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ABSTRACT: Impaired glucose tolerance is a preliminary stage in the development of type 2 diabetes mellitus and has been shown to increase the risk of cardiovascular morbidity and mortality in addition to causing endothelial dysfunction. In this study, we sought to determine if impaired glucose tolerance is related to slow coronary flow, an angiographic phenomenon caused by coronary micro and macrovascular endothelial dysfunction.
The population of this prospective study consisted of 28 patients with documented slow coronary flow, defined according to TIMI frame count method, [20 (71.4%) males; 51+/-9 years] and 30 patients with normal coronary flow [17 (56.6%) males; 47+/-6 years]. All study patients underwent an oral glucose tolerance test after 12 h of fasting. Lipid profile, hemoglobin A1c and systemic blood pressure were measured in all patients.
There was no difference between two groups with respect to age, fasting plasma glucose, triglyceride, total cholesterol, high density lipoprotein, low density lipoprotein, hemoglobin A1c, systolic-diastolic blood pressure levels, history of smoking and alcohol consumption. Plasma glucose at 2 h of oral glucose tolerance test was significantly higher in slow coronary flow patients compared to control group (145+/-44 vs. 112+/-38 mg/dl, P = 0.001, respectively). In addition, the number of patients who met the criteria of impaired glucose tolerance was significantly higher in slow coronary flow patient group [16 (57%) vs. 7 (23%), P = 0.002, respectively).
Our results suggest that impaired glucose tolerance may be an independent etiological factor for slow coronary flow phenomenon.
International Journal of Cardiology 08/2006; 111(1):142-6. · 7.08 Impact Factor
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ABSTRACT: In patients diagnosed with calcific aortic valve stenosis, cardiac risk factors are similar to those of coronary artery disease; homocysteine concentration is an independent risk factor for coronary artery disease. The aim of this study was to investigate the correlation between plasma homocysteine levels and aortic valve stenosis and the influence of homocysteine levels on the coexistence of coronary artery disease in patients with moderate to severe aortic valve stenosis.
Fifty-eight patients who had been diagnosed with moderate to severe aortic stenosis formed the test group of this study, and 47 healthy subjects without coronary artery disease or aortic valve stenosis formed the control group. The patients with aortic stenosis were divided into two groups according to the presence or absence of coronary artery disease in their coronary angiograms. After 12 h fasting venous blood samples were collected and total cholesterol, low-density lipoprotein, high-density lipoprotein, triglycerides and homocysteine levels were measured and compared between the two groups.
The mean blood homocysteine level was 10.8 +/- 3.3 micromol/l in patients with aortic valve stenosis and 8.1 +/- 4.7 micromol/l in the control group; the difference between these levels was statistically insignificant. The patients with aortic valve stenosis had significantly higher levels of total cholesterol and hypertension and were more likely to have a positive family history for coronary artery disease. When the two subgroups of patients with aortic valve stenosis were compared, mean blood homocysteine levels were 13.2 +/- 3.1 and 8.3 +/- 2.2 micromol/l, respectively, showing significantly higher levels in the group with coronary artery disease. In this comparison patients with coronary artery disease were also found to have significantly higher levels of total cholesterol and LDL and they were more likely to be smokers.
Although there was no relation between blood homocysteine levels and the existence of aortic valve stenosis, in cases with both coronary heart disease and aortic stenosis homocysteine levels were significantly higher than in the patients with pure aortic valve stenosis.
Cardiology 02/2005; 103(4):207-11. · 1.71 Impact Factor
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ABSTRACT: We investigated the relationship between P wave dispersion, which is easily measured on the surface electrocardiogram and may be used in evaluating the risk of atrial fibrillation, and left ventricular diastolic function. There were 133 patients: 73 with diastolic dysfunction and 60 without. P wave dispersions were calculated by measuring minimum and maximum P wave duration values on the surface electrocardiogram. The relationships between P wave dispersion and the presence, cause, severity, and echocardiographic measurements of diastolic dysfunction were investigated. P wave dispersion was 53 +/- 9 ms in patients with diastolic dysfunction and 43 +/- 9 ms in the control group (P < 0.01). When patients were grouped according to stage of diastolic dysfunction, P wave dispersion was 48 +/- 7 ms in stage 1, 54 +/- 8 ms in stage 2, and 58 +/- 9 ms in stage 3. As the severity of diastolic dysfunction increased, P wave dispersion increased but the difference did not reach statistical significance (P < 0.05). When the cause of diastolic dysfunction was considered, P wave dispersion was 53 +/- 8 ms in patients with ischemic heart disease and 52 +/- 9 ms in patients with left ventricular hypertrophy (P > 0.05). We conclude that P wave dispersion increases in diastolic dysfunction, but that this increase is not related to the severity or cause of diastolic dysfunction. When clinical and echocardiographic variables are taken into account, there is a weak but significant correlation only between P wave dispersion and left ventricular ejection fraction.
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital 01/2005; 32(2):163-7. · 0.65 Impact Factor
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ABSTRACT: Coronary artery aneurysm (CAA) is a rare disorder, characterized by abnormal dilatation of a localized portion or diffuse segments of the coronary artery. CAA may cause angina, myocardial infarction, sudden death due to thrombosis, embolisation, or rupture. In this report, a 63 year old Turkish male patient is presented who had an acute non-Q wave myocardial infarction due to spontaneous rupture of the left circumflex artery aneurysm. An extremely rare clinical presentation of rupture of a left circumflex CAA is discussed.
Japanese Heart Journal 04/2004; 45(2):331-6. · 0.40 Impact Factor
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ABSTRACT: Coronary artery fistulae, being a rare form of congenital anomalies of the coronary arteries, are usually discovered by chance during coronary arteriography. However, these fistulae can cause an important coronary morbidity and mortality leading to angina, syncope, congestive heart failure, myocardial infarction and sudden death. The coincidence of mitral stenosis and congenital artery fistula is rare in the literature. In our case report, a patient with a coronary artery fistula originating from the circumflex, draining to the main pulmonary artery, discovered at cardiac catheterization and coronary angiography done with a prediagnosis of mitral stenosis is presented in the light of the literature.
The International Journal of Cardiovascular Imaging 01/2004; 19(6):533-6. · 2.29 Impact Factor
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ABSTRACT: In 30-40% of patients with clinical heart failure diastolic dysfunction is present although systolic function is normal. Evaluation of diastolic functions are important for the patient's early diagnosis, treatment and prognosis. QT dispersion is an important parameter that reflects heterogeneity of ventricular repolarization and predicts ventricular arrhythmia and sudden death. According to several studies, QT dispersion is significantly increased in patients with diastolic dysfunction due to ischemic heart disease and left ventricular hypertrophy compared to the patients without diastolic dysfunction. However, a study about the relation between the stage of left ventricular diastolic dysfunction and QT dispersion is not present. The aim of this study was to investigate the correlation between the stage of left ventricular diastolic function determined by transthoracic echocardiography and QT dispersion.
In our study the left ventricular diastolic functions of 80 patients were evaluated by transthoracic echocardiography. Eighty patients were divided to four stages each containing 20 patients. Stage 0 was defined as normal, stage 1 as prolonged relaxation pattern, stage 2 as pseudonormal pattern and stage 3 as restrictive pattern. We measured QT dispersion (QT D) and corrected QT dispersion (QTc D) values according to Bazzet's formula in their ECGs. QT D and QTc D were found 20+/-8 ms vs. 26+/-1 ms in normal patients, 25+/-8 ms vs. 37+/-9 ms in the patients with prolonged relaxation pattern, 28+/-10 ms vs. 38+/-11 ms in the patients with pseudonormal pattern and 38+/-13 ms vs. 41+/-14 ms in the patients with restrictive pattern. A significant direct relation was found between the stage of left ventricular diastolic function and QT, QTc dispersion (p<0.01). Furthermore, when classified according to the aetiology of the left ventricular diastolic dysfunction (stage 1, 2, 3) QT D and QTc D were 24+/-6 ms vs. 32+/-9 ms in the patients with left ventricular hypertrophy (LVH), and 32+/-9 ms vs. 41+/-12 ms in the patients with ischaemic heart disease (IHD). The differences between the two groups were statistically significant (p<0.01).
These findings show that QT D and QTc dispersion values increase in relation to increasing left ventricular diastolic functional stage that is determined by echocardiography and that the patients with ischaemic heart disease have much more increased QT values than the patients with left ventricular hypertrophy.
Acta cardiologica 08/2003; 58(4):303-8. · 0.61 Impact Factor
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ABSTRACT: Results of the studies performed have suggested that hypercholesterolaemia and inflammation are important aetiologic factors in aortic valve stenosis (AVS). However up to now no such data has been obtained to evaluate whether these predictors may still serve as valuable tools to estimate the progression and severity of AVS. If factors contributing to the "progression" of degenerative process can be understood and preventive measures can be taken, both clinical and economical beneficial effects can be achieved. The objective of this study is to investigate the correlation of serum cholesterol, triglyceride and CRP levels with the severity of aortic stenosis echocardiographically evaluated in patients with aortic valve stenosis.
Aortic valvular areas of 60 patients (pts) hospitalized in our clinic with suspected AVS were calculated with Doppler echocardiography. Patients were grouped into mild, moderate and advanced AVS, each category containing 20 pts, and then were subclassified regarding those with and without coronary artery disease (CAD).
Total cholesterol and CRP levels were found to be 215+/-42 mg/dl and 2.0+/-1.4 mg/dl; 224+/-43 mg/dl and 2.4+/-2.1 mg/dl; 225+/-55 mg/dl and 2.7+/-2.1 mg/dl in pts with mild, moderate and advanced AVS, respectively. A statistically significant difference was not detected among the three groups (p>0.05). When subclasses were classified the levels were found to be much more increased in those patients having additional CAD.
We have demonstrated that severity of AVS does not correlate significantly with hypercholesterolaemia and CRP and their levels do not rise in accordance with increasing severity of AVS. Elevations of lipid levels in AVS were found to correlate with the presence of CAD rather than the severity of AVS. So, not in patients with simply AVS but in patients under higher cardiovascular risks, investigation of CRP plus lipid levels might provide benefit with respect to preventive treatment and benefit from cholesterol-lowering drugs can be expected in such kind of patients.
Acta cardiologica 08/2003; 58(4):321-6. · 0.61 Impact Factor
