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Öğe 33 Questions about Triglycerides and Cardiovascular Effects: Expert Answers(Turkish Soc Cardiology, 2017) Cetinkalp, Sevki; Koylan, Nevrez; Ozer, Necla; Onat, Altan; Ozgen, A. Gokhan; Koldas, Z. Lale; Guven, Gulay Sain; Ozdogan, Oner; Karsidag, Kubilay; Yigit, Zerrin; Kayikcioglu, Meral; Tokgozoglu, Lale; Can, Levent H.; Tartan, Zeynep; Kultursay, Hakan; Karpuz, Baris; Kirilmaz, Bahadir; Ersanli, Murat; Ural, Dilek; Erbakan, Ayse Naciye; Oguz, Aytekin; Kayikcioglu, Ozcan R.; Temizhan, Ahmet; Sansoy, Vedat; Ceyhan, Ceyhun; Ongen, Zeki; Bayram, Fahri; Orem, Cihan; Sonmez, Alper; Beyaz, Sengul; Ukinc, Kubilay; Yurekli, Banu Sarer; Coker, Mahmut; Canda, Ebru; Simsir, Ilgin YildirimÖğe Effect of Mean Platelet Volume on Postintervention Coronary Blood Flow in Patients with Chronic Stable Angina Pectoris(H M P Communications, 2008) Duygu, Hamza; Turkoglu, Cuneyt; Kirilmaz, Bahadir; Turk, UgurObjectives. In our study we sought to determine whether mean platelet volume (MPV), measured on admission, could be used in determining decreased coronary blood flow (CBF) in stable coronary artery disease (CAD) patients after percutaneous coronary intervention (PCI). Background. Platelets play a crucial role in the pathophysiology of CAD. MPV reflects platelet function and activity. There are no reports regarding the effect of MPV on CBF in patients with stable CAD undergoing PCI. Methods. A total of 66 consecutive patients (mean age: 58 +/- 5 years, 74% male) with the diagnosis of stable CAD who were hospitalized for PCI were prospectively enrolled in our study. Coronary flow rates of all subjects were documented by corrected thrombolysis in myocardial infarction (TIMI) frame count (CTFC) for each major coronary artery before and after PCI. Blood samples for MPV estimation, platelet count and other laboratory data obtained on admission were measured on the day of the scheduled PCI. Patients were divided into two groups according to MPV levels measured on admission: 1) high MPV group and 2) normal MPV group. Results. A final TIMI 3 flow was achieved in all patients with no complications. Procedural characteristics of PCI, except left anterior descending artery intervention, were similar in the two groups. Patients with high MPV had significantly higher CTFC than those with a normal MPV (24 +/- 3 vs. 17 +/- 5; p = 0.001). The MPV correlated strongly with post-PCI CTFC (R = 0.625; p = 0.0001). Multiple logistic regression analysis showed that only MPV was an independent predictor of post-PCI CTFC after adjustment for baseline characteristics (OR 1.9, 95% CI 1.2-2.3; p = 0.001). Conclusions. MPV may be considered a useful hematological marker, allowing for early and easy identification of patients with stable CAD who are at a higher risk of post-PCI low-reflow.Öğe A Floating Thrombus in Sinus of Valsalva Complicated with Cardiogenic Shock in a Patient with Plasminogen Activator Inhibitor 1 4G/5G Polymorphism(Wiley-Blackwell, 2011) Saygi, Serkan; Alioglu, Emin; Karabulut, Mehmet Nuri; Turk, Ugur Onsel; Kirilmaz, Bahadir; Tuzun, Nurullah; Sahin, Fahri; Kosova, Buket; Tengiz, IstemihanThrombus in sinus of Valsalva is unusual reason for acute myocardial infarction. We demonstrated a case with floating thrombus in sinus of Valsalva obstructing the right coronary ostium intermittently, and causing cardiogenic shock. The patient was diagnosed with multiplane transesophageal echocardiography and treated successfully with surgical removal of mass. A homozygote polymorphism of plasminogen activator inhibitor (PAI) 1 4G/5G was found. This is the first report demonstrating a patient with PAI 1 polymorphism and thrombus of Valsalva complicated with cardiogenic shock. (Echocardiography 2011;28:E64-E167)Öğe Impaired endothelial function in patients with myocardial bridge(Blackwell Publishing, 2006) Zoghi, Mehdi; Duygu, Hamza; Nalbantgil, Sanem; Kirilmaz, Bahadir; Turk, Ugur; Ozerkan, Filiz; Akilli, Azem; Akin, Mustafa; Turkoglu, CuneytObjective: The relationship between myocardial bridging (MB) and ischemic heart disease is still controversial. In this study, we aimed to evaluate the existing atherosclerosis and noninvasive endothelial function of brachial artery in patients with MB. Methods: The present study included 50 patients (group I) who had MB in left anterior descending (LAD) on coronary angiography. All of the coronary artery segments were evaluated by intravascular ultrasound (IVUS). Endothelial function was assessed with measurement of flow-mediated dilatation (FMD) and nitrate-dependent dilatation in the brachial artery. The study also included 30 healthy control subjects (group II). Patients in the group I were further subdivided into two subgroups based on the findings on IVUS: group IA included 20 patients without atherosclerotic lesions and group IB included 30 patients with atherosclerotic coronary artery disease in addition to MB. Results: FMD values were found to be significantly lower in the patients with MB (group I) than in the control (6.4 +/- 3% vs 11 +/- 4%, P < 0.001). In regard to FMD values in subgroups, FMD was 7 +/- 2% in the group IA and 5.8 +/- 1% in the group IB (P = 0.023). On IVUS, atherosclerotic plaque was found proximal to the bridge in the same coronary artery segment in addition to MB in 75% of the patients in group I (group IB). No atherosclerotic plaque was found in within or distal segments of MB. Conclusion: Endothelial function is impaired in patients with MB and there is an increased tendency for atherosclerosis proximal to the bridge in the patients with MB. Endothelial dysfunction is more severe in the patients with atherosclerosis proximal to the bridge.Öğe Myocardial bridge: a bridge to atherosclerosis(Turkish Soc Cardiology, 2007) Duygu, Hama; Zoghi, Mebdj; Nalbantgil, Sanem; Kirilmaz, Bahadir; Tuerk, Ugur; Ozerkan, Filiz; Akilli, Azem; Akm, MustafaObjective: Myocardial bridge (MB) is a congenital anomaly characterized by narrowing during systole of some of the epicardial coronary arterial segments running in the myocardium. Although, it is considered as a benign anomaly, it may lead to such complications as acute myocardial infarction, ventricular tachycardia, syncope, atrioventricular block and sudden cardiac death. In this study, we aimed to investigate demographic, clinical and angiographic characteristics of the patients with MB found on coronary angiography. Methods: The present study included 71 patients with MB found on coronary angiographies performed in our institution between January 1999 and September 2003. Based on the findings on angiography, the patients were subdivided into group A (n=41) and group B (n=30). The patients in the group A had no atherosclerotic lesion and the patients in the group B had coronary artery disease in addition to MB. Angiographic, demographic and clinical characteristics of both groups were compared. Results: There were no differences between two groups in distribution of gender and risk factors of coronary artery diseases whereas mean age of the patients in the group A was lower (47 +/- 5 years vs 55 +/- 11 years, p = 0.01). Frequency of two or more risk factors for coronary artery disease in a particular patient was significantly higher in the group B (55% vs 30%, p = 0.03). Myocardial bridge was located at proximal or mid segments of left anterior descending artery (LAD) in 40 patients whereas its presence in both LAD and right coronary artery was found only in one patient in group A. Mean bridging percent was 43 +/- 27% in group A. Localization of MB was LAD in 29 patients of group B, which was significantly higher than in group A (p<0.05). Atherosclerotic narrowing developed in only LAD in 14 patients, LAD and other vessels in 7 patients and in the vessels without MB in 9 patients. In patients with MB in LAD atherosclerotic narrowing of vessel developed proximally to the MB. Clinically, stable angina pactoris was seen more frequently in group A than group B (70% vs 35%, p = 0.01), whereas the frequency of acute coronary syndrome was higher in group B (65% vs 30%, p=0.04). In regard to therapeutic approach, more patients in the group A received medical management (80% vs 50%, p=0.01), while more patients in the group B underwent surgical and percutaneous interventions (50% vs 18%, p=0.04). Conclusion: Myocardial bridge probability should be considered in young patients presenting with angina or if the same symptoms are persistent in the patients without more than one risk factor for coronary artery disease. Myocardial bridge may initiate the development of atherosclerotic lesion or may facilitate progression of atherosclerosis in the proximal segment of the vessel. The risk of acute coronary syndrome rises when atherosclerosis is superimposed on MB. Myocardial bridge should be considered in the young patients, presenting with angina or its equivalents without atherosclerotic lesions on coronary angiography.Öğe Objective ischemic evidence in patients with myocardial bridging: Ultrasonic tissue characterization with dobutamine stress integrated backscatter(Mosby-Elsevier, 2007) Duygu, Hamza; Ozerkan, Filiz; Zoghi, Mehdi; Nalbantgil, Sanem; Kirilmaz, Bahadir; Akilli, Azem; Onder, Remzi; Erturk, Umit; Akin, MustafaBackground: in this study, we investigated the sensitivities of dobutamine stress echocardiography (DSE) and integrated backscatter (IBS) in detecting ischemia in patients with symptomatic myocardial bridging (MB). Methods: Fourteen patients given the diagnosis of MB in the left anterior descending coronary artery as shown by coronary angiography were enrolled. All patients underwent DSE and stress IBS. The cyclic variation of IBS (CVIBS) was taken from the midanteroseptal, midinferior, and midposterolateral areas of the parasternal short-axis images at rest, low dose, peak dose, and recovery. The low-dose, peak-dose, and recovery CVIBS data were compared with baseline values. Results: At peak dose, hypokinesia was observed in the left anterior descending coronary artery region in two patients (14%). A significant reduction in CVIBS was detected only when compared with the baseline at peak dose in the anteroseptal wall (8.4 +/- 1.3 vs 5.9 +/- 0.8, P = .003). A significant negative correlation was found between the CVIBS and the systolic narrowing percentage (R = -0.856, P = .001) and the length of MB (R = -0.576, P = .01) in the anteroseptal wall at peak dose. Conclusions. Whereas DSE is not sufficiently sensitive in the detection of ischemia in patients with symptomatic MB, the reduction in CVIBS during DSE may be an objective sign of ischemia.Öğe Serum resistin level: as a predictor of atrial fibrillation after coronary artery bypass graft surgery(Lippincott Williams & Wilkins, 2011) Gungor, Hasan; Ayik, Mehmet Fatih; Kirilmaz, Bahadir; Ertugay, Serkan; Gul, Ilker; Yildiz, Bekir Serhat; Nalbantgil, Sanem; Zoghi, MehdiAim Atrial fibrillation (AF) is the most common arrhythmia with an incidence of 25-40%, after coronary artery bypass grafting (CABG). Resistin is a newly identified adipocyte-secreted hormone belonging to a cysteine-rich protein family. This study examined the relation of preoperative and postoperative early serum resistin level, which can play an important role as an inflammatory marker to predict AF after CABG. Methods We prospectively analyzed 40 consecutive patients (mean age, 59.2+10.3 years; 31 men and nine women) who were undergoing CABG between September and November 2009 at our department. Blood samples were taken to examine quantities of resistin level, the day before surgery and on the 24th hour in the intensive care unit. Results The incidence of AF was 25% (n=10, 2.2+1.1 days, 1.2+0.4 episodes). Preoperative resistin level was higher in the AF group (10.6+3.3 vs. 9.1+4.5 ng/ml, P=0.33), but it was not statistically significant. Postoperative resistin level was significantly higher in the AF group (27.4+8.4 vs. 17.9+9.1 ng/ml, P=0.012) compared with the sinus rhythm group. Resistin levels significantly increased after the surgery in both groups [9.1+4.5 vs. 17.9+9.1 ng/ml, P<0.001 (sinus rhythm group) and 10.6+3.3 vs. 27.4+8.4 ng/ml, P<0.001 (AF group)]. Conclusion Patients with an elevated postoperative resistin level may have high risk for AF after CABG. This intervention targeting inflammation might help reduce the incidence of AF. Coron Artery Dis 22:484-490 (C) 2011 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.Öğe Turkish registry for diagnosis and treatment of acute heart failure: TAKTIK study(Turkish Soc Cardiology, 2016) Eren, Mehmet; Zoghi, Mehdi; Tuncer, Mustafa; Cavusoglu, Yuksel; Demirbag, Recep; Sahin, Mahmut; Serdar, Osman Akin; Onrat, Ersel; Mutlu, Hasim; Dursunoglu, Dursun; Yilmaz, Mehmet Birhan; Temizhan, Ahmet; Acarturk, Esmeray; Bakirci, Murat; Basarici, Ibrahim; Bulur, Serkan; Celebi, Savas; Ciftci, Sema; Dede, Ozkan; Deveci, Bulent; Deveci, Onur Sinan; Duygu, Hamza; Ekmekci, Ahmet; Ekmekci, Cenk; Erer, Betul; Erkoc, Sultanbaliz; Erol, Mustafa Kemal; Gemici, Gokmen; Guvenc, Tolga Sinan; Helvaci, Aysen; Iltumur, Kenan; Iyigun, Ufuk; Kalay, Nihat; Kirilmaz, Bahadir; Korkmaz, Hasan; Oto, Ali; Ozcan, Turkay; Ozdemir, Kurtulus; Ozhan, Hakan; Ozturk, Sercan; Sahin, Yildiray; Satiroglu, Omer; Teyyareci, Yelda; Ulgen, Siddik; Yazici, Mehmet; Yilmaz, Remzi; Yilmaz, YucelObjective: The goal of this study was to develop a national database of patients hospitalized in Turkey with acute heart failure (AHF) using evaluations of diagnostic and therapeutic approaches. Methods: Patient data were collected using an Internet-based survey. A total of 588 patients were enrolled from 36 participating medical centers across the country. Results: Mean age was 62 +/- 13 years and 38% of the patients were female. Ratio of de novo AHF to study cohort was 24%. Coronary heart disease and hypertension were found in 61% and 53% of the patients, respectively. Valvular heart disease was the underlying cause in 46% of heart failure patients. The most frequent factor associated with decompensation was noncompliance with treatment, observed in 34% of patients. Systolic blood pressure was 125 +/- 28 mmHg and heart rate was 93 +/- 22 beats/minute in the cohort. The most common findings on physical examination were inspiratory fine crackles (84%), peripheral edema (64%), and cold extremities in 34%. Mean ejection fraction (EF) measured at admission was 33 +/- 13%. Preserved EF (>=%40) was present in 20% of patients. On admission, 60%, 46%, and 40% of patients were using angiotens-in-converting enzyme inhibitor/angiotensin receptor blocker, beta-blocker, or aldosterone antagonist, respectively. In-hospital events were reported as 3.4% death, 1.6% stroke and 2% myocardial infarction. Conclusion: Compared to previous data collected around the world, AHF patients in Turkey were younger, had more frequently valvular heart disease as the underlying cause, and were more noncompliant with medical treatment, but overall mortality was lower. Drugs shown to reduce mortality, and which also form the basis of guideline-directed medical therapy, are still used inadequately.Öğe What have we learned from Turkish familial hypercholesterolemia registries (A-HIT1 and A-HIT2)?(Elsevier Ireland Ltd, 2018) Kayikcioglu, Meral; Tokgozoglu, Lale; Dogan, Volkan; Ceyhan, Ceyhun; Tuncez, Abdullah; Kutlu, Merih; Onrat, Ersel; Alici, Gokhan; Akbulut, Mehmet; Celik, Ahmet; Yesilbursa, Dilek; Sahin, Tayfun; Sonmez, Alper; Ozdogan, Oner; Temizhan, Ahmet; Kilic, Salih; Bayram, Fahri; Sabuncu, Tevfik; Coskun, Fatma Yilmaz; Ildizli, Muge; Durakoglugil, Emre; Kirilmaz, Bahadir; Yilmaz, Mehmet Birhan; Yigit, Zerrin; Yildirim, Aytul Belgi; Gedikli, Omer; Topcu, Selim; Oguz, Aytekin; Demir, Mesut; Yenercag, Mustafa; Yildirir, Aylin; Demircan, Sabri; Yilmaz, Mehmet; Kaynar, Leyla Gul; Aktan, Melih; Durmus, Rana Berru; Gokce, Cumali; Ozcebe, Osman Ilhami; Akyol, Tulay Karaagac; Okutan, Harika; Sag, Saim; Gul, Ozen Oz; Salcioglu, Zafer; Altunkeser, Bulent Behlul; Kuku, Irfan; Yasar, Hurriyet Yilmaz; Kurtoglu, Erdal; Kose, Melis Demir; Demircioglu, Sinan; Pekkolay, Zafer; Ilhan, Osman; Can, Levent H.Background and aims: Familial hypercholesterolemia (FH) is a common genetic disease of high-level cholesterol leading to premature atherosclerosis. One of the key aspects to overcome FH burden is the generation of largescale reliable data in terms of registries. This manuscript underlines the important results of nation-wide Turkish FH registries (A-HIT1 and A-HIT2). Methods: A-HIT1 is a survey of homozygous FH patients undergoing low density lipoprotein (LDL) apheresis (LA). A-HIT2 is a registry of adult FH patients (homozygous and heterozygous) admitted to outpatient clinics. Both registries used clinical diagnosis of FH. Results: A-HIT1 evaluated 88 patients (27 +/- 11 years, 41 women) in 19 centers. All patients were receiving regular LA. There was a 7.37 +/- 7.1-year delay between diagnosis and initiation of LA. LDL-cholesterol levels reached the target only in 5 cases. Mean frequency of apheresis sessions was 19 +/- 13 days. None of the centers had a standardized approach for LA. Mean frequency of apheresis sessions was every 19 +/- 13 (7-90) days. Only 2 centers were aware of the target LDL levels. A-HIT2 enrolled 1071 FH patients (53 +/- 8 years, 606 women) from 31 outpatients clinics specialized in cardiology (27), internal medicine (1), and endocrinology (3); 96.4% were heterozygous. 459 patients were on statin treatment. LDL targets were attained in 23 patients (2.1% of the whole population, 5% receiving statin) on treatment. However, 66% of statin-receiving patients were on intense doses of statins. Awareness of FH was 9.5% in the whole patient population. Conclusions: The first nationwide FH registries revealed that FH is still undertreated even in specialized centers in Turkey. Additional effective treatment regiments are urgently needed.
