Archives of the Turkish Society of Cardiology, 2004
Özet Kronik iskemiye bağli fonksiyon bozukluğu olanfakat canltlığı devam eden (hiberne) miyokard;... more Özet Kronik iskemiye bağli fonksiyon bozukluğu olanfakat canltlığı devam eden (hiberne) miyokard; revaskülarizasyon g irişimleri sonrası fonksiyonel iyileşme göstermektedir. Bu çalı.şmada total oklüzyon/u olgularda ilgili damar bölgesine olan gelişmiş kollateral dolaşımın; dobutanıin stres ekokardiyografi ( DSE) ile saptanan nıiyo kard canlıliğı ve koroner arter bypass greft cerrahisi ( KABG) sonrası fonksiyonel iyileşme üzerine etkisi araşıı
Turk Kardiyoloji Dernegi Arsivi-Archives of the Turkish Society of Cardiology, 2017
The aim of the present study was to assess the efficacy and safety of tolvaptan for severe hypona... more The aim of the present study was to assess the efficacy and safety of tolvaptan for severe hyponatremia (SH) in hypervolemic heart failure (HF) patients within daily clinical practice. Methods: We restrospectively reviewed our database on tolvaptan as an add-on treatment in hypervolemic patients admitted to our clinic due to deterioration of HF and having hyponatremia resistant to standard therapy. Severe hyponatremia was defined as serum sodium concentration ≤125 mEq/L. The database included demographic, clinical, laboratory, and echocardiographic findings on admission, and numerous outcome measures for oral tolvaptan treatment were used to assess its efficacy and safety. Results: The study group consisted of 56 hypervolemic HF patients with severe hyponatremia (25 female and 31 male) with mean age of 66 years. All patients received a single dose of tolvaptan 15 mg daily for an average of 3.2 days due to severe hyponatremia. Sodium and potassium concentrations, fluid intake, and urine volume increased (p<0.0001, p=0.037, p<0.0001, and p<0.0001, respectively), whereas furosemide dosage, body weight, heart rate, systolic and diastolic blood pressure, and New York Heart Association class decreased significantly in response to tolvaptan treatment, without a rise in serum creatinine or urea concentrations (p<0.0001, p<0.0001, p=0.001, p<0.049, p<0.009 ve p=0.001, respectively). Conclusion: In this retrospective, single-centered study conducted in a small group of Turkish patients, short-term treatment with low-dose tolvaptan added to standard therapy of hypervolemic HF patients with severe hyponatremia was well tolerated with a low rate of major side effects and was effective in correcting severe hyponatremia. Amaç: Hipervolemik kalp yetersizliği (KY) olan hastalardaki ciddi hiponatremide tolvaptan'ın etkinlik ve güvenilirliğini değerlendirmek. Yöntemler: KY'nin kötüleşmesi nedeniyle kliniğimize yatırılan hipervolemik hastalarda standart tedaviye dirençli hiponatreminin tolvaptan eklenerek tedavisi için oluşturulan bir veritabanı geriye dönük olarak tarandı. Serum sodyum düzeyinin ≤125 mEq/L ciddi hiponatremi olarak tanımlandı. Bu veritabanı, hastaneye yatış sırasındaki demografik, klinik, laboratuvar ve ekokardiyografik bulguları içermekteydi. Oral tolvaptan tedavisinin etkinlik ve güvenilirliğini değerlendirmek amacıyla tolvaptan tedavisiyle ilgili bilgiler ile serum elektrolitleri dahil çok sayıda sonlanım ölçütü de kaydedildi. Bulgular: Toplam 56 (25 kadın, 31 erkek, ortalama yaş 66) ciddi hiponatremisi olan hipervolemik kalp yetersizlikli hasta dahil edildi. Tüm hastalar ciddi hiponatremi nedeniyle ortalama 3.2 gün boyunca günde 15 mg'lık tek doz tolvaptan aldı. Tolvaptan tedavisiyle serum üre ve kreatinin düzeylerinde bir artış olmaksızın sodyum ve potasyum düzeyleri, sıvı alımı ve idrar hacmi anlamlı artarken (sırasıyla, p<0.0001, p=0.037, p<0.0001 ve p<0.0001) furosemit dozu, vücut ağırlığı, nabız sayısı, sistolik ve diyastolik kan basınçları ile New York Kalp Cemiyeti fonksiyonel sınıfı anlamlı biçimde azaldı (sırasıyla, p<0.0001, p<0.0001, p=0.001, p<0.049, p<0.009 ve p=0.001). Sonuç: Bu küçük, geriye dönük, tek merkezli ve Türk popülâsyonunda ilk olan çalışmada, hipervolemik kalp yetersizlikli hastalardaki ciddi hiponatremi için standart tedaviye ek olarak verilen kısa süreli, düşük doz tolvaptan, düşük bir majör yan etki oranıyla iyi tolere edildi ve ciddi hiponatreminin düzeltilmesinde etkili oldu.
The aim of this study was to assess the efficacy and feasibility of an enhanced heart failure (HF... more The aim of this study was to assess the efficacy and feasibility of an enhanced heart failure (HF) education with a 6-month telephone follow- up program in post-discharge ambulatory HF patients. The Hit-Point trial was a multicenter, randomized, controlled trial of enhanced HF education with a 6-month telephone follow-up program (EHFP) vs routine care (RC) in patients with HF and reduced ejection fraction. A total of 248 patients from 10 centers in various geographical areas were randomized: 125 to EHFP and 123 to RC. Education included information on adherence to treatment, symptom recognition, diet and fluid intake, weight monitoring, activity and exercise training. Patients were contacted by telephone after 1, 3, and 6 months. The primary study endpoint was cardiovascular death. Although all-cause mortality didn't differ between the EHFP and RC groups (p=NS), the percentage of cardiovascular deaths in the EHFP group was significantly lower than in the RC group at the 6-month ...
Clinical chemistry and laboratory medicine, Jan 22, 2016
Contrast induced nephropathy (CIN) has been proven to be a clinical condition related to adverse ... more Contrast induced nephropathy (CIN) has been proven to be a clinical condition related to adverse cardiovascular outcomes. In recent studies, the monocyte to high density lipoprotein ratio (MHR) has been postulated as a novel parameter associated with adverse renal and cardiovascular outcomes. In this study we investigated the association of MHR with CIN in ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PCI). Consecutive STEMI patients treated with primary PCI were prospectively recruited. Subjects were categorized into two groups; as patients who developed CIN (CIN+) and patients who did not develop CIN (CIN-) during hospitalization. CIN was defined as either a 25% increase in serum creatinine from baseline or 44.20 µmol/L increase in absolute value, within 72 h of intravenous contrast administration. A total number of 209 patients were included in the study. Thirty-two patients developed CIN (15.3%). In the CIN (...
We report on a patient in whom a giant thrombus in the left atrium was detected by transthoracic ... more We report on a patient in whom a giant thrombus in the left atrium was detected by transthoracic echocardiography. Anticoagulant theraphy was started. After two months of therapy, repeat echocardiography showed complete resolution of the thrombus. This case indicates that large and presumably organised thrombi may be treated with anticoagulant therapy.
Anadolu kardiyoloji dergisi : AKD = the Anatolian journal of cardiology, 2008
In this study, we aimed to determine the relation of presence and severity of coronary artery dis... more In this study, we aimed to determine the relation of presence and severity of coronary artery disease with microalbuminuria, fasting insulin levels and the classical risk factors in non-diabetic patients. We enrolled 100 non-diabetic patients that had an indication for coronary angiography. Group 1 consisted of 55 patients with coronary artery disease, and 45 patients without coronary artery disease were included in Group 2. The study was cross-sectional and case-controlled. In all patients 24-hour microalbuminuria, serum total, high density lipoprotein (HDL), low density lipoprotein (LDL) cholesterol and lipoprotein a, triglyceride, fasting blood sugar levels were obtained. Fasting insulin levels were determined and routine urinary tests were performed. Gensini scoring was done for determination of the severity of coronary artery disease. Statistical analysis was performed using unpaired t test, Mann-Whitney U test, Chi-square test, ROC analysis and multiple logistic regression ana...
Primary cardiac lymphoma (PCL) is an extremely rare disorder. In this report, a 57-year-old male ... more Primary cardiac lymphoma (PCL) is an extremely rare disorder. In this report, a 57-year-old male with diffuse large B-cell lymphoma involving the heart and great vessels is presented. Trans-thoracic echocardiography was the first modality used to establish the diagnosis. Fluorine-18fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) showed diffuse increased metabolic activity of the heart walls and hypermetabolic lesions occupying cardiac chambers in some areas. The patient underwent systemic chemotherapy, and after 13 days, a marked regression of the tumour mass was evident based on echocardiographic examination. After completing six R-CHOP chemotherapy treatments, PET imaging was planned to control the residual mass, but the patient was intubated due to pneumonia that developed after the sixth chemotherapy session and subsequently died due to sepsis.
Primary sarcoma of the pulmonary artery (PSPA) is an extremely rare tumor of the cardiovascular s... more Primary sarcoma of the pulmonary artery (PSPA) is an extremely rare tumor of the cardiovascular system. The prognosis is very poor. The clinical symptoms and imaging findings imitate those of pulmonary emboli, causing delays in diagnosis. In this case report, we describe a 73-year-old man with PSPA who initially was admitted with exertional shortness of breath. Transthoracic echocardiographic evaluation revealed 2 masses in the pulmonary artery causing pulmonary hypertension. The patient underwent operation, but he could not be weaned off cardiopulmonary bypass at the end of the operation and died. Pathologic examination of the masses revealed pulmonary sarcoma. Although this patient was admitted to our clinic only 2 weeks after the initial symptoms, he already had distal metastases.
Takayasu's arteritis is a rare chronic vasculitis of unknown etiology. Symptomatic pulmonary arte... more Takayasu's arteritis is a rare chronic vasculitis of unknown etiology. Symptomatic pulmonary artery disease may be the first sign of Takayasu's arteritis. We describe a 51-year-old woman who presented with severe dyspnea. The initial evaluation and routine exams suggested the presence of pulmonary hypertension of unknown etiology. Absence of bilateral radial and brachial pulses in the physical examination led to an angiographic study, which confirmed the diagnosis of Takayasu's arteritis with severe pulmonary hypertension. During bosentan therapy, the patient's clinical symptoms and exercise capacity improved and her 6-min walking distance increased. We emphasize the importance of considering Takayasu's arteritis in the early diagnosis and therapy of pulmonary artery hypertension.
Journal of the American College of Cardiology, 2013
Background: Atrial Fibrillation (AF), a dysrhythmia with negative consequences on mortality and m... more Background: Atrial Fibrillation (AF), a dysrhythmia with negative consequences on mortality and morbidity, is noted in approximately 30% of patients with Heart Failure (HF). Permanent AF is a situation in which the sinus rhythm can't be restored with the usual therapy. Paroxysmal and persistent atrial fibrillations eventually yield in permanent AF, particularly in patients with HF. An association of CA-125 with poor prognosis in patients with HF has been demonstrated previously by a number of studies. The purpose of the present study was to investigate the relationship between CA-125 levels and permanent AF in patients with systolic HF. Methods: The study included 216 patients (152 males and 64 females) with stable systolic HF (EF 45%). The patients were classified into two groups: those with permanent AF (n¼76) and those without permanent AF (all in sinus rhythm on index ECG, hence called patients in sinus rhythm) (n¼140). Patients were followed up for HF related hospitalization and mortality for 21 months. Results: Patients with permanent AF had higher levels of CA-125 compared to those with sinus rhythm (113.1 U/ml vs. 34.5 U/ml; p<0.001). Patients with permanent AF had larger left atrial diameter compared to those with sinus rhythm (4.6AE0.6 vs 4.4AE0.7 cm, p¼0.025). There were more patients with moderate-severe mitral regurgitation (50.0 vs. 26.6%; p¼0,001), moderate-severe tricuspid regurgitation (53.9 vs. 25.7%; p<0.001) in the group with permanent AF compared to those with sinus rhythm. Number of HF related hospitalizations was also significantly higher among the patients with permanent AF than in those with sinus rhythm on follow up (63.2 vs. 47.9%; p¼0.031). CA-125 levels predicted presence of permanent AF in patients with stable HF (AUC: 0.742, 95% CI 0.673-0.812, p<0.001). Furthermore, CA-125 level of more than 150 U/ml predicted presence of permanent AF with a sensitivity of 37% and specificity of 91% in a group of patients with systolic HF, and associated with 5.699 times more likelihood of permanent AF (Odds ratio, 95% CI 2.727-11.907, p<0.001). Conclusıon: CA-125 levels were significantly higher among the stable systolic HF patients with permanent AF compared to those with sinus rhythm and there was a higher rate of hospitalizations in patients with permanent AF due to HF on follow up. It seems a high CA-125 level (>150 U/ml) can rule-in (high specificity) the presence of permanent AF in patients with HF.
Journal of the American College of Cardiology, 2013
Results: Patients between ages 30 and 60 years with MetS diagnosis were included in this study. 3... more Results: Patients between ages 30 and 60 years with MetS diagnosis were included in this study. 31 patients (41.9%) were male and 43 patients (58.9%) were female. Patients were divided into 2 groups according to CIMT measurement: 35 patients with CIMT !1,0 mm were at group 1 and 39 patients with CIMT<1,0 mm were at group 2. There were difference only age and fasting blood glucose parameter among groups. In the multi-varians analysis, age and fasting blood glucose related in CIMT values were not statistically significant (p>0.05). Additionally, the common effect of age and fasting blood glucose variables on the CIMT values were not statistically significant (p¼0.241). The MPV level was significantly higher in patients with CIMT !1,0 mm than in patients with CIMT <1,0 mm (8.2AE0.7 vs. 7.8AE0.6 fl; p¼0.01) (Figure 1). Conclusıons: The risk of atherosclerosis could be shown with following the MPV values in MetS patients. Therefore, our results suggest that MPV is an important marker for early detecting the risk of atherosclerosis in patients with MetS. In our study, we showed that this risk could be determined with a simple blood count. Risk of atherosclerosis can be assessed by examining the values of MPV, without any additional blood tests or radiological examination.
This study assessed the amount and prognostic value of myocardial viability in patients with non-... more This study assessed the amount and prognostic value of myocardial viability in patients with non-Q-wave myocardial infarction (NQMI) and Q-wave myocardial infarction (QMI). A total of 175 patients with MI and an ejection fraction ≤ 45% underwent dobutamine stress echocardiography. On the basis of clinical criteria and myocardial viability, 110 patients were revascularized. The amount of viable myocardium and the clinical outcome were compared in the NQMI and QMI groups. Patients with NQMI exhibited a larger amount of viable myocardium compared with those with QMI. The mortality rate was 6% in patients with NQMI with viable myocardium and subsequent revascularization, 33% in patients with NQMI without viable myocardium or revascularization, 27% in patients with QMI with viable myocardium and subsequent revascularization, and 33% in patients with QMI without viable myocardium or revascularization. In conclusion, our data suggest that patients with NQMI and viable myocardium have the b...
Archives of the Turkish Society of Cardiology, 2004
Özet Kronik iskemiye bağli fonksiyon bozukluğu olanfakat canltlığı devam eden (hiberne) miyokard;... more Özet Kronik iskemiye bağli fonksiyon bozukluğu olanfakat canltlığı devam eden (hiberne) miyokard; revaskülarizasyon g irişimleri sonrası fonksiyonel iyileşme göstermektedir. Bu çalı.şmada total oklüzyon/u olgularda ilgili damar bölgesine olan gelişmiş kollateral dolaşımın; dobutanıin stres ekokardiyografi ( DSE) ile saptanan nıiyo kard canlıliğı ve koroner arter bypass greft cerrahisi ( KABG) sonrası fonksiyonel iyileşme üzerine etkisi araşıı
Turk Kardiyoloji Dernegi Arsivi-Archives of the Turkish Society of Cardiology, 2017
The aim of the present study was to assess the efficacy and safety of tolvaptan for severe hypona... more The aim of the present study was to assess the efficacy and safety of tolvaptan for severe hyponatremia (SH) in hypervolemic heart failure (HF) patients within daily clinical practice. Methods: We restrospectively reviewed our database on tolvaptan as an add-on treatment in hypervolemic patients admitted to our clinic due to deterioration of HF and having hyponatremia resistant to standard therapy. Severe hyponatremia was defined as serum sodium concentration ≤125 mEq/L. The database included demographic, clinical, laboratory, and echocardiographic findings on admission, and numerous outcome measures for oral tolvaptan treatment were used to assess its efficacy and safety. Results: The study group consisted of 56 hypervolemic HF patients with severe hyponatremia (25 female and 31 male) with mean age of 66 years. All patients received a single dose of tolvaptan 15 mg daily for an average of 3.2 days due to severe hyponatremia. Sodium and potassium concentrations, fluid intake, and urine volume increased (p<0.0001, p=0.037, p<0.0001, and p<0.0001, respectively), whereas furosemide dosage, body weight, heart rate, systolic and diastolic blood pressure, and New York Heart Association class decreased significantly in response to tolvaptan treatment, without a rise in serum creatinine or urea concentrations (p<0.0001, p<0.0001, p=0.001, p<0.049, p<0.009 ve p=0.001, respectively). Conclusion: In this retrospective, single-centered study conducted in a small group of Turkish patients, short-term treatment with low-dose tolvaptan added to standard therapy of hypervolemic HF patients with severe hyponatremia was well tolerated with a low rate of major side effects and was effective in correcting severe hyponatremia. Amaç: Hipervolemik kalp yetersizliği (KY) olan hastalardaki ciddi hiponatremide tolvaptan'ın etkinlik ve güvenilirliğini değerlendirmek. Yöntemler: KY'nin kötüleşmesi nedeniyle kliniğimize yatırılan hipervolemik hastalarda standart tedaviye dirençli hiponatreminin tolvaptan eklenerek tedavisi için oluşturulan bir veritabanı geriye dönük olarak tarandı. Serum sodyum düzeyinin ≤125 mEq/L ciddi hiponatremi olarak tanımlandı. Bu veritabanı, hastaneye yatış sırasındaki demografik, klinik, laboratuvar ve ekokardiyografik bulguları içermekteydi. Oral tolvaptan tedavisinin etkinlik ve güvenilirliğini değerlendirmek amacıyla tolvaptan tedavisiyle ilgili bilgiler ile serum elektrolitleri dahil çok sayıda sonlanım ölçütü de kaydedildi. Bulgular: Toplam 56 (25 kadın, 31 erkek, ortalama yaş 66) ciddi hiponatremisi olan hipervolemik kalp yetersizlikli hasta dahil edildi. Tüm hastalar ciddi hiponatremi nedeniyle ortalama 3.2 gün boyunca günde 15 mg'lık tek doz tolvaptan aldı. Tolvaptan tedavisiyle serum üre ve kreatinin düzeylerinde bir artış olmaksızın sodyum ve potasyum düzeyleri, sıvı alımı ve idrar hacmi anlamlı artarken (sırasıyla, p<0.0001, p=0.037, p<0.0001 ve p<0.0001) furosemit dozu, vücut ağırlığı, nabız sayısı, sistolik ve diyastolik kan basınçları ile New York Kalp Cemiyeti fonksiyonel sınıfı anlamlı biçimde azaldı (sırasıyla, p<0.0001, p<0.0001, p=0.001, p<0.049, p<0.009 ve p=0.001). Sonuç: Bu küçük, geriye dönük, tek merkezli ve Türk popülâsyonunda ilk olan çalışmada, hipervolemik kalp yetersizlikli hastalardaki ciddi hiponatremi için standart tedaviye ek olarak verilen kısa süreli, düşük doz tolvaptan, düşük bir majör yan etki oranıyla iyi tolere edildi ve ciddi hiponatreminin düzeltilmesinde etkili oldu.
The aim of this study was to assess the efficacy and feasibility of an enhanced heart failure (HF... more The aim of this study was to assess the efficacy and feasibility of an enhanced heart failure (HF) education with a 6-month telephone follow- up program in post-discharge ambulatory HF patients. The Hit-Point trial was a multicenter, randomized, controlled trial of enhanced HF education with a 6-month telephone follow-up program (EHFP) vs routine care (RC) in patients with HF and reduced ejection fraction. A total of 248 patients from 10 centers in various geographical areas were randomized: 125 to EHFP and 123 to RC. Education included information on adherence to treatment, symptom recognition, diet and fluid intake, weight monitoring, activity and exercise training. Patients were contacted by telephone after 1, 3, and 6 months. The primary study endpoint was cardiovascular death. Although all-cause mortality didn't differ between the EHFP and RC groups (p=NS), the percentage of cardiovascular deaths in the EHFP group was significantly lower than in the RC group at the 6-month ...
Clinical chemistry and laboratory medicine, Jan 22, 2016
Contrast induced nephropathy (CIN) has been proven to be a clinical condition related to adverse ... more Contrast induced nephropathy (CIN) has been proven to be a clinical condition related to adverse cardiovascular outcomes. In recent studies, the monocyte to high density lipoprotein ratio (MHR) has been postulated as a novel parameter associated with adverse renal and cardiovascular outcomes. In this study we investigated the association of MHR with CIN in ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PCI). Consecutive STEMI patients treated with primary PCI were prospectively recruited. Subjects were categorized into two groups; as patients who developed CIN (CIN+) and patients who did not develop CIN (CIN-) during hospitalization. CIN was defined as either a 25% increase in serum creatinine from baseline or 44.20 µmol/L increase in absolute value, within 72 h of intravenous contrast administration. A total number of 209 patients were included in the study. Thirty-two patients developed CIN (15.3%). In the CIN (...
We report on a patient in whom a giant thrombus in the left atrium was detected by transthoracic ... more We report on a patient in whom a giant thrombus in the left atrium was detected by transthoracic echocardiography. Anticoagulant theraphy was started. After two months of therapy, repeat echocardiography showed complete resolution of the thrombus. This case indicates that large and presumably organised thrombi may be treated with anticoagulant therapy.
Anadolu kardiyoloji dergisi : AKD = the Anatolian journal of cardiology, 2008
In this study, we aimed to determine the relation of presence and severity of coronary artery dis... more In this study, we aimed to determine the relation of presence and severity of coronary artery disease with microalbuminuria, fasting insulin levels and the classical risk factors in non-diabetic patients. We enrolled 100 non-diabetic patients that had an indication for coronary angiography. Group 1 consisted of 55 patients with coronary artery disease, and 45 patients without coronary artery disease were included in Group 2. The study was cross-sectional and case-controlled. In all patients 24-hour microalbuminuria, serum total, high density lipoprotein (HDL), low density lipoprotein (LDL) cholesterol and lipoprotein a, triglyceride, fasting blood sugar levels were obtained. Fasting insulin levels were determined and routine urinary tests were performed. Gensini scoring was done for determination of the severity of coronary artery disease. Statistical analysis was performed using unpaired t test, Mann-Whitney U test, Chi-square test, ROC analysis and multiple logistic regression ana...
Primary cardiac lymphoma (PCL) is an extremely rare disorder. In this report, a 57-year-old male ... more Primary cardiac lymphoma (PCL) is an extremely rare disorder. In this report, a 57-year-old male with diffuse large B-cell lymphoma involving the heart and great vessels is presented. Trans-thoracic echocardiography was the first modality used to establish the diagnosis. Fluorine-18fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) showed diffuse increased metabolic activity of the heart walls and hypermetabolic lesions occupying cardiac chambers in some areas. The patient underwent systemic chemotherapy, and after 13 days, a marked regression of the tumour mass was evident based on echocardiographic examination. After completing six R-CHOP chemotherapy treatments, PET imaging was planned to control the residual mass, but the patient was intubated due to pneumonia that developed after the sixth chemotherapy session and subsequently died due to sepsis.
Primary sarcoma of the pulmonary artery (PSPA) is an extremely rare tumor of the cardiovascular s... more Primary sarcoma of the pulmonary artery (PSPA) is an extremely rare tumor of the cardiovascular system. The prognosis is very poor. The clinical symptoms and imaging findings imitate those of pulmonary emboli, causing delays in diagnosis. In this case report, we describe a 73-year-old man with PSPA who initially was admitted with exertional shortness of breath. Transthoracic echocardiographic evaluation revealed 2 masses in the pulmonary artery causing pulmonary hypertension. The patient underwent operation, but he could not be weaned off cardiopulmonary bypass at the end of the operation and died. Pathologic examination of the masses revealed pulmonary sarcoma. Although this patient was admitted to our clinic only 2 weeks after the initial symptoms, he already had distal metastases.
Takayasu's arteritis is a rare chronic vasculitis of unknown etiology. Symptomatic pulmonary arte... more Takayasu's arteritis is a rare chronic vasculitis of unknown etiology. Symptomatic pulmonary artery disease may be the first sign of Takayasu's arteritis. We describe a 51-year-old woman who presented with severe dyspnea. The initial evaluation and routine exams suggested the presence of pulmonary hypertension of unknown etiology. Absence of bilateral radial and brachial pulses in the physical examination led to an angiographic study, which confirmed the diagnosis of Takayasu's arteritis with severe pulmonary hypertension. During bosentan therapy, the patient's clinical symptoms and exercise capacity improved and her 6-min walking distance increased. We emphasize the importance of considering Takayasu's arteritis in the early diagnosis and therapy of pulmonary artery hypertension.
Journal of the American College of Cardiology, 2013
Background: Atrial Fibrillation (AF), a dysrhythmia with negative consequences on mortality and m... more Background: Atrial Fibrillation (AF), a dysrhythmia with negative consequences on mortality and morbidity, is noted in approximately 30% of patients with Heart Failure (HF). Permanent AF is a situation in which the sinus rhythm can't be restored with the usual therapy. Paroxysmal and persistent atrial fibrillations eventually yield in permanent AF, particularly in patients with HF. An association of CA-125 with poor prognosis in patients with HF has been demonstrated previously by a number of studies. The purpose of the present study was to investigate the relationship between CA-125 levels and permanent AF in patients with systolic HF. Methods: The study included 216 patients (152 males and 64 females) with stable systolic HF (EF 45%). The patients were classified into two groups: those with permanent AF (n¼76) and those without permanent AF (all in sinus rhythm on index ECG, hence called patients in sinus rhythm) (n¼140). Patients were followed up for HF related hospitalization and mortality for 21 months. Results: Patients with permanent AF had higher levels of CA-125 compared to those with sinus rhythm (113.1 U/ml vs. 34.5 U/ml; p<0.001). Patients with permanent AF had larger left atrial diameter compared to those with sinus rhythm (4.6AE0.6 vs 4.4AE0.7 cm, p¼0.025). There were more patients with moderate-severe mitral regurgitation (50.0 vs. 26.6%; p¼0,001), moderate-severe tricuspid regurgitation (53.9 vs. 25.7%; p<0.001) in the group with permanent AF compared to those with sinus rhythm. Number of HF related hospitalizations was also significantly higher among the patients with permanent AF than in those with sinus rhythm on follow up (63.2 vs. 47.9%; p¼0.031). CA-125 levels predicted presence of permanent AF in patients with stable HF (AUC: 0.742, 95% CI 0.673-0.812, p<0.001). Furthermore, CA-125 level of more than 150 U/ml predicted presence of permanent AF with a sensitivity of 37% and specificity of 91% in a group of patients with systolic HF, and associated with 5.699 times more likelihood of permanent AF (Odds ratio, 95% CI 2.727-11.907, p<0.001). Conclusıon: CA-125 levels were significantly higher among the stable systolic HF patients with permanent AF compared to those with sinus rhythm and there was a higher rate of hospitalizations in patients with permanent AF due to HF on follow up. It seems a high CA-125 level (>150 U/ml) can rule-in (high specificity) the presence of permanent AF in patients with HF.
Journal of the American College of Cardiology, 2013
Results: Patients between ages 30 and 60 years with MetS diagnosis were included in this study. 3... more Results: Patients between ages 30 and 60 years with MetS diagnosis were included in this study. 31 patients (41.9%) were male and 43 patients (58.9%) were female. Patients were divided into 2 groups according to CIMT measurement: 35 patients with CIMT !1,0 mm were at group 1 and 39 patients with CIMT<1,0 mm were at group 2. There were difference only age and fasting blood glucose parameter among groups. In the multi-varians analysis, age and fasting blood glucose related in CIMT values were not statistically significant (p>0.05). Additionally, the common effect of age and fasting blood glucose variables on the CIMT values were not statistically significant (p¼0.241). The MPV level was significantly higher in patients with CIMT !1,0 mm than in patients with CIMT <1,0 mm (8.2AE0.7 vs. 7.8AE0.6 fl; p¼0.01) (Figure 1). Conclusıons: The risk of atherosclerosis could be shown with following the MPV values in MetS patients. Therefore, our results suggest that MPV is an important marker for early detecting the risk of atherosclerosis in patients with MetS. In our study, we showed that this risk could be determined with a simple blood count. Risk of atherosclerosis can be assessed by examining the values of MPV, without any additional blood tests or radiological examination.
This study assessed the amount and prognostic value of myocardial viability in patients with non-... more This study assessed the amount and prognostic value of myocardial viability in patients with non-Q-wave myocardial infarction (NQMI) and Q-wave myocardial infarction (QMI). A total of 175 patients with MI and an ejection fraction ≤ 45% underwent dobutamine stress echocardiography. On the basis of clinical criteria and myocardial viability, 110 patients were revascularized. The amount of viable myocardium and the clinical outcome were compared in the NQMI and QMI groups. Patients with NQMI exhibited a larger amount of viable myocardium compared with those with QMI. The mortality rate was 6% in patients with NQMI with viable myocardium and subsequent revascularization, 33% in patients with NQMI without viable myocardium or revascularization, 27% in patients with QMI with viable myocardium and subsequent revascularization, and 33% in patients with QMI without viable myocardium or revascularization. In conclusion, our data suggest that patients with NQMI and viable myocardium have the b...
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Papers by Aysel Kaderli