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Yayın Can serum lipid and CRP levels predict the "severity" of aortic valve stenosis?(TAYLOR & FRANCIS LTD, 2003) Gunduz, H; Akdemir, R; Binak, E; Tanier, A; Keser, N; Uyan, GBackground - 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. Material and methods -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). Results -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. Conclusion - 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.Yayın A case of coronary artery fistula with mitral stenosis(KLUWER ACADEMIC PUBL, 2003) Gunduz, H; Akdemir, R; Binak, E; Ayarcan, Y; Kurtoglu, N; Uyan, CCoronary 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.Yayın Relation between stage of left ventricular diastolic dysfunction and QT dispersion(ACTA CARDIOLOGICA, 2003) Gunduz, H; Akdemir, R; Binak, E; Tamer, A; Uyan, GObjective - 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. Methods and Results - 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 I 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). Conclusions -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.Yayın Spontaneous rupture of a coronary artery aneurysm - A case report and review of the literature(JAPAN HEART JOURNAL, SECOND DEPT OF INTERNAL MED, 2004) Gunduz, H; Akdemir, R; Binak, E; Tamer, A; Uyan, CCoronary 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.
