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    Giant left ventricular pseudoaneurysm detected three years after myocardial infarction
    (2006) Soylu A.; Gök H.; Narin C.; Kayrak M.
    A 70-year-old male patient presented with symptoms of heart failure three years after having myocardial infarction. Transthoracic echocardiography revealed severely compromised left ventricular systolic function (ejection fraction 20%) and a large left ventricular pseudoaneurysm. The diagnosis was confirmed by computed tomography. The size of the pseudoaneurysm sac was 11 x9 cm. At surgery, the pseudoaneurysmal sac was resected and a defect of 3.5x4 cm was detected in the anterolateral wall of the left ventricle. The defect was repaired by the remodeling ventriculoplasty method of Dor. The patient whose general condition improved through intensive medical treatment was discharged with medications for heart failure and coronary artery disease on the 15th postoperative day.
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    The prognostic value of serum troponin T in unstable angina
    (Elsevier Ireland Ltd, 1996) Cin V.G.; Gök H.; Kaptano?lu B.
    Background: Cardiac troponin T is a regulatory contractile protein not normally found in blood. Its detection in the circulation has been shown to be a sensitive and specific marker for myocardial cell damage. We used a newly developed enzyme immunoassay for troponin T to determine whether its presence in the serum of patients with unstable angina was a prognostic indicator. Methods: We screened 72 patients with unstable angina (Class III, acute unstable angina) for serum creatine kinase activity, creatine kinase myocardial band (isoenzyme M) activity, and troponin T, every 8 h for 2 days after admission to the hospital. The outcomes of interest during the hospitalization were death and myocardial infarction. Results: Troponin T was detected in the serum of 24 of the 72 patients (34%) with acute angina at rest. Only four of these patients had elevated creatine kinase M activity. Of the 24 patients who were positive for troponin T, 12 had myocardial infarction, and 6 of these died during hospitalization. In contrast, only 2 of the 48 patients with angina at rest who were negative for troponin T had an acute myocardial infarction, and these patients died. Thus, 12 of the 14 patients with myocardial infarctions had detectable levels of troponin T; only 2 had elevated creatine kinase M activity. Conclusions: Cardiac troponin T in serum appears to be a more sensitive indicator of myocardial-cell injury than serum creatine kinase MB activity, and its detection in the circulation may be a useful prognostic indicator in patients with unstable angina.
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    The role of tissue Doppler echocardiography in the evaluation of functional capacity of patients with heart failure [Kalp yetersizli?i olan hastalarda fonksiyonel kapasitenin de?erlendirilmesinde doku Doppler ekokardiyografinin rolü]
    (2008) Düzenli M.A.; Özdemir K.; Aygül N.; Zengin K.; Gök H.
    Objectives: We investigated correlations between the New York Heart Association (NYHA) functional classification system, which is commonly used to asses functional capacity, and conventional echocardiographic and tissue Doppler echocardiographic (TDE) parameters in patients with heart failure (HF). Study design: The study included 122 patients (31 females, 91 males; mean age 59±11 years) with HF, whose left ventricular (LV) ejection fraction (EF) was less than 50%. The patients were evaluated in two groups based on the NYHA class I-II (n=79; mean age 58 years) and class III-IV (n=43; mean age 61 years). Correlations were sought between the functional status and standard two-dimensional echocardiographic and TDE parameters. Results: The NYHA class showed significant inverse correlations with LV EF, LV stroke volume, mitral deceleration time of early filling, and flow propagation velocity (Vp), and significant positive correlations with end-systolic and enddiastolic diameters and volumes, pulmonary artery pressure (PAP), and the E/Vp ratio. Mitral early (E) and late (A) diastolic peak velocities and the E/A ratio were not correlated. Concerning TDE parameters, the NYHA class was in significant inverse correlation with systolic (Sm), early (Em) and late (Am) diastolic myocardial velocities, and in positive correlation with the E/Em ratio, whereas no correlation was found with the Em/Am ratio. Linear regression analysis showed that Sm, EF, and PAP were independent variables of functional capacity (?=-0.33, p<0.005; ?=-0.26, p<0.05; ?=0.23, p<0.05, respectively). Conclusion: There is significant relationship between myocardial velocities and functional capacity, and Sm, in particular, has the strongest association compared to conventional echocardiographic and other TDE parameters.