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Öğe The angiographic correlation between ST segment depression in noninfarcted leads and the extent of coronary artery disease in patients with acute inferior myocardial infarction: A clue for multivessel disease(Elsevier Science Inc, 2003) Zoghi, M; Gurgun, C; Yavuzgil, O; Turkoglu, I; Kultursay, H; Akilli, A; Akin, M; Turkoglu, CBACKGROUND: Although reciprocal ST segment depression (RSTD) in patients with acute inferior myocardial infarction is a common electrocardiogram finding, its significance is not yet established. In this prospective study, the relationship between RSTD and the extent of coronary artery disease (CAD) was investigated. PATIENTS AND METHODS: One hundred eighty-eight patients with acute inferior myocardial infarction who received thrombolytic therapy were enrolled in this study. The magnitude and location of ST segment depression in noninfarcted leads and the maximum ST segment elevation (STEmax) in inferior leads were measured. All patients were divided into two main groups according to the presence of RSTD and five subgroups according to the location of RSTD, the maximum RSTD and the STEmax. The coronary angiography was performed in all patients 28 4 days after acute myocardial infarction. RESULTS: There were no significant differences in the proportion of coronary disease risk factors in patients with, versus those without, RSTD (P=0.6). Multivessel CAD was present in 63 of the 108 (58%) patients with RSTD and in 32 of the 80 (40%) patients with no RSTD (P=0.02). According to the location of reciprocal changes, multivessel disease was present in significantly more patients with anterior RSTD concomitant with or without lateral ST segment depression (P=0.01 and P=0.03, respectively); the proportion of single vessel disease was greater in patients with only lateral RSTD (P=0.02). In addition, the presence of anterior RSTD to a greater magnitude than the STEmax in inferior myocardial infarction increases the likelihood of multivessel disease (P=0.006). CONCLUSIONS: The presence of RSTD during an acute inferior myocardial infarction correlates with the presence of multivessel CAD and may not be only an electrical phenomenon.Öğe The angiographic correlation between ST segment depression in noninfarcted leads and the extent of coronary artery disease in patients with acute inferior myocardial infarction: A clue for multivessel disease(Elsevier Science Inc, 2003) Zoghi, M; Gurgun, C; Yavuzgil, O; Turkoglu, I; Kultursay, H; Akilli, A; Akin, M; Turkoglu, CBACKGROUND: Although reciprocal ST segment depression (RSTD) in patients with acute inferior myocardial infarction is a common electrocardiogram finding, its significance is not yet established. In this prospective study, the relationship between RSTD and the extent of coronary artery disease (CAD) was investigated. PATIENTS AND METHODS: One hundred eighty-eight patients with acute inferior myocardial infarction who received thrombolytic therapy were enrolled in this study. The magnitude and location of ST segment depression in noninfarcted leads and the maximum ST segment elevation (STEmax) in inferior leads were measured. All patients were divided into two main groups according to the presence of RSTD and five subgroups according to the location of RSTD, the maximum RSTD and the STEmax. The coronary angiography was performed in all patients 28 4 days after acute myocardial infarction. RESULTS: There were no significant differences in the proportion of coronary disease risk factors in patients with, versus those without, RSTD (P=0.6). Multivessel CAD was present in 63 of the 108 (58%) patients with RSTD and in 32 of the 80 (40%) patients with no RSTD (P=0.02). According to the location of reciprocal changes, multivessel disease was present in significantly more patients with anterior RSTD concomitant with or without lateral ST segment depression (P=0.01 and P=0.03, respectively); the proportion of single vessel disease was greater in patients with only lateral RSTD (P=0.02). In addition, the presence of anterior RSTD to a greater magnitude than the STEmax in inferior myocardial infarction increases the likelihood of multivessel disease (P=0.006). CONCLUSIONS: The presence of RSTD during an acute inferior myocardial infarction correlates with the presence of multivessel CAD and may not be only an electrical phenomenon.Öğe Anterior myocardial infarction in an adult patient with left ventricular hypertrabeculation/noncompaction(Elsevier Ireland Ltd, 2006) Yavuzgil, O; Gurgun, C; Cinar, CS; Yuksel, AÖğe Cardiovascular involvement in Behcet's disease(Japan Heart Journal, Second Dept Of Internal Med, 2002) Gurgun, C; Ercan, E; Ceyhan, C; Yavuzgil, O; Zoghi, M; Aksu, K; Cinar, CS; Turkoglu, CThe incidence and nature of cardiac involvement in Behcet's disease are not yet clearly documented. We first used transesophageal echocardiography in combination with resting and signal averaged electrocardiography to define cardiac involvement in Behcets patients. Transthoracic and multiplane transesophageal echocardiography, and resting and signal averaged electrocardiography were performed in 35 Beh et's disease patients (9 women and 26 men, mean age: 38 12 years) and 30 normal subjects. Higher incidences of interatrial septum aneurysm (31% to 6%), mitral valve prolapse (25% to 3%), mitral regurgitation (40% to 6%) and aneurysmal dilatations of sinus valsalva and ascendan aorta were observed in the Beliget's disease patients than in the normal subjects. Mean QT dispersion and mean corrected QT dispersion values were significantly greater in the patients with Beliget's disease. Patients with interatrial septum aneurysm (and/or PFO), valvular dysfunction or proximal aorta dilatation had greater QT dispersion values than thase without these pathologies in the Behqet's group (63+/-11 vs 44+/-19 ms, 58+/-23 vs 41+/-24 and 60 27 vs 42 23 ms respectively, P<0.05). Positive signal averaged electrocardiography parameters were detected in 18 (51%) Beh et's disease patients compared with one (3%) in controls (P<0.001). Dilatation of the proximal aorta, interatrial septal aneurysm, mitral valve prolapse, and mitral regurgitation are the common findings of cardiac involvement in Beliget's disease. Increased dispersion of ventricular repolarisation and positive late potentials are also detected. QT dispersion is significantly higher in patients with these cardiac abnormalities. These findings suggest that cardiac involvement in this disorder is a diffuse process which involves both cardiac structure and vascular elements.Öğe Detachment of the mitral anterior leaflet as a complication of aortic valve replacement(Texas Heart Inst, 2006) Islamoglu, F; Apaydin, AZ; Degirmenciler, K; Gurgun, C; Durmaz, IMitral regurgitation after aortic valve replacement is generally reported as a complication of a Manouguians procedure for annulus enlargement. However even if no annular enlargement procedure is performed, this complication may be encountered after isolated aortic valve replacement because of either extensive decalcification of the aortic annulus or progressive tension on the anterior leaflet of the mitral valve, caused by aortic valve sutures placed adjacent to firm or heavily calcified valve tissue. Routine transthoracic echocardiography may be inadequate for diagnosis of this condition; transesophageal echocardiography should be used both for preoperative diagnosis and for intraoperative management. We report the case of a patient who had severe mitral regurgitation that occurred after aortic valve replacement with a mechanical valve.Öğe Effect of antihypertensive treatment on the prevalence of ventricular arrhythmias among patients with isolated systolic hypertension without left ventricular hypertrophy(Excerpta Medica Inc, 2002) Gurgun, C; Nalbantgil, S; Nalbantgil, I; Zoghi, M; Yilmaz, H; Boydak, B; Onder, RBackground: The high incidence of ventricular arrhythmias in patients with hypertension and left ventricular hypertrophy (LVH) is well documented. However, few studies have been conducted on the prevalence of ventricular arrhythmias in patients with isolated systolic hypertension without LVH. Objectives: The objectives of this study were to (1) determine the prevalence of ventricular arrhythmias in patients with systolic hypertension without LVH and (2) estimate the effect of a perindopril/indapamide combination, which does not have an antiarrhythmic effect, on the incidence of ventricular arrhythmias. Methods: Patients with newly diagnosed isolated systolic hypertension (systolic blood pressure [SBP] >160 mm Hg) and a control group of normotensive patients were enrolled. During the 2-week washout period, patients underwent physical examination (including blood pressure measurements), ambulatory electrocardiography monitoring, echocardiography, and laboratory urine and blood tests. Absence of LVH was confirmed by echocardiographic examination. The group of hypertensive patients received 1 tablet of 2 mg perindopril/0.625 mg indapamide per day for a total of 4 weeks. Physical examinations and ambulatory electrocardiographic monitoring were repeated after treatment. Results: A total of 60 hypertensive (mean age, 63.1 years; mean SBP, 176.8 +/- 3.1 mm Hg; mean diastolic blood pressure, 82.6 +/- 2.9 mm Hg) and 60 normotensive patients were enrolled. Ambulatory electrocardiographic monitoring indicated that 18 of the 60 hypertensive patients (30%) had ventricular arrhythmias: 17 had ventricular premature contractions (>100/24 h) and 1 had ventricular tachycardia plus ventricular premature contractions. In the control group, 7 of 60 subjects (11.7%) had ventricular premature contractions. The difference between the 2 groups in incidence of ventricular arrhythmias was significant (P < 0.01). After treatment, mean SBP decreased to 136.1 +/- 3.2 mm Hg, and ventricular premature contractions were found in 9 of 60 hypertensive patients (15%) (P < 0.02 vs pretreatment). Conclusions: The results of this study suggest that in patients with isolated systolic hypertension without LVH, (1) the prevalence of ventricular arrhythmia is higher than in normotensive patients and (2) treatment with perindopril/ indapamide decreases the incidence of ventricular arrhythmias.Öğe The effect of cholesterol lowering therapy with atorvastatin on flow-mediated vasodilatation in patients with hypercholesterolaemic coronary artery disease(W B Saunders Co Ltd, 2000) Ercan, E; Gurgun, C; Ceyhan, C; Zoghi, M; Akilli, A; Payzin, S; Can, L; Akin, M; Turkoglu, CÖğe The effect of exercise on P-wave and QT dispersion in coronary artery disease: an angiographic correlation(W B Saunders Co Ltd, 2000) Zoghi, M; Gurgun, C; Ozerkan, F; Ercan, E; Yavuzgil, O; Akilli, A; Payzin, S; Turkoglu, C; Akin, MÖğe Effect of statins on plasma fibrinogen levels in hypertensive hyperlipidemic patients(Lippincott Williams & Wilkins, 2002) Nalbantgil, S; Nalbantgil, I; Boydak, B; Ozerkan, F; Gurgun, C; Zoghi, M; Aytimur, M; Onder, RÖğe Endothelial function in patients with vasculogenic erectile dysfunction(Elsevier Ireland Ltd, 2005) Yavuzgil, O; Altay, B; Zoghi, M; Gurgun, C; Kayikcioglu, M; Kultursay, HObjectives: Erectile dysfunction (ED) commonly coexists with coronary artery disease (CAD) and/or risk factors for atherosclerosis. Because the silent or documented atherosclerosis or vascular risk factors are very frequent, the possibility of endothelial dysfunction in ED patients is expected to be increased. Our aim was to evaluate the endothelial functions in patients with vasculogenic ED with vascular risk factors and compare them with age-matched non-ED patients or healthy controls. Design: We studied 36 patients with presumed vasculogenic ED, 39 age-matched patients with similar risk factors without ED and 25 age-matched healthy controls without ED, known cardiovascular disease or risk factors. Erectile function was evaluated by the International Index of Erectile Dysfunction (IIEF) scores. Brachial artery flow-mediated dilatation (FMD) and nitroglycerine-mediated dilatation (NMD) were measured. Results: Baseline demographics were similar except the IIEF score and duration of diabetes in patients with ED. Brachial artery FMD and NMD were significantly reduced in patients with ED (3.2 +/- 3. vs. 6 +/- 4, p < 0.0001 for FMD, 12.2 +/- 6 vs. 15.4 +/- 6 p=0.032 for NMD). In patients with similar risk factors but without ED, FMD was significantly lower but NMD were not different compared with healthy controls (6 +/- 4 vs. 10.2 +/- 3,p < 0.0001 for FMD and 15.4 +/- 8 vs. 16.4 +/- 6,p=0.81). IIEF scores were weakly correlated with FMD (r=0.25, p=0.028) in patients with ED. There were significant correlations between FMD and NMD in patients with ED (r=0.46, p=0.05) and with risk factors (r=0.72, p < 0.0001) but not in healthy controls (r=0.54, p=0.792). Vasculogenic ED patients have more markedly impaired endothelial and smooth muscle functions compared with patients with similar risk factors but no ED. (c) 2004 Elsevier Ireland Ltd. All rights reserved.Öğe Evaluation of endothelial function with flow-mediated dilatation of brachial artery in patients with erectile dysfunction(Lippincott Williams & Wilkins, 2002) Yavuzgil, O; Altay, B; Zoghi, M; Gurgun, CÖğe Evaluation of prosthetic valve dysfunctioning(Medimond S R L, 2001) Cinar, CS; Gurgun, C; Bae, JH; Nanda, NCAlthough significant modifications in valve design, prosthetic materials, and surgical techniques have improved prosthetic valve function, the hemodynamic profile of prosthetic valves is still inferior to that of native valves.(1) Complications after cardiac valvular operations include structural valvular deterioration (wear, racture, poppet escape, calcification, leaflet tear), nonstructural dysfunction (entrapment by pannus, tissue or suture; paravalvular leak, inappropriate sizing or positioning and hemolytic anemia), valve thrombosis, embolism, bleeding events and endocarditis. Changes in baseline auscultatory findings and clinical presentation of dyspnea, exercise intolerance, or embolic phenomenon should prompt an evaluation of prosthetic function.Öğe Exercise testing induces fatal thromboembolism from mechanical mitral valve(Texas Heart Inst, 2002) Yavuzgil, O; Ozerkan, F; Gurgun, C; Zoghi, M; Can, L; Akin, MThromboembolism is still one of the most important complications of prosthetic heart valves. Embolism to a major coronary branch is rare, but acute proximal occlusions can be fatal, even when the coronary arteries are otherwise normal and intervention is rapid. We report a fatal complication of an exercise test in a patient who had a St. Jude bileaflet mitral valve. After an exercise test, a 42-year-old woman with a mechanical prosthetic valve had a severe hemodynamic collapse with acute ST segment changes. Coronary angiography showed a totally occluded left main coronary artery with TIMI grade 0 to I flow. Rapid injection of contrast material and the passage of a floppy guidewire through the thrombus restored a TIMI grade 3 flow. Angiography showed no coronary atherosclerostic involvement. Despite successful coronary reperfusion, intra-aortic balloon counterpulsation, and intensive medication, the patient died. This case demonstrates that exercise testing should be applied with great caution in patients with prosthetic valves, and only after a careful evaluation of valve function, We recommend transesophageal echocardiography prior to exercise testing in these patients.Öğe A giant inferoposterior true aneurysm of the left ventricle mimicking a pseudoaneurysm(Springer, 2006) Yavuzgil, O; Gurgun, C; Apaydin, A; Cinar, CS; Yuksel, A; Kultursay, HA left ventricular aneurysm (LVA) is most commonly the result of myocardial infarction, usually involving the anterior wall. A left ventricular pseudoaneurysm (LVPSA) or false aneurysm forms when cardiac rupture is contained by adherent pericardium or scar tissue. The accurate diagnosis, although difficult to establish, is an important one to make because these aneurysms are prone to rupture. In this article, we report a challenging case of a cardiac aneurysm a year after a coronary bypass operation which could not be definitively diagnosed despite of imaging with different techniques including echocardiography, coronary angiography, left ventriculography and magnetic resonance imaging (MRI). The patient underwent a second cardiac surgery, the aneurysm was resected, the mitral valve was replaced and the defect in the ventricular wall was repaired. Because of the combined diagnostic capabilities like detailed and functional pathoanatomy and aneurysmal wall characterization, MRI seems to have multiple advantages in differential diagnosis.Öğe Giant right atrial diverticulum associated with Wolff-Parkinson-White syndrome(Wiley, 2006) Hasdemir, C; Gurgun, C; Yavuzgil, O; Yuksel, A; Beckman, KJÖğe Heart rate variability in two different patterns of left ventricular hypertrophy and geometry(W B Saunders Co Ltd, 2002) Gurgun, C; Abbasaliyev, A; Zoghi, M; Yavuzgil, O; Erturk, UÖğe Large inferoposterior wall pseudoaneurysm - of the left ventricle with a thrombus after myocardial infarction(Texas Heart Inst, 1999) Ozerkan, F; Gurgun, C; Zoghi, M; Yavuzgil, O; Turkoglu, CA 70-year-old man was admitted to our coronary care unit with severe dyspnea, nonproductive cough, and palpitations 1 month after an inferoposterolateral myocardial infarction. Two-dimensional echocardiography demonstrated severe left ventricular dysfunction and a large (6.6 x 7.9 cm) inferoposterior wall pseudoaneurysm of the left ventricle with a thrombus (Fig, 1). Electrocardiography showed QS formation in leads II, III, aVF, and V-5,V-6; Rs in V-1; and sustained ventricular tachycardia (Fig. 2). The patient refused such interventions as coronary angiography and surgery. His symptoms of heart failure and arrhythmia were relieved by medical therapy He was discharged from the hospital ar his request, and his wife found him dead in his bed 3 weeks later.Öğe Patient characteristics according to HDL cholesterol levels in acute myocardial infarction(Elsevier Sci Ireland Ltd, 1999) Gurgun, C; Yavuzgil, O; Zoghi, M; Ozerkan, F; Ercan, E; Kultursay, H; Turkoglu, CÖğe Plasma and bronchoalveolar lavage fluid levels of endothelin-1 in patients with chronic obstructive pulmonary disease and pulmonary hypertension(Karger, 2003) Bacakoglu, F; Atasever, A; Ozhan, MH; Gurgun, C; Ozkilic, H; Guzelant, ABackground: Secondary pulmonary hypertension (PH) and cor pulmonale are the major clinical cardiovascular complications affecting prognosis in patients with chronic obstructive pulmonary disease (COPD). It is also known that endothelin-1 (ET-1) is a potent vasoconstrictor peptide produced by the pulmonary vascular endothelium, and ET-1 may be implicated in the pathogenesis of PH. Objectives: The purpose of this study was to investigate the presence of ET-1 in patients with COPD and to assess the correlation of ET-1 levels in the plasma and bronchoalveolar lavage (BAL) fluid (BALF) in COPD patients with or without PH. Methods: Twenty-two patients with COPD and 15 healthy controls were enrolled in the study. Peripheral venous blood samples were collected in all patients and controls. BAL was obtained in COPD patients, and ET-1 levels were measured by radioimmunoassay in all plasma and BALF samples. Results: Plasma ET-1 levels were 2.46 +/- 0.55 and 1.70 +/- 0.42 pmol/dl in patients with COPD and controls, respectively (p < 0.0001). Sixteen of the 22 patients with COPD (73%) had PH established by echocardiography. The ET-1 level in these patients amounted to 2.59 +/- 0.50 pmol/dl, and it was 2.10 +/- 0.54 pmol/dl in 6 patients with COPD without PH. In COPD patients with and without PH, BALF ET-1 levels were 0.19 +/- 0.08 and 0.24 +/- 0.01 pmol/dl, respectively (p > 0.05). Conclusions: These results suggest that ET-1 is detectable in both the peripheral blood and BALF of COPD patients, but the levels do not statistically differ between patients with and without PH. Copyright (C) 2003 S. Karger AG, Basel.Öğe The prevalence of silent myocardial ischemia in patients with white coat, dipper and non-dipper hypertension(Lippincott Williams & Wilkins, 2002) Nalbantgil, S; Nalbantgil, I; Yilmaz, H; Ozerkan, F; Boydak, B; Gurgun, C; Zoghi, M; Onder, R
