Nihal Akar Bayram

Yıldırım Beyazıt Üniversitesi, Engüri, Ankara, Turkey

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Publications (70)203.44 Total impact

  • Cenk Sarı · Abdullah Nabi Aslan · Serdal Baştuğ · Nihal Akar Bayram
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    ABSTRACT: Permanent pacemaker implantation (PPI) is usually a very safe procedure with a low complication risk. It is a relatively straightforward process carried out under local anesthetic. This case report presents an 80-year-old male patient who required a permanent pacemaker due to complete atrioventricular (AV) block, and who developed cyanosis and was diagnosed with methemoglobinemia after the pacemaker insertion procedure, in which the local anesthetic prilocaine was administered. To our knowledge, this is the first case in the literature to describe methemoglobinemia developing after PPI.
    Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir 07/2015; 43(5):468-471.
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    ABSTRACT: The aim of this single-center study was to assess the incidence and predictors of in-hospital access site complications related to transcatheter aortic valve implantation (TAVI) performed with new delivery systems in our hospital which has the largest case series in Turkey. We performed successful TAVI with the Edwards Sapien XT valve to 127 (46 male) patients via a transfemoral (121), trans-subclavian (5) and transapical (1) approach. Access site complications were defined according to the Valve Academic Research Consortium (VARC) end-point definitions. Vascular complications occurred in 10.1% of patients. There was negative correlation between vascular complications and diameter of the common femoral artery (r = - 0.301, p=0.004), external iliac artery (r = - 0.327, p=0.004) and common iliac artery (r = - 0.324, p=0.004), but positive correlation between diabetes (r =0.240, p=0.008), sheath to femoral artery ratio (SFAR), sheath to external iliac artery ratio (SEIAR), procedure time, discharge time and the Society of Thoracic Surgeons (STS) score (respectively; r=0.339, 0.001, 0.527, 0.361, 0.289, p=0.003, 0.001, 0.001, 0.001, 0.002). The incidence of vascular complications was significantly higher in patients with diabetes and a high STS score. VARC bleeding complications occurred in 11.7 % of patients. The learning curve pointing out the importance of experience was significantly important in decreasing both bleeding and vascular complications. In this study, we demonstrated that major vascular complications related to TAVI decrease with the use of smaller delivery systems and experience and increase with high-risk scores (STS) and the presence of diabetes. In addition, VARC major vascular complications, observed mostly in patients with diabete mellitus (DM) and high STS scores, were associated with vascular diameters. These results further underline the importance of experience and a multidisciplinary team in patient selection and management for TAVI. © The Author(s) 2015.
    Perfusion 03/2015; DOI:10.1177/0267659115578002 · 1.08 Impact Factor
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    ABSTRACT: Emerging evidence suggests that the neutrophil-to-lymphocyte ratio (NLR) may be a useful marker of inflammation and aortic stiffness. Markers of inflammation and aortic stiffness are both indicators of cardiovascular events. We, therefore, investigated whether the NLR is associated with aortic stiffness in patients with type 1 diabetes mellitus. We examined the relationship of the NLR to aortic stiffness in 76 people with type 1 diabetes and 36 healthy controls. The NLRs in the group with type 1 diabetes were higher than in the controls (2.33±0.95 vs. 1.80±0.68, respectively; p=0.003). Aortic strain and aortic distensibility, the parameters of aortic stiffness, measured noninvasively by the help of echocardiography, were significantly decreased in the patient group compared to controls (8.0%±1.5% vs. 13.1%±3.3 %; p<0.001 and 3.6±1.1 cm(2).dyn(-1).10(-3) vs. 6.0±2.1 cm(2).dyn(-1).10(-3); p<0.001, respectively). There were negative correlations between NLR and distensibility (r: -0.40; p<0.001) and strain (r: -0.57; p<0.001) in patients with type 1 diabetes. We have demonstrated that there is a significant negative correlation between the NLR and markers of aortic stiffness in patients with type 1 diabetes, indicating a potential association between inflammation and arterial stiffness. Accordingly, a higher NLR may be a useful additional measure in determining the cardiovascular risks of patients with type 1 diabetes in our clinical practice. Copyright © 2015 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.
    03/2015; DOI:10.1016/j.jcjd.2015.01.004
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    ABSTRACT: Transcatheter aortic valve implantation (TAVI) is a minimally invasive, emerging therapy in surgically high risk, or inoperable patients. Parameters used for risk classification have some deficiencies in the selection of patients. The objective of this study is to evaluate the impact of TAVI on carbohydrate antigen 125 (CA125) and N-Terminal pro Brain-type Natriuretic Peptide (NT-proBNP) as biomarkers that have been used frequently in recent years, and also the relationship of these biomarkers to prognosis. Transcatheter aortic valve implantation was practiced on 31 patients in this study. Then, CA125 and NT-proBNP levels studied in patients prior to and after the TAVI were evaluated. The patients were also grouped in accordance with their left ventricular ejection fraction (LVEF) and CA125 levels (LVEF ≥ 40% and < 40%; CA125 ≤ 35 U/L and > 35 U/L). The TAVI operation was successfully performed in all patients. There was no in-hospital mortality and substantial improvement in functional capacity was detected at follow ups. In addition, a statistically significant decrease was detected in post-TAVI CA125 and NT-proBNP levels of all patients (CA125 83.8 ± 18.1 U/L vs. 64.3 ± 14.2 U/L, P = 0.008; NT-proBNP: 4633.6 ± 627.6 pg/mL vs. 2866.3 ± 536.8 pg/mL, P < 0.001). In groups divided according to the CA125 levels, there was also statistically significant post-TAVI decline in CA125 levels. Within CA125 > 35 U/L and LVEF < 40% groups, the permanent need for a pacemaker was required in one (3.2%) patient and mortality was observed in two (6.4%) patients after TAVI at follow up. The results show that TAVI can be performed effectively and reliably in patients with high baseline levels of CA125 and NT-proBNP. These biomarkers are reduced substantially with TAVI, while high biomarker levels are associated with undesired events, and certainly, these biomarkers can be used for risk classifications in patient selection for TAVI.
    Journal of Geriatric Cardiology 03/2015; 12(2):100-6. DOI:10.11909/j.issn.1671-5411.2015.02.002 · 1.06 Impact Factor
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    ABSTRACT: Electrophysiological changes are observed following mechanical stretches due to pressure overload in patients with severe aortic stenosis (AS). The electrical instability occurs after depolarization and dispersion of repolarization. The aim of this study was to evaluate changes in ventricular repolarization following transcatheter aortic valve implantation (TAVI). Thestudypopulationincluded 100 consecutive patients with severe AS thatunderwent TAVI. Electrocardiography (ECG) was performed at baseline, immediately after TAVI, and 1 week after TAVI. The mean age of the patients was 78.2 ± 7.2 years. Thirty-four (34%) of the patients were male and 66 (66%) were female. Compared to the baseline, mean QT dispersion (QTd) immediately after TAVI and 1 week after TAVI decreased significantly (82.8 ± 26.5,75.6 ± 25.2, and 65.8 ± 28.3, respectively, P < 0.001). Likewise, compared to the baseline, mean corrected QTd (QTcd) immediately after TAVI and 1 week after TAVI decreased significantly (84.7 ± 25.2, 76.7 ± 30.8, and 69.1 ± 31.4, respectively, P < 0.001). QTd is indicative of heterogeneity of ventricular refractoriness and is prolonged in patients with AS. Following TAVI, a decrease in QTd might reduce the risk of ventricular arrhythmia in patients with severe AS.
    Turkish Journal of Medical Sciences 01/2015; 45(3):615-618. DOI:10.3906/sag-1402-49 · 0.84 Impact Factor
  • Minerva cardioangiologica 12/2014; 62(6):501-4. · 0.48 Impact Factor
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    ABSTRACT: Pulmonary hypertension (PH) is common in patients with severe aortic stenosis (AS). The prognostic effect of PH in high-risk patients undergoing transcatheter aortic valve implantation (TAVI) remains unknown. The aim of this study was to examine the feasibility of TAVI in patients with PH and to determine the effect of TAVI on PH.
    Echocardiography 10/2014; 62(18). DOI:10.1111/echo.12811 · 1.25 Impact Factor
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    ABSTRACT: Introduction: It was aimed to calculate QT intervals in patients with acromegaly and to reveal its correlation between QT intervals, and growth hormone and insulin like growth factor-1. Material and Methods: Forty-one patients with acromegaly were enrolled into the study. Another 41 individuals with similar features, such as comorbid diseases, age and sex constituted the control group. The electrocardiographies of patients with acromegaly were evaluated at the baseline and after the follow-up. Only one electrocardiography was performed for controls. QT maximum, QT minimum, QT dispersion, corrected QT maximum, corrected QT minimum and corrected QT dispersion were calculated. Results: Baseline QT maximum, QT dispersion, corrected QT maximum and corrected QT dispersion were significantly longer than the values of controls. Corrected QT maximum and corrected QT dispersion were significantly shorter after the follow-up, compared to the baseline in patients. QT maximum, QT dispersion, corrected QT maximum and corrected QT dispersion after the follow-up were not statistically different from the values of controls. Except the negative correlation between growth hormone and corrected QT dispersion in patients after the follow-up, no other correlation was detected between QT values and growth hormone or insulin like growth factor-1 levels. Corrected QT dispersion was found to be related with the disease duration in patients. Discussion: For acromegaly patients, it is important to detect clinical predictors of cardiac arrhytmias. QT dispersion is considered a beneficial predictor for ventricular arrhytmias. When compared to controls, prolonged QT intervals were determined in our acromegalic patients. Conclusion: We consider that QT intervals may also be utilized in the evaluation of increased cardiovascular risk in patients with acromegaly.
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    ABSTRACT: Transcatheter aortic valve implantation is a promising alternative to high risk surgical aortic valve replacement. The procedure is mainly indicated in patients with severe symptomatic aortic stenosis who cannot undergo surgery or who are at very high surgical risk.
    Postepy w Kardiologii Interwencyjnej / Advances in Interventional Cardiology 06/2014; 10(2):84-90. DOI:10.5114/pwki.2014.43511 · 0.07 Impact Factor
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    ABSTRACT: Aortic stenosis (AS) increases with age. According to guidelines, left ventricular systolic dysfunction (LVSD) is an indication for aortic valve replacement, even in asymptomatic patients. There is no clear data on the application of transcatheter aortic valve implantation (TAVI), which is a method showing continuous improvement in recent years, in patients with reduced ejection fraction (REF) having a poor prognosis for surgical aortic valve replacement (s-AVR). We therefore aimed to investigate the effect of TAVI on left ventricular ejection fraction (LVEF) and also its efficacy and safety in patients with REF.
    Cardiology journal 05/2014; 22(1). DOI:10.5603/CJ.a2014.0040 · 1.22 Impact Factor
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    ABSTRACT: Hyperglycemia on admission is associated with increased mortality and morbidity in acute coronary syndrome (ACS) irrespective of presence of diabetes mellitus. To the best of our knowledge, no evidence on the relationship between stress hyperglycemia (SH) and the extent of coronary artery disease is found in the literature. Our objective in this study is to assess the relationship of SH with the prognosis of acute coronary syndrome, extent of coronary artery disease (CAD), development of arrhythmia, and major adverse cardiac events.89 patients who were hospitalized in the coronary intensive care unit with diagnosis of ACS between January 2010 and June 2010 were enrolled in the study. The patients were separated into 2 groups as having stress hypergly-cemia or not, according to their blood glucose levels on admission. TIMI and GRACE risk scores were obtained and GENSINI scoring was performed to assess CAD extent for all the patients. Major adverse cardiac events (MACE) (death, MI, re-revascularization, stroke) were recorded for all patients while in the hospital and at 1st and 6th months.In our study, MACE, GENSINI scores at 6 months and development of in-hospital arrhythmia rates were statistically significantly higher and left ventricular ejection fractions were statistically significantly lower in the group with SH. The association of TIMI, GRACE, GENSINI, New York Heart Association (NYHA) and Killip classifications with blood glucose, fasting blood glucose and HbA1c on admission was confirmed.Prognostic course happens to be worse and CAD is more extensive in patients with SH. In addition, blood glucose values may have to be estimated lower compared to the samples in the literature, in order to diagnose SH.
    Experimental and Clinical Endocrinology & Diabetes 04/2014; 122(4):222-6. DOI:10.1055/s-0034-1367002 · 1.76 Impact Factor
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    ABSTRACT: Cardiovascular morbidity and mortality are increased in patients with primary hyperparathyroidism (PHPT). We aimed to evaluate left ventricle systolic and diastolic functions with tissue Doppler imaging (TDI) and strain and strain rate echocardiography in patients with PHPT. Thirty-one patients with PHPT and 29 healthy controls were evaluated with conventional and pulse Doppler echocardiography, TDI and strain and strain rate echocardiography. Myocardial performance index (MPI) was calculated. Strain and peak systolic strain rate in mid and basal segments of lateral, anterior, inferior, and septal walls of left ventricle were determined. TDI showed similar late diastolic myocardial peak velocity in two groups. Peak systolic mitral annular velocity, early diastolic myocardial peak velocity, and ratio of early to late diastolic myocardial peak velocity were lower in PHPT patients (p = 0.01, p < 0.001 and p < 0.001, respectively). MPI calculated by TDI was 0.53 ± 0.15 in PHPT group and 0.44 ± 0.09 in control group (p = 0.013). Strain values were lower in mid and basal segments of septum, lateral and anterior walls, and basal segment of inferior wall in PHPT patients. Mean systolic strain was -20.88 ± 2.30 and -24.25 ± 2.13 in PHPT patients and control group, respectively (p < 0.001). Mean strain rate was lower in PHPT patients compared to control group (-1.38 ± 0.19 vs -1.57 ± 0.25) (p = 0.002). Patients with PHPT, but no cardiac symptoms or documented cardiovascular disease, have subclinical systolic and diastolic myocardial dysfunction. Evaluation of these patients with TDI and S and Sr echocardiography in addition to conventional echocardiography might be valuable to detect subclinical cardiac involvement.
    Endocrine 03/2014; 47(2). DOI:10.1007/s12020-014-0245-7 · 3.53 Impact Factor
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    ABSTRACT: Previous studies have shown association between paraoxonase (PON) activity and the presence and severity of coronary atherosclerosis. The aim of the present study was to demonstrate any association between serum PON activity and the presence and severity of coronary artery calcification (CAC). A total of 156 consecutive patients having the suspicion of coronary atherosclerosis or needing risk stratification for cardiovascular events were included in the present study. Peripheral venous blood samples of all participants to measure serum PON activity were collected before undergoing multidetector computed tomography, which was used to determine the presence and quantity of CAC. Serum PON-1 levels were lower in CAC group compared with no CAC group (60 [35 - 96] U/L vs. 291 [230 - 371] U/L, respectively, p<0.001). There was a significant negative correlation between total CAC score and PON (r² = 0.335, p<0.001). In multivariate analysis, the significant and independent predictors of the presence of CAC were male sex, hsCRP and PON. Similarly, increased PON was significantly and independently associated with freedom from CAC. In ROC analysis, PON level <197 U/L had 87% sensitivity, 91% specificity, 93% positive predictive value, and 85% negative predictive value in predicting CAC. Diminished serum PON activity was significantly and independently associated with the presence and severity of CAC and vice versa.
    Kardiologia polska 03/2014; DOI:10.5603/KP.a2014.0061 · 0.52 Impact Factor
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    ABSTRACT: Transcatheter aortic valve implantation (TAVI) has emerged as an acceptable treatment modality for patients with severe aortic stenosis (AS) who are deemed unsuitable for conventional surgical aortic valve replacement. TAVI not only provides the treatment of AS, but also makes some other diseases treatable by relieving hemodynamic distress resulting from AS. In this case report, we presented a 74-year-old patient with Hodgkin's lymphoma (HL) that had been left untreated due to the development of acute pulmonary edema caused by severe degenerative AS during chemotherapy. This is the first report of the use of TAVI in a patient with HL.
    International journal of hematology 01/2014; DOI:10.1007/s12185-014-1500-7 · 1.68 Impact Factor
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    ABSTRACT: Interestingly, prostate-specific antigen (PSA), which is used to monitor prostate disorders, has been suggested to be beneficial in estimating prognosis associated with coronary artery disease (CAD). The aim of the present study was to investigate the relationship of serum levels of PSA and free PSA (fPSA) with prognosis of acute coronary syndromes (ACS), extent of CAD and major adverse cardiac events in patients with acute coronary syndromes. Materials and Methods: Sixty-seven male patients who were diagnosed with acute coronary syndromes were included. All patients were assessed according to the Thrombolysis in Myocardial Infarction (TIMI) classification [ST elevation myocardial infarction (STEMI) and non-ST elevation (NSTE)-ACS groups, separately], the Global Registry of Acute Cardiac Events (GRACE) (difference between PSA and fPSA) risk score and the Killip classification. All patients underwent angiography. The degree of stenosis was scored using the Gensini score to assess the extent of CAD. Results: Serum PSA, fPSA, fPSA/PSA levels, and alpha 1-antichymotrypsin-PSA (ACT-PSA) (difference between PSA and fPSA) results were found to be moderately correlated with the TIMI and GRACE risk scores, which are predictors of short- and mid-term prognosis. While there was no correlation between the Gensini score and PSA and ACT-PSA, the Gensini score was moderately correlated with fPSA and fPSA/PSA. There were no significant differences between patients with major adverse cardiovascular events (MACEs) and those without MACEs at the 6-month follow-up in terms of PSA, fPSA, fPSA/PSA, and ACT-PSA results. Conclusion: There may be a relationship between serum PSA and fPSA levels and prognosis of ACS and extent of CAD. It should be kept in mind that additional biomarkers could be used together with current scoring systems in risk classification in cases for which clinical decisionmaking is challenging. Moreover, PSA and fPSA results should be approached with caution in patients to be screened for prostate cancer as their serum levels may be influenced from several factors (ACS, infection, etc.).
    Urology journal 01/2014; 11(1):1278-86. · 0.71 Impact Factor
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    ABSTRACT: Capable of multi-organ involvement in Sjogren's syndrome (SS), cardiac findings of pulmonary effusion, left ventricular diastolic dysfunction and pulmonary hypertension are seen in patients with SS. Aortic stiffness (AS) reflects the mechanical tension and elasticity of the aorta. In this study, our aim is to determine if there is any differences in AS and left ventricular function between patients diagnosed as SS and healthy control groups. We enrolled 50 patients with SS and 47 healthy volunteers with similar demographic characteristics. It was found that isovolumetric relaxation time (IVRT) and deceleration time (DT) were significantly longer and early diastolic wave (E) was significantly lower in patients with SS, but there was no difference in the other parameters. When tissue Doppler echocardiography (TDE) findings were compared between the two groups, it was found that myocardial systolic wave (Sm), myocardial early diastolic wave (Em) and Em/Am ratio were significantly lower, and myocardial isovolumetric relaxation time (IVRTm) and myocardial performance index (MPI) values were significantly higher in patients with SS. A significant positive correlations between aortic strain and Sm (r = 0.35, P < 0.001), Em (r = 0.42, P < 0.001) and Em/Am (r = 0.26, P = 0.008) and negative correlations in IVRTm (r = -0.36, P < 0.001) and MPI (r = -0.24, P = 0.01) were detected. A significant positive correlation between aortic distensibility and Sm (r = 0.36, P < 0.001), Em (r = 0.44, P < 0.001), Em/Am (r = 0.26, P = 0.009) and negative correlation of IVRTm (r = -0.22, P = 0.02) were determined. There is a significant relationship between AS and left ventricular diastolic dysfunction in patients with SS in this study. The parameters of aortic elasticity measured by 2D echocardiographic methods can be beneficial in predicting early cardiovascular risk in SS.
    International Journal of Rheumatic Diseases 12/2013; 17(6). DOI:10.1111/1756-185X.12258 · 1.77 Impact Factor
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    ABSTRACT: In recent years, emerging transcatheter aortic valve implantation (TAVI) has become an alternative for surgery. However, with advanced age, several co-morbid factors together with contrast agent usage can cause deterioration in renal function and increase in the risk of acute kidney injury (AKI) with poor prognosis in patients with AKI. Therefore, many patients cannot benefit from this treatment. In this study, we aim to examine the effects of TAVI on renal functions. Seventy patients, mean age of 77.6 years, underwent TAVI between July 2011 and December 2012. Estimated glomerular filtration rate (eGFR) was calculated by using the Cockcroft and Gault Formula. Patients were monitored for 48 h for urine output. Stage 1 AKI, according to the VARC-2 AKIN system, developed in only five (7.1%) of the patients after the procedure. There was a statistically significant increase between the mean 1(st) month eGFRs before (68.2 vs. 61.0, P < 0.01) and after (68.2 vs. 63.6, P < 0.05) the TAVI in the cohort. After TAVI (48.5 mL/min, P < 0.01) and the 1(st) month (52.1 mL/min, P < 0.01), the eGFR of the 36 (51.4%) patients diagnosed with chronic kidney disease before the procedure showed a statistically significant increase in renal functions. The hospital mortality rate was higher in the group which developed AKI (P < 0.01). First month eGFR showed a more statistically significant increase than pre-TAVI eGFR (62.8 and 69.8, P < 0.05, respectively) in AKI developing patients and this difference - though statistically not significant - continued into the sixth month. In this study, we showed that the treatment of aortic stenosis through TAVI allows improvement of renal functions, and that AKI rates will be lower with careful patient selection, proper pre-procedural hydration, and careful use of contrast agent.
    Journal of Geriatric Cardiology 12/2013; 10(4):317-22. DOI:10.3969/j.issn.1671-5411.2013.04.010 · 1.06 Impact Factor
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    Journal of the American College of Cardiology 10/2013; 62(18). DOI:10.1016/j.jacc.2013.08.669 · 15.34 Impact Factor
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    Journal of the American College of Cardiology 10/2013; 62(18). DOI:10.1016/j.jacc.2013.08.657 · 15.34 Impact Factor
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    Journal of the American College of Cardiology 10/2013; 62(18). DOI:10.1016/j.jacc.2013.08.100 · 15.34 Impact Factor

Publication Stats

154 Citations
203.44 Total Impact Points

Institutions

  • 2013–2015
    • Yıldırım Beyazıt Üniversitesi
      • Faculty of Medicine
      Engüri, Ankara, Turkey
  • 2013–2014
    • Ankara University
      Engüri, Ankara, Turkey
  • 2008–2014
    • Ankara Atatürk Training and Research Hospital
      Engüri, Ankara, Turkey
  • 2007–2013
    • Ataturk Chest Diseases and Chest Surgery Education and Research Hospital
      Engüri, Ankara, Turkey
  • 2008–2010
    • İzmir Atatürk Eğitim ve Araştırma Hastanesi
      Ismir, İzmir, Turkey