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PubMed | Hitit University, Kartal Kosuyolu Education and Research Hospital, Akdeniz University and Turkey Yuksek Ihtisas Education and Research Hospital
Type: Journal Article | Journal: The Thoracic and cardiovascular surgeon | Year: 2016

BackgroundThis pilot study aimed to evaluate the effectiveness of posterior left atrial wall plication (T-plasty) in patients with persistent atrial fibrillation (AF) (> 7 days) undergoing mitral valve surgery. Materials and MethodsA total of 60 patients who were scheduled for mitral valve replacement were randomly allocated into two groups: one would receive (Group 1; n=32, mean age; 49.379.00) and one would not receive (Group 2; n=28; mean age 48.648.6) left atrial size reduction using T-plasty technique. Patients with a clear indication for combined procedures other than tricuspid valve disease, aortic valve disease, and coronary artery stenosis were not included. Follow-up was performed at 6th, 12th, and 18th months after the operation. ResultsAfter the operation, 21 patients (65.6%) in Group 1 and 13 patients (46.4%) in Group 2 regained sinus rhythm (p=0.13). Mortality did not occur. AF recurrence rates were not significantly different between the groups in three follow-ups. Restoration of sinus rhythm was significantly more common in Group 1 patients than in Group 2 patients during follow-up. Patients in Group 1 had lower left atrial volume indexes than those in Group 2 at the 6th and 12th months, whereas the difference at the 18th month was at the limit of significance. ConclusionWe achieved satisfactory results using the T-plasty technique for left atrial size reduction in terms of mid-term restoration and preservation of normal sinus rhythm in patients undergoing mitral valve surgery. Further study may be justified to reveal the prognostic importance of the technique described herein.


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.


PubMed | Yozgat State Hospital and Turkey Yuksek Ihtisas Education and Research Hospital
Type: Journal Article | Journal: Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing | Year: 2016

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.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.Mean age of patients were 51.87.7 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 (20.742.67 vs 22.392.21, 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.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.


PubMed | Yozgat State Hospital and Turkey Yuksek Ihtisas Education and Research Hospital
Type: | Journal: Angiology | Year: 2016

We investigated the relationship between resting heart rate (HR) and The Synergy between percutaneous coronary intervention with Taxus and cardiac surgery (SYNTAX) score in patients with stable coronary artery disease (SCAD). A total of 420 patients who were admitted to our outpatient clinic for stable angina pectoris with sinus rhythm and had at least 50% narrowing in at least 1 coronary artery after coronary angiography were included in the study. Patients were divided into 3 tertiles based on the resting HR: HR of tertile 1 was 65 (n = 138), tertile 2 was between 66 and 76 (n = 139), and tertile 3 was 77 beats/min (n = 143). The SYNTAX score (7.6 4.6, 12.4 5.6, 20.3 8.1; P < .001) was significantly higher for those in tertile 3 than for those in tertiles 1 and 2. Leukocyte count (7.8 2.2, 7.9 2.2, 8.4 2.3 10


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.


Demirkan B.,Turkey Yuksek Ihtisas Education and Research Hospital | Guray Y.,Turkey Yuksek Ihtisas Education and Research Hospital | Guray U.,Turkey Yuksek Ihtisas Education and Research Hospital | Ege M.R.,Turkey Yuksek Ihtisas Education and Research Hospital | And 3 more authors.
Herz | Year: 2013

Background and aim of the study: The predisposition to atrial fibrillation (AF) in mitral stenosis (MS) has been demonstrated with several electrocardiographic (increased P-wave dispersion) and echocardiographic parameters (atrial electromechanical delay). Despite the improvement in P-wave dispersion after percutaneous mitral balloon valvuloplasty (PMBV), the changes in echocardiographic parameters related to AF risk are unknown. In this study we aimed to investigate the acute effect of PMBV on atrial electromechanical delay (EMD) assessed by tissue Doppler echocardiography in addition to electrocardiographic parameters. Materials and methods: This single-center study consisted of 30 patients with moderate or severe MS (23 females and seven males, aged 36.5 ± 8.5 years, with a mean MVA of 1.1 ± 0.2 cm 2) who underwent successful PMBV without complication at our clinic and 20 healthy volunteers from hospital staff as a control group (16 females and four males, aged 35.4 ± 6 years). We compared the two groups in regard to clinical, electrocardiographic and echocardiographic features. The patients with MS were also evaluated after PMBV within 72 h of the procedure. The P-wave dispersion was calculated from12-lead ECG. Interatrial and intra-atrial EMDs were measured by tissue Doppler echocardiography. These ECG and echocardiographic parameters after PMBV were compared with previous values. Results: The maximum P-wave duration (138 ± 15 vs. 101 ± 6 ms, p < 0.01), PWD (58 ± 18 vs 23 ± 4, p < 0.01), the interatrial (55 ± 16 vs 36 ± 11 ms, p < 0.01) and left-sided intra-atrial EMD (40 ± 11 vs 24 ± 12 ms, p < 0.01) were higher in patients with MS than in healthy subjects. The left atrial (LA) diameter, LA volume and LA volume index had positive association with the interatrial (r = 0.5, p < 0.01; r = 0.5, p < 0.01 and r = 0.5, p < 0.01, respectively) and left-sided intra-atrial EMD (r = 0.5, p < 0.01; r = 0.4, p < 0.01; r = 0.4, p < 0.01 respectively). After PMBV, the interatrial (55 ± 16 vs. 40 ± 11 ms, p < 0.01) and left-sided intra-atrial EMD (40 ± 11 vs 31 ± 10, p < 0.01) showed significant improvement compared to previous values. There was also a statistically significant difference in maximum P-wave duration and PWD between pre-and post-PMBV (138 ± 15 vs 130 ± 14, p < 0.01, and 58 ± 18 vs 49 ± 16, p < 0.01, respectively). Conclusions: Our study shows that PMBV has a favorable effect on the electrocardiographic and echocardiographic parameters related with AF risk in patients with MS. © 2012 Urban & Vogel, Muenchen.


PubMed | Turkey Yuksek Ihtisas Education and Research Hospital
Type: Journal Article | Journal: Coronary artery disease | Year: 2016

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.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.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.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.


PubMed | Turkey Yuksek Ihtisas Education and Research Hospital
Type: Journal Article | Journal: Scandinavian cardiovascular journal : SCJ | Year: 2015

Epicardial adipose tissue (EAT) is the ectopic fat surrounding the heart, and it may contribute to coronary collateral vessel (CCV) formation. We aimed to evaluate the association of EAT with the presence of CCV in patients with acute coronary syndrome (ACS).A total of 230 patients with ACS were included. The CCVs were graded according to the Rentrop scoring system, and a Rentrop grade 0-1 was accepted as low-grade CCV group, Rentrop grade 2-3 was accepted as high-grade CCV group.According to angiography, 70 (30%) patients constituted the high-grade CCV group and 160 (70%) constituted the low-grade CCV group. The high-grade CCV group had thicker EAT than the low-grade CCV group (6.1 1.4 vs. 5.3 1.4 mm; p = 0.001). Multivariate logistic regression analysis showed that presence of CCV was independently associated with EAT thickness, ejection fraction, presenting with ST-segment elevation myocardial infarction, and presence of angina on admission. EAT thickness of > 5.7 mm can independently predict high-grade CCV with 73% sensitivity and 69% specificity (area under the curve or AUC: 0.65; 95% confidence interval or CI: 0.57-0.72).EAT thickness on admission was associated with the presence of CCVs in patients with ACS.


PubMed | Turkey Yuksek Ihtisas Education and Research Hospital
Type: Journal Article | Journal: Coronary artery disease | Year: 2015

A growing body of evidence supports an association between vitamin D and cardiovascular diseases. Coronary artery bypass grafting surgery is a treatment modality for suitable patients with coronary artery disease; however, patency rates of saphenous vein grafts (SVGs) are low. In this study we aimed to determine the association between vitamin D levels and the SVG disease.The study population included 180 patients who had undergone a primary coronary artery bypass grafting surgery with at least one SVG and later had a control angiography because of clinical indications. Patients were divided into two groups: 100 patients with SVG disease and 80 of them with patent SVG.The mean age of 180 patients was 57.48.8 years, and 64.4% of the study population were men. The total number of SVGs was 364, and the mean number of SVGs to each patient was 2.020.61. Vitamin D levels were higher in the patent SVG group than in the SVG disease group (36.210.7 and 21.110.4, respectively; P<0.001). C-reactive protein levels were significantly higher in the SVG disease group (8.3 vs. 6.5mg/dl, P=0.001). In a multivariate regression analysis, current smoking, diabetes mellitus, target artery diameter less than 1.5mm, bypass time duration, and vitamin D levels remained as independent factors associated with SVG disease.Lower vitamin D levels are associated with occlusion of SVGs in patients with coronary artery disease.


PubMed | Van Ercis State Hospital and Turkey Yuksek Ihtisas Education and Research Hospital
Type: Journal Article | Journal: Angiology | Year: 2016

We investigated the relationship between epicardial adipose tissue (EAT) and infarct-related artery (IRA) patency before mechanical reperfusion in patients with ST-segment elevation myocardial infarction (STEMI). Patients (n = 640) were divided into 2 groups based on the thrombolysis in myocardial infarction (TIMI) flow grade. Impaired flow was defined as TIMI grades 0, 1, and 2, and normal flow was defined as TIMI 3. On the admission angiography, 65 (10.2%) patients had TIMI 3 flow, and the remaining 575 (89.8%) had TIMI 0, 1, or 2 flow. The impaired flow group patients had a higher incidence of diabetes mellitus (53.7% vs 41.5%, P = .035), higher EAT thickness (5.66 1.84 vs 4.87 2.09 mm, P = .001), and lower ejection fraction (43.1% 8.9% vs 47.4% 9.1%, P = .025). Multivariate stepwise logistic regression analysis showed that IRA patency was independently associated with EAT thickness (odds ratio [OR] 0.785; 95% confidence interval [CI] 0.712-0.858; P = .001) and neutrophil-lymphocyte ratio (OR 0.815; 95% CI 0.732-0.917; P = .025). Thickness of EAT was an independent predictor of lower TIMI flow in IRA in patients with STEMI.

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