardioinhibitory response to the carotid sinus massage and the severity of coronary artery lesions and left ventricular impairment was investigated in 86 patients who underwent coronary angiography. The study group (Group 1) comprised 63 patients who had coronary lesions and the control group (Group 2) comprised 23 patients who had normal coronary arteries. There was no significant relationship between the severity of coronary artery lesions and the cardioinhibitory response to the carotid sinus massage in the study group. However, there was a positive correlation (r = 0.478, P < 0.01) between total left ventricular segment scores and the maximal change in RR interval (%) during the right carotid sinus massage in the study group. During the right carotid sinus massage, maximal change of RR interval (%) was significantly higher in patients who had segmental wall motion abnormalities than in patients who did not (83.0 +/- 72.4% vs. 32.9 +/- 42.5%, P < 0.01, respectively). In the patients who could have echocardiographic measurements there was negative correlation between fractional shortening value and maximal change of RR interval (%) (right massage; r = -0.482, P < 0.01, left massage; r = -0.334, P < 0.05). In conclusion, we found a significant relationship between the cardioinhibitory response to carotid sinus massage and the presence and severity of the segmental wall motion abnormalities and left ventricular impairment in patients with coronary artery disease.
International Journal of Cardiology 12/1993; 42(3):277-83. · 7.08 Impact Factor
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ABSTRACT: The value of high frequency QRS potentials (HFQRS) during acute myocardial infarction (AMI) was assessed to define infarct size and prognosis. HFQRS were recorded by signal-averaged ECG with 150-250 Hz frequency ranges, using X, Y, Z orthogonal leads. Recordings were obtained in surviving AMI patients (n = 33, 12 inferior, 11 anterior, 10 anterior-inferior) on the first and tenth days, but in non-survived patients (n = 5, 2 inferior, 1 anterior, 2 anterior-inferior) only on the first day. Additionally, the frequency of ventricular tachycardia (VT) was evaluated by 24-h Holter monitoring in all patients at the same days. The control group consisted of 11 healthy people. In surviving AMI patients, RMS voltage of vector magnitude reduced in anterior and anterior-inferior MI but filtered QRS duration was longer in inferior MI than normals (P < 0.05, < 0.05, < 0.01, respectively). In nonsurvived patients, RMS voltages of leads X, Y, Z and vector magnitude were lower than normals (P < 0.01, < 0.05, < 0.01, < 0.01, respectively) and surviving AMI patients (P < 0.01, < 0.05, < 0.05, < 0.05, respectively), the filtered QRS duration was found to be longer than normals and survived patients (P < 0.01, < 0.01). In patients who had VT on Holter monitoring, filtered QRS duration was significantly longer than in patients without VT (P < 0.05). As a result, HFQRS was important for defining infarct size but not malignant ventricular arrhythmias. VT was related to filtered QRS duration. HFQRS may offer significant prognostic information and contribute to early risk stratification of AMI patients.
International Journal of Cardiology 12/1993; 42(2):147-53. · 7.08 Impact Factor
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ABSTRACT: The diagnosis of chronic major-vessel thromboembolic pulmonary hypertension was made in a 63-year-old man by noninvasive methods (Echo, CT, MRI) and confirmed by pulmonary angiography and surgery. All these methods proved very useful in detecting and defining this rare entity.
European Heart Journal 08/1993; 14(7):1004-5. · 10.48 Impact Factor
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ABSTRACT: To determine the immediate and remote prognostic significance of bundle branch block (BBB) associated with acute myocardial infarction (AMI), 40 patients with AMI and BBB were studied. One hundred forty-four patients with AMI but without BBB were evaluated during the in-hospital phase and 45 of them were taken as a control group. These patients were followed for an average of 15 months (3-28 months). Arrhythmias and left ventricular function were investigated with 24-hr Holter monitoring and echocardiography, respectively. The hospital mortality was significantly greater in patients with BBB than in the control group (32.5% vs 10.4%, p < 0.001). The main cause of mortality was pump failure in the group with BBB (76.9%) and ventricular fibrillation in the control group (53.3%). The peak creatine kinase level was significantly higher in the group with BBB than in the control group (2094.8 +/- 288.4 IU/L vs 416.7 +/- 30.5 IU/L, p < 0.001). In patients with BBB prophylactic temporary pacemaker insertion was not found to improve the hospital mortality rate. In the hospital phase, although 32% of the patients with BBB had complicated arrhythmias (multiform, paired VPB, runs, R-on-T) the cause of death in 10 of the 13 patients who died was pump failure but not arrhythmia. In patients with BBB the wall motion index and the number of patients who had a left ventricular aneurysm were greater than in patients without BBB (9.5 +/- 0.9 vs 6.3 +/- 0.6, p < 0.01 and 52.0% vs 14.3%, p < 0.01, respectively). In patients with BBB follow-up mortality (12.0%) was lower than hospital mortality (32.5%). During the follow-up period there was no significant difference between patients with BBB and those without with regard to complicated arrhythmias (14.8% vs 15.6%). These results indicate that the main cause of poor prognosis during the hospital period in patients with AMI and BBB was not arrhythmia or conduction disturbance but severe pump failure due to extensive myocardial necrosis. Prophylactic temporary pacemaker insertion did not improve the hospital mortality rate of these patients, and patients with AMI and BBB who survive the in-hospital phase after infarction have a good prognosis during the following 15 months.
Japanese Heart Journal 03/1993; 34(2):145-57. · 0.40 Impact Factor
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ABSTRACT: From January 1984 to June 1989, 259 Omniscience valve prostheses were implanted in 225 patients. Of the 225 patients; 143 (63.6%) received mitral, 48 (21.3%) aortic, and 34 (15.1%) double valve replacements. The early mortality rate was 8.9%; 97.6% of the patients were included in this study. These patients represent a cumulative follow-up of 407.9 patient-years, with a mean follow-up of 2.03 +/- 0.1 (standard error) years. The late mortality rate was 4.03% overall, which corresponds to 2.0% +/- 0.7%/pt-yr (SE). The annual rate of valve endocarditis was 1.0% +/- 0.5%/pt-yr (SE). The linearized rate of thromboembolism was 1.2% +/- 0.5%/pt-yr (SE). Anticoagulant-related hemorrhage occurred in 15 patients with an annual rate of 3.7% +/- 0.9%/pt-yr (SE). The linearized rate of valve thrombosis was 0.2% +/- 0.2%/pt-yr (SE). By echocardiography the mean mitral valve opening was 75.9 +/- 3.1 degrees (standard deviation) for 27 patients. During follow-up study, 136 (70.8%) patients were in New York Heart Association class I, 44 (22.9%) were in class II, and 12 (6.3%) were in class III; there were 25 (11.1%) patients in class II, 166 (73.8%) in class III, and 34 (15.1%) in class IV preoperatively. Actuarial freedom from thromboembolism was 94.5% +/- 3.6% (SE); freedom from endocarditis, 97.8% +/- 1.0% (SE); freedom from anticoagulant-related hemorrhage, 91.5% +/- 2.0% (SE); freedom from valve thrombosis 99.1% +/- 0.8% (SE); and freedom from hemolysis 98.5% +/- 1.2% (SE). Actuarial survival at 6 years is 94.0% + 2.3% (SE) overall. In conclusion, the overall rate of valve-related complications with this valve is low.
Journal of Thoracic and Cardiovascular Surgery 03/1992; 103(2):259-66. · 3.41 Impact Factor
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ABSTRACT: A 24-year-old woman with pheochromocytoma associated with asymmetric septal hypertrophy, Wolff-Parkinson-White syndrome and pigmentation was operated on and the tumor was excised. The asymmetric hypertrophy and the pre-excitation disappeared after the operation, but the pigmentation increased. We discuss the relation between excessive catecholamines and these findings.
International Journal of Cardiology 10/1991; 32(3):403-5. · 7.08 Impact Factor
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Journal of Thoracic and Cardiovascular Surgery 06/1989; 97(5):804-5. · 3.41 Impact Factor
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ABSTRACT: The case is described of a 14-year-old boy who had a hepatoma with a right atrial extension. He presented with edema, abdominal pain, and ascites. Two-dimensional echocardiography showed a right atrial tumor that had invaded from the inferior vena cava as an extension into the right atrium of the hepatoma.
Pediatric Cardiology 02/1989; 10(4):236-7. · 1.30 Impact Factor
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ABSTRACT: Two patients with familial Mediterranean fever showed the classic features of pericardial involvement and one of them (Case 2) had pericardial effusion detected by echocardiography. These and previously published cases show that familial Mediterranean fever should be considered as a cause of pericarditis and/or pericardial effusion.
Postgraduate Medical Journal 07/1988; 64(752):453-4. · 1.94 Impact Factor
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ABSTRACT: As it is a rare case, we report a 37-year-old woman who had transmural myocardial infarction in her last trimester. Coronary arteriography done 15 days after her normal delivery showed normal coronary arteries and left ventriculography showed an apical aneurysm. The proposed cause appears to be coronary spasm.
Cardiology 02/1988; 75(3):218-20. · 1.71 Impact Factor
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ABSTRACT: The triad of right superior vena cava connecting to the left atrium, persistent left superior vena cava draining into the right atrium (coronary sinus), and atrial septal defect is a rare malformation. Recently, we successfully corrected this anomaly in a 47-year-old man.
Journal of Thoracic and Cardiovascular Surgery 08/1987; 94(1):151-3. · 3.41 Impact Factor
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ABSTRACT: A 30-year-old pregnant woman was admitted to the Cardiology Research Center with syncope, dizziness, and fatigue on exertion. On ECG complete atrioventricular block was diagnosed. Permanent pacemaker implantation was performed with the guidance of ECG and two-dimensional echocardiography and without the use of fluoroscopy.
Pacing and Clinical Electrophysiology 06/1987; 10(3 Pt 1):543-5. · 1.35 Impact Factor
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ABSTRACT: Anomalous origin of the right coronary artery from the left sinus of Valsalva is a rare congenital abnormality diagnosed by coronary angiography. This is the first report of an echocardiographic diagnosis of a patient with this anomaly, as far as is known.
Angiology 04/1987; 38(3):268-70. · 1.51 Impact Factor
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ABSTRACT: A patient with Behçet's disease who had pulmonary and cardiac involvement is described. The cardiac lesion was endocarditis in the right ventricle and a thrombus on this lesion which caused pulmonary emboli. The thrombus was excised completely and hemoptysis stopped. Pulmonary defects shown by pulmonary scintigraphy did not disappear with the therapies given to the patient. These abnormalities in Behçet's disease are very rare, echocardiographic examination can be useful in detecting them.
European Heart Journal 12/1986; 7(11):999-1002. · 10.48 Impact Factor
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ABSTRACT: An unusual and new cross sectional echocardiographic feature, bulging of the inferior left ventricular wall during diastole, is described in a 35 year old woman with congenital total absence of the left pericardium. The diagnosis was made on the characteristic clinical, electrocardiographic, echocardiographic, and radiological findings.
Heart 05/1986; 55(4):405-7.
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The American Journal of Cardiology 12/1985; 56(12):833-4. · 3.37 Impact Factor
