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Uğur Canpolat, Kudret Aytemir,
Hikmet Yorgun,
Tuncay Hazirolan,
Ergün Bariş Kaya,
Ahmet Hakan Ateş,
Hamza Sunman,
Muhammet Dural,
Muhammed Ulvi Yalçin,
Lale Tokgözoğlu,
Giray Kabakçi,
Ali Oto
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ABSTRACT: Diabetes mellitus (DM) is strongly associated with increased risk of coronary artery disease (CAD). The aim of this study was to determine differences in presence, extent and morphology of coronary atherosclerotic plaques (CAP) detected by multidetector computed tomography (MDCT) between symptomatic patients with and without diabetes.
The CAPs (calcified, non-calcified, mixed) were compared between patients with/without diabetes (104/257 DM; mean age 58.6 +/- 11 y; 46.3% male) who underwent dual-source 64-slice MDCT for evaluation of CAD. Severity, extent and morphology of CAPs were determined per each segment.
Critical coronary stenosis was higher in patients with diabetes (33.7% vs. 19.6%) after adjustment for all risk factors (P = 0.022). Patients with DM had a higher prevalence and extent of CAP compared to non-diabetic subjects (87.5% vs. 43.8%, 4.8 +/- 3.5 vs. 1.9 +/- 2.7, respectively; P < 0.001). Noncalcified and mixed CAP were more prevalent in patients with diabetes as compared to those without diabetes (2.61 +/- 2.63 vs. 0.86 +/- 1.69, 0.81 +/- 1.6 vs. 0.35 +/- 0.96, respectively, P < 0.001). Patients with DM tended to have higher prevalence of significant 1-, 2- and 3-vessel disease (P = 0.006).
Among individuals referred for the evaluation of CAD, those with DM had a higher risk of coronary stenosis and overall increased CAP burden independent from other cardiovascular risk factors shown by MDCT. Further studies are needed to evaluate the prognostic value of different plaque compositions observed in patients with diabetes.
Acta cardiologica 02/2012; 67(1):71-7. · 0.61 Impact Factor
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Circulation 01/2012; 125(2):e241-3. · 14.74 Impact Factor
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International journal of cardiology 01/2012; 160(1):e1-2. · 7.08 Impact Factor
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ABSTRACT: Background: The aim of this cross-sectional study was to evaluate cardiac autonomic function by heart rate turbulence (HRT) indices in normotensive and hypertensive individuals with either non-dipper or dipper type circadian rhythm of blood pressure (BP). Methods: A total of 122 patients were allocated into four groups: normotensive/dipper, n = 33; normotensive/non-dipper, n = 31; hypertensive/dipper, n = 29; and hypertensive/non-dipper, n = 29. HRT indices (turbulence slope [TS] and turbulence onset [TO]) were calculated from 24-h ambulatory electrocardiographic recordings. Results: TS values were higher (TS = 10.0 ± 3.4 vs 8.0 ± 1.5, p = 0.004) and TO values were lower (TO = -2.9 [-3.6, -2.2] vs -2.0 [-2.3, -1.9], p = 0.037) in the dipper subgroup of normotensive cases than in the non-dipper subgroup of normotensive cases. Similarly, TS values were higher (TS = 8.4 ± 3.5 vs 6.2 ± 2.9, p = 0.012) and TO values were lower (TO = -2.1 [-3.4, -2.0] vs -1.6 [-1.9, -0.2], p = 0.003) in the dipper subgroup of hypertensive cases than in the non-dipper subgroup of hypertensive cases. Spearman's correlation analyses revealed a high positive correlation between percentage of dipping and TS (r = 0.600, p = 0.001) and a higher negative correlation between percentage of dipping and TO (r = -0.653, p = 0.001). Conclusions: Blunting of the nocturnal fall in BP is associated with impaired.
Cardiology journal 01/2012; 19(2):140-5. · 1.31 Impact Factor
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ABSTRACT: Left internal mammary artery (LIMA) is the most commonly used graft during coronary bypass surgery. LIMA side branches are clipped during surgery in order to prevent coronary steal. In cases of patent LIMA side branches, there are differingapproaches. Herein, we report a case with patent thoracic side branch of LIMA graft, occlusion of this side branch by Amplatzer Vascular Plug because of documented myocardial ischemia, and long term follow-up results. (Cardiol J 2012; 19, 2: 197-200).
Cardiology journal 01/2012; 19(2):197-200. · 1.31 Impact Factor
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Kardiologia polska 01/2012; 70(12):1316. · 0.51 Impact Factor
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ABSTRACT: For many years, ergotamine has been used for the acute treatment of migraine. Ergotamine may produce coronary vasospasm, which is often associated with ischemic electrocardiography changes and angina pectoris. A 62-year-old woman who was admitted to the emergency department because of chest pain is described. She had a history of severe migraine attacks and started to use ergotamine tartrate 0.75 mg daily the day before. Electrocardiography revealed sinus tachycardia with left anterior hemiblock and T wave inversion in the precordial leads. Cardiac biomarker levels were elevated. After discontinuation of the drug and initiation of vasodilator treatment, her chest pain resolved. Patients with migraine may have an underlying vasospastic disorder predisposing them to coronary artery spasm. Physicians should be alerted to potential cardiac vasospastic effects of low-dose ergotamine in the treatment of migraine.
Experimental and clinical cardiology 01/2012; 17(1):43-4. · 0.58 Impact Factor
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ABSTRACT: Background: The main purpose of this study is to determine the correlation of inter- and intraatrial conduction times between the electrophysiological and tissue Doppler echocardiographic measurements, and to evaluate the appropriateness of tissue Doppler echocardiography for this measurement. Methods: One-hundred and one patients were included in the study who underwent electrophysiological study for clinical arrhythmias. Inter- and intraatrial conduction times were measured from intracardiac electrograms. Atrial conduction times were also measured by tissue Doppler echocardiography by evaluating atrial electromechanical delay between lateral mitral annulus, septal mitral annulus, and right ventricular tricuspid annulus. The correlation between electrophysiological and echocardiographic atrial conduction times were analyzed. Results: We found a weak correlation between the measurements of interatrial conduction times with the electrophysiological and tissue Doppler techniques (r = 0.308; p = 0.002). The correlation for intraleft atrial conduction times was moderate (r = 0.652; p 〈 0.001). There was no correlation between the measurements of intra-right atrial conduction times. Conclusions: We concluded that tissue Doppler echocardiography can be used for the measurement of interatrial and intra-left atrial conduction times. Tissue Doppler echocardiography can be a suitable technique to evaluate atrial substrate. (Cardiol J 2012; 19, 5: 487-493).
Cardiology journal 01/2012; 19(5):487-93. · 1.31 Impact Factor
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ABSTRACT: Coronary artery perforations are life-threatening complications with a poor outcome. Historically, if the perforation was not controlled using conservative methods such as prolonged balloon inflation and protamine administration, emergency cardiac surgery has been performed. However, several percutaneous methods including covered stents and embolization materials have emerged as therapeutic options to manage coronary perforations. We report a case of right coronary artery perforation after high pressure stent post-dilatation that was successfully sealed with a polytetrafluoroethylene-covered stent.
Cardiology journal 01/2012; 19(6):639-42. · 1.31 Impact Factor
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ABSTRACT: Behçet's disease is a multisystem chronic inflammatory disease generally presenting as recurrent oral-genital ulcers and uveitis. Vascular involvement is a common presentation. However, cardiac involvement is rare in this disorder. In this case report, we present a large right ventricular thrombus detected both in computed tomography and echocardiography in a 32 year-old male patient with complaints of fever, haemoptysis and weight loss. Intracardiac thrombus showed both clinical and radiological regression with oral anticoagulant and immunosuppressive therapy.
Acta medica (Hradec Králové) / Universitas Carolina, Facultas Medica Hradec Králové 01/2012; 55(4):186-8.
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ABSTRACT: Aim: Studies investigating the effects of type II diabetes mellitus on exercise capacity, peripheral muscle strength, and physical activity level in patients with heart failure are limited. This study aimed to compare maximal exercise capacity, peripheral muscle strength, and physical activity level in patients with heart failure with and without diabetes mellitus.
Methods: Thirty-four patients with heart failure—16 diabetic and 18 nondiabetic (New York Heart Association Class II and III, left ventricular ejection fraction below 40%)—were included. Pulmonary function was evaluated using spirometry, peripheral muscle strength using a handheld dynamometer, maximal exercise capacity using Modified Incremental Shuttle Walk Test (MISWT), energy expenditure in daily activities, and physical activity level using the International Physical Activity Questionnaire.
Results: The MISWT distance was significantly shorter in diabetic patients with heart failure than in nondiabetic ones (P < .05). Hand grip, biceps brachii, and quadriceps femoris muscle strength were significantly lower in diabetic patients than in nondiabetic ones (P < .05). Thirteen percent of the patients with heart failure with diabetes were minimally active, 88% were inactive. In the nondiabetic group, 11% were minimally active and 88.89% patients were inactive. There was no significant difference in energy expenditure in daily activities between diabetic and nondiabetic patients (P > .05).
Conclusions: Presence of diabetes mellitus further decreases maximal exercise capacity, and peripheral muscle strength in patients with heart failure. Energy expenditure in daily activities is severely impaired in both in diabetic and nondiabetic patients with heart failure. Physical inactivity is present in heart failure independent of the diabetes. Diabetes mellitus should be taken in consideration while evaluating maximal exercise capacity and peripheral muscle strength in patients with heart failure.
Topics in Geriatric Rehabilitation 12/2011; 28(1):54–59. · 0.14 Impact Factor
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Sercan Okutucu,
Ugur Nadir Karakulak,
Levent Sahiner, Kudret Aytemir,
Edis Demiri,
Banu Evranos,
Sefik Gorkem Fatihoglu,
Ergun Baris Kaya,
Giray Kabakci,
Lale Tokgozoglu,
Hilmi Ozkutlu,
Ali Oto
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ABSTRACT: The aim of the present cross-sectional study was to evaluate ventricular repolarization dynamics by QT dynamicity in normotensive and hypertensive individuals with either a non-dipper-type or a dipper-type circadian rhythm of blood pressure (BP).
A total of 103 patients were allocated into four groups as follows: (i) normotensive/dipper, n=28; (ii) normotensive/nondipper, n=26; (iii) hypertensive/dipper, n=25; and (iv) hypertensive/nondipper, n=24. The linear regression slopes of the QT interval measured to the apex and to the end of the T wave plotted against R-R intervals (QTapex/R-R and QTend/R-R slopes, respectively) were calculated from 24-h ambulatory ECG recordings using a dedicated algorithm.
QTapex/R-R and QTend/R-R slopes were higher in the nondipper subgroup of normotensive cases with respect to the dipper subgroup of normotensive cases (QTapex/R-R=0.171±0.017 vs. 0.127±0.023, P=0.001; QTend/R-R=0.159±0.015 vs. 0.133±0.025, P=0.001). QTapex/R-R and QTend/R-R slopes were higher in the nondipper subgroup of hypertensive cases with respect to the dipper subgroup of hypertensive cases (QTapex/R-R=0.187±0.019 vs. 0.133±0.019, P=0.001; QTend/R-R=0.183±0.018 vs. 0.147±0.022, P=0.001). Pearson's correlation analyses revealed a higher negative correlation between night-time decline in BP and QTapex/R-R (r=-0.638, P=0.001). There was also a moderate negative correlation between night-time decline in BP and QTend/R-R (r=-0.504, P=0.001). The correlation coefficients for degree of night-time dipping and QT dynamicity indices were higher in hypertensive groups than in the normotensive groups.
Blunting of the nocturnal fall in BP associates with impaired QT dynamicity indices in both normotensive and hypertensive groups.
Blood pressure monitoring 12/2011; 17(1):14-9. · 1.62 Impact Factor
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International journal of cardiology 12/2011; 159(2):e27-8. · 7.08 Impact Factor
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ABSTRACT: Percutaneous left atrial appendage (LAA) closure is an important therapeutic option for prevention of thromboembolic stroke in patients with atrial fibrillation (AF), especially when contraindications exist for oral anticoagulation. We aimed to evaluate our short-term results of LAA closure (initial experience) using the WATCHMAN LAA system.
Eleven patients (8 men, 3 women; mean age 68.4±7.0 years) with nonvalvular AF, a high risk for cardioembolic stroke (mean CHADS2 score 2.6±1.2, mean CHA2DS2-VASc score 4.0±1.5), and contraindications to oral anticoagulation underwent percutaneous LAA closure using the WATCHMAN LAA system. All the procedures were performed under general anesthesia and fluoroscopy and transesophageal echocardiography (TEE) guidance. The patients were evaluated clinically (at 45 days and 6 months) and by TEE (at 45 days).
The LAA was successfully occluded in all the patients (100%). The mean procedural and fluoroscopy times were 58.6±8.1 and 19.1±5.2 minutes, respectively. The mean diameter of the LAA ostium was measured as 20.4±3.8 mm by TEE. The mean device size was 24.6±3.8 mm. The mean hospital stay was 1.7±0.9 days. Follow-up TEE showed closure of all LAA orifices without device-related thrombus formation. Two patients (18.2%) had minimal peri-device leaks (<3 mm). None of the patients experienced major adverse events during a median follow-up of 90 days (interquartile range 60-185 days).
Our initial experience suggests that percutaneous LAA closure with the WATCHMAN LAA system is safe and feasible, with favorable short-term clinical outcomes.
Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir 12/2011; 39(8):668-74.
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ABSTRACT: We evaluated our paclitaxel-eluting stent (Genius TAXCOR I) implantations and follow-up results in patients with coronary artery disease.
The study included 101 patients (75 men, 26 women; mean age 60±10 years) who underwent elective paclitaxel-eluting stent deployment for de novo native coronary artery lesions. Sixteen patients received two stents. Lesion types were as follows: type A (23.9%), type B1 (29.1%), type B2 (32.5%), and type C (14.5%). Twelve lesions (10.3%) exhibited mild tortuosity, 32 (27.4%) had mild calcification, 12 had (10.3%) an angulation of more than 45 degrees, while eight (7.7%) had thrombus. Following stent implantation, the patients were examined at 1, 6, and 12 months, and annually thereafter. The mean follow-up period was 48.9±5.7 months (range 35 to 60 months).
Stent implantation was successful in all the patients. The mean diameter stenosis was 82.8±9.9%, the mean stent diameter was 3.1±0.6 mm, and the mean stent length was 16.0±5.2 mm. During the follow-up period, 46 patients (45.5%) required coronary angiography, of which eight (17.4%) received target vessel revascularization, and four (8.7%) received target lesion revascularization. One patient (1.0%) died from sudden cardiac death.
The clinical and angiographic follow-up results of this study involving relatively low- and intermediate-risk patients indicate that the use of the Genius TAXCOR I stents is effective and beneficial for the prevention of stent thrombosis and restenosis.
Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir 12/2011; 39(8):675-82.
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Uğur Canpolat,
Muhammed Dural, Kudret Aytemir,
Ali Akdoğan,
Ergün Barış Kaya,
Levent Sahiner,
Ulvi Yalçin,
Asena Gökçay Canpolat,
Meral Calgüneri,
Giray Kabakçi,
Lale Tokgözoğlu,
Ali Oto
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ABSTRACT: Familial Mediterranean fever (FMF) is characterized by sporadic, acute attacks of fever and serositis. Cardiovascular involvement is one of the leading cause of morbidity and mortality among FMF patients. Herein, we aimed to evaluate cardiac autonomic functions in FMF patients without overt cardiac symptoms.
We enrolled 38 patients (20 female; mean age 34.4 ± 10.2 years) with FMF and 34 healthy subjects (18 female; mean age 33.2 ± 9.3 years). All participants underwent 24-hour Holter recording. Heart rate recovery (HRR) indices were calculated by subtracting first, second, and third minute heart rates from maximal heart rate. All patients underwent heart rate variability (HRV), heart rate turbulance (HRT) and QT dispersion analysis. The mean FMF duration was 9.8 ± 4.2 years.
Both groups were similar with regard to baseline characteristics. Mean HRR1 (p=0.001), HRR2 (p=0.003) and HRR3 (p<0.001) were significantly lower in FMF group. SDNN (standard deviation of all NN intervals), SDANN (SD of the 5 min mean RR intervals), RMSSD (root square of successive differences in RR interval), and PNN50 (proportion of differences in successive NN intervals >50 ms) and high-frequency (HF) components were significantly decreased, but low frequency (LF) and LF/HF were significantly higher in FMF patients. HRT onset and slope were significantly less negative in FMF patients. Also, QTd was significantly higher in FMF patients (p<0.001).
Patients with FMF showed delayed recovery of heart rate and abnormal HRV and HRT parameters with respect to normal subjects. Cardiac autonomic functions might be involved in FMF patients even in patients without cardiac symptoms.
Autonomic neuroscience: basic & clinical 11/2011; 167(1-2):70-4. · 1.82 Impact Factor
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ABSTRACT: The autonomic nervous system (ANS) and cardiovascular function are intricately and closely related. One of the most frequently used diagnostic and prognostic tools for evaluating cardiovascular function is the exercise stress test. Exercise is associated with increased sympathetic and decreased parasympathetic activity and the period of recovery after maximum exercise is characterized by a combination of sympathetic withdrawal and parasympathetic reactivation, which are the two main arms of the ANS. Heart rate recovery after graded exercise is one of the commonly used techniques that reflects autonomic activity and predicts cardiovascular events and mortality, not only in cardiovascular system disorders, but also in various systemic disorders. In this article, the definition, applications and protocols of heart rate recovery and its value in various diseases, in addition to exercise physiology, the ANS and their relationship, will be discussed.
Expert Review of Cardiovascular Therapy 11/2011; 9(11):1417-30.
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ABSTRACT: Percutaneous closure of patent foramen ovale (PFO) has been increasingly performed for several indications; mostly due to cryptogenic stroke. In this study we aimed to evaluate the safety and efficacy of transthoracic echocardiographic (TTE) guidance during percutaneous closure of PFO in using the Amplatzer and Occlutech Figulla PFO occluder devices.
Between October 2005 and March 2011, 139 patients (74 male, mean age: 40.4 ± 10.3) underwent transcatheter PFO closure. In all patients transesophageal echocardiography performed subsequently to diagnose, assess the size and evaluate for suitability of the defect for percutaneous closure. During the procedure fluoroscopy and TTE were used for guidance.
Among 139 patients, Amplatzer PFO occluder was used in 74 patients and in 65 of them Occlutech Figulla device was selected for occlusion. The indications for PFO closure were ischemic stroke in 98 (70.5%), recurrent transient ischemic attacks (TIA) in 40 (28.7%), peripheral embolism in 1 (0.8%) of the patients. In all patients, percutaneous intervention was performed successfully under TTE guidance. There have been no neurologic (recurrent strokes or TIAs) and cardiovascular complications during the immediate and long-term follow-up period (2-67 months, median 29). There was significant difference between the mean fluoroscopic time from the beginning which is 8.6 ± 3.4 min in the former versus 3.4 ± 1.9 min in the latter (P < 0.05).
Our study confirms the efficacy and safety of TTE guidance during percutaneous closure of PFO, which shortens the procedural time and obviates the need for general anesthesia or endotracheal intubation.
Echocardiography 10/2011; 28(10):1074-80. · 1.24 Impact Factor
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Erol Tulumen,
Indira Khalilayeva, Kudret Aytemir,
F E S C Ergun Baris Kaya,
Onur Sinan Deveci,
Hakan Aksoy,
Ugur Kocabas,
Sercan Okutucu,
Lale Tokgozoglu,
Giray Kabakci,
Hilmi Ozkutlu,
Ali Oto
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ABSTRACT: Although predictive value of heart rate recovery (HRR) has been tested in large populations, the reproducibility of HRR in treadmill exercise test has not been assessed prospectively. This prospective study examined whether HRR index has test-retest stability in the short term.
A total of 52 healthy volunteers without cardiovascular risk factors (mean age, 30 ± 10 years, 30 females) underwent standardized graded treadmill exercise test, and the test was repeated on the 7th and the 30th days. The subjects' maximal heart rates and the decrease of heart rate from the peak exercise level to the level of 1, 2, 3, 4, and 5 minutes after the termination of the exercise were examined on each test, and heart rates for each minute from the first, second, and third tests were compared for each individual.
The maximal heart rates on the 1st, 7th, and the 30th days were 179 ± 11, 177 ± 10, 178 ± 10 beats/min, respectively [P = 0.07, intraclass correlation coefficient (ICC) = 0.92], and the 1st minute HRR indices after peak exercise were 33 ± 10, 33 ± 10, 33 ± 11, respectively (P = 0.66, ICC = 0.88). There was no statistical difference in the 2nd, 3rd, 4th, and 5th minute heart rates of the recovery phase among the 1st, 7th, and 30th day treadmill exercise tests, either.
Maximal heart rates and the decline of heart rate to the 5th minute on recovery phase after treadmill exercise test have short-term reproducibility.
Annals of Noninvasive Electrocardiology 10/2011; 16(4):365-72. · 1.10 Impact Factor
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Hikmet Yorgun,
Uğur Canpolat,
Tuncay Hazırolan,
Ahmet Hakan Ateş,
Hamza Sunman,
Muhammet Dural,
Levent Sahiner,
Ergün Barış Kaya, Kudret Aytemir,
Lale Tokgözoğlu,
Giray Kabakçı,
Ali Oto
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ABSTRACT: BACKGROUND: Human epicardial adipose tissue (EAT) is a type of visceral adipose tissue functioning as a metabolically active endocrine organ by secreting several hormones and adipocytokines. In this study, we aimed to assess the relationship between EAT measured by dual source multidetector computed tomography (MDCT) and the presence and components of metabolic syndrome (MS). METHODS: A total of 83 patients (43.4% male, mean age 56.1±11.9) who underwent MDCT for suspected coronary artery disease were enrolled in this study. Thickness of the EAT was measured on contrast enhanced multiplanar reformat images with parasternal short axis view at basal, mid-ventricular and apical levels and horizontal long axis view. RESULTS: The mean EAT thickness was significantly increased in patients with MS compared to those without MS (8.49±1.43mm vs 7.39±2.10mm, p<0.001). Additionally there was a graded relationship between increasing number of MS components and mean total EAT and pericoronary fat thickness (p<0.05). Simple regression analysis revealed that the presence of MS, age and body mass index (BMI) were correlated with mean EAT thickness (r=0.398, r=0.376 and r=0.371 respectively, p<0.001). Multiple regression analysis revealed that the presence of MS, age and BMI were the strongest independent variables related to EAT. CONCLUSION: In this study we demonstrated that EAT and pericoronary fat thickness were associated with the presence of MS. Those findings may implicate that, EAT and pericoronary fat may be a novel and useful indicator for MS.
International journal of cardiology 09/2011; · 7.08 Impact Factor
