Aycan Esen Zencirci

Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, İstanbul, Istanbul, Turkey

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Publications (15)63.94 Total impact

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    ABSTRACT: This report sought to compare live/real-time three-dimensional transesophageal echocardiography (3D-TEE) with two-dimensional transesophageal echocardiography (2D-TEE) and to determine whether there are advantages to using 3D-TEE on patients with pulmonary stenosis (PS). Sixteen consecutive adult patients (50 % male and 50 % female; mean age 33 ± 13.4 years) with PS and indications of TEE were prospectively enrolled in this study. Following this, initial 2D-TEE and 3D-TEE examinations were performed, and 3D-TEE images were analyzed using an off-line Q-lab software system. Finally, the 2D-TEE and 3D-TEE findings were compared. In the present study, 3D-TEE allowed us to obtain the en face views of pulmonary valves (PVs) in all but one patient. While this patient was without a PV due to a previous tetralogy of Fallot operation, we could detect the type of PV in the other 15 (93.7 %) patients by using 3D-TEE. Due to poor image quality, the most stenotic area was not measurable in only one (6.2 %) of the patients. In eight (50 %) of the patients, severity and localization of stenosis were more precisely determined with 3DTEE than with 2D-TEE. The PVs' maximal annulus dimensions were found to be significantly larger when they were measured using 3D modalities. This study provides evidence of the incremental value of using 3D-TEE rather than 2D-TEE during assessments of PS, specifically in cases where special conditions (pregnancy, pulmonary regurgitation, and concomitant atrial septal defects) cause recordings of the transvalvular peak gradient to be inaccurate. Therefore, 3D-TEE should be used as a complementary imaging tool to 2D-TEE during routine echocardiographic examinations.
    No preview · Article · Nov 2015 · The International Journal of Cardiovascular Imaging
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    ABSTRACT: The determinants of clinical outcomes in patients with acute ST-elevation myocardial infarction (STEMI) are still being debated. The aim of this study was to investigate the prognostic value of the no-reflow phenomenon and epicardial adipose tissue (EAT) thickness for clinical outcomes in patients undergoing primary percutaneous coronary intervention (pPCI) for STEMI. The present study prospectively included 114 consecutive patients (mean age 54 ± 10 years, 15 women) who underwent successful pPCI. Patients were divided into two groups according to the occurrence of the no-reflow phenomenon and further subdivided according to the tertile of EAT thickness (Group I <5.1 mm, Group II ≥5.1 mm). We assessed the composite and separate occurrence of major adverse cardiac events. Throughout the 3-year follow up, the number of admissions for heart failure was significantly higher in patients with no-reflow (n=5 [20%] vs. n=1 [1%], p=0.003) and in female patients (n=4 [26%] vs. n=2 [2%], p=0.004). In the subgroup analysis, group I patients with no-reflow showed a higher frequency of admission for heart failure (n=4 [44%] vs. n=1 [6%], p=0.04). However, multivariate logistic regression analysis demonstrated that only no-reflow and female sex independently predicted admission for heart failure (OR: 19.3, 95%CI: 1.4-269.7, p=0.03, and OR: 24.9, 95%CI: 2.2-288.8, p=0.01, respectively). No-reflow and female sex are independent predictors of admission for heart failure in the longterm follow up of patients with STEMI. However, EAT thickness is not associated with clinical outcomes after pPCI.
    Full-text · Article · Jul 2015
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    ABSTRACT: Subclinical hypothyroidism (SH) is considered to be a potential risk factor for cardiovascular disease. Epicardial adipose tissue (EAT) thickness is also closely related to cardiovascular disorders. The aim of this study was to evaluate whether SH is associated with higher EAT thickness. Fifty-one consecutive patients with SH and 51 healthy control subjects were prospectively enrolled into this trial. Thyroid hormone levels, lipid parameters, body mass index, waist and neck circumference, and EAT thickness measured by echocardiography were recorded in all subjects. Mean EAT thickness was increased in the SH group compared to the control group (6.7±1.4 mm vs. 4.7±1.2 mm, p<0.001). EAT thickness was shown to be correlated with thyroid stimulating hormone level (r=0.303, p=0.002). Multivariate logistic regression analysis revealed that EAT thickness was independently associated with SH {odds ratio (OR): 3.87, 95% confidence interval (CI): 1.92-7.78, p<0.001; OR: 3.80, 95% CI: 2.18-6.62, p<0.001}. Epicardial adipose tissue thickness is increased in patients with SH compared to control subjects, and this increase in EAT thickness may be associated with the potential cardiovascular adverse effects of SH.
    Preview · Article · May 2015 · Korean Circulation Journal
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    ABSTRACT: Objectives: The genetic risk factors that contribute to the risk of developing aortic dissection (AD) have been studied. We assessed the association of endothelial nitric oxide synthase (eNOS) gene polymorphism with AD. Study design: Patients who underwent surgery with the diagnosis of AD and survived after the operation in our center between May 2007 and June 2011 were recruited retrospectively. The eNOS intron 4a/b polymorphism was determined by polymerase chain reaction (PCR) using oligonucleotide primers (sense: 5'-AGGCCCTATGGTAGTGCCTTT-3'; antisense: 5'-TCTCTTAGTGCTGTGGTCAC-3') that flank the region of the 27 bp VNTR in intron 4. Results: Thirty-nine patients (88%) had type A AD, while the remainder (12%) had type B AD. The distribution of eNOS4 a/b gene polymorphism differed significantly from the control group, with higher frequencies of eNOS 4a/a and 4a/b genotypes in the AD group (x(2)=7.16, p=0.03). Conclusion: In this study, the distribution of eNOS genotypes differed between the AD and control groups; however, this polymorphism was not found to be an independent factor for the development of AD.
    Full-text · Article · Jan 2014 · Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir
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    ABSTRACT: The relationship between epicardial adipose tissue (EAT) and coronary artery disease has been predominantly demonstrated in the last two decades. The aim of this study was to investigate the predictive value of EAT thickness on ST-segment resolution that reflects myocardial reperfusion in patients undergoing primary percutaneous coronary intervention (pPCI) for acute ST-segment elevation myocardial infarction (STEMI). The present study prospectively included 114 consecutive patients (mean age 54 ± 10 years, range 35-83, 15 women) with first acute STEMI who underwent successful pPCI. ST-segment resolution (ΔSTR) <70 % was accepted as ECG sign of no-reflow phenomenon. The EAT thickness was measured by two-dimensional echocardiography. EAT thickness was increased in patients with no-reflow (3.9 ± 1.7 vs. 5.4 ± 2, p = 0.001). EAT thickness was also found to be inversely correlated with ΔSTR (r = -0.414, p = 0.001). Multivariate logistic regression analysis demonstrated that EAT thickness independently predicted no-reflow (OR 1.43, 95 % CI 1.13-1.82, p = 0.003). Receiver operating characteristic curve analysis demonstrated good diagnostic accuracy for EAT thickness in predicting no-reflow [area under curve (AUC) = 0.72, 95 % CI 0.63-0.82, p < 0.001]. In conclusion, increased EAT thickness may play an important role in the prediction of no-reflow in STEMI treated with pPCI.
    Full-text · Article · Jan 2014 · Heart and Vessels
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    ABSTRACT: Clinical outcomes of patients with myocardial infarction are primarily determined by successful restoration of myocardial reperfusion and the severity of coronary atherosclerosis. The purpose of this study was to investigate the predictive value of Gensini score on ST-segment resolution (STR) in patients undergoing primary percutaneous coronary intervention (pPCI) for acute ST-elevation myocardial infarction (STEMI). The present study prospectively included 114 consecutive patients (mean age 54 ± 10 years, 15 women) with STEMI who underwent successful pPCI. Sum of ST-segment elevation amount in millimeters was obtained before angioplasty and 60 minutes after pPCI. ∑STR <50% was accepted as a ECG sign of no-reflow phenomenon. Thrombus grading were calculated according to the results of coronary angiography and Gensini score (GS-pPCI) was calculated after pPCI without incorporating culprit lesion. Patients were divided into two groups according to ST-segment resolution: those with STR (-) and those with STR (+). Patients were also analyzed according to the infarct-related artery. GS-pPCI was significantly higher in patients with STR(-) (10.1±11.8 vs 22±18.6, p=0.005). GS-pPCI was inversely correlated with STR (r=-0.287, p=0.002). In subgroup analysis, patients in STR(-) group with culprit lesion in left anterior descending artery (LAD) and left circumflex artery (LCX) also showed higher GS-pPCI (10.9±13.5 vs 23.5±21.3,p=0.03 and 9.6±8.7 vs 24.1±21, p=0.04; respectively). High thrombus burden was also observed more frequently in patients with STR (-) (68% vs. 43%, p=0.03). Multivariate logistic regression analysis demonstrated that GS-pPCI and high thrombus burden independently predicted inadequate STR (OR: 1.07, 95%CI: 1.03-1.12, p=0.001 and OR: 3.28, 95%CI: 1.11-9.72, p=0.03 respectively). GS-pPCI and high thrombus burden play an important role in the prediction of the inadeqaute STR in patients with STEMI treated with pPCI.
    Full-text · Article · Jan 2014 · Kardiologia polska
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    ABSTRACT: Free-Floating thrombi in the right cardiac chambers is rare, being found almost exclusively in patients with suspected or confirmed pulmonary thromboembolism. Floating Right Heart Thrombus (FRHTh) which is classified into two groups according to their origin, type A orginates from deep peripheral veins while type B orginates from intracardiac, can be defined as free moving mobile masses inside the right heart, and not attached to an intracardiac structure. FRHThs are well diagnosed by transthoracic echocardiograpy(TTE) in patients suspected to have pulmonary tromboembolism. Mortality rates in pulmonary thromboembolism in patients with FRHTh are more higher than pulmonary thromboembolism alone and exceeds %40. Herein we present a woman with a giant free-floating thrombi in right atrium which was complicated with massive pulmonary embolism and right heart failure. CASE: A 75-year-old female with antecedant hypertension, diabetes mellitus (DM), obesity (BMI>= 33) and smoking (1 pack/year) admitted to our hospital with complaints of chest pain and dyspnea. On admission heart rate was 109/min, saturation with pulse oximetry was %75, temperature 37.2 C and systolic blood pressure was at average of cardiogenic shock 85 mmHg. Sinusal tachycardia and incomplet RBBB elektrocardiogram were existed.Chest radiogram detected nothing serious while arterial blood gas showed hypoxia and hypocarbia. Transthorasic echocardiography revealed a free floating thin fibriller mass in the right atrium which protruding to the right ventricle through the tricuspid valve in atrial systole (Figure 1,2,3). Right ventricle was enlarged, paradoxal septal motion was present and the systolic tricuspid pressure was 39mmHg with moderate tricuspid regurgitation. After the diagnosis of FRHTh, intravenous (i.v.) dose adjusted heparin and isotonic saline infusion were started. An immadiate cardiopulmonary bypass (CPB) was established with bicaval drainage and ascendan aortic perfusion. Hypokinetic and dilated right ventricle and right atrium were detected. Right atriotomy and extraction of the trombus which elongating from right atrium to the vena cava inferior was followed by pulmonary artery incision and trombus extraction. Weaning from CPB effort was failed and patient died. Histopatolojical examination of the material confirmed trombus. CONCLUSİON: In patients with FRHTh, surgical embolectomy has own set of potential complications including genaral anesthesia, duration and inabilty to remove the coexisting pulmonary embolus beyond the central pulmonary artery (6). Early administration of fibrinolitic therapy provides resolution of thrombus in right heart, pulmonary artery and in deep lower extremities veins together.The benefit of thrombolysis is debated because of attendant risk of bleeding or stroke which may be occured by fargmentation of thrombus and obstrucion of the pulmonary arteries leading sudden cardiac death. Keywords: Free-floating right atrial thrombus, pulmonary embolism, right heart failure
    No preview · Article · Oct 2013
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    Full-text · Article · Oct 2013 · Journal of the American College of Cardiology
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    Full-text · Article · Oct 2013 · Journal of the American College of Cardiology
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    Full-text · Article · Oct 2013 · Journal of the American College of Cardiology
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    ABSTRACT: Nitric oxide (NO) plays a major role in the regulation of endothelial functions and reduced NO synthesis has been implicated in the development of coronary atherosclerosis. Endothelial nitric oxide synthase (eNOS) intron 4a/b polymorphism has been shown to be related to plasma nitric oxide concentrations and coronary artery disease in various population studies. The aim of this study is to assess the relationship between eNOS 4a/b polymorphism and premature CAD. A total of 70 patients under age 35 who presented with ST-segment elevation myocardial infarction (STEMI) were included in this study.The control group included 50 age- and gender-matched subjects with normal coronary arteries on angiography.The eNOS 4a/b polymorphism was assessed with polymerase chain reaction (PCR).The frequencies of eNOS 4a/b genotypes and alleles were compared. Multivariate regression analysis was used for estimation of the independent predictors of premature CAD. Frequency of eNOS4a/b gene, aa and ab genotypes were significantly higher in STEMI patients when compared to control group. Presence of allele'a'of the eNOS gene was an independent predictor of STEMI in a young population (OR: 2.78 95% CI: 1.02-7.56 P = 0.044). A significant correlation of eNOS gene polymorphism with other clinical properties of subjects was not established. The eNOS4a/b gene polymorphism may be associated with early development of atherosclerosis and myocardial infarction possibly secondary to deterioration of the endothelial function.
    Full-text · Article · Oct 2013 · Acta cardiologica
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    ABSTRACT: Ventricular noncompaction/hypertrabeculation (NC/HT) is a rare form of congenital cardiomyopathy. We aimed to investigate the presence of serum tenascin-C (TN-C) in adult patients with NC/HT and evaluate its value. Serum TN-C levels were measured by ELISA in 50 NC/HT patients both with/without systolic dysfunction and in 23 normal controls. Systolic dysfunction was defined as ejection fraction (EF) ≤ 40. Mann-Whitney U-test and ROC curve analysis were done. Of 49 NC/HT patients, 24 (49%) patients had systolic dysfunction (mean age 36 ± 15) and 25 patients (51%) had normal systolic function (mean age 36 ± 17). The ages between groups were not different. The mean levels of serum TN-C in patients with or without systolic dysfunction were 26 ± 10 ng/mL and 26 ± 8 ng/mL respectively, compared to normal controls, 7 ± 2 ng/mL (P < 0.001). No significance was observed between 2 groups of NC/HT patients regarding TN-C levels (P = 0.8). The ROC curve analysis revealed that a TN-C value of 11.7 ng/mL identified patients with NC/HT with 100% sensitivity and specifity. High serum TN-C levels are present in adult NC/HT cardiomyopathy even when left ventricular systolic function remains normal. Also, serum TN-C levels could be regarded as a candidate biomarker in the diagnosis of NC/HT which needs to be tested in larger prospective studies.
    No preview · Article · Jul 2013 · Echocardiography
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    ABSTRACT: Admission hyperglycemia is associated with high inhospital and long-term adverse events in patients that undergo primary percutaneous coronary intervention (PCI). We aimed to evaluate whether hyperglycemia predicts inhospital mortality. We prospectively analyzed 503 consecutive patients. The patients were divided into tertiles according to the admission glucose levels. Tertile I: glucose <118 mg/dL (n = 166), tertile II: glucose 118 to 145 mg/dL (n = 168), and tertile III: glucose >145 mg/dL (n = 169). Inhospital mortality was 0 in tertile I, 2 in tertile II, and 9 in tertile III (P < .02). Cardiogenic shock occurred more frequently in tertile III compared to tertiles I and II (10% vs 4.1% and 0.6%, respectively, P = .01). Multivariate logistic regression analysis revealed that patients in tertile III had significantly higher risk of inhospital major adverse cardiac events compared to patients in tertile I (odds ratio: 9.55, P < .02). Admission hyperglycemia predicts inhospital adverse cardiac events in mortality and acute ST-segment elevation myocardial infarction in patients that underwent primary PCI.
    Full-text · Article · May 2013 · Angiology
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    ABSTRACT: BACKGROUND: Resistin is a novel adipokine that is suggested to be involved in inflammatory conditions and atherosclerosis. In this study we aimed to investigate the prognostic importance of resistin in acute coronary syndrome (ACS) patients. METHODS: Resistin levels were measured in a population which is consisted of 132 patients with acute MI where 72 (65%) of them with a diagnosis of STEMI and 60 (35%) of the patients with NSTEMI. Thirty-three consecutive subjects who were referred to elective coronary angiography due to chest pain evaluation with normal coronary angiograms served as controls. All patients were followed-up for the occurrence of major adverse cardiac events (MACE). RESULTS: There was a significant increase in serum resistin levels in patients with acute myocardial infarction compared to controls (3.71 ± 4.20 vs. 2.00 ± 1.05, p=0.001; respectively). However, serum resistin levels were similar in patients with STEMI and NSTEMI. (4.26 ± 5.11 vs 3.06 ± 2.64, p= 0.49; respectively). The patients with cardiovascular mortality had significantly higher levels of serum resistin levels compared to either ACS or control group (6,35± 5,47 p=0,005 , respectively). Logistic regression analysis revealed that resistin and CABG were independent predictors of MACE in ACS patients (OR=1.11 95% CI: 1.01-1.22; p=0,03 and OR=3.84 95% CI: 1.26-11.71; p=0,018; respectively. ). CONCLUSION: High initial resistin levels were significantly correlated with MACE in ACS patients.
    Full-text · Article · Apr 2013 · Kardiologia polska
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    ABSTRACT: We report a case of a young man with a very rare cause of atypical chest pain in whom primary mediastinal embryonal carcinoma causing extrinsic pulmonary stenosis was diagnosed with echocardiography and computed tomography. This patient illustrates an unusual presentation of the very rapid progression of the tumor in as little as 6 months. The patient underwent surgical resection and was successfully treated with adjuvant chemotherapy. (Ann Thorac Surg 2012;94:e113-4) (C) 2012 by The Society of Thoracic Surgeons
    No preview · Article · Nov 2012 · The Annals of thoracic surgery