Tansel Erol

Baskent University, Ankara, Ankara, Turkey

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Publications (35)81.73 Total impact

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    ABSTRACT: To examine the feasibility and accuracy of teleconsultation of coronary angiograms using iPhone 4 and FaceTime.METHODS: The study was conducted in two stages. Coronary angiograms of 100 patients with single-vessel disease were retrospectively selected by a core laboratory unit and then re-evaluated by a consultant cardiologist on both an iPhone 4 screen via the FaceTime application and on the workstation monitor of the angiography laboratory. The interpretations of the consultant cardiologist on localization and severity of angiographic lesions were recorded and compared with those of the core laboratory. Using the same teleconsultation system, the consultant cardiologist outside the hospital was presented live angiographic images of 10 patients undergoing primary percutaneous intervention (PCI) for acute myocardial infarction. Interpretations of the consultant cardiologist on the localization and severity of 100 lesions on both the smartphone screen and workstation monitor showed high levels of agreement with the results of the core laboratory (for all, κ > 0.80). Of 10 patients whose PCI was performed under live video teleconsultation, eight patients underwent successful PCI while two patients had normal coronary arteries. There was an excellent agreement between the consultant cardiologist and the operator regarding lesion localization.CONCLUSIONS: Smartphones allow highly accurate interpretations on angiographic lesions and thus may serve as a supplementary teleconsultation tool in both elective and emergency situations.
    Technology and health care: official journal of the European Society for Engineering and Medicine 04/2013; · 0.64 Impact Factor
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    ABSTRACT: Left ventricular diverticulum is a rare congenital malformation consisting of a localized protrusion of the endocardium and myocardium from the free wall of the left ventricle (LV). The prevalence of the disease is 0.26% in nonselected patients who underwent cardiac catheterization. It is believed that the etiology is an intrinsic abnormality developing during embryogenesis. It often does not cause any symptoms. We report a case of isolated left ventricular diverticulum with complaints of transient ischemic attack.
    Balkan Journal of Medical Genetics 12/2012; 29(4):458-9. · 0.08 Impact Factor
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    ABSTRACT: Behçet's disease (BD) is a chronic multi-system disease presenting with recurrent oral and genital ulceration, and relapsing uveitis. Heart rate recovery (HRR) after exercise is a marker of parasympathetic activity. A delayed recovery of systolic blood pressure (SBP) after exercise might reflect sympathetic hyperactivity. The analysis of variations in heart rate has also been used to determine the balance between sympathetic and vagal nerve activities in the heart. Our objective was to determine HRR, the SBP response to exercise and heart rate variability (HRV) in patients with BD in the absence of neurological involvement. The study population consisted of 32 patients with BD and 30 healthy controls who were matched with respect to age, sex, and physical activity. Heart rate recovery was calculated as the difference between heart rate at peak exercise and heart rate at 1, 2, and 3 min of recovery. Blood pressure recovery indexes were determined by dividing the systolic blood pressure at 2 and 3 min in recovery to the systolic blood pressure at peak exercise. In patients with BD, mean HRR at 1 min (HRR1) were not significantly different than that of controls (21 ± 7 vs 20 ± 7 bpm, p = 0.50). Although, resting mean SBP of patients with BD was higher than controls (121 ± 13 vs 115 ± 12 mmHg, p = 0.039), the SBP recovery indices of the patients with BD at 2 and 3 min were similar to those of controls (0.84 ± 0.07 vs 0.84 ± 0.09, p = 0.89 and 0.78 ± 0.09 vs 0.78 ± 0.08, p = 0.93, respectively). Both time domain and frequency domain parameters of patients with BD were similar to that of controls. This study shows that the patients with BD have normal HRR1 and normal SBP response to exercise and normal HRV. These findings might suggest unaltered autonomic neural control of the cardiovascular system in this disorder in the absence of neurological involvement.
    Clinical Rheumatology 07/2012; 31(10):1499-504. · 2.04 Impact Factor
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    ABSTRACT: To investigate the relation between parathyroid hormone (PTH) and heart failure with preserved ejection fraction (HF-PEF) in outpatients. One hundred consecutive patients who had preserved left ventricular (LV) ejection fraction and heart failure (HF) symptoms, were enrolled. Echocardiography, assessing the diastolic functions was performed. Blood samples were collected for intact PTH and brain natriuretic peptide (BNP). Significant correlations between PTH level and predictors of advanced HF-PEF were found (p < 0.05). PTH level and left atrium diameter were found to be independent predictors of DHF. Measurement of serum PTH provides complementary information for the diagnosis and prognosis of HF-PEF.
    Biomarkers 05/2012; 17(5):447-54. · 1.88 Impact Factor
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    ABSTRACT: BACKGROUND: Contrast-induced nephropathy (CIN) remains a common complication of radiographic procedures. Radiocontrast agents can cause a reduction in renal function that may be due to reactive oxygen species. Conflicting evidence suggests that administration of antioxidants prevents CIN. METHODS: We assessed the efficacy of allopurinol in preventing CIN. We prospectively randomized 159 patients with a serum creatinine concentration >1.1mg/dL undergoing cardiac catheterization/interventions to receive allopurinol (300mg, p.o.) 24h before administration of radiocontrast agent and hydration (1mg/kg/hN/saline for 12h pre- and post-contrast, n=79), or hydration alone (1mg/kg/hN/saline for 12h pre- and post-contrast, n=80). RESULTS: CIN occurred in 6 of 80 patients (7.5%) in the control group and no subjects in the allopurinol group (p=0.013). In the allopurinol group, median serum creatinine concentration decreased significantly from 1.43mg/dL [1.1-4.15mg/dL] to 1.35mg/dL [0.7-4.15mg/dl] at 48h and to 1.27mg/dL [0.66-4.37mg/dL] at 4days after radiocontrast administration (p<0.0001 and p<0.0001 compared with baseline, respectively). In the control group, median serum creatinine concentration decreased non-significantly from 1.48mg/dL [1.1-2.96mg/dL] to 1.43mg/dL [0.73-3.02mg/dL] and to 1.45mg/dL [0.86-3.71mg/dL] (p=0.045 and p=0.57, respectively) 48h and 4days after radiocontrast administration. CONCLUSIONS: Prophylactic oral administration of allopurinol, along with hydration, may protect against CIN in high-risk patients undergoing coronary procedures.
    International journal of cardiology 05/2012; · 6.18 Impact Factor
  • Deniz Yerdelen, Tansel Erol, Filiz Koc
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    ABSTRACT: Autonomic manifestations regarding cardiac function in epilepsy are not rare and are being recognized with increasing frequency. The aim of this study was to assess autonomic function by measuring heart rate recovery (HRR), an index of vagal activity, in patients with epilepsy who were not taking any medication. Fourteen patients (eight with primary generalized epilepsy, four with secondary generalized epilepsy, and two with complex partial epilepsy) and 14 control subjects underwent exercise tolerance tests according to the modified Bruce protocol. HRR at 1 and 3 min (HRR1 and HRR3) were calculated. HRR1 and HRR3 were increased in patients with epilepsy. These results suggest increased parasympathetic function in epilepsy and support results of previous studies indicating autonomic dysfunction in epilepsy.
    The International journal of neuroscience 04/2012; 122(9):515-8. · 0.86 Impact Factor
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    ABSTRACT: Coronary slow flow (CSF) has been documented in 25% of patients evaluated for angina or angina-like chest pain, despite the presence of normal epicardial coronary arteries on angiography. The risk for the development of clinical events in patients with non-obstructive coronary artery disease (NOCAD) is higher than in patients with completely normal coronary arteries. The object of this study was to evaluate changes in blood and plasma viscosity in patients with CSF or NOCAD. The study included 147 subjects (CSF, n = 42, NOCAD, n = 42 and controls, n = 63). Blood and plasma viscosity, complete blood counts, fibrinogen, and high sensitivity C-reactive protein (hs CRP) levels were measured. There was no significant difference between the groups with respect to blood and plasma viscosity (p > 0.05). Hemoglobin, hematocrit, and erythrocyte counts were significantly higher in the CSF group compared to the NOCAD group (p = 0.017, p = 0.023 and p = 0.023 respectively) and the control group (p = 0.026, p = 0.02 and p = 0.02, respectively). High sensitivity CRP levels in the NOCAD group were higher than the CSF group and the control group (p = 0.001 and p = 0.018, respectively). In conclusion, no significant difference was observed in the blood and plasma viscosity in patients with CSF or NOCAD. Increases in hemoglobin and hematocrit values without an increase in viscosity may play a role in the pathophysiology of CSF.
    Clinical hemorheology and microcirculation 04/2012; · 3.40 Impact Factor
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    ABSTRACT: In this study, the diagnostic accuracy of interpretations of electrocardiogram (ECG) images taken by a mobile phone and sent as multimedia message was investigated. The ECGs of 305 patients who were admitted to the emergency department with cardiac complaints were photographed with the camera of a Nokia (Espoo, Finland) N93 mobile phone. The images were sent via a multimedia messaging system to an identical mobile phone carried by a cardiologist and were interpreted on the screen of that mobile phone. Another cardiologist and an emergency physician interpreted ECG paper printouts separately. The findings of the core laboratory were used as the gold standard. The interpretation errors were scaled from 1 to 4 with respect to the significance of findings. The total ratio of Grade 4 errors, which consisted of significant errors, did not show any significant difference (p=0.76) between the interpretations by the emergency medicine specialist and the cardiologist who interpreted the ECGs on the mobile phone; the cardiologist who interpreted the ECG paper printouts made significantly fewer mistakes than the other two specialists (p=0.025 and p=0.023, respectively). The separate assessment of the findings showed that in the diagnostic process of ST-segment elevation, depression, and supraventricular tachycardia, the consistency of the interpretations (κ=0.81, κ=0.81, and κ=1.0, respectively) made on the mobile phone screen was slightly better than that of the emergency medicine specialist (κ=0.73, κ=0.77, and κ=0.80, respectively) and was similar to that of the cardiologist (κ=0.91, κ=0.91, and κ=1.0, respectively) who interpreted ECG paper printouts. Our findings suggest that sending the ECG images via a multimedia message service may be a practical and inexpensive telecardiology procedure.
    Telemedicine and e-Health 03/2012; 18(2):126-31. · 1.40 Impact Factor
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    ABSTRACT: Increased parathyroid hormone (PTH) level is associated with all-cause mortality in patients with heart failure (HF). However its role for identifying advanced HF has not been previously studied. We aimed to investigate whether the assessment of serum PTH could enable clinicians to identify patients with advanced HF. One hundred fifty consecutive patients who visited our outpatient clinic with systolic HF were enrolled in the present study. Serum levels of PTH and brain natriuretic peptide (BNP) were measured across all New York Heart Association functional classes. Mean levels of PTH were 43 ± 19, 84 ± 56, 121 ± 47, and 161 ± 60 pg/ml in New York Heart Association functional classes I, II, III, and IV, respectively (p <0.001). In univariate analysis, body mass index, disease duration, PTH, BNP and hemoglobin levels, creatinine clearance, heart rate, systolic blood pressure, left ventricular ejection fraction, left ventricular diastolic diameter, left atrial size, presence of atrial fibrillation, and diuretic usage were found to be predictors of advanced HF. In multivariate logistic regression analysis, PTH level (hazard ratio 1.032, 95% confidence interval 1.003 to 1.062, p = 0.003) and body mass index (hazard ratio 0.542, 95% confidence interval 0.273 to 1.075, p = 0.079) were associated with advanced HF. Furthermore, serum PTH levels were correlated with BNP level and left ventricular ejection fraction (p <0.001 for the 2 comparisons). In receiver operator characteristics curve analysis, the optimal cut-off value of PTH to predict advanced HF was >96.4 pg/ml, with 93.3% sensitivity and 64.2% specificity. In conclusion, measurement of serum PTH could provide complementary information and a simple biomarker strategy to categorize patients with advanced HF based on increased PTH levels, allowing rapid risk stratification in these patients.
    The American journal of cardiology 01/2012; 109(2):252-6. · 3.58 Impact Factor
  • Yerdelen D, Erol T, Koc F
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    ABSTRACT: Autonomic manifestations regarding cardiac function in epilepsy are not rare and are being recognized with increasing frequency. The aim of this study was to assess autonomic function by measuring heart rate recovery (HRR), an index of vagal activity, in patients with epilepsy who were not taking any medication. Fourteen patients (eight with primary generalized epilepsy, four with secondary generalized epilepsy, and two with complex partial epilepsy) and 14 control subjects underwent exercise tolerance tests according to the modified Bruce protocol. HRR at 1 and 3 min (HRR1 and HRR3) were calculated. HRR1 and HRR3 were increased in patients with epilepsy. These results suggest increased parasympathetic function in epilepsy and support results of previous studies indicating autonomic dysfunction in epilepsy.
    Int J Neurosci. 01/2012; 122(9):515-8.
  • Tansel Erol, Hakan Altay, Ebru Tarim
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    ABSTRACT: A cardiac hydatid cyst in pregnancy is a very rare condition. Surgical intervention followed by medical therapy is the treatment of choice. A hydatid disease in pregnancy is challenging with a varied presentation and manifestation. A pregnant woman presented with a ruptured pericardial cyst diagnosed by echocardiography, magnetic resonance and serology. Finally, she received medical treatment and no surgical intervention.
    Acta cardiologica 06/2011; 66(3):387-9. · 0.61 Impact Factor
  • International Journal of Cardiology - INT J CARDIOL. 01/2011; 147.
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    ABSTRACT: To determine prevalence of newly diagnosed hyperglycemia (NDH) among patients with acute coronary disease, inquire relationship of stress hyperglycemia (SH) with functional outcomes. Admission (APG) and first morning fasting plasma glucose (FPG) measurements were obtained, capillary glucose measurements (CGM) every 6-h within first day were performed-Group 1: Normoglycemics. Group 2: NDH cases: No known diabetes, APG>200mg/dl and/or FPG>126 and/or any of CGM>200. Group 2a: unrecognized glycemic disorder, HbA1c>6.0%. Group 2b: stress hyperglycemia, HbA1c<6.0%. Group 3: Recognized diabetes. Duration of ICU stays, APACHE-II scores were recorded. Logistic regression analysis was performed using ICU stay as dependent variable and age, groups, co-morbidities, problems in hospital, APACHE-II scores, CGMs were used as independent risk factors. There were 255 (51.6%) in Group 1, 82 (16.6%) in Group 2; 37 (7.5%) cases in Group 2a, 45 (9.1%) in Group 2b and 157 (31.8%) in Group 3. Group 2b spent longer time in ICU, had higher APACHE-II scores (p=0.0001, p=0.0001). Regression analysis demonstrated SH as an independent risk factor for duration of ICU stay (OR: 2.8, 95% CI: 1.3-6.2). Hyperglycemia was present in 48.4%; 16.6% had NDH, 9.1% had SH. Poor functional conditions of SH cases pointed that they need to be considered carefully.
    Diabetes research and clinical practice 10/2010; 90(1):8-14. · 2.74 Impact Factor
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    ABSTRACT: To evaluate longitudinal function of ischemic and nonischemic myocardial tissue detected by Tc-99m MIBI single photon emission computed tomography (SPECT) prior to coronary revascularization in patients with stable angina pectoris. We studied 24 consecutive patients (mean age 62+/-9 years; 5 women) with stable angina pectoris. All patients underwent myocardial perfusion SPECT. Tissue Doppler imaging (TDI) was performed to detect myocardial systolic velocities of anterior, inferior, septum and lateral walls at rest and peak dobutamine stress. A total of 96 segments were visualized with SPECT study. Maximum mean septal, lateral, anterior and inferior TDI systolic velocities were similar in ischemic and nonischemic segments (6.73+/-1.04 cm/sec, 6.93+/-1.34 cm/sec, respectively) at rest. At peak stress, maximum mean TDI systolic velocities were lower in the 37 ischemic segments (11.00+/-2.03 cm/sec) than 59 nonischemic segments (13.76+/-1.97 cm/sec, p = 0.001). Because we detected ischemia in whole group using both diagnostic tests, coronary angiography was decided. Critical coronary artery stenosis related to ischemic segments was detected and coronary revascularization decided. TDI with dobutamine stress can be used in patients with stable angina pectoris. In this study, we observed that quantitative data by TDI associated with SPECT showed an agreement for coronary revascularization.
    Anadolu kardiyoloji dergisi: AKD = the Anatolian journal of cardiology 08/2010; 10(4):334-9. · 0.72 Impact Factor
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    ABSTRACT: Unicuspid aortic valve is a rare pathology among congenital heart diseases that requires cardiac surgery and is often confused with bicuspid valve. Herein, we report a case of a unicommisural form of unicuspid aortic valve concomitant with aortic aneurysm and secundum type atrial septal defect.
    Clinical Cardiology 07/2010; 33(7):E38-9. · 1.83 Impact Factor
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    ABSTRACT: Autonomic dysfunction is a common and important complication in Guillain-Barre syndrome (GBS) and may be the cause of significant morbidity or death. Objectives : To show the possible autonomic involvement in patients with GBS. The sympathetic skin response (SSR) and the parameters of heart rate variability gathered from a 24-h electrocardiogram recording were studied in 14 patients with GBS [13 with acute inflammatory demyelinating polyneuropathy (AIDP) and one with acute motor axonal neuropathy (AMAN)]. In two of the patients, SSR couldn't be elicited. In the rest of the patients, amplitude of SSR was found to be decreased when compared with the control subjects. In the time domain analysis of the 24-h electrocardiogram, SDNN (the standard deviation of all R-R intervals), SDANN (the standard deviation of the averages of R-R intervals during all 5-min periods that constitute the 24-h day), SDNN index (mean of the standard deviations of all R-R intervals for all 5-min segments of the 24-h recording); in the frequency domain analysis HF(high frequency), LF(low frequency), VLF (very low frequency) and total power were found decreased in patients when compared with the control subjects. When the mean values with standard deviations of controls were compared with the patients' values one by one, the pregnant patient with AMAN had increased heart rate variability parameters. The remaining 13 patients had decreased values. These findings reflect an involvement of both the parasympathetic and sympathetic systems in GBS. Our results suggest that SSR and heart rate variability parameters may be used for early detection of any autonomic dysfunction in patients with GBS.
    Neurology India 01/2010; 58(3):398-402. · 1.04 Impact Factor
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    ABSTRACT: An adequate pool of free intracellular cholesterol is essential for steroidogenesis in gonads and LDL is the major source of cholesterol used in this pathway. Effect of peripheral LDL on the synthesis of steroids is dose dependent and although LDL levels around 100 mg/dl is demonstrated to be safe in terms of steroidogenesis, effect of LDL levels <70 mg/dl with higher doses of statins on steroidogenesis remains controversial. Androgen and gonadotropin levels are prospectively evaluated at baseline and after 12 weeks of treatment in 77 male coronary heart disease patients receiving high doses of atorvastatin (40-80 mg daily) targeting serum LDL levels <70 mg/dl and in 83 male coronary heart disease patients receiving regular doses of atorvastatin (10-20 mg daily) targeting serum LDL levels <100 mg/dl. At the end of the study, mean LDL levels of the high and regular dose atorvastatin groups were 77+/-9 mg/dl and 98+/-10 mg/dl respectively. After twelve weeks of treatment, there were no significant alterations in serum total testosterone, free testosterone, sex hormone binding globulin, luteinizing hormone and follicle stimulating hormone levels between two groups. High dose atorvastatin in order to reach serum LDL levels around 70 mg/dl seems to be as safe as regular doses in order to reach serum LDL levels around 100 mg/dl, in terms of gonadal steroidogenesis in men with coronary heart disease.
    Experimental and Clinical Endocrinology & Diabetes 02/2009; 117(2):60-3. · 1.56 Impact Factor
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    ABSTRACT: Direct stenting without predilatation is a well-defined, feasible method with bare metal stents. Direct stenting has also been shown to be safe and feasible with drug-eluting stents, however, there is much less evidence with this type of device when compared with bare metal stents. Three hundred and sixty-four coronary lesions in 257 consecutive patients (mean age, 57.4 +/- 9.8 years; 63 women) who had undergone elective stenting either with or without predilatation via a paclitaxel-eluting stent between March 2003 and March 2006 were retrospectively analyzed. Quantitative coronary angiography analysis was compared between the two groups of procedures; stenting with predilatation and direct stenting. All procedures were uneventful. No deaths occurred during the follow-up period. Direct stenting when compared with the predilatation technique, significantly decreased both procedure time (32.1 +/- 17.9 minute versus 41.2 +/- 18.6 minute, P < 0.0001) and fluoroscopy time (10.6 +/- 7.8 minute versus 15.5 +/- 7.6 minute, P < 0.0001). There was no difference in quantitative analysis parameters of coronary angiography during follow-up or the rates of stent thrombosis and restenosis. Direct stenting seems to be as feasible and safe as conventional predilatation and stenting in selected cases. Direct stenting seems to decrease procedural time and radiation exposure without any negative effect on quantitative analysis parameters of coronary angiography with approximately a one-year follow-up period.
    International Heart Journal 10/2008; 49(5):545-52. · 1.23 Impact Factor
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    ABSTRACT: It has been demonstrated that rheumatic mitral valve stenosis (RMVS) is associated with an increase in markers of endothelial dysfunction. It is not known whether this association indicates an impairment of flow-mediated dilatation (FMD) of the vascular endothelium. Thirty patients with RMVS and 30 healthy subjects were studied. FMD in patients with RMVS was significantly smaller than in healthy controls (11.9+/-0.4% vs 15.4+/-0.70%, p=0.003). The absolute change in brachial artery diameter in patients with RMVS was also significantly smaller than in healthy subjects (0.42+/-0.26 mm vs 0.64+/-0.32 mm, p<0.001). These findings suggest that vascular endothelial function is altered in patients with RMVS.
    International journal of cardiology 04/2008; 125(3):410-2. · 6.18 Impact Factor
  • Anadolu kardiyoloji dergisi: AKD = the Anatolian journal of cardiology 02/2008; 8(6):E37-8. · 0.72 Impact Factor