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Acar G.,Kartal Kosuyolu Yuksek Ihtisas Heart Education and Research Hospital | Akcakoyun M.,Kartal Kosuyolu Yuksek Ihtisas Heart Education and Research Hospital | Sari I.,Marmara University | Bulut M.,Kartal Kosuyolu Yuksek Ihtisas Heart Education and Research Hospital | And 7 more authors.
Sleep and Breathing | Year: 2013

Background: Sleep deprivation (SD) is known to be associated with adverse cardiovascular events. Strain and strain rate measure the local deformation of the myocardium and have been used to evaluate atrial phasic function in various disease states. The aim of the study was to investigate whether strain rate imaging enables the identification of left atrial dysfunction in otherwise healthy young adults with acute SD which has not been studied previously. Method:s Adequate echocardiographic images of 27 healthy volunteers were obtained both after a night with regular sleep and after a night with SD. Tissue Doppler-derived strain and strain rate were measured from the apical fourand two-chamber views of the left atrium, and global values were calculated as the mean of all segments. Measurements included peak systolic strain, systolic strain rate (S-Sr), early diastolic (E-Sr) and late diastolic (A-Sr) strain rate. Phasic left atrial (LA) volumes and fractions were also calculated. Results: There was no significant difference in the traditional parameters of atrial function and LA volumes. Subjects had similar S-Sr, A-Sr and global atrial strain values after the night of sleep debt when compared after regular sleep, whereas they had significantly reduced E-Sr values (mean (SD) 3.2 (0.7) s-1 vs 3.7 (0.6) s-1, p<0.001). Moreover, global E-Sr showed a significant correlation with sleep time (r00.554, p<0.001). Conclusion: Acute SD in healthy adults is associated with a reduction in LA early diastolic strain rate in the absence of geometric alterations or functional impairment of the left atrium, raising the possibility that chronic SD may more profoundly affect LA function and thereby promote the occurrence of atrial fibrillation. © Springer-Verlag Berlin Heidelberg 2013.


Karabay C.Y.,Kartal Kosuyolu Yuksek Ihtisas Heart Education and Research Hospital | Kocabay G.,University of Padua | Kalayci A.,Kartal Kosuyolu Yuksek Ihtisas Heart Education and Research Hospital | Tasar O.,Kartal Kosuyolu Yuksek Ihtisas Heart Education and Research Hospital | Kirma C.,Kartal Kosuyolu Yuksek Ihtisas Heart Education and Research Hospital
Herz | Year: 2014

Stent thrombosis is an example of device-induced, platelet-mediated arterial thrombosis with a potentially fatal adverse event that often leads to myocardial infarction and/or death. The optimal treatment of patients with drug-eluting stent thrombosis in whom mechanical thrombectomy has failed is not established. This case demonstrates the usefulness of intracoronary thrombolysis after failed mechanical thrombectomy in patients with stent thrombosis. To our knowledge, this is the first report on using intracoronary thrombolysis in this specific situation. © 2014 Urban & Vogel.


Acar G.,Kartal Kosuyolu Yuksek Ihtisas Heart Education and Research Hospital | Bulut M.,Kartal Kosuyolu Yuksek Ihtisas Heart Education and Research Hospital | Arslan K.,Kartal Kosuyolu Yuksek Ihtisas Heart Education and Research Hospital | Alizade E.,Kartal Kosuyolu Yuksek Ihtisas Heart Education and Research Hospital | And 6 more authors.
Echocardiography | Year: 2013

Aim: Nondippers are known to carry a high risk of cardiovascular morbidity and mortality. The aim of this study was to investigate the effects of dipper and nondipper status of hypertension on longitudinal systolic and diastolic functions of left atrial (LA) myocardial tissue by means of two-dimensional speckle-tracking echocardiography in treated hypertensive patients. Methods: A total of 78 outpatients treated with antihypertensive drugs for at least 1 year were included in the study. The patients were classified as nondippers if their daytime ambulatory systolic and diastolic blood pressure did not decrease by at least 10% during the night. Global longitudinal LA strain/strain rate data were obtained by two-dimensional speckle imaging with automated software and compared between the groups. Results: LA volume index, left ventricular (LV) wall thickness and mass index as well as filling pressure (E/E′) were significantly higher in nondippers (all P < 0.001), whereas systolic tissue velocity (S′) was significantly lower in nondippers. They also had decreased values of mean peak LA strain (dippers = 27.6 ± 5.5% vs. nondippers = 21.5 ± 4.5%, P < 0.001), strain rate during reservoir (dippers = 1.27 ± 0.4/sec vs. nondippers = 0.98 ± 0.3/sec, P = 0.001), and conduit period (dippers = 1.41 ± 0.4/sec vs. nondippers = 1.06 ± 0.3/sec, P < 0.001). Moreover, we found that LA mechanical dysfunction was closely associated with LV mass, filling pressure, and regional LV contractility. Conclusion: Nondipping in treated hypertensive patients was associated with an adverse cardiac remodeling and impaired LA mechanical function. Further studies are warranted to demonstrate the long-term prognostic significance of these findings. © 2012, Wiley Periodicals, Inc.


Yaziciolu M.V.,Kartal Kosuyolu Yuksek Ihtisas Heart Education and Research Hospital
European review for medical and pharmacological sciences | Year: 2012

Recent findings suggest that there is a close relationship between chronic heart failure and uric acid. The aim of the study was to assess whether increased uric acid levels in patients with dilated cardiomyopathy might correlate with the degree of functional mitral regurgitation (MR). Sixty two consecutive patients diagnosed with dilated cardiomyopathy were included in the study. The patients were classified according to severity of functional MR into two groups: mild-moderate functional MR (ERO < 0.2 cm2) and severe functional MR. The patients with severe functional MR had significantly higher serum uric acid levels compared to patients without severe functional MR (6.34 ± 1.61 mg/dL vs 5.43 ± 1.17 mg/dL respectively, p = 0.012). Furthermore, tenting area, an important predictor of functional MR severity, was moderately correlated with the serum uric acid levels (r = 0.351, p = 0.005). It was also shown that the serum uric acid concentrations were inversely correlated with left ventricular (LV) ejection fraction, and positively correlated with LV volumes. There was also a significant relation between the serum uric acid and left atrial volumes and also brain natriuretic peptide (BNP) levels. In conclusion, this study demonstrates that elevated serum uric acid levels in patients with dilated cardiomyopathy are correlated with the severity of functional MR and echocardiographic volume indices.


Ozkan B.,Kartal Kosuyolu Yuksek Ihtisas Heart Education and Research Hospital | Acar G.,Kartal Kosuyolu Yuksek Ihtisas Heart Education and Research Hospital | Cakalagaoglu K.C.,Kartal Kosuyolu Yuksek Ihtisas Heart Education and Research Hospital | Koksal C.,Kartal Kosuyolu Yuksek Ihtisas Heart Education and Research Hospital | Esen A.M.,Kartal Kosuyolu Yuksek Ihtisas Heart Education and Research Hospital
Heart Surgery Forum | Year: 2012

Coronary subclavian steal syndrome refers to decreased or reversed internal mammary artery flow, which causes angina related to severe subclavian steno-occlusive disease in patients with in situ internal mammary-to-coronary artery graft. We present a 48-year-old man with cerebrovascular and peripheral artery disease and the first case in the literature of a saphenous vein graft-coronary-subclavian unidirectional steal syndrome. © 2012 Forum Multimedia Publishing, LLC.


Yildiz M.,Kartal Kosuyolu Yuksek Ihtisas Heart Education and Research Hospital | Kocabay G.,Kartal Kosuyolu Yuksek Ihtisas Heart Education and Research Hospital
Journal of Forensic and Legal Medicine | Year: 2013

Aluminium (Al) is the third most prevalent element, representing approximately 8% of total mineral components in the earth's crust (1). Chronic exposure to Al is mainly encountered at particular work places, for example, in foundries or in the Al powder industry, as an occupational exposure. In case of occupational Al exposure, inhalation is the main route of uptake. Chronic exposure to Al is associated with skeletal, neurological, hematological and lung changes. Studies regarding the Al powder industry showed that long-term inhalative exposure to Al can induce pulmonary fibrosis (2). Although there is only one report about ventricular tachycardia as a cardiac manifestation in occupationally exposed persons (3), in this report, we presented a case that had Mobitz type I second-degree atrioventricular block and nonsustained ventricular tachycardia. To our knowledge, this is the first report in chronic poisoning. © 2013 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.


Karabay C.Y.,Kartal Kosuyolu Yuksek Ihtisas Heart Education and Research Hospital | Kocabay G.,Kartal Kosuyolu Yuksek Ihtisas Heart Education and Research Hospital | Kalayci A.,Kartal Kosuyolu Yuksek Ihtisas Heart Education and Research Hospital | Zehir R.,Kartal Kosuyolu Yuksek Ihtisas Heart Education and Research Hospital | Tanboga H.,Kartal Kosuyolu Yuksek Ihtisas Heart Education and Research Hospital
Cardiology | Year: 2010

Trastuzumab is a monoclonal antibody used for the treatment of metastatic breast carcinoma in women whose tumors overexpress the human epidermal growth factor receptor-2. Although trastuzumab is generally well tolerated, cardiac toxicity has occurred as a rare but potentially serious complication that limits its use in some patients. In this study, we detected new-onset mitral regurgitation in trastuzumab-treated patients. To our knowledge, there is no report or survey on new-onset mitral regurgitation during this treatment. We discussed the possible reasons for this newly described side effect of the drug in the light of left ventricular longitudinal global strain and papillary muscle dyssynchrony of the patient by detecting two-dimensional speckle tracking echocardiography. Copyright © 2011 S. Karger AG, Basel.


PubMed | Kartal Kosuyolu Yuksek Ihtisas Heart Education and Research Hospital
Type: Journal Article | Journal: Sleep & breathing = Schlaf & Atmung | Year: 2013

Sleep deprivation (SD) is known to be associated with adverse cardiovascular events. Strain and strain rate measure the local deformation of the myocardium and have been used to evaluate atrial phasic function in various disease states. The aim of the study was to investigate whether strain rate imaging enables the identification of left atrial dysfunction in otherwise healthy young adults with acute SD which has not been studied previously.Adequate echocardiographic images of 27 healthy volunteers were obtained both after a night with regular sleep and after a night with SD. Tissue Doppler-derived strain and strain rate were measured from the apical four- and two-chamber views of the left atrium, and global values were calculated as the mean of all segments. Measurements included peak systolic strain, systolic strain rate (S-Sr), early diastolic (E-Sr) and late diastolic (A-Sr) strain rate. Phasic left atrial (LA) volumes and fractions were also calculated.There was no significant difference in the traditional parameters of atrial function and LA volumes. Subjects had similar S-Sr, A-Sr and global atrial strain values after the night of sleep debt when compared after regular sleep, whereas they had significantly reduced E-Sr values (mean (SD) 3.2 (0.7) s(-1) vs 3.7 (0.6) s(-1), p < 0.001). Moreover, global E-Sr showed a significant correlation with sleep time (r = 0.554, p < 0.001).Acute SD in healthy adults is associated with a reduction in LA early diastolic strain rate in the absence of geometric alterations or functional impairment of the left atrium, raising the possibility that chronic SD may more profoundly affect LA function and thereby promote the occurrence of atrial fibrillation.


PubMed | Kartal Kosuyolu Yuksek Ihtisas Heart Education and Research Hospital
Type: Journal Article | Journal: Perfusion | Year: 2014

During coronary artery bypass grafting (CABG), one of the most important complications related to the internal mammary artery (IMA) is perioperative spasm. Nebivolol causes endothelium-dependent vascular relaxation by increasing nitric oxide (NO) release and prevents endothelial dysfunction in long-term use. In our study, we measured the effect of a third generation beta blocker, nebivolol, on the flow dynamics of IMA grafts.We recruited 90 hypertensive patients undergoing isolated CABG operation, who were divided into three groups and each group included 30 patients: Group 1 patients were under antihypertensive treatment other than beta-blockers (angiontensin-converting enzyme [ACE] inhibitors, calcium channel blockers or diuretics; monotherapy or combination therapy), Group 2 received metoprolol (50 mg/day) and Group 3 received nebivolol (5 mg/day). These antihypertensive therapies were given for at least one week before the operation and continued thereafter. IMA blood flow volume was measured for one minute just before cardiopulmonary bypass (measurement A) and before left internal mammary artery (LIMA)-left anterior descending (LAD) artery anastomosis (measurement B) in the three groups. Cardiac output measurements were also achieved simultaneously.The measurement A results were 56.3 36.2, 54.6 28.1 and 66.8 34.2 mL/min in Groups 1, 2 and 3, respectively (p<0.05). The measurement B results were 78.3 29.6, 80 28.8 and 91.1 40.8 mL/min in Groups 1, 2 and 3 (p<0.05), respectively. There were no differences in cardiac outputs among the groups; 5.2 1.4, 5.0 1.6 and 5.3 1.1 L/min (p>0.05). While the cardiac outputs were similar within the three groups, the IMA free flow volume was higher in the nebivolol group after local papaverine use.Nebivolol might represent a good choice in hypertensive patients undergoing cardiac surgery by preventing perioperative myocardial hypoperfusion which increases early morbidity and mortality.


PubMed | Kartal Kosuyolu Yuksek Ihtisas Heart Education and Research Hospital
Type: Journal Article | Journal: European review for medical and pharmacological sciences | Year: 2013

To assess early outcome of predilatation prior stenting of severe carotid artery stenosis and to evaluate early major adverse cardiovascular and cerebral events (MACCE).The study group consisted of 265 consecutive patients (200 males, 65 female, mean age 66.7 8.6 years) in whom 275 percutaneous transluminal angioplasty (PTA) procedures of carotid arteries were performed. Staged carotid stenting was performed in patients with bilateral carotid stenosis. Neuroprotection with a distal protection device was used in all cases. The patients were divided into two groups: direct carotid stent implantation without previous pre-dilation was performed in 233 patients (direct stenting group) and predilatation was performed in 42 patients (predilatation group). Early events were recorded and analyzed subsequently.We treated 275 carotid stenoses and the stent was implanted in all patients. Ten patients (3.7%) were treated by staged carotid artery stenting (CAS) due to bilateral carotid artery disease. The technical success rate was 97.1%. During 1-month follow-up, the prevalence of primary endpoint was 2.18%. The prevalence of MACCE at 30 days was higher in the predilatation group (2.4% vs. 2.1%; p = 0.924). Also periprocedural rate of hypotension was higher in predilatation group (7.1% vs. 1.7%; p = 0.04).Balloon predilatation prior to stenting can be performed to treat severe carotid artery stenosis with acceptable periprocedural complication rate.

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