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    Clinical importance of elevated CK-MB and troponin I levels in congestive heart failure
    (HEALTH COMMUNICATIONS INC, 2006) Yilmaz, Ahmet; Yalta, Kenan; Turgut, Okan Onur; Yilmaz, Mehmet Birhan; Ozyol, Ali; Kendirlioglu, Omer; Karadas, Filiz; Tandogan, Izzet
    Myocyte necrosis has been considered to play a fundamental role in the pathophysiology of congestive heart failure (CHF), which has usually evolved as a consequence of depletion of compensatory mechanisms and contractile reserve of myocardium. Elevated levels of creatine kinase MB (CK-MB) and troponin I (Tn-I) have been regarded as biochemical markers of myocyte necrosis. This study was planned to investigate the specificity and sensitivity of Tn-I and CK-MB in CHF and to examine the correlation of these markers with disease severity. A total of 104 patients (38 female, 66 male; mean age, 66 y [range, 36-89]) with symptoms and signs of heart failure on admission and with a reduced left ventricular ejection fraction (EF; by transthoracic echocardiography) were labeled "the patient group," and 58 patients (40 female, 18 male; mean age, 61 y [range, 34-77]) with no signs or symptoms of CHF and with a normal EF detected by transthoracic echocardiography were included in the study as "the control group." Left ventricular EFs, end-diastolic diameters, and end-systolic diameters of patients in both groups were measured. Blood samples were drawn from all patients in both groups on admission, so that levels of CK-MB and Tn-I could be measured. All patients in both groups also underwent coronary angiography. Conditions leading to elevation of CK-MB or Tn-I were considered exclusion criteria. The 2 groups failed to show any significant differences in terms of mean age and the presence of coronary artery disease, hypertension, or diabetes mellitus (P >.05). Mean EF in the patient group was lower than that in the control group (P <.05). Mean CK-MB and Tn-I in the patient group were significantly higher than in the control group (P <.05). In the patient group, hypertensive patients were found to have significantly higher mean values of CK-MB than were seen in normotensive patients in the same group (P <.05). In the patient group, 52 cases were considered to be class I-II (New York Heart Association [NYHA]) (group 1), and 52 were considered to be class III-IV (group 2). Group 1, group 2, and the control group did not differ significantly from one another with regard to the presence of coronary artery disease, hypertension, and diabetes mellitus (P >.05). The mean EF in group 2 was significantly lower than that in group I and in the control group (P <.05); the mean EF in group I was significantly lower than that in the control group (P <.05). Group 1 values did not differ significantly from those of group 2 or the control group in terms of enzymatic markers (P >.05), but group 2 had significantly higher mean values of CK-MB and Tn-I than were noted in the control group (P <.05). The uphill course of CK-MB and Tn-I values from the control group to group 2 (NYHA class III-IV) was statistically significant (P <.05). Serum concentrations of CK-MB and Tn-I may become elevated in severely symptomatic patients with CHIF (particularly NYHA class III-IV), demonstrating a relationship between clinical severity of the disease and elevation of myocardial enzymes (CK-MB and Tn-I).
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    Evaluation of the patients' level of knowledge about diagnostic and therapeutic procedures in cardiology
    (Turkish Soc Cardiology, 2006) Yilmaz, Mehmet Birhan; Turgut, Okan Onur; Yilmaz, Ahmet; Karadas, Filiz; Ozyol, Ali; Kendirlioglu, Omer; Bektasoglu, Gokhan
    Objectives: It is sometimes observed that informing patients about cardiovascular procedures is not taken into appropriate consideration. In this study, we assessed the patients' level of knowledge obtained through informing regarding the procedures performed in cardiology. Study design: A 22-item questionnaire was developed to measure the knowledge of patients about cardiovascular procedures. After validation in a group of 10 volunteer patients, the questionnaire was administered to 200 participants (115 males, mean age 53 years; 85 females, mean age 49 years). The patients were inquired about their knowledge of electrocardiography (ECG), Holter, exercise stress test, echocardiography, coronary angiography (CAG), percutaneous coronary interventions (PCI), electrophysiological study, and pacemaker implantation. Results: Of the participants, 33% had hypertension, 7.5% had diabetes mellitus, and 23% had coronary artery disease. Although the majority of the patients (n=159, 79.5%) had a prior electrocardiogram, only 7% (n=14) responded that it gave information about coronary artery disease. Eighty-six percent (n=172) of the participants did not know what Holter was. According to 44%, CAG was performed for visualization, and to 37%, for patency of the coronary arteries. Concerning the PCI procedure, 42% stated that they did not know how it was carried out, and 35% stated that the balloon was blown up during the procedure. Conclusion: Furnishing patients with necessary information about cardiovascular procedures is important for improved health of individuals and the society at large, and there seems to be a considerable gap in this respect.
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    Tortuosity of coronary arteries: an indicator for impaired left ventricular relaxation?
    (SPRINGER, 2007) Turgut, Okan; Yilmaz, Ahmet; Yalta, Kenan; Yilmaz, Birhan M.; Ozyol, Ali; Kendirlioglu, Omer; Karadas, Filiz; Tandogan, Izzet
    Objective To investigate the relationship between coronary tortuosity and impaired left ventricular relaxation. Methods One hundred and four subjects who underwent coronary angiography were included in the study. Left anterior descending, left circumflex, and right coronary arteries were traced. Tortuosity was identified by the finding of >= 3 bends (defined as >= 45 degrees change in vessel direction) along main trunk of at least one artery. Study population were divided into tortuosity (n = 54) and no tortuosity (n = 50) groups. Subjects were all submitted to pulsed-wave Doppler and two-dimensional echocardiographic examination to assess left ventricular functions. Results For subjects with tortuosity, early transmitral inflow (E) velocity was lower, late transmitral inflow (A) velocity was higher, E/A ratio was smaller compared with subjects without tortuosity (P < 0.001). Subjects with tortuosity had longer deceleration time of E velocity (DT) and isovolumic relaxation time (IVRT) than did subjects without tortuosity (P < 0.001). End-diastolic interventricular septal and left ventricular posterior wall thicknesses were greater in subjects with tortuosity than those without tortuosity (P = 0.01 and P = 0.005). There was an inverse correlation between total number of arteries with tortuosity and E/A ratio (r = -0.750, P < 0.001). Total number of arteries with tortuosity displayed correlations with DT (r = 0.723, P < 0.001) and IVRT (r = 0.703, P < 0.001). Conclusions This study depicts that coronary tortuosity is associated with impaired left ventricular relaxation.Thus, coronary tortuosity might be an indicator of impaired left ventricular relaxation.