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Zencirci A.E.,Siyami Ersek Cardiovascular and Thoracic Surgery Training and Research Hospital | Zencirci E.,Acibadem Maslak Hospital | Degirmencioglu A.,Acibadem University | Erdem A.,Siyami Ersek Cardiovascular and Thoracic Surgery Training and Research Hospital | And 7 more authors.
Hellenic Journal of Cardiology | Year: 2015

Introduction: The determinants of clinical outcomes in patients with acute ST-elevation myocardial infarction (STEMI) are still being debated. The aim of this study was to investigate the prognostic value of the no-reflow phenomenon and epicardial adipose tissue (EAT) thickness for clinical outcomes in patients undergoing primary percutaneous coronary intervention (pPCI) for STEMI. Methods: The present study prospectively included 114 consecutive patients (mean age 54 ± 10 years, 15 women) who underwent successful pPCI. Patients were divided into two groups according to the occurrence of the no-reflow phenomenon and further subdivided according to the tertile of EAT thickness (Group I <5.1 mm, Group II ≥5.1 mm). We assessed the composite and separate occurrence of major adverse cardiac events. Results: Throughout the 3-year follow up, the number of admissions for heart failure was significantly higher in patients with no-reflow (n=5 [20%] vs. n=1 [1%], p=0.003) and in female patients (n=4 [26%] vs. n=2 [2%], p=0.004). In the subgroup analysis, group I patients with no-reflow showed a higher frequency of admission for heart failure (n=4 [44%] vs. n=1 [6%], p=0.04). However, multivariate logistic regression analysis demonstrated that only no-reflow and female sex independently predicted admission for heart failure (OR: 19.3, 95%CI: 1.4-269.7, p=0.03, and OR: 24.9, 95%CI: 2.2-288.8, p=0.01, respectively). Conclusion: No-reflow and female sex are independent predictors of admission for heart failure in the longterm follow up of patients with STEMI. However, EAT thickness is not associated with clinical outcomes after pPCI. © 2015, Hellenic Cardiological Society. All rights reserved.


Zencirci E.,Acibadem Maslak Hospital | Zencirci A.E.,Siyami Ersek Cardiovascular and Thoracic Surgery Training and Research Hospital | Degirmencioglu A.,Acibadem University | Karakus G.,Acibadem Maslak Hospital | And 9 more authors.
Heart and Vessels | Year: 2014

The relationship between epicardial adipose tissue (EAT) and coronary artery disease has been predominantly demonstrated in the last two decades. The aim of this study was to investigate the predictive value of EAT thickness on ST-segment resolution that reflects myocardial reperfusion in patients undergoing primary percutaneous coronary intervention (pPCI) for acute ST-segment elevation myocardial infarction (STEMI). The present study prospectively included 114 consecutive patients (mean age 54 ± 10 years, range 35-83, 15 women) with first acute STEMI who underwent successful pPCI. ST-segment resolution (ΔSTR) <70 % was accepted as ECG sign of no-reflow phenomenon. The EAT thickness was measured by two-dimensional echocardiography. EAT thickness was increased in patients with no-reflow (3.9 ± 1.7 vs. 5.4 ± 2, p = 0.001). EAT thickness was also found to be inversely correlated with ΔSTR (r = -0.414, p = 0.001). Multivariate logistic regression analysis demonstrated that EAT thickness independently predicted no-reflow (OR 1.43, 95 % CI 1.13-1.82, p = 0.003). Receiver operating characteristic curve analysis demonstrated good diagnostic accuracy for EAT thickness in predicting no-reflow [area under curve (AUC) = 0.72, 95 % CI 0.63-0.82, p < 0.001]. In conclusion, increased EAT thickness may play an important role in the prediction of no-reflow in STEMI treated with pPCI. © 2014 Springer Japan.


Zencirci E.,Umraniye Training and Research Hospital | Gunduz S.,Umraniye Training and Research Hospital | Zencirci A.E.,Siyami Ersek Cardiovascular and Thoracic Surgery Training and Research Hospital | Gunduz N.,Iskenderun State Hospital | And 2 more authors.
Annals of Thoracic Surgery | Year: 2012

We report a case of a young man with a very rare cause of atypical chest pain in whom primary mediastinal embryonal carcinoma causing extrinsic pulmonary stenosis was diagnosed with echocardiography and computed tomography. This patient illustrates an unusual presentation of the very rapid progression of the tumor in as little as 6 months. The patient underwent surgical resection and was successfully treated with adjuvant chemotherapy. © 2012 The Society of Thoracic Surgeons.


Arugaslan E.,Dr Siyami Ersek Cardiovascular And Thoracic Surgery Training And Research Hospital | Karaca M.,Dr Siyami Ersek Cardiovascular And Thoracic Surgery Training And Research Hospital | Ozcan K.S.,Dr Siyami Ersek Cardiovascular And Thoracic Surgery Training And Research Hospital | Zengin A.,Dr Siyami Ersek Cardiovascular And Thoracic Surgery Training And Research Hospital | And 6 more authors.
Turk Kardiyoloji Dernegi Arsivi | Year: 2016

Objective: Therapeutic hypothermia improves neurologic prognosis after cardiac arrest. The aim of this study was to report clinical experience with intravascular method of cooling in patients with cardiac arrest resulting from ST-segment elevation myocardial infarction (STEMI). Methods: Thirteen patients (11 male, 2 famele; mean age was 39.6±9.4 years) who had undergone mild therapeutic hypothermia (MTH) by intravascular cooling after cardiac arrest due to STEMI were included. Clinical, demographic, and procedural data were analyzed. Neurologic outcome was assessed by Cerebral Performance Category (CPC) score. Results: Anterior STEMI was observed in 9 patients. One patient died of cardiogenic shock complicating STEMI. Mean cardiopulmonary resuscitation (CPR) duration and door-toinvasive cooling were 32.9±20.1 and 286.1±182.3 minutes, respectively. Precooling Glasgow Coma Scale score was 3 in 9 subjects. Twelve patients were discharged, 11 with CPC scores of 1 at 1-year follow-up. No major complication related to procedure was observed. Conclusion: In comatose survivors of STEMI, therapeutic hypothermia by intravascular method is a feasible and safe treatment modality. © 2016 Turkish Society of Cardiology.


PubMed | Istanbul University, Siyami Ersek Cardiovascular and Thoracic Surgery Training and Research Hospital and Dr Siyami Ersek Cardiovascular And Thoracic Surgery Training And Research Hospital
Type: Journal Article | Journal: Turk Kardiyoloji Dernegi arsivi : Turk Kardiyoloji Derneginin yayin organidir | Year: 2016

Therapeutic hypothermia improves neurologic prognosis after cardiac arrest. The aim of this study was to report clinical experience with intravascular method of cooling in patients with cardiac arrest resulting from ST-segment elevation myocardial infarction (STEMI).Thirteen patients (11 male, 2 famele; mean age was 39.69.4 years) who had undergone mild therapeutic hypothermia (MTH) by intravascular cooling after cardiac arrest due to STEMI were included. Clinical, demographic, and procedural data were analyzed. Neurologic outcome was assessed by Cerebral Performance Category (CPC) score.Anterior STEMI was observed in 9 patients. One patient died of cardiogenic shock complicating STEMI. Mean cardiopulmonary resuscitation (CPR) duration and door-to-invasive cooling were 32.920.1 and 286.1182.3 minutes, respectively. Precooling Glasgow Coma Scale score was 3 in 9 subjects. Twelve patients were discharged, 11 with CPC scores of 1 at 1-year follow-up. No major complication related to procedure was observed.In comatose survivors of STEMI, therapeutic hypothermia by intravascular method is a feasible and safe treatment modality.


Gungor B.,Siyami Ersek Cardiovascular and Thoracic Surgery Training and Research Hospital | Yilmaz H.,Siyami Ersek Cardiovascular and Thoracic Surgery Training and Research Hospital | Ekmekci A.,Siyami Ersek Cardiovascular and Thoracic Surgery Training and Research Hospital | Ozcan K.S.,Siyami Ersek Cardiovascular and Thoracic Surgery Training and Research Hospital | And 7 more authors.
Journal of Cardiology | Year: 2014

Background: Atherosclerosis and arterial stiffening may coexist and the correlation of these parameters in patients with premature coronary artery disease (CAD) has not been well elucidated. Tissue Doppler imaging of the ascending aorta may be used in the assessment of elastic properties of the great arteries. Objective: To investigate the correlation between aortic stiffness and premature CAD using parameters derived from two-dimensional and tissue Doppler imaging (TDI) echocardiography of the ascending aorta. Methods: Fifty consecutive subjects younger than 40 years old who were hospitalized with diagnosis of acute coronary syndrome and had undergone coronary angiography were recruited. The control group included 70 age-sex matched individuals without a diagnosis of CAD. Aortic stiffness index (SI), aortic distensibility (D), and pressure-strain elastic modulus (Ep) were calculated from the aortic diameters measured by two-dimensional M-mode echocardiography and blood pressure obtained by sphygmomanometry. Aortic systolic velocity (SAo), and early (EAo) and late (AAo) diastolic velocities were determined by pulse-wave TDI from the anterior wall of ascending aorta 3cm above the aortic cusps in parasternal long-axis view. Results: Stiffness index was higher [median 5.40, interquartile range (IQR) 5.98 vs. median 4.14 IQR 2.43; p=0.03] and distensibility was lower (median 2.86×10-6cm2/dyn, IQR 2.51×10-6cm2/dyn vs. median 3.46×10-6cm2/dyn, IQR 2.38×10-6cm2/dyn; p=0.04) in patients with CAD compared to the control group. EAo was significantly lower in the CAD group (7.2±1.8cm/s vs. 9.2±2.4cm/s, p<0.01). The difference in EAo remained significant when CAD patients with a left ventricular ejection fraction >55% was compared to the control group. SAo and AAo velocities of ascending aorta were similar in control and CAD groups. There was a significant correlation between EAo velocity and aortic stiffness index (r=-0.28, p=0.01), distensibility (r=0.19, p=0.04) and elastic modulus (r=-0.24, p=0.01). In multivariate regression analysis, decreased levels of high-density lipoprotein cholesterol [odds ratio (OR): 1.12 95% CI 1.06-1.19; p=0.01] and EAo (OR: 1.41 95% CI 1.12-1.79; p=0.01) measurements remained as the variables independently correlated with premature CAD in the study group. Conclusion: Arterial stiffness is increased in patients with premature CAD. EAo of the anterior wall of ascending aorta measured with pulse-wave TDI echocardiography is correlated with arterial stiffening and is decreased in patients with premature CAD. © 2013 Japanese College of Cardiology.


Ilhan E.,Van Ercis State Hospital | Guvenc T.S.,Kafkas University | Altay S.,Siyami Ersek Cardiovascular and Thoracic Surgery Training and Research Hospital | Cagdas M.,Siyami Ersek Cardiovascular and Thoracic Surgery Training and Research Hospital | And 6 more authors.
Coronary Artery Disease | Year: 2012

OBJECTIVES: Recent studies have reported a strong independent association between increased red cell distribution width (RDW) and the risk of adverse outcomes in patients with heart failure, stable coronary disease, and acute coronary syndromes. However, in this study we aimed to determine the impact of an elevated RDW level on the postinterventional thrombolysis in myocardial infarction (TIMI) flow and intrahospital mortality in patients with acute anterior myocardial infarction (AMI). METHODS: A total of 763 patients with acute AMI undergoing a primary percutaneous coronary intervention were evaluated retrospectively. Upon admission, the RDW level was measured by an automated complete blood count. Postinterventional TIMI flow and intrahospital mortality was documented for all patients from hospital registries. The patients were classified according to the RDW level. RDW more than 14.8% was defined as elevated RDW. All groups were compared statistically according to the preinterventional characteristics. RESULTS: Elevated RDW was found to be an independent predictor of increased intrahospital mortality in multivariate regression analysis (hazard ratio: 3.677, 95% confidence interval: 1.228-11.008, P=0.02). Other independent predictors for intrahospital mortality were diabetes mellitus (hazard ratio: 6.743, 95% confidence interval: 1.941-23.420, P=0.003), smoking (hazard ratio: 6.779, 95% confidence interval: 1.505-30.534, P=0.013), and creatinine more than 0.8 mg/dl (hazard ratio: 7.982, 95% confidence interval: 1.759-36.211, P=0.007). However, there were no independent predictors for TIMI including elevated RDW. CONCLUSION: A high admission RDW level in patients with acute AMI undergoing a primary percutaneous coronary intervention was associated with an increased risk for intrahospital cardiovascular mortality, but was not associated with worse postinterventional TIMI flow.© 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.


PubMed | Siyami Ersek Cardiovascular and Thoracic Surgery Training and Research Hospital
Type: Journal Article | Journal: Journal of cardiology | Year: 2014

Atherosclerosis and arterial stiffening may coexist and the correlation of these parameters in patients with premature coronary artery disease (CAD) has not been well elucidated. Tissue Doppler imaging of the ascending aorta may be used in the assessment of elastic properties of the great arteries.To investigate the correlation between aortic stiffness and premature CAD using parameters derived from two-dimensional and tissue Doppler imaging (TDI) echocardiography of the ascending aorta.Fifty consecutive subjects younger than 40 years old who were hospitalized with diagnosis of acute coronary syndrome and had undergone coronary angiography were recruited. The control group included 70 age-sex matched individuals without a diagnosis of CAD. Aortic stiffness index (SI), aortic distensibility (D), and pressure-strain elastic modulus (Ep) were calculated from the aortic diameters measured by two-dimensional M-mode echocardiography and blood pressure obtained by sphygmomanometry. Aortic systolic velocity (SAo), and early (EAo) and late (AAo) diastolic velocities were determined by pulse-wave TDI from the anterior wall of ascending aorta 3cm above the aortic cusps in parasternal long-axis view.Stiffness index was higher [median 5.40, interquartile range (IQR) 5.98 vs. median 4.14 IQR 2.43; p=0.03] and distensibility was lower (median 2.8610(-6)cm(2)/dyn, IQR 2.5110(-6)cm(2)/dyn vs. median 3.4610(-6)cm(2)/dyn, IQR 2.3810(-6)cm(2)/dyn; p=0.04) in patients with CAD compared to the control group. EAo was significantly lower in the CAD group (7.21.8cm/s vs. 9.22.4cm/s, p<0.01). The difference in EAo remained significant when CAD patients with a left ventricular ejection fraction >55% was compared to the control group. SAo and AAo velocities of ascending aorta were similar in control and CAD groups. There was a significant correlation between EAo velocity and aortic stiffness index (r=-0.28, p=0.01), distensibility (r=0.19, p=0.04) and elastic modulus (r=-0.24, p=0.01). In multivariate regression analysis, decreased levels of high-density lipoprotein cholesterol [odds ratio (OR): 1.12 95% CI 1.06-1.19; p=0.01] and EAo (OR: 1.41 95% CI 1.12-1.79; p=0.01) measurements remained as the variables independently correlated with premature CAD in the study group.Arterial stiffness is increased in patients with premature CAD. EAo of the anterior wall of ascending aorta measured with pulse-wave TDI echocardiography is correlated with arterial stiffening and is decreased in patients with premature CAD.

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