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Analysis of the Myocardial Velocities in Patients With Mitral Stenosis
(MOSBY, Inc, 2002) Özdemir, Kurtuluş; Altunkeser, Bülent Behlül; Gök, Hasan; İçli, Abdullah; Temizhan, Ahmet
Background: Pure mitral stenosis (MS) affects left-ventricular performance as a result of myocardial and functional factors. We planned this study to evaluate the effect of MS on right- and left-ventricular functions using Doppler tissue imaging (DTI). Methods. A total of 46 patients with an established diagnosis of MS (mean age: 41 +/- 11 years), and 40 age-matched healthy individuals (mean age: 40 +/- 9 years) were included in this study. Echocardiography equipped with DTI function was performed on each participant. The mitral valve area was measured. Myocardial velocities were recorded at 4 different sites (septum, lateral, anterior, and inferior) of the left ventricle, and the right-ventricular free wall annulus by DTI The positive systolic velocity when the mitral and tricuspid ring moved toward the cardiac apex, and 2 negative diastolic velocities when the mitral annulus moved toward the base away from the apex (I during the early phase of diastole and another in the late phase of diastole [A(m)]) were measured. The early diastolic velocity/A(m) ratio was calculated for each wall. The mean of systolic and diastolic myocardial velocities of the left ventricle was calculated. Patients with pure MS were compared with healthy participants, and the relationship of DTI variables with mitral valve area was evaluated. Results. The myocardial velocities of the left ventricle indicating left-ventricular function were found to be significantly lower in patients with pure MS. Right-ventricular annulus velocities, on the other hand, were similar in both groups. A significant positive correlation could be established between mitral valve area and mean positive systolic velocity, A(m) of the left ventricle, and right-ventricular A(m) (r = 0.50, P <.001; r = 0.48, P =.001; r = 0.45, P =.002, respectively), whereas a significant negative correlation (r = -0.42, P =.004) was established for right-ventricular early diastolic velocity/A(m) ratio. Conclusion This first study where pure MS was evaluated by DTI shows that MS affects left-ventricular performance on long axis. The results indicate that the decrease in left-ventricular performance is caused by both functional and myocardial factors.
Comparison of Pulmonary Venous Flow Velocities and Left Ventricular Diastolic and Ejection Time in Patients With Moderate Mitral and Aortic Stenosis - Pulmonary Venous Flow Velocities in Mitral and Aortic Stenosis
(Kluwer Academic Publ, 2003) Altunkeser, Bülent Behlül; Özdemir, Kurtuluş; İçli, Abdullah; Gök, Hasan
Background: Doppler pulmonary venous flow velocities (PVFV) pattern are useful parameters in assessing the left ventricular diastolic functions. Both mitral stenosis (MS) and aortic stenosis (AS) lead to diastolic dysfunction. We compared PVFV and left ventricular diastolic and ejection time (ET) in patients with moderate MS and AS. Methods: Forty-three patients with moderate MS (group 1), 65 patients with moderate AS (group 2), and 33 healthy subjects as controls (group 3) were included in this study. After obtaining standard measurements echocardiographically, diastolic period (DP), ET, the ratio of the DP to the ET (DP/ET) isovolumetric contraction time (ICT), isovolumetric relaxation time (IRT), peak systolic flow velocity (PS), peak antegrade diastolic flow velocity (PD) peak reversal flow velocity at atrial contraction (PRA), the ratio of the peak systolic to the diastolic flow velocity (PS/PD), deceleration time of the antegrade diastolic flow (PDDT), and pressure half time of the peak antegrade diastolic flow velocity (PDPHT) were measured. Mitral valve area (MVA), aortic valve area (AVA), systolic pulmonary artery pressure (PAP), peak and mean gradients were calculated with standard formulas. Results:In univariate analysis, MVA was correlated with PDPHT and PDDT (r = -0.41; p < 0.01, r = -0.36; p < 0.05, respectively), also it was correlated with DP/ET (r = -0.57; p < 0.001). Mitral peak and mean diastolic gradient were correlated with PS/PD (r = -0.43; p < 0.01, r = -0.36; p < 0.05, respectively) and DP/ET (r = 0.51; p < 0.01, r = 0.46; p < 0.01, respectively). AVA was only correlated with DP/ET (r = 0.38; p < 0.05). Aortic peak and mean systolic gradient were correlated with PS/PD (r = -0.29; p < 0.05, r = -0.27; p < 0.05, respectively) and DP/ET (r = -0.38; p < 0.01, r = -0.40; p < 0.01, respectively). In the same analysis, PAP in patients in group 1 and 2 was correlated with PS/PD (r = -0.42; p < 0.01 and r = -0.40; p < 0.01, respectively) and also it was correlated with PD (r = -0.37; p < 0.05 and r = -0.27; p < 0.05, respectively) in both groups. Conclusion : Moderate MS and AS similarly affect the PVFV and PS/PD correlates with hemodynamics similarly both in MS and AS. Nevertheless, PDDT and PDPHT correlate with solely MVA. IRT higher in AS than MS, though DP/ET and ICT higher in MS than AS, and DP/ET relates with the severity of both MS and AS.
Diyabetik Olmayan Akut Koroner Sendromlarda Erken Dönem Yeni Bir Risk Önbelirleyicisi Olarak "Geliş İnsülin Rezistans İndeksi (GİRİ)’nin" Değerlendirilmesi
(2002) İçli, Abdullah; Gök, Hasan; Altunkeser, Bülent Behlül; Özdemir, Kurtuluş; Gürbilek, Mehmet; Gederet, Yavuz Turgut; Sökmen, Gülizar
Amaç: İnsülin rezistansı birçok kardiyovasküler hastalık için bir risk göstergesidir. Ancak, bazılarının etyoloji ve prognozu üzerinde etkisi tam olarak açığa kavuşmamıştır. Bu çalışmamızda, insülin rezistansının pratik olarak belirlenmesinde yeni sunulmuş olan "Geliş İnsülin Rezistans İndeksi (GİRİ)'nin" diyabetik olmayan akut koroner sendromlarda erken dönem yeni bir risk önbelirleyicisi olup olmadığını araştırmayı amaçladık. Yöntem: Çalışmamıza akut miyokard infarktüsü (AMİ) (Grup I, yaş ortalaması 5812 yıl olan 72 hasta) ve kararsız angina pektoris (KAP), (Grup II, yaş ortalaması 5810 yıl olan 88 hasta) tanılarıyla koroner yoğun bakım ünitesine yatırılan ve koroner anjiyografi (KAG) yapılan 160 diyabetik olmayan hasta dahil edildi. Tüm hastalarda geliş insülin ve glukoz değerlerinin çarpımının, normal glukoz düzeyi (5mmol/L) ve insülin düzeyinin (5mU/L) çarpımına bölünmesiyle GİRİ hesaplandı. Hastaların ekokardiyografik olarak sol ventrikül ejeksiyon fraksiyonu (SVEF), duvar hareket skor indeksi (SVDHSİ) ve KAG'lerinden Gensini skor indeksi belirlenerek 30 gün boyunca major kardiyak olaylar (kalp yetersizliği, atriyal fibrilasyon, reinfarktüs, ciddi ventriküler aritmiler, atriyo-ventriküler blok, revaskülarizasyon gereksinimi ve mortalite) bakımından izlemleri yapıldı. Bulgular: Grup I'de GİRİ daha yüksek bulundu.(7.25.3'e karşın, 5.24.4, p0.01). Grup I'de GİRİ ile Gensini skoru ve SVDHSİ arasında pozitif (sıra ile; r0.41, p0.01; r0.48, p0.001), SVEF arasında ise negatif korelasyon (r-0.37, p0.001) tespit edildi. Ayrıca Grup I'de çok değişkenli regresyon analizinde, GİRİ ile Gensini skor indeksi (r0.23, p0.01) ve SVDHSİ (r0.43, p0.0001) arasındaki pozitif korelasyonun devam ettiği görüldü. Yine Grup I'de kalp yetersizliği (r0.42, p0,0001), atriyal fibrilasyon (r0.35, p0.002) ve reinfarktüs (r0.23, p0.04) arasında anlamlı korelasyon tespit edilirken, çok değişkenli regresyon analizinde de, kalp yetersizliği (r0.21, p0.007), atriyal fibrilasyon (r0.18, p0.01) ve reinfarktüs (r0.18, p0.01) ile anlamlı pozitif korelasyonun devam ettiği görüldü. Buna karşın Grup II'de GİRİ ile bu parametreler arasında anlamlı bir ilişki tespit edilmedi. Sonuç: Geliş İnsülin Rezistans İndeksi, AMİ ile gelen ve diyabetik olmayan hastalarda erken dönem yeni bir risk önbelirleyicisi olarak yüksek riskli alt grupların erken belirlenmesinde kullanılabilir. Aynı zamanda GİRİ, AMİ'lü hastalarda sol ventrikül disfonksiyonunun ve koroner arter hastalığının yaygınlığını belirleyen bağımsız bir risk faktörü olarak, pratik olarak hesaplanabilen ve geniş ölçekli klinik çalışmalarda kolaylıkla kullanılabilir bir parametredir.
Does the Myocardial Performance Index Affect Pulmonary Artery Pressure in Patients With Mitral Stenosis? A Tissue Doppler Imaging Study
(WILEY, 2003) Özdemir, Kurtuluş; Altunkeser, Bülent Behlül; Gök, Hasan; İçli, Abdullah
Background: The relation between systolic pulmonary artery pressure (PAP) and mitral stenosis (MS) has been poorly understood. Although the mitral valve area (WA) is an important factor affecting the PAP, there is a wide spectrum of the PAP in patients with MS despite a similar WA. So, we analyzed whether the left and right ventricular myocardial performance index (MPI) correlated with the PAP. Methods: Two-dimensional Doppler echocardiography was performed in 46 patients with MS. The left atrial diameter, mean mitral gradient, and WA were measured. The PAP was derived from the tricuspid regurgitant jet velocity. The ejection time (ET), isovolumetric relaxation time (IRT), and contraction time (ICT) were measured on annulus of interventricular septum, lateral, inferior and anterior wall of left ventricle, and right ventricle free wall from apical two- and four-chamber views in patients with MS and 40 age-matched healthy patients by tissue Doppler imaging (TDI). Then the MPI was calculated as (IRT + ICT)/ET for both left and right ventricle. The correlation of PAP with WA, mean mitral gradient, left atrial diameter, and left and right ventricular MPI was evaluated. Results: WA and PAP were measured as 1.57 +/- 0.39 cm(2) (0.8-2.5 cm(2)) and 42 +/- 16 mmHg, respectively. It was determined that the MPI increased inpatients with MS (0.59 +/- 0.1 vs 0.48 +/- 0.07, P < 0.001). It was also demonstrated that the WA, left atrial diameter, mean diastolic gradient, and left ventricular MPI were correlated with PAP (r = -0.39 (P = 0.0071, r = 0.43 (P = 0.0031,.r = 0.58 [P < 0.001), and r = 0.65 [P < 0.001), respectively). In multivariate analysis, although the PAP correlated with mean diastolic gradient and MPI (r = 0.39 (P = 0.013), and r = 0.48 [P < 0.001)), it did not correlate with left atrial diameter and MVA. The PAP also correlated with right ventricular MPI (r = 0.63 (P < 0.001)). Conclusion: This study demonstrates that the left ventricular MPI obtained by TDI is an important marker of PAP, and right ventricular MPI correlates with the PAP in patients with MS.
Effect of postmenopausal hormone replacement therapy on cardiovascular performance
(ELSEVIER IRELAND LTD, 2004) Özdemir, Kurtuluş; Çelik, Çetin; Altunkeser, Bülent Behlül; İçli, Abdullah; Albeni, Havva; Düzenli, Mehmet Akif; Akyürek, Cemalettin; Gök, Hasan
Summ.: Postmenopausal hormone replacement therapy (HRT) has usually been evaluated the relationship with atherosclerotic disease, whereas its effect on direct cardiac functions hasn't been investigated in detail. This study was planned to investigate the long-term effects of HRT on cardiac functions and exercise performance. Methods: Thirty-six postmenopausal women (mean age: 51+/-4 years, 39-60 years) were prospectively analyzed with pulsed wave Doppler echocardiography and symptom-limited exercise stress test before HRT (oral 0.625 mg conjugated estrogen and 2.5 mg medroxyprogesteron acetate/day), and at the third and the sixth months. The effect of HRT on left ventricular ejection fraction (EF), early filling velocity (E wave) and late filling velocity (A wave), E wave deceleration time (EDT), E/A ratio, myocardial performance index (MPI), exercise duration and METS changes were examined. Results: HRT did not significantly alter the left ventricular EF. At the third month of HRT, there was an insignificant increase in E wave, EDT, and E/A ratio, whereas an insignificant decrease was noted in MPI (P > 0.05). However, at the sixth month of HRT, these changes became significant (68+/-12 vs. 75+/-13 cm/s, P < 0.01; 171+/-24 vs. 184+/-14 ms, P < 0.01; 1.01+/-0.23 vs. 1.11+/-0.27, P < 0.01, and 44+/-9 vs. 39+/-8%, P < 0.001, respectively). On the other hand, exercise duration and exercise METS values showed significant improvements at the third month of HRT (423 104 vs. 482+/-104 s, P < 0.001; 8.2+/-1.7 vs. 9.1+/-2 METS, P < 0.001). These improvements also continued at the sixth month of HRT. In conclusion, postmenopausal HRT leads to a progressive improvement on left ventricular function parameters, and in parallel, in exercise performance. (C) 2003 Elsevier Ireland Ltd. All rights reserved.
The Effect of Postmenopausal Hormone Replacement Therapy on Cardiovascular Performance
(W B SAUNDERS CO LTD, 2001) Özdemir, Kurtuluş; Çelik, Çetin; Altunkeser, Bülent Behlül; İçli, Abdullah; Albeni, Havva; Akyürek, Cemalettin; Gök, Hasan; Düzenli, Mehmet Akif
Summary: Postmenopausal hormone replacement therapy (HRT) has usually been evaluated the relationship with atheroscle- rotic disease, whereas its effect on direct cardiac functions hasn't been investigated in detail. This study was planned to investigate the long-term effects of HRT on cardiac functions and exercise performance. Methods: Thirty-six postmenopausal women (mean age: 51 ± 4 years, 39-60 years) were prospectively analyzed with pulsed wave Doppler echocardiography and symptom-limited exercise stress test before HRT (oral 0.625 mg conjugated estrogen and 2.5 mg medroxyprogesteron acetate/day), and at the third and the sixth months. The effect of HRT on left ventricular ejection fraction (EF), early filling velocity (E wave) and late filling velocity (A wave), E wave deceleration time (EDT), E/A ratio, myocardial performance index (MPI), exercise duration and METS changes were examined. Results: HRT did not significantly alter the left ventricular EF. At the third month of HRT, there was an insignificant increase in E wave, EDT, and E/A ratio, whereas an insignificant decrease was noted in MPI (P>0.05). However, at the sixth month of HRT, these changes became significant (68±12 vs. 75 ± 13 cm/s, P<0.01; 171 ±24 vs. 184 ± 14 ms, P<0.01; 1.01±0.23 vs. 1.11±0.27, P<0.01, and 44±9 vs. 39±8%, P<0.001, respectively). On the other hand, exercise duration and exercise METS values showed significant improvements at the third month of IIRT (423± 104 vs. 482±104 s. P<0.001; 8.2±1.7 vs. 9.1±2 METS, P<0.001). These improvements also continued at the sixth month of IIRT. In conclusion, postmenopausal HRT leads to a progressive improvement on left ventricular function parameters, and in parallel, in exercise performance.
The Effect of Valsalva Maneuver on P Wave in 12-Lead Surface Electrocardiography in Patients With Paroxysmal Atrial Fibrillation
(Sage Publications Inc, 2002) Altunkeser, Bülent Behlül; Özdemir, Kurtuluş; Gök, Hasan; Yazıcı, Mehmet; İçli, Abdullah
The previous studies relating to the effect of the Valsalva maneuver on P wave do not provide detailed information. In those studies, the parameters related to P wave duration during the release phase of the Valsalva maneuver were evaluated. The authors evaluated P wave amplitude as well as P wave duration during the strain phase of the Valsalva maneuver. Thirty-seven normal subjects and 36 patients with paroxysmal atrial fibrillation (PAF) were included in the study. Twelve-lead surface electrocardiography (ECG) was obtained from all the patients before and during the strain phase of the Valsalva maneuver. The authors evaluated the parameters related to both P wave duration and P wave amplitude. The highest P wave voltage was expressed as the P wave amplitude maximum (P amp max), the lowest P wave voltage as the P wave amplitude minimum (P amp min), and the P wave amplitude dispersion (P amp dispersion) as "the P amp max - the P amp min." Also, the maximum P wave duration was expressed as the P maximum (P max), the minimum P wave duration as the P minimum (P min), and the P wave dispersion as "the maximum P wave duration (P max) - the minimum P wave duration (P min)." All these parameters were measured before and during the strain phase of the Valsalva maneuver, P max, P dispersion, P amp max, and P amp dispersion were higher in patients with PAF compared to those of normal subjects before the Valsalva maneuver. In normal subjects, P max, P wave dispersion, P amp max, and P amp dispersion values were significantly higher in the strain phase of the Valsalva maneuver than before (p < 0.01, p < 0.01, p < 0.05, and p < 0.05, respectively). In the patients with PAF, P max, P wave dispersion, P amp max, and P amp dispersion values were significantly lower during the strain phase of the Valsalva maneuver than before. In conclusion, in the patients with PAF, P wave parameters were decreased during the strain phase of the Valsalva maneuver, approaching to the normal levels.
Effects of Long-Term Hormone Replacement Therapy on QT and Corrected QT Dispersion During Resting and Peak Exercise Electrocardiography in Post-Menopausal Women
(Japan Heart Journal, Second Dept of Internal Med, 2002) Altunkeser, Bülent Behlül; Özdemir, Kurtuluş; İçli, Abdullah; Çelik, Çetin; Akyürek, Cemalettin; Gök, Hasan
It is known that the QT interval is longer in women than men. Estrogen is reported to account for the QT interval prolongation in several studies conducted with hormone replacement therapy (HRT) in postmenopausal women. Along with this, there are conflicting data as regards the effects of HRT on QT interval and dispersion. Moreover, there is no evidence about the effect of HRT on exercise QT parameters. We compared QT parameters obtained from Surface electrocardiograms during resting and peak exercise before and after 6 months of HRT consisting of estrogen Plus progesterone in healthy postmenopausal women. Twenty-four healthy postmenopausal women were given 0.625 mg/day conjugated estrogens and 2.5 mg/clay medroxyprogesterone acetate for 6 months. Exercise stress testing using the Bruce protocol was performed before and after HRT. QT maximum, minimum, dispersion and corrected QT maximum, minimum and dispersion were calculated during testing and peak exercise. HRT resulted in a significant increase in estradiol plasma levels from 24+/-10 pg/mL to 117+/-66 pg/mL (P<0.001). There was no significant difference in resting QT parameters after HRT, whereas QT dispersion and corrected QT dispersion were significantly increased during peak exercise (20+/-7 versus 25+/-10 ins; P<0.05, 33+/-12 versus 41+/-16 ms; P<0.05, respectively). Nonetheless, the other exercise QT parameters were unchanged. The resting QT parameters are not affected by long term HRT consisting of estrogen plus progesterone, which leads to an increase in QT dispersion and corrected QT dispersion during peak exercise.
Evaluation of "Admission Index of Insulin Resistance (Airi)" as an Early Stage Risk Predictor in Nondiabetic Acute Coronary Syndromes
(2002) İçli, Abdullah; Gök, H.; Altunkeser, Bülent Behlül; Özdemir, K.; Gürbilek, Mehmet; Gederet, Y. T.; Sökmen, Gülizar
Objective: Insulin resistance is a risk predictor for many cardiovascular diseases, but its effect on etiology and prognosis of diseases has not been clearly identified. In this study, we aimed to investigate whether admission index of insulin resistance (aIRI), recently and practically presented for determination of insulin resistance, could be a new risk predictor of early prognosis in nondiabetic acute coronary syndromes. Methods: One hundred and sixty nondiabetic patients admitted to the intensive coronary care unit and underwent coronary angiography with the diagnosis of acute myocardial infarction (AMI) (Group I; 72 patients; mean age - 58 ± 12 years) or unstable angina pectoris (UAP) (Group II; 88 patients; mean age 58 ± 10 years) were included in the study. In all patients blood glucose and insulin levels were measured on admission and AIRI was calculated by the formula of "admission glucose level X insulin level / normal blood glucose level (5mmol/L) X normal insulin level (5 mU/L)" for each patient. After determining the left ventricular ejection fraction (LVEF) and wall motion score index (LVWMSI) echocardiographically and calculating the Gensini score index from coronary angiography, the patients were followed up for major cardiac events (heart failure, atrial fibrillation, reinfarction, life-threatening ventricular arrhythmias, atrio-ventricular block, need for revascularisation and mortality) for 30 days. Results: AIRI was found higher in Group I (7.2 ± 5.3 versus 5.2 ± 4.4, p< 0.01) than in Group II. AIRI was positively correlated with Gensini score and LVWMSI (r=0.41, p<0.01 and r=0.48, p<0.48, p<0.001, respectively) and negatively correlated with LVEF (r=-0.37, p=0.001) in Group I. In addition, it was seen that positive correlation of AIRI with Gensini score (r=0.23, p=0.01) and LVWMSI (r=0.43, p=0.0001) in Group I persisted on multivariate regression analysis. Again, AIRI was significantly correlated with heart failure (r=0.42, p<0.0001) atrial fibrillation (r=0.35, p=0.002) and reinfarction (r=0.23, p=0.04) in Group I. Along with this, in multivariate regression analysis, it was correlated with heart failure (r=0.21, p<0.007), atrial fibrillation (r=0.18, p=0.01) and reinfarction (r=0.18, p=0.01). On the other hand, there was no significant correlation between AIRI and these parameters in Group II. Conclusion: AIRI can be used in early stage as a risk predictor to determine high-risk subgroups of nondiabetic patients presenting with AMI. Also AIRI, a parameter, which is practically calculated and easily used, is an independent risk factor detecting the extent of coronary artery disease and left ventricular dysfunction in patients with AMI.
Evaluation of Electrocardiographic and Echocardiographic Findings In Patients Diagnosed with Polycythemia Vera and Essential Thrombocythemia
(Selçuk Üniversitesi, 2024 Şubat) Kaya, Bahattin Engin; Demircioğlu, Sinan; Tekinalp, Atakan; Sertdemir, Ahmet Lütfi; Ergün, Mustafa Çağrı; Tuna, Ali Kürşat; Kandemir, Şerif Ahmet; İçli, Abdullah; Çeneli, Özcan
ABSTRACT Background/Aims: Polycythemia vera (PV) and essential thrombocythemia (ET) are chronic myeloproliferative diseases that can lead to various clinical outcomes, including arterial and venous thrombosis, pulmonary hypertension, and myocardial infarction. This study was designed to assess the cardiac effects of these diseases using electrocardiography and echocardiography. Methods: A total of 50 patients diagnosed with PV, 50 patients diagnosed with ET, and 50 healthy individuals forming the control group were enrolled in this study. Demographic information for all subjects was collected. Electrocardiography (ECG) recordings and standard transthoracic echocardiographic examinations were conducted for all patients and control subjects. Pulse wave velocity (PWV) measurements were assessed using a Holter blood pressure device. Results: In total, 50 PV patients, 50 ET patients, and 50 control group were included in the study. The demographic characteristics of the PV, ET and control groups were similar. The PR interval was significantly shorter in control subjects than in PV and ET patients (p = 0.007, p = 0.024). Although the measured values were within normal limits, diastolic posterior wall thickness was significantly lower in the control group compared to PV and ET patients (p = 0.019, p = 0.009). PWV was significantly higher in ET patients compared to the control group (p = 0.012). Conclusion: ECG parameters used to predict ventricular arrhythmias (QT, QTc, Tp-Te, Tp-Te/QT) and Pulmonary Artery Pressure showed no significant change, in opposition to existing literature. Nonetheless, similar to previous publications, PV and ET were found to negatively affect the diastolic function parameters on transthoracic echocardiography. While the aortic stiffness was significantly higher in ET patients compared to the control group, no significant difference was noted between PV patients and control subjects in terms of aortic stiffness.
Menapoza Giren Kadınlarda Uzun Süreli Hormon Replasman Tedavisinin Istirahat ve Zirve Egzersiz Elektrokardiografideki QT ve Hıza Göre Düzeltilmiş QT Dispersiyonuna Etkisi
(2002) Altunkeser, Bülent Behlül; Özdemir, Kurtuluş; İçli, Abdullah; Çelik, Çetin; Akyürek, Cemalettin; Gök, Hasan
AMAÇ: Kadınlarda QT süresinin erkeklere göre daha uzun olduğu bilinmektedir. Postmenapozal kadınlarda hormon replasman tedavisi (HRT) ile yapılan bazı çalışmalarda QT uzamasından sorumlu olarak östrojen suçlanmıştır. Bununla birlikte, HRT'nin QT süresi ve QT dispersiyonu üzerine etkileri ile ilgili çalışma sonuçları çelişkilidir. Ayrıca HRT'nin egzersiz QT parametrelerine etkisiyle ilgili bilgi yoktur. GEREÇ VE YÖNTEM: Postmenapozal sağlıklı kadınlarda östrojen progesteron ile HRT öncesi ve 6 ay sonrasında istirahat ve zirve egzersizde yüzey elektrokardiyogramdan elde edilen QT parametrelerini karşılaştırdık. Bu amaçla 24 sağlıklı postmenapozal kadına 0.625 mg konjuge östrojen/gün ve 2.5 mg medroksiprogesteron asetat/gün ile HRT uygulandı ve 6 ay süreyle devam edildi. Tedavi öncesi ve sonrasında Bruce protokolüne göre egzersiz stres testi uygulandı. İstirahat ve zirve egzersizde QT maksimum, minimum, dispersiyon ve hıza göre düzeltilmiş QT maksimum, minimum ve dispersiyon hesaplandı. BULGULAR: HRT sonrası östrojen seviyesinin önemli olarak arttığı görüldü (2410 pg/ml'ye karşın 11766, p0.001). HRT sonrası istirahat QT parametrelerinde bir değişiklik gözlenmezken, zirve egzersizde QT ve hıza göre düzeltilmiş QT dispersiyonun önemli derecede arttığı tespit edildi (Sırasıyla, 207'ye karşın 2510 msn; p0.05, 3312'ye karşın 4116msn; p0.05). Diğer egzersiz QT parametreleri ise değişmedi. SONUÇ: Uzun süreli östrojen progesteron ile yapılan HRT, istirahat QT parametrelerini etkilemezken, zirve egzersiz QT ve hıza göre düzeltilmiş QT dispersiyonunda artışa yol açar.
New Parameters in Identification of Right Ventricular Myocardial Infarction and Proximal Right Coronary Artery Lesion
(Elsevier Science Bv, 2003) Özdemir, Kurtuluş; Altunkeser, Bülent Behlül; İçli, Abdullah; Özdil, Hüseyin; Gök, Hasan
Objective: The diagnosis of right ventricular myocardial infarction (RVMI) accompanied by acute inferior myocardial infarction (MI) is still a problem that we encounter. This study was designed. to find out the usefulness both of peak myocardial systolic velocity (Sm) and of the myocardial performance index (MPI) of the right ventricle measured by pulsed-wave tissue Doppler imaging (TDI) in assessing right ventricular function. Methods: Sixty patients who experienced a first acute inferior MI (mean [+/- SD] age, 57 +/- 9 years) were prospectively assessed. An ST-segment elevation of greater than or equal to 0.1 mV in V-4-V6R lead derivations was defined as an RVMI. From the echocardiographic apical four-chamber view, the Sm, the peak early diastolic velocity, peak late diastolic velocity, the ejection time, the isovolumetric relaxation time, and the contraction time of the right ventricle were recorded at the level of the tricuspid annulus by using TDI. Then, the MPI was calculated. The patients were classified into the following three groups, according to the localization of the infarct-related artery (IRA) detected using coronary angiography: group 1, proximal right coronary artery; group 11, distal right coronary artery; and group 111, circumflex coronary artery. Results: RVMIs were detected in sixteen patients, and the IRA in 27 patients was the proximal right coronary artery. The right ventricular Sur was observed to be significantly low in patients with RVMIs and those in group I compared to those without RVMIs and those in groups 11 and 111 (10.9 +/- 1.3 vs 14.3 +/- 3.2 cm/s, respectively [p < 0.001]; 11.5 +/- 2.5 vs 15.1 +/- 3 cm/s, respectively; and 14.9 +/- 2.6 cm/s, respectively [p < 0.001]). in the diagnosis of RVMI, the values for sensitivity, specificity, negative predictive value, and positive predictive value of Sur < 12 cm/s were 81%, 82%, 92%, and 62% respectively, and in the diagnosis of the proximal right coronary artery as the IRA, those values were 63%, 88%, 74%, and 81%, respectively. The MPI was high in the same patient groups (0.83 +/- 0.12 vs 0.57 +/- 0.11 in those patients without RVMI, respectively, [P < 0.001]; 0.74 +/- 0.13 vs 0.56 +/- 0.15 in group 11 and 0.54 +/- 0.07 in group 111, respectively [p < 0.001]). The sensitivity, specificity, negative predictive value, and positive predictive value of an MPI of > 0.70 in the diagnosis of RVMI were calculated as 94%,80%,97%, and 63%, respectively, and in the diagnosis of the proximal right coronary artery as the IRA, those values were 78%, 91%, 83%, and 88% respectively. Conclusions: An Sin < 12 cm/s and an MPI > 0.70 obtained by TDI may define RVMI concomitant with acute inferior MI, and the IRA.

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