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Cagirci G.,Antalya Education and Research Hospital | Cay S.,Turkey Yuksek Ihtisas Education and Research Hospital | Gulsoy K.G.,Diskapi Yildirim Beyazit Research and Educational Hospital | Bayindir C.,Diskapi Yildirim Beyazit Research and Educational Hospital | And 6 more authors.
Journal of Electrocardiology | Year: 2011

Objectives: Obstructive sleep apnea (OSA) has been reported to be associated with an increased risk of atrial fibrillation. The aim of this study was to investigate atrial electromechanical couplings in patients with OSA and the relationship between these parameters and P-wave dispersion (Pd). Methods: One hundred twenty-six patients were enrolled in this study. All patients underwent polysomnographic examination. The apnea-hypopnea index (AHI) was defined as the number of apneas and hypopneas per hour of sleep. An AHI score of 5 or more was diagnosed as OSA, and an AHI score of less than 5 was diagnosed as OSA (-). Thirty-nine of the patients had an AHI score of less than 5 (group 1), 42 of the patients had AHI score between 5 and 30 (mild and moderate, group 2), 45 of the patients had an AHI score more than 30 (severe, group 3). Atrial electromechanical coupling (PA), intra-atrial, and interatrial electromechanical delay were measured with tissue Doppler imaging. P-wave dispersion was calculated from 12-lead electrocardiogram. Results: Maximum P-wave duration was higher in group 3 compared with groups 2 and 1 (126.0 ± 16.7 vs 111.0 ± 12.5 [P < .001] and 126.0 ± 16.7 vs 99.9 ± 10.0 [P < .001], respectively). Maximum P-wave duration was higher in group 2 than in group 1 (111.0 ± 12.5 vs 99.9 ± 10.0, P < .001). P-wave dispersion was higher in group 3 compared with groups 2 and 1 (50.9 ± 11.5 vs 37.0 ± 8.6 [P < .001] and 50.9 ± 11.5 vs 27.9 ± 6.8 [P < .001], respectively). P-wave dispersion was higher in group 2 than in group 1 (37.0 ± 8.6 vs 27.9 ± 6.8, P < .001). Minimum P-wave duration did not differ between the groups. Atrial PA at the left lateral mitral annulus (lateral PA), septal mitral annulus (septal PA), and right ventricular tricuspid annulus (RV PA) were significantly higher in group 3 than in group 2 (P < .001, P = .001, and P = .009, respectively). Lateral PA, septal PA, and RV PA were higher in group 2 compared with group 1 (P < .001, P = .003, and P = .009, respectively). Interatrial electromechanical delay (lateral PA - RV PA) was significantly longer in group 3 compared with groups 2 and 1 (33.6 ± 12.1 vs 22.4 ± 9.4 [P < .001] and 33.6 ± 12.1 vs 14.9 ± 9.2 [P < .001], respectively). Interatrial electromechanical delay was longer in group 2 than in group 1 (22.4 ± 9.4 vs 14.9 ± 9.2, P = .001). There was a positive correlation between AHI and Pd, lateral PA, septal PA, RV PA, interatrial electromechanical delay, and left-sided intra-atrial electromechanical delay. Conclusion: Prolongation of electromechanical delay and increased Pd are associated with apnea-hypopnea index (AHI) and hence the severity of disease. © 2011 Elsevier Inc. All rights reserved. Source


Unal S.,Turkey Yuksek Ihtisas Education and Research Hospital
Coronary Artery Disease | Year: 2016

OBJECTIVE: The CHA2DS2-VASc score is used to estimate thromboembolic risk in atrial fibrillation (AF). Its usefulness in predicting outcome in patients after a percutaneous coronary intervention is unknown. We aimed to evaluate the predictive value of the CHA2DS2-VASc score in AF-free patients who have undergone stent implantation. DESIGN: Patients were evaluated retrospectively. Among the 1371 patients, 38 presented with acute stent thrombosis (ST) and were included in the study. The CHA2DS2-VASc score was calculated before percutaneous coronary intervention and the association between the score and stent thrombosis was investigated. RESULTS: The patients were grouped into ST (+) and ST (−). The average CHA2DS2-VASc score for the ST (+) group was 3.79, whereas that for the ST (–) group was 2.16 (P<0.001). A direct correlation was observed between CHA2DS2-VASc scores and the rate of ST. When patients with a CHA2DS2-VASc score of greater than 2 were compared with those with a CHA2DS2-VASc score of up to 2, the higher score had a higher frequency of ST (P<0.001) and multivariate analysis identified the CHA2DS2-VASc score as an independent predictor of acute ST. CONCLUSION: A CHA2DS2-VASc score of greater than 2 was found to be an independent predictor for incidence of ST. The role of the CHA2DS2-VASc score in predicting ST has not been investigated earlier in an AF-free population and our study is the first to explore this aspect. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. Source


Ylmaz S.,Cardiology Clinic | Kuyumcu M.S.,Turkey Yuksek Ihtisas Education and Research Hospital | Akboga M.K.,Turkey Yuksek Ihtisas Education and Research Hospital | Sen F.,Turkey Yuksek Ihtisas Education and Research Hospital | And 5 more authors.
Journal of Interventional Cardiac Electrophysiology | Year: 2016

Purpose: Endothelial dysfunction plays a major role in erectile dysfunction (ED). Atrial fibrillation (AF), regardless of subtype, is associated with a prothrombotic state, which is related to endothelial dysfunction. In this study, we aimed to determine whether AF is an independent risk factor for ED. Methods: A total of 50 patients diagnosed with paroxysmal lone AF and 80 age-, gender-, and body mass index-matched controls without AF who admitted to outpatient clinics at a tertiary center were enrolled. Diagnosis of ED was performed by using Sexual Health Inventory for Men (SHIM) questionnaire. Patients with a SHIM score ≤21 were defined as having ED. Results: Mean age of patients were 51.8 ± 7.7 and all of the study population were male. Twenty-nine of 50 patients in lone AF group and 25 of 80 patients in control group were diagnosed with ED (58 vs 31.2 %, p = 0.002). Mean SHIM score was significantly lower in lone AF group compared with controls (20.74 ± 2.67 vs 22.39 ± 2.21, p < 0.001). The multivariate stepwise logistic regression analyses showed that lone AF (OR 1.94 (1.44–2.46), p < 0.001), smoking (OR 1.92 (1.35–2.44), p = 0.003), fasting blood glucose (OR 1.51 (1.10–1.85), p = 0.012), and uric acid levels (OR 1.56 (1.13–1.92), p = 0.009) were independent predictors of ED. Conclusions: Beat-to-beat variation may lead to ED in patients with paroxysmal lone AF and questioning erectile function in patients with lone AF may be recommended. © 2016 Springer Science+Business Media New York Source


Yilmaz S.,Turkey Yuksek Ihtisas Education and Research Hospital | Canpolat U.,Turkey Yuksek Ihtisas Education and Research Hospital | Aydogdu S.,Turkey Yuksek Ihtisas Education and Research Hospital | Abboud H.E.,University of Texas Health Science Center at San Antonio
Korean Circulation Journal | Year: 2015

Patients with diabetes have an increased risk for development of cardiomyopathy, even in the absence of well known risk factors like coronary artery disease and hypertension. Diabetic cardiomyopathy was first recognized approximately four decades ago. To date, several pathophysiological mechanisms thought to be responsible for this new entity have also been recognized. In the presence of hyperglycemia, non-enzymatic glycosylation of several proteins, reactive oxygen species formation, and fibrosis lead to impairment of cardiac contractile functions. Impaired calcium handling, increased fatty acid oxidation, and increased neurohormonal activation also contribute to this process. Demonstration of left ventricular hypertrophy, early diastolic and late systolic dysfunction by sensitive techniques, help us to diagnose diabetic cardiomyopathy. Traditional treatment of heart failure is beneficial in diabetic cardiomyopathy, but specific strategies for prevention or treatment of cardiac dysfunction in diabetic patients has not been clarified yet. In this review we will discuss clinical and experimental studies focused on pathophysiology of diabetic cardiomyopathy, and summarize diagnostic and therapeutic approaches developed towards this entity. © 2015 The Korean Society of Cardiology. Source


Cagirci G.,Diskapi Yildirim Beyazit Research and Educational Hospital | Cay S.,Turkey Yuksek Ihtisas Education and Research Hospital | Canga A.,Turkey Yuksek Ihtisas Education and Research Hospital | Karakurt O.,Diskapi Yildirim Beyazit Research and Educational Hospital | And 6 more authors.
Journal of Cardiovascular Medicine | Year: 2011

OBJECTIVES: Aortic valve stenosis is the most common valvular heart disease in the Western world. The most common cause of aortic valve stenosis in adults is calcification of a normal trileaflet or congenital bicuspid valve. Calcific aortic valve stenosis is an active disease process characterized by mechanical stress, endothelial damage, lipid accumulation, inflammation, synthesis of extracellular matrix proteins, and calcification, reminiscent of atherosclerosis in many aspects. Asymmetrical dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide synthase which reduces the bioavailability of nitric oxide and begets endothelial dysfunction. The goal of this study was to examine the association between ADMA activity and severity of aortic valve stenosis. METHODS: One hundred and nine patients were included in this study. Patients were grouped as those with mild aortic stenosis (42 patients, group 1), moderate aortic stenosis (36 patients, group 2), and severe aortic stenosis (31 patients, group 3). ADMA activity was measured by ELISA kit. RESULTS: Mean ADMA activity in group 3 was significantly higher than that in groups 1 and 2 (1.94 ± 0.45 vs. 0.87 ± 0.37 μmol/l, P < 0.001 and 1.94 ± 0.45 vs. 1.34 ± 0.52 μmol/l, P < 0.001, respectively). Serum ADMA activity was positively correlated with mean aortic gradient and maximum aortic gradient and negatively correlated with aortic valve area. CONCLUSION: Our results showed that serum ADMA activity is higher in patients with severe aortic valve stenosis. ADMA activity is positively correlated with aortic valve stenosis severity. Serum ADMA level may be used as a precious marker to evaluate and follow up the severity of aortic valve stenosis. © 2011 Italian Federation of Cardiology. Source

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