Orhan Maden

Publications (58)108.9 Total impact

• Article: High levels of high sensitivity C-reactive protein predict the progression of chronic rheumatic mitral stenosis

  Omer Alyan, Fatma Metin, Fehmi Kacmaz, Ozcan Ozdemir, Orhan Maden, Serkan Topaloglu, Ahmet Duran Demir, Zulkuf Karahan, Aziz Karadede, Erdogan Ilkay
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  ABSTRACT: Background High sensitive C-Reactive Protein (hs-CRP) predicts morbidity and mortality in various clinical conditions. The effect of hsCRP on progression of chronic rheumatic mitral stenosis (CRMS) has not been demonstrated. Methods and results A total of 132 patients with CRMS (95 female, 37 male) and 145 control (100 female, 45 male) were included in the study. Baseline clinical, echocardiographic, hematologic and hs-CRP measurements were collected prospectively. Mean mitral valve area (MVA) was 1.4±0.3 cm2, mean wilkins valve score value was 8.9±1.7, left atrial diameter was 5.0±0.7cm, left atrial area was 37.2±12.6 cm2, and systolic pulmonary arterial pressure (SPAP) was 44±11mmHg in patients with CRMS. The mean levels of hs-CRP value, fibrinogen, and mean platelet volume (MPV) were significantly higher in CRMS group compared to control group. The levels of hsCRP were found to be positively correlated with mean Wilkins valve score value, SPAP, presence of atrial fibrillation (AF), left atrial diameter, left atrial area, presence of LASEC(+), fibrinogen, and MPV and inversely correlated with MVA in patients with CRMS. Linear regression analysis revealed that the hsCRP level independently affects mean Wilkins valve score value, left atrial area (LAA), LASEC(+) and AF in the patients with CRMS. Conclusions These results suggest that increased hsCRP levels are associated with CRMS severity. These association may be important when treating patients with CRMS.
  Journal of Thrombosis and Thrombolysis 04/2012; 28(1):63-69. · 1.48 Impact Factor
• Article: A new electrocardiographic marker of myocardial reperfusion in patients with acute ST-segment elevation myocardial infarction treated with primary percutaneous intervention: the value of QRS duration.

  Erdogan Ilkay, Fehmi Kacmaz, Orhan Maden, Tolga Aksu, Mehmet-Timur Selcuk, Ali-Riza Erbay, Ahmet-Duran Demir
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  ABSTRACT: Although ischaemia-induced QRS complex changes have been described previously, their relation with reperfusion status is not clear. We aimed to investigate the relation of QRS duration with reperfusion at tissue level compared to myocardial blush in patients with acute myocardial infarction who underwent successful primary percutaneous coronary angioplasty. One hundred and forty-eight patients were enrolled. Based on the post-angioplasty myocardial blush grade (MBG), patients were divided into reperfusion (grades 2 and 3) and impaired reperfusion (grades 0 and 1) groups. Although the two groups did not differ in terms of admission QRS duration (81±17 vs. 79±15 msec, p=0.473), the patients in the impaired reperfusion group had a significantly longer QRS duration both at immediate post-angioplasty (78±18 vs. 68±17 msec, p=0.001) and at the 60th minute ECG (77±17 vs. 60±17 msec, p<0.001). Patients in the impaired reperfusion group revealed significantly less narrowing of QRS duration in the post-angioplasty 60th minute ECG (6±5 vs. 20±5 msec, p<0.001) when compared to the patients in the reperfusion group. After adjusting all variables, QRS narrowing in the 60th minute ECG was determined as an independent electrocardiographic predictor of reperfusion (OR:1.39, 95% CI: 1.25-1.54, p<0.001). We demonstrated that QRS duration is a strong indicator of myocardial reperfusion status.
  EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 04/2012; 7(12):1406-12. · 3.29 Impact Factor
• Article: Ambulatory blood pressure variability is associated with restenosis after percutaneous coronary intervention in normotensive patients.

  Serkan Cay, Goksel Cagirci, Ahmet Duran Demir, Yucel Balbay, Ali Riza Erbay, Sinan Aydogdu, Orhan Maden
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  ABSTRACT: Previous studies have showed that BP variability is associated with cardiovascular events. However, no data were available regarding binary restenosis as an end-point after percutenous coronary intervention (PCI). This multicenter study included 100 consecutive normotensive patients with stable coronary artery disease who were planned for PCI. Before the index procedure, office BP and 24-h ambulatory BP measurements were performed. BP variability indices including systolic and diastolic 24-h average, the day and the night values of standard deviation (SD) and variation coefficient (VC) were measured and calculated. All patients underwent repeat coronary angiography at 6-month. According to angiographic results, 2 groups were formed; a restenosis group (n=30) with binary restenosis of the stented segment and a control group (n=70) with a stenosis diameter of <50% in stented segment. Systolic SD and VC values for 24-h average (14.0±2.8mmHg vs. 9.5±1.6mmHg, p<0.001 and 16%±3 vs. 11%±2, p<0.001, respectively), the day (15.2±3.9mmHg vs. 10.6±1.7mmHg, p<0.001 and 17%±4 vs. 12%±2, p<0.001, respectively), and the night (12.8±4.1mmHg vs. 8.4±2.4mmHg, p<0.001 and 14%±5 vs. 11%±3, p=0.004, respectively) values were significantly higher in restenosis group compared to control group. Similarly, diastolic SD and VC values for 24-h average (10.6±2.5mmHg vs. 8.1±1.5mmHg, p<0.001 and 12%±3 vs. 9%±2, p=0.001, respectively), the day (11.1±2.9mmHg vs. 9.0±1.8mmHg, p=0.003 and 12%±3 vs. 10%±2, p=0.006, respectively), and the night (10.0±3.6mmHg vs. 7.2±2.0mmHg, p=0.001 and 11%±5 vs. 9%±3, p=0.059, respectively) values were significantly higher in restenosis group compared to no restenosis group except for diastolic VC night. All systolic and diastolic BP variability indices except diastolic VC night were found to be independent predictors of risk of restenosis in multivariate analysis. In addition, the cut-off values of 11.4mmHg and 13% for 24-h systolic SD and VC, respectively, were found to be highly sensitive (93% for both) and specific (94% and 91%, respectively) for predicting binary restenosis at 6-month after PCI. BP variability indices are significantly and independently associated with binary restenosis and higher values can predict restenosis after PCI sensitively and specifically.
  Atherosclerosis 12/2011; 219(2):951-7. · 3.79 Impact Factor
• Article: Elevated plasma asymmetric dimethylarginine level in acute myocardial infarction patients as a predictor of poor prognosis and angiographic impaired reperfusion.

  Nihat Sen, Mehmet Fatih Ozlu, Emin Ozgur Akgul, Selcuk Kanat, Tuncer Cayci, Osman Turak, Halil Yaman, Erdogan Sokmen, Firat Ozcan, Orhan Maden, Ahmet Duran Demir, Adrian Covic, Mehmet Kanbay
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  ABSTRACT: We aimed to investigate the effects of admission asymmetric dimethylarginine (ADMA) levels on myocardial perfusion and prognosis in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). ADMA, an endogenous inhibitor of endothelial nitric oxide synthase, was found to be elevated in plasma of patients with cardiovascular risk factors. 168 consecutive patients undergoing primary PCI for STEMI <12 h after symptom onset and 75 healthy age and sex matched volunteer controls were enrolled in the study. Patients with STEMI were grouped into tertiles according to their admission plasma ADMA levels. Major adverse cardiac events during hospitalization or at one-year clinical follow-up were evaluated. Also angiographic impaired reperfusion was assessed by 3 different methods after PCI: angiographic thrombolysis in myocardial infarction (TIMI) flow, TIMI frame count and TIMI myocardial perfusion grade (TMPG). Plasma level of L-arginine were lower in patients with STEMI than in the control group subjects, whereas plasma ADMA levels were increased in the STEMI patient group. The rate of impaired angiographic reperfusion increased across the tertile groups. Also one-year mortality rates showed a significant increase across the tertile groups (4% vs. 10% vs. 20%, p<0.01). Using multiple Cox regression analysis, only TIMI risk score, left ventricle ejection fraction (LVEF), abnormal TMPG, and increased ADMA values on admission emerged as independent predictors of one-year mortality. The ROC analysis indicated an optimal cut-point of ≥1.37 μmol/L, which detects one-year mortality with a negative predictive value of 96%. In STEMI patients undergoing primary PCI, high admission ADMA levels were found to be associated with impaired myocardial perfusion and increased one-year mortality. Therefore admission ADMA level detection may be helpful in identifying the patients at a greater risk of impaired myocardial perfusion and poor prognosis.
  Atherosclerosis 06/2011; 219(1):304-10. · 3.79 Impact Factor
• Article: Lower Fetuin-A Predicts Angiographic Impaired Reperfusion and Mortality in ST-Elevation Myocardial Infarction

  Nurcan Basar, Nihat Sen, Selcuk Kanat, Mehmet Fatih Ozlu, Firat Ozcan, Serkan Cay, Gonul Erden, Kumral Ergun Cagli, Metin Yildirimkaya, Orhan Maden, Adrian Covic, Mehmet Kanbay
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  ABSTRACT: Aims: Fetuin-A is an anti-inflammatory negative acute-phase glycoprotein, synthesized by the liver. In this study, we aimed to investigate the effects of admission fetuin-A levels on coronary and myocardial blood flow and short- and long-term prognosis in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention. Methods and Results: One hundred eighty consecutive patients admitted with diagnosis of STEMI and 55 healthy age- and sex-matched volunteer controls were enrolled in the study. Patients with STEMI were divided into 2 groups in respect to thrombolysis in myocardial infarction myocardial perfusion grade after primary PCI: with thrombolysis in myocardial infarction myocardial perfusion grade 0-1-2 and thrombolysis in myocardial infarction myocardial perfusion grade 3. Serum levels of fetuin-A were lower in patients with STEMI than in the healthy group subjects. In-hospital and 1-year deaths were significantly higher in patients from the abnormal perfusion group. In-hospital major adverse cardiac event (MACE) and 1-year follow-up MACE also were significantly higher in patients from the abnormal perfusion group. The receiver-operating characteristic analysis indicated an optimal cut point of less than 200 μg/mL, which detects 1-year mortality with a negative predictive value of 95%. The 1-year mortality rate and 1-year MACE were significantly higher in patients with low fetuin-A level as compared with those with high fetuin-A level. Conclusions: Because low-admission fetuin-A levels are associated with impaired coronary flow in STEMI patients undergoing primary percutaneous coronary intervention, admission fetuin-A level detection may be helpful in identifying the patients at a greater risk of poor coronary blood flow and worse short- and long-term prognosis.
  Journal of Investigative Medicine 05/2011; 59(5):816-822. · 1.96 Impact Factor
• Article: Lower fetuin-A predicts angiographic impaired reperfusion and mortality in ST-elevation myocardial infarction.

  Nurcan Basar, Nihat Sen, Selcuk Kanat, Mehmet Fatih Ozlu, Firat Ozcan, Serkan Cay, Gonul Erden, Kumral Ergun Cagli, Metin Yildirimkaya, Orhan Maden, Adrian Covic, Mehmet Kanbay
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  ABSTRACT: Fetuin-A is an anti-inflammatory negative acute-phase glycoprotein, synthesized by the liver. In this study, we aimed to investigate the effects of admission fetuin-A levels on coronary and myocardial blood flow and short- and long-term prognosis in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention. One hundred eighty consecutive patients admitted with diagnosis of STEMI and 55 healthy age- and sex-matched volunteer controls were enrolled in the study. Patients with STEMI were divided into 2 groups in respect to thrombolysis in myocardial infarction myocardial perfusion grade after primary PCI: with thrombolysis in myocardial infarction myocardial perfusion grade 0-1-2 and thrombolysis in myocardial infarction myocardial perfusion grade 3. Serum levels of fetuin-A were lower in patients with STEMI than in the healthy group subjects. In-hospital and 1-year deaths were significantly higher in patients from the abnormal perfusion group. In-hospital major adverse cardiac event (MACE) and 1-year follow-up MACE also were significantly higher in patients from the abnormal perfusion group. The receiver-operating characteristic analysis indicated an optimal cut point of less than 200 μg/mL, which detects 1-year mortality with a negative predictive value of 95%. The 1-year mortality rate and 1-year MACE were significantly higher in patients with low fetuin-A level as compared with those with high fetuin-A level. Because low-admission fetuin-A levels are associated with impaired coronary flow in STEMI patients undergoing primary percutaneous coronary intervention, admission fetuin-A level detection may be helpful in identifying the patients at a greater risk of poor coronary blood flow and worse short- and long-term prognosis.
  Journal of Investigative Medicine 03/2011; 59(5):816-22. · 1.96 Impact Factor
• Article: Elevated serum uric acid predicts angiographic impaired reperfusion and 1-year mortality in ST-segment elevation myocardial infarction patients undergoing percutaneous coronary intervention.

  Nurcan Basar, Nihat Sen, Firat Ozcan, Gonul Erden, Selcuk Kanat, Erdogan Sokmen, Ahmet Isleyen, Huseyin Yuzgecer, Mehmet Fatih Ozlu, Metin Yildirimkaya, Orhan Maden, Adrian Covic, Richard J Johnson, Mehmet Kanbay
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  ABSTRACT: Serum uric acid (SUA) is associated with microvascular disease that could alter coronary blood flow and prognosis. We evaluated the effects of admission SUA levels on coronary blood flow and prognosis in 185 consecutive patients with ST-segment elevation myocardial infarction (STEMI) who underwent acute primary percutaneous coronary intervention (PCI). Patients undergoing PCI for an acute STEMI were stratified into elevated SUA (>6.5 mg/dL) and normal SUA group (≤6.5 mg/dL). Primary end points were post-PCI myocardial blood flow and in-hospital and 1-year mortality. Serum uric acid level was high in 45 patients (24%) on admission. Subjects with elevated SUA had a higher prevalence of hypertension, previous myocardial infarction, multivessel disease, and Killip functional class III or higher. Corrected thrombolysis in myocardial infarction (TIMI) frame count was longer, and mean TIMI myocardial perfusion grade was higher in patients with elevated uric acid compared with controls. Patients with elevated SUA levels had higher in-hospital (6.6% vs 2.8%, P < 0.01) and 1-year mortality (11.1% vs 5.7%, P < 0.01). Major adverse cardiac events were higher in patients with elevated SUA levels both in-hospital (11.1% vs 5.7%, P < 0.01) and at 1 year (17.7% vs 10%, P < 0.05). An elevated admission SUA level also independently predicted both 1-year mortality (odds ratio, 1.41; 95% confidence interval, 1.24-2.69) and abnormal myocardial perfusion detected by TIMI myocardial perfusion grade in STEMI patients undergoing primary PCI (odds ratio, 2.14; 95% confidence interval, 1.17-4.19, respectively). Elevated SUA level on admission independently predicts impaired myocardial flow and poor prognosis in STEMI patients undergoing primary PCI.
  Journal of Investigative Medicine 03/2011; 59(6):931-7. · 1.96 Impact Factor
• Article: Safety of clopidogrel in older patients: a nonrandomized, parallel-group, controlled, two-centre study.

  Serkan Cay, Goksel Cagirci, Sinan Aydogdu, Yucel Balbay, Nihat Sen, Orhan Maden, Ahmet D Demir, Ali R Erbay
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  ABSTRACT: The safety and efficacy of clopidogrel therapy in patients with stable coronary artery disease or acute coronary syndromes undergoing percutaneous coronary intervention (PCI) have been demonstrated. To evaluate the safety (primary outcome, defined as any bleeding complication or thrombocytopenia) and adverse outcomes (secondary outcomes, defined as death from cardiovascular causes, myocardial infarction or stroke) of clopidogrel therapy in patients aged ≥75 years with stable or unstable coronary artery disease undergoing PCI, and to compare these outcomes with those in younger controls. Patients with both stable coronary heart disease and acute coronary syndromes undergoing PCI were included in the study. Two groups were formed according to age at the time of admission. Patients aged ≥75 years (the study group, n = 149) formed one group; the other group included patients aged <75 years (the control group, n = 298). During an ad hoc PCI procedure, a 600 mg loading and 75 mg/day maintenance dose of clopidogrel in addition to aspirin (acetylsalicylic acid) therapy (300 mg/day) were administrated to both treatment groups. In-hospital outcomes were investigated during a mean ± SD follow-up period of 5.3 ± 3.9 days. The first safety (primary) outcome of any bleeding event occurred in 16.1% of the patients in the study (older) group and 6.0% of the patients in the control (younger) group (odds ratio [OR] 2.987; 95% CI 1.565, 5.701; p = 0.001). The second safety outcome of TIMI (Thrombolysis in Myocardial Infarction) major bleeding occurred in 4.0% of the patients in the study group and 0.7% of the patients in the control group (OR 6.210; 95% CI 1.238, 31.151; p = 0.012). Other safety outcomes of TIMI minor/minimal bleeding and thrombocytopenia were not different between the two groups. The rate of the first adverse (secondary) outcome of the composite of death from cardiovascular causes, myocardial infarction or stroke was higher in older patients (12.1% vs 5.4%) [OR 2.422; 95% CI 1.197, 4.899; p = 0.012], primarily driven by stroke events (2.0% vs 0%; p = 0.014). Any bleeding and TIMI major bleeding complications increase in patients aged ≥75 years treated with clopidogrel in addition to aspirin.
  Drugs & Aging 02/2011; 28(2):119-29. · 2.67 Impact Factor
• Article: Long-term follow-up data of coronary sinus stenting for the stabilization of the left ventricular leads.

  Ahmet Duran Demir, Serkan Cay, Ali Riza Erbay, Orhan Maden, Ramazan Atak, Yucel Balbay
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  ABSTRACT: Cardiac resynchronization therapy has been increasingly used for patients with heart failure. However, unstable and dislocated coronary sinus leads reduce the effectiveness of this important intervention. Aim: To examine the long-term effects of coronary sinus side branch stenting on sensing and pacing parameters of the left ventricular leads. A total of eight patients (six males; two females; mean age, 56.6 ± 14.4 years) whose coronary sinus lead dislocated during the procedure were included in the study. Targeted coronary sinus side branch stenting was performed to stabilize the leads. Sensing and pacing parameters including lead impedance, capture threshold, and R-wave amplitude were measured at implantation, first month, sixth month, and every 6-month period. Mean follow-up period was 30.4 ± 7.4 months. At the time of implantation, lead impedance, capture threshold, and R-wave amplitude were 656 ± 162 Ω, 1.1 ± 0.5 V, and 13.0 ± 6.8 mV, respectively. No statistically significant mean lead impedance, capture threshold, and R-wave amplitude differences were observed between at the time of implantation and at the time of last follow-up (697 ± 164 Ω, 1.1 ± 0.5 V, 12.8 ± 6.9 mV, respectively). In this long-term study, coronary sinus side branch stenting for the stabilization of dislocated leads seems to be effective.
  Pacing and Clinical Electrophysiology 10/2010; 33(12):1485-9. · 1.35 Impact Factor
• Article: Case images: giant coronary aneurysm accompanied by a coronary artery fistula.

  Nihat Sen, Erdoğan Sökmen, Fırat Ozcan, Orhan Maden
  Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir 01/2010; 38(4):302.
• Article: Double right coronary artery from different ostia.

  Ramazan Astan, Fehmi Kacmaz, Orhan Maden, Aysel Turkvatan
  Internal Medicine 01/2010; 49(12):1249. · 0.94 Impact Factor
• Article: Documentation of impaired coronary blood flow in chronic obstructive pulmonary disease patients.

  Hatice Selcuk, Orhan Maden, Mehmet Timur Selcuk, Mehmet Kutlu Celenk, Bilal Geyik, Omac Tüfekcioglu
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  ABSTRACT: In the current study, the effects of moderate to severe chronic obstructive pulmonary disease (COPD) on coronary blood flow in patients with angiographically proven normal coronary arteries was evaluated. A total of 85 patients with moderate to severe COPD and 39 age- and sex-matched control partcipants, who underwent diagnostic coronary angiography and found to have normal epicardial coronary angiogram constituted the COPD and control groups, respectively. The 2 groups were compared for Thrombolysis In Myocardial Infarction (TIMI) frame counts in each major coronary artery. The TIMI frame count of the COPD group was significantly higher than that of control group for all 3 major individual coronary arteries: left anterior descending (corrected), 37+/-13 vs 20+/-4; right coronary artery, 32+/-14 vs 21+/-4; and left circumflex artery, 34+/-12 vs 20+/-5, (P<0.001 for all). In addition, TIMI frame counts in individual coronary arteries were found to be positively correlated with forced expiratory volume 1 s percent, serum high sensitive C-reactive protein and fibrinogen concentrations, in the COPD group. Our findings suggest that an increased slow coronary flow might be a manifestation of harmful effects of COPD on the coronary circulation, regardless of the underlying mechanism.
  Circulation Journal 12/2009; 74(2):346-52. · 3.77 Impact Factor
• Article: [Elevated serum uric acid levels in patients with isolated coronary artery ectasia].

  Nihat Sen, Firat Ozcan, Belma Uygur, Tolga Aksu, Ibrahim Akpinar, Serkan Cay, Mustafa Cetin, Erdoğan Sökmen, Mustafa Akçakoyun, Orhan Maden, Yücel Balbay, Ali Riza Erbay
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  ABSTRACT: It has been shown that serum uric acid (SUA) constitutes an important independent risk factor for cardiovascular disease. We investigated SUA levels in patients with coronary artery ectasia (CAE). Serum uric acid levels were measured in three groups of patients who underwent coronary angiography. One group consisted of 97 consecutive patients (69 males, 28 females; mean age 58.1+/-9.5 years) with isolated CAE, another group included 104 patients (79 males, 25 females; mean age 58.4+/-8.8 years) with coronary artery disease (CAD), and finally 90 subjects (66 males, 24 females; mean age 57.6+/-10.1 years) with normal coronary arteries comprised the control group. Coronary artery ectasia was defined as a luminal dilatation of at least 1.5 times of the adjacent normal coronary segments, without any stenotic lesions. In addition, patients with CAE were assessed in four groups of severity and extension. The three groups were similar with respect to age, sex, body mass index, and the frequencies of hypertension, diabetes mellitus, and smoking (p>0.05). The mean SUA level did not differ significantly between the CAE and CAD groups (6.6+/-1.9 mg/dl and 6.3+/-1.9 mg/dl, respectively; p=0.184); however, compared with the control group (5.4+/-1.8 mg/dl), SUA levels were significantly higher in both groups (p<0.001). A significant correlation was found between the SUA level and the presence of isolated CAE (r=0.625; p<0.001). Multivariate logistic regression analysis showed an independent relationship between isolated CAE and SUA (OR 1.896; 95% CI 1.1048-1.5014; p<0.001). Serum uric acid levels did not differ significantly among the four subgroups of CAE severity. Our study is the first to demonstrate significantly increased SUA levels in patients with isolated CAE. Our results support relevant data suggesting an association between endothelial function and the SUA level.
  Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir 10/2009; 37(7):467-72.
• Article: Simultaneous treatment of a fistula and a stenosis at right coronary artery: one stone two birds.

  Mehmet Fatih Ozlü, Fırat Ozcan, Orhan Maden, Fatma Metin Doğan, Kumral Cağlı
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  ABSTRACT: Coronary artery fistulas are abnormal and rare communications between a coronary artery and a cardiac chamber or a major vessel. Some devices have been designed to treat coronary fistulas percutaneously like coils and vascular occlusion devices. But most of these have been developed for fistulas unaccompanied by coronary artery disease. It is rational to treat a coronary fistula adjacent to a stenosis with one covered stent graft. This report describes a case of a coronary-to-pulmonary artery fistula with an adjacent right coronary artery stenosis that were both successfully treated by a single expanded polytetrafluoroethylene covered stent graft.
  International journal of cardiology 08/2009; 149(3):e118-9. · 7.08 Impact Factor
• Article: Impact of metabolic syndrome on future cardiovascular events in patients with first acute myocardial infarction.

  Hatice Selcuk, Ahmet Temizhan, Mehmet Timur Selcuk, Taner Sen, Orhan Maden, Sebahat Tekeli, Ali Sasmaz
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  ABSTRACT: The prevalence of metabolic syndrome (MetS) is increasing worldwide and patients with MetS have increased risk of cardiovascular events. Recent studies in different populations showed higher prevalences of MetS in patients with acute myocardial infarction (MI) and identified MetS as an independent predictor of future cardiac events. This study sought to determine the prevalence of MetS in patients with acute MI and investigate the impact of MetS on adverse cardiovascular events after acute MI. One hundred and eighty-eight patients (155 men, 33 women) admitted with first acute MI were enrolled into the study. Of the total patients, 80 (42.6%) patients were diagnosed with MetS according to the National Cholesterol Education Program Adult Treatment Panel III criteria with modifications for high blood pressure and high fasting plasma glucose. Kaplan-Meier curves showed that the cumulative event-free survival rates did not differ between the patients with and without MetS during a median follow-up period of 27.7 (min:14, max:42) months (P>0.05). On multivariate Cox regression analysis controlling for hypertension, diabetes mellitus, glucose, MetS, and waist-to-hip ratio, there was no association between the major adverse coronary events and the presence of MetS (P>0.05), whereas Killip class (relative risk: 2.853, 95% confidence interval: 1.606-5.070; P<0.001) was identified as the only independent predictor of long-term cardiovascular outcomes. This study shows that MetS has no effect on long-term prognosis after MI. However, Killip class was identified as an independent predictor of major cardiac events.
  Coronary artery disease 07/2009; 20(6):370-5. · 1.56 Impact Factor
• Article: Relationship of admission hematological indexes with myocardial reperfusion abnormalities in acute ST segment elevation myocardial infarction patients treated with primary percutaneous coronary interventions.

  Orhan Maden, Fehmi Kacmaz, Hatice Selcuk, Mehmet T Selcuk, Tolga Aksu, Omac Tufekcioglu, Emir K Senen, Yucel Balbay, Erdogan Ilkay
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  ABSTRACT: Elevated values of mean platelet volume (MPV) and elevated white blood cell (WBC) count are predictors of an unfavourable outcome among survivors of ST segment elevation myocardial infarction (STEMI). However, their relationship with reperfusion abnormalities is less clear. To evaluate the value of admission MPV and WBC count in predicting impaired reperfusion in patients with acute STEMI who are treated with primary percutaneous coronary intervention (PCI). Blood samples were obtained on admission from 368 STEMI patients who underwent successful PCI. According to the 60th minute ST segment resolution ratio, patients were divided into impaired reperfusion and reperfusion groups. Impaired reperfusion was detected in 40% of study patients. Patients in the impaired reperfusion group had a higher admission MPV (9.8+/-1.3 fL versus 8.6+/-1.0 fL; P<0.001) and a higher WBC count (14.4+/-5.5 x 10(9)/L versus 12.1+/-3.8 x 10(9)/L; P<0.001) compared with the patients in the reperfusion group. In regression analysis, MPV (OR 2.21, 95% CI 1.69 to 2.91; P<0.001) and WBC count (OR 1.08, 95% CI 1.02 to 1.15; P=0.01) were found to be independently associated with impaired reperfusion. The best cut-off value of MPV for predicting impaired reperfusion was determined to be 9.05 fL, with a sensitivity of 74% and a specificity of 73%. The results indicate that leukocytes and platelets have a role in the mediation of reperfusion injury. In patients with STEMI who are undergoing PCI, admission MPV may be valuable in discriminating a higher-risk patient subgroup and thus, may help in deciding the need for adjunctive therapy to improve the outcome.
  The Canadian journal of cardiology 06/2009; 25(6):e164-8. · 3.36 Impact Factor
• Article: The impact of obesity on late patency of left internal mammary artery grafts.

  Serkan Cay, Goksel Cagirci, Senay Funda Biyikoglu, Orhan Maden, Yucel Balbay, Sinan Aydogdu
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  ABSTRACT: Arterial conduits having long-term patency rates have been increasingly used for bypass of coronary arteries although some risk factors for their occlusion such as recipient vessel size, older age, and hyperlipidaemia have been described. Obesity, on the other hand, has been well established as a coronary risk factor. However, the effects of obesity on patency of arterial conduits, especially the internal mammary artery, have not been studied previously. To assess the long-term effects of obesity on left internal mammary artery (LIMA) patency. Methods: Angiograms of all patients with a LIMA conduit only were analysed. Two groups were formed according to the LIMA patency: group 1 - patients with occluded LIMA (n = 59), and group 2 - patients with patent LIMA (n = 68). Baseline demographic, haemodynamic, and laboratory characteristics of patients in both groups were compared. Obesity was defined as body mass index > or = 30 kg/m2. The mean BMI value in group 1 was significantly higher than in group 2 (30.4 +/- 3.1 vs. 28.7 +/- 4.7, p = 0.025). The two groups differed in time from surgery, drug use, and HDL cholesterol level. In addition, patients in both groups were categorised by BMI, and obese and non-obese groups were formed. Higher BMI was significantly associated with LIMA occlusion such that 71% of patients in group 1 had increased BMI, compared with 25% of patients in group 2 (p < 0.001). Multivariate analysis showed that multiple adjusted OR of the risk of LIMA occlusion was 7.41 (95% CI 3.38-16.28) for patients with increased BMI. Obesity (> or = 30 kg/m2) has a significant and independent negative effect on the patency of the LIMA graft.
  Kardiologia polska 05/2009; 67(4):398-403. · 0.51 Impact Factor
• Article: Brucella endocarditis - a registry study.

  Serkan Cay, Goksel Cagirci, Orhan Maden, Yucel Balbay, Sinan Aydogdu
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  ABSTRACT: A zoonotic infection caused by Brucella spp., brucellosis, is endemic in some areas of the world, like in our country. One of the most devastating conditions related to this infection is endocarditis, although it is rare. Unfortunately, adequate studies on the characteristics of Brucella endocarditis have not been performed. In addition, there was no consensus on optimal type and duration of medical and interventional therapies. To answer the following questions: what are the clinical characteristics of Brucella endocarditis, which type of therapy should be performed, and can an alternative antibiotic regimen be applied? Patients with the diagnosis of Brucella endocarditis were included in the study during a 6-year period. A total of 10 patients were interrogated for their signs, symptoms, drug use, and clinical conditions. In addition, baseline clinical and laboratory characteristics of the patients were evaluated. All patients in the study were male with a mean age of 55.9 +/- 12.7 years. Hospitalisation and total follow-up periods were 52.6 +/- 11.2 and 80.6 +/- 29.0 days, respectively. The most frequently presenting symptom was fever (60%). Dyspnoea and fatigue were the other frequent symptoms in descending order. Valve pathology was present in 70% of the study population. The aortic valve was affected more than the mitral valve. Affected mitral valves had rheumatic disease whereas only 57% of the aortic valves had underlying pathology. Isolation of Brucella spp. was possible in 20% of the patients. Mortality rate was 30% in our study; 20% of the patients were on medical follow-up without disease progression and with clinical stability, 60% of patients were on a combination therapy with a tetracycline group, a rifampicin, and a third-generation cephalosporin. Patients who took this combination and underwent aortic valve replacement had good clinical results with a mortality rate of 20%. The 30% of patients were on a combination therapy with a tetracycline group, rifampicin, and an aminoglycoside group. Mortality rate with this combination was 33%, although the success rate was 67%. Brucella endocarditis should be considered in the differential diagnosis in patients with vegetations on the cardiac valves, especially in endemic areas. Optimal therapy seems to be a combination of antibiotics and surgery, although medical therapy can be an alternative, especially in stable patients. Addition of a third-generation cephalosporin instead of aminoglycoside to the combination therapy is an alternative.
  Kardiologia polska 04/2009; 67(3):274-80. · 0.51 Impact Factor
• Article: Increased mean platelet volume in patients with slow coronary flow.

  Nihat Sen, Nurcan Basar, Orhan Maden, Firat Ozcan, Mehmet Fatih Ozlu, Omer Gungor, Kumral Cagli, Ali Riza Erbay, Yucel Balbay
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  ABSTRACT: Mean platelet volume (MPV) is an indicator of platelet activation, a central process in the pathophysiology of coronary heart disease (CAD). The importance of slow coronary flow (SCF) phenomenon results from its association with angina pectoris, acute myocardial infarction, hypertension and sudden cardiac death. The aim of this study is to evaluate the values of MPV in patients with SCF. MPV was measured in 84 consecutive patients with SCF and 88 patients with CAD and 84 control subjects. The association between thrombolysis in myocardial infarction (TIMI) frame count (TFC) and MPV level and other clinical and laboratory parameters were evaluated. There were no statistically significant differences in MPV between SCF group and CAD group. MPV was significantly higher in patients in the both SCF and CAD groups, compared with control group. The TFC for all the epicardial coronary arteries and the mean TFC were significantly higher in the SCF group than the both CAD group and control group. The mean TFC was positively and moderately correlated with MPV in the whole study population. To determine the independent predictors of mean TFC, a stepwise linear regression analysis was performed by including the parameters that were correlated with the mean TFC in the bivariate analysis. MPV level was the only independent predictor of the mean TFC (b = 0.312, p < 0.001). These findings have shown that MPV level is significantly associated with coronary blood flow and that elevated MPV level might be an independent predictor for the presence of SCF. We believe that further studies are needed to clarify the role of MPV in SCF complicated CAD, especially in relation to angiographic and clinical parameters, before we conclude that MPV to be used as a follow-up marker during the management of relevant patients.
  Platelets 03/2009; 20(1):23-8. · 1.85 Impact Factor
• Article: Decreased plasma concentrations of adiponectin in patients with slow coronary flow.

  Hatice Selcuk, Mehmet Timur Selcuk, Ahmet Temizhan, Orhan Maden, Gul Sevim Saydam, Hakan Ulupinar, Mehmet Dogan, Cengiz Aydin, Deniz I Topcu, Ali Sasmaz
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  ABSTRACT: Adiponectin has multiple protective effects on vascular endothelium through anti-inflammatory and anti-atherogenic properties. Recent data suggested that endothelial activation and inflammation may contribute to the pathogenesis of slow coronary flow (SCF). Therefore, we investigated whether adiponectin plasma concentrations were decreased in patients with SCF compared to subjects with normal coronary flow. The study population consisted of 35 patients with angiographically documented SCF in all three coronary arteries and 35 sex- and age-matched cases with normal coronary flow. Coronary flow rates of all participants were determined by Thrombolysis in Myocardial Infarction (TIMI) frame count. Plasma adiponectin concentrations were measured by an enzyme-linked immunosorbent assay method using commercially available adiponectin kits. There were no statistically significant differences between the patients with SCF and the subjects with normal coronary flow in terms of demographic characteristics and cardiovascular risk factors (P>0.05). Plasma adiponectin concentrations of patients with SCF were found to be significantly lower than those with normal coronary flow (4.77+/-3.86 mg/ml vs 10.8+/-6.60 mg/ml, P=0.001, respectively). Plasma adiponectin levels were correlated significantly and inversely with mean TIMI frame count in patients with SCF (r= -0.441, P=0.008). Furthermore, the Receiver Operator Characteristics curve of adiponectin concentrations showed that an adiponectin <4.6 mg/ml is associated with SCF with a sensitivity of 68.6%, specificity of 82.9%, positive predictive value of 80.0%, and negative predictive value of 72.5%. Our findings suggest that endothelial inflammation may play a role in the pathogenesis of SCF phenomenon.
  Heart and Vessels 01/2009; 24(1):1-7. · 2.05 Impact Factor