Objectives: This study aims to estimate the current and future burden of cardiovascular diseases ... more Objectives: This study aims to estimate the current and future burden of cardiovascular diseases (CVD) in Turkey, and quantify the impact of reducing modifiable risk factors. MethOds: A burden of disease model was used to forecast the burden of CVD in Turkey, and estimate the impact of reducing modifiable risk factors (tobacco use, hypertension, type 2 diabetes, obesity and physical inactivity) in the general Turkish population, in accordance with World Health Organization (WHO) targets. Another model estimated the impact of reducing LDL-cholesterol through increased access to effective treatment for two high risk populations: heterozygous familial hypercholesterolemia (HeFH) and secondary prevention (SP), with a focus on patients with LDL-cholesterol > 100 mg/dL. Inputs for the models included disease and risk factor prevalence, population forecast, CVD event rates, and treatment effectiveness, primarily derived from published literature. Direct costs to the public health care system and indirect costs from lost productivity due to premature mortality, hospitalizations, and early retirement were included, although the cost of programs and pharmacological interventions to reduce risk factors was not considered. Results: The prevalence of CVD is projected to increase to 5.4 million adults by 2035, while the economic burden, including both direct and indirect costs, would increase to US$5.7 billion. The value of reducing modifiable risk factors (except LDL-cholesterol) is estimated at US$9.2 billion over the forecast period. Reducing the prevalence of uncontrolled LDL-cholesterol through increased access to evolocumab could lead to savings of up to US$691.3 million for HeFH patients and up to US$8.1 billion for high-risk SP patients over the forecast period. cOnclusiOns: The burden of CVD is significant and growing. Efforts to achieve WHO risk factor targets and further lower LDL-cholesterol through increased access to effective treatment for high-risk patients are projected to greatly reduce the clinical, economic, and humanistic burden of cardiovascular disease in Turkey. PCV67 Modelling The Burden of CardioVasCular disease in Brazil and The iMPaCT of reduCing ModifiaBle risk faCTors
Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology, Jan 25, 2017
Transradial access is widely used for both diagnostic and interventional cardiac procedures. The ... more Transradial access is widely used for both diagnostic and interventional cardiac procedures. The use of transradial access offers several advantages, including decreased bleeding, fewer vascular complications, and reduced length of hospital stay and cost. However, the small size of the radial artery limits the size of the equipment that can be used via this approach. In this study we sought to investigate whether preprocedural manual heating of the radial artery facilitates radial artery puncture. Patients undergoing transradial cardiac catheterization were randomized to subcutaneous nitroglycerin plus diltiazem or manual heating. The study endpoint was puncture score (score 1: easiest - puncture at first attempt; score 2: second attempt; score 3: third attempt; score 4: fourth attempt or more; score 5: puncture failed). Ninety consecutive patients were enrolled in the study, 45 allocated to the drug treatment group and 45 to the heating group. Patients underwent radial artery ultra...
Gamma-glutamyl transferase (GGT) level was found to be elevated in plasma of patients with cardio... more Gamma-glutamyl transferase (GGT) level was found to be elevated in plasma of patients with cardiovascular risk factors. The aim of our study was to assess the relationship between serum GGT levels and the occurrence of no-reflow as well as to evaluate the prognostic value of GGT in ST-segment elevation myocardial infarction (STEMI) population. One hundred sixty-eight consecutive patients with STEMI who underwent percutaneous coronary intervention (PCI) were enrolled in the study. Patients with STEMI were grouped into tertiles according to their admission serum GGT levels. No-reflow after PCI was assessed both angiographically (thrombolysis in myocardial infarction [TIMI] flow and myocardial blush grade) and electrocardiographically (ST resolution). Gamma-glutamyl transferase levels were higher in patients with STEMI compared to the elective PCI group subjects. Patients with angiographically (TIMI flow ≤2 or TIMI flow 3 with final myocardial bush grade ≤2 after PCI) and electrocardiographically (ST resolution <30%) detected no-reflow were increased in number across the GGT tertiles. In addition, 1-year mortality rates showed a significant increase across the tertile groups (4% vs 11% vs 23%, P < 0.01). Multivariable logistic regression analysis revealed that GGT levels on admission were a significant predictor of long-term mortality of myocardial blush grade-detected no-reflow phenomenon. High GGT level on admission was a significant predictor for long-term mortality and major adverse cardiac events. In patients with STEMI undergoing primary PCI, high GGT levels at admission were found to be associated with no-reflow phenomenon and increased long-term mortality.
Türk Kardiyoloji Derneği arşivi : Türk Kardiyoloji Derneğinin yayın organıdır, 2014
In this article, our aims were to analyze and assess the data related to coronary revascularizati... more In this article, our aims were to analyze and assess the data related to coronary revascularization rates, particularly in recent years. For this purpose, results of important studies, statistics of the Organisation for Economic Co-operation and Development (OECD) countries and data from Turkey's Social Security Agency (SSA) were analyzed for the first time. Until recently, there has been no healthy digital database regarding revascularization rates in Turkey. In the years following the establishment of SSA, it became possible to collect and analyze data obtained from the Medulla database of the Agency. Using the data from the Agency for the period 2009-2011, revascularization rates and cost analyses were performed. Between 2000 and 2010 in European countries as well as in other OECD countries, the percutaneous coronary intervention (PCI) rate was on average 75% of the total revascularization rate and neared 80%. In some countries, the rate has exceeded 85%. In our country, in 2...
A zoonotic infection caused by Brucella spp., brucellosis, is endemic in some areas of the world,... more 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....
Warfarin, an oral anticoagulant, is the therapy of choice to maintain anticoagulation. An individ... more Warfarin, an oral anticoagulant, is the therapy of choice to maintain anticoagulation. An individual requiring five- to 20-fold higher dosage than average for anticoagulation may be considered as having resistance to warfarin. In order to evaluate a subtherapeutic response to high-dose warfarin, the clinician must consider many possible causes of resistance, such as non-compliance, drug interactions, or pharmacokinetic changes. When these factors have been eliminated, an hereditary warfarin resistance might be considered responsible. The case is reported of a 49-year-old woman who received warfarin after mitral valve replacement and experienced mechanical mitral valve thrombosis due to inadequate anticoagulation, possibly caused by warfarin resistance.
Anadolu kardiyoloji dergisi : AKD = the Anatolian journal of cardiology, 2005
To determine whether pulmonary vascular bed contributes to the development of in situ thrombosis ... more To determine whether pulmonary vascular bed contributes to the development of in situ thrombosis and vascular remodelling in secondary pulmonary hypertension (SPH) via changes in its local secretory activities. Seventy-one patients with the diagnosis of secondary pulmonary hypertension (38 females, mean age 40.36+/-1.05 years) were included in the study. Selective right and left heart catheterization was performed to each patient for diagnostic purposes. Blood samples obtained from left ventricle (LV) and pulmonary artery (PA) of each patient were analyzed for levels of plasminogen activator inhibitor-1 (PAI-1), platelet derived growth factor (PDGF), vascular endothelial growth factor (VEGF), D-dimer, von Willebrand factor (vWF), protein-C, antithrombin-III, fibrinogen, and plasminogen. Results were compared between LV and PA. Correlation analysis between each parameter and mean pulmonary artery pressure (MPAP) was performed. Although mean level of VEGF in LV and PA were found to be...
We report a patient having exercise-induced left bundlebranch block found to have normal coronary... more We report a patient having exercise-induced left bundlebranch block found to have normal coronary arteries and slow coronary flow on angiogram. The association of exercise induced left bundle branch block with slow coronary flow in angiography has not been previously reported. Bu vaka raporunda normal koroner arterler ve yavaş koroner akıma sahip bir hastada egzersiz testi sırasında gelişen sol dal bloğu sunulmuştur. Bildiğimiz kadarıyla anjiografide koroner yavaş akım ile egzersizle indüklenen sol dal bloğu birlikteliği daha önce rapor edilmemiştir.
Türk Kardiyoloji Derneği arşivi : Türk Kardiyoloji Derneğinin yayın organıdır, 2009
It has been shown that serum uric acid (SUA) constitutes an important independent risk factor for... more 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 frequ...
Background: Cardiac resynchronization therapy has been increasingly used for patients with heart ... more Background: 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. Methods: 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.
Objective: This prospective study was designed to compare potential predictive effect of lipocali... more Objective: This prospective study was designed to compare potential predictive effect of lipocalin on the development of contrast-induced nephropathy (CIN) following coronary angiography in patients with renal dysfunction. Methods: Eighty-five patients with stable coronary symptoms with a creatinine level ≥1.2 mg/dl were included for this prospective study. Patients underwent routine coronary angiography. Serum creatinine was assessed just before, immediately after and 48 hours after the procedure. CIN was defined as an increase in serum creatinine concentration of ≥25% within 48 hours after the procedure compared to the patient's baseline value. Serum lipocalin levels were measured just before, and 4 hours after the procedure. Results: Following coronary angiography, serum creatinine levels increased significantly in study population. Contrast induced nephropathy developed in 13 patients (15%) within 48 hours. In patient group with contrast induced nephropathy, post angiographic lipocalin levels at 4th hour increased significantly comparing with basal measurements (133.8±89 ng/ml and 267.0±143 ng/ml, p: 0.01, basal and post-angiographic measurements respectively). In contrast this twofold increase in lipocalin level was not observed in patient group without CIN. Post angiographic lipocalin levels did not change significantly comparing with basal measurements in patient group without CIN (213.2±153 ng/ml and 217.4±139.7 ng/ml, p: 0.8 basal and post-angiographic measurements respectively). Conclusions: In summary, lipocalin elevation following coronary angiography may be an early marker of development of CIN in patients with impaired renal function.
Background: The safety and efficacy of clopidogrel therapy in patients with stable coronary arter... more Background: 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. Objectives: 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. Methods: 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. Results: 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).
Background The protective effects and the prognostic importance of collaterals during and after a... more Background The protective effects and the prognostic importance of collaterals during and after acute myocardial infarction (MI) are under debate and heart rate variability (HRV) is a strong predictor of risk of mortality and arrhythmic events after acute MI. We aimed to examine the effects of collateral circulation on HRV in the early period after acute MI. Methods Sixty-four patients admitted to our clinics who were diagnosed with acute anterior MI and underwent thrombolytic therapy were enrolled in this study. We applied 24 h Holter monitoring for HRV analysis to all patients and compared the patients with and without collaterals to the infarct-related artery. Results Mean heart rate, low frequency (LF) (day, night and 24 h) and LF/high frequency (HF) (day, night and 24 h) were higher, SD of all NN intervals (SDNN), root mean square of successive differences (RMSSD), number of NN intervals that differed by more than 50 ms from the adjacent interval divided by the total number of all NN intervals (PNN50) and HF night values were lower in patients without collaterals than in those with collaterals. SDNN was negatively correlated with left anterior descending coronary artery (LAD) stenosis, ventricle score indices and left ventricular ejection fraction (LVEF); LF/HF ratio was positively correlated with ventricle score indices and negatively correlated with LVEF and Thrombolysis in Myocardial Infarction flow grade. Linear regression analysis showed that ventricle score index and coronary collaterals affect HRV and LAD stenosis, ventricle score, LVEF and coronary collaterals affect LF/HF ratio. A SDNN < 80 ms increased the development of ventricular arrhythmias in the early period by 4.7 fold, a LF/HF ratio > 2.7 increased it by 9.8 fold and a LVEF < 35% increased it by 12.8 fold, whereas the presence of well-developed collaterals decreased the arrhythmia development by 2.5 fold. Conclusions The collaterals to the infarct-related artery have great impact on HRV, autonomic nervous system activity and the development of ventricular arrhythmias in patients with acute anterior MI. Our results suggest a protective role of collaterals on myocardial electrophysiology in the early period after acute MI. Coron Artery Dis 15:405-411 c 2004 Lippincott Williams & Wilkins.
Background: Coronary angiography is the gold standard for diagnosing coronary artery fistulas (CA... more Background: Coronary angiography is the gold standard for diagnosing coronary artery fistulas (CAFs). Multidetector computed tomography (MDCT) is a recently developed imaging technique for detecting coronary artery stenosis, coronary artery anomalies, and coronary artery fistulas and their courses. Objective: We aimed to determine accuracy or sensitivity of MDCT in patients having CAF. Method: We evaluated 13 patients with 15 CAFs detected earlier by coronary angiography. MDCT was carried out on all patients and the results were compared with coronary angiography, following which, sensitivity of MDCT was detected. Results: Eleven of 15 CAFs were shown on MDCT and the overall sensitivity of MDCT was found to be 73%. Seven of 8 CAFs that coursed between two vascular structures were detected and the sensitivity of MDCT This manuscript has been accepted as a poster presentation at the second Annual Congress on Update in Cardiology and Cardiovascular Surgery, and the abstract was published in the Clinical Cardiology journal.
he primary goal of reperfusion therapy in acute ST segment elevation myocardial infarction (STEMI... more he primary goal of reperfusion therapy in acute ST segment elevation myocardial infarction (STEMI) is to achieve complete and sustained myocardial reperfusion in a timely fashion. 1 Nevertheless, after standard current fibrinolytic regimens, many patients have suboptimal reperfusion even after successfully restored infarct related artery (IRA) patency, possibly due to loss of microvascular integrity. 2,3 While there is no definitely established advantage in routine immediate coronary angiography after thrombolytic administration, 4 rescue therapy might benefit a limited proportion of patients with suboptimal reperfusion, if they
Objectives: This study aims to estimate the current and future burden of cardiovascular diseases ... more Objectives: This study aims to estimate the current and future burden of cardiovascular diseases (CVD) in Turkey, and quantify the impact of reducing modifiable risk factors. MethOds: A burden of disease model was used to forecast the burden of CVD in Turkey, and estimate the impact of reducing modifiable risk factors (tobacco use, hypertension, type 2 diabetes, obesity and physical inactivity) in the general Turkish population, in accordance with World Health Organization (WHO) targets. Another model estimated the impact of reducing LDL-cholesterol through increased access to effective treatment for two high risk populations: heterozygous familial hypercholesterolemia (HeFH) and secondary prevention (SP), with a focus on patients with LDL-cholesterol > 100 mg/dL. Inputs for the models included disease and risk factor prevalence, population forecast, CVD event rates, and treatment effectiveness, primarily derived from published literature. Direct costs to the public health care system and indirect costs from lost productivity due to premature mortality, hospitalizations, and early retirement were included, although the cost of programs and pharmacological interventions to reduce risk factors was not considered. Results: The prevalence of CVD is projected to increase to 5.4 million adults by 2035, while the economic burden, including both direct and indirect costs, would increase to US$5.7 billion. The value of reducing modifiable risk factors (except LDL-cholesterol) is estimated at US$9.2 billion over the forecast period. Reducing the prevalence of uncontrolled LDL-cholesterol through increased access to evolocumab could lead to savings of up to US$691.3 million for HeFH patients and up to US$8.1 billion for high-risk SP patients over the forecast period. cOnclusiOns: The burden of CVD is significant and growing. Efforts to achieve WHO risk factor targets and further lower LDL-cholesterol through increased access to effective treatment for high-risk patients are projected to greatly reduce the clinical, economic, and humanistic burden of cardiovascular disease in Turkey. PCV67 Modelling The Burden of CardioVasCular disease in Brazil and The iMPaCT of reduCing ModifiaBle risk faCTors
Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology, Jan 25, 2017
Transradial access is widely used for both diagnostic and interventional cardiac procedures. The ... more Transradial access is widely used for both diagnostic and interventional cardiac procedures. The use of transradial access offers several advantages, including decreased bleeding, fewer vascular complications, and reduced length of hospital stay and cost. However, the small size of the radial artery limits the size of the equipment that can be used via this approach. In this study we sought to investigate whether preprocedural manual heating of the radial artery facilitates radial artery puncture. Patients undergoing transradial cardiac catheterization were randomized to subcutaneous nitroglycerin plus diltiazem or manual heating. The study endpoint was puncture score (score 1: easiest - puncture at first attempt; score 2: second attempt; score 3: third attempt; score 4: fourth attempt or more; score 5: puncture failed). Ninety consecutive patients were enrolled in the study, 45 allocated to the drug treatment group and 45 to the heating group. Patients underwent radial artery ultra...
Gamma-glutamyl transferase (GGT) level was found to be elevated in plasma of patients with cardio... more Gamma-glutamyl transferase (GGT) level was found to be elevated in plasma of patients with cardiovascular risk factors. The aim of our study was to assess the relationship between serum GGT levels and the occurrence of no-reflow as well as to evaluate the prognostic value of GGT in ST-segment elevation myocardial infarction (STEMI) population. One hundred sixty-eight consecutive patients with STEMI who underwent percutaneous coronary intervention (PCI) were enrolled in the study. Patients with STEMI were grouped into tertiles according to their admission serum GGT levels. No-reflow after PCI was assessed both angiographically (thrombolysis in myocardial infarction [TIMI] flow and myocardial blush grade) and electrocardiographically (ST resolution). Gamma-glutamyl transferase levels were higher in patients with STEMI compared to the elective PCI group subjects. Patients with angiographically (TIMI flow ≤2 or TIMI flow 3 with final myocardial bush grade ≤2 after PCI) and electrocardiographically (ST resolution &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;30%) detected no-reflow were increased in number across the GGT tertiles. In addition, 1-year mortality rates showed a significant increase across the tertile groups (4% vs 11% vs 23%, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01). Multivariable logistic regression analysis revealed that GGT levels on admission were a significant predictor of long-term mortality of myocardial blush grade-detected no-reflow phenomenon. High GGT level on admission was a significant predictor for long-term mortality and major adverse cardiac events. In patients with STEMI undergoing primary PCI, high GGT levels at admission were found to be associated with no-reflow phenomenon and increased long-term mortality.
Türk Kardiyoloji Derneği arşivi : Türk Kardiyoloji Derneğinin yayın organıdır, 2014
In this article, our aims were to analyze and assess the data related to coronary revascularizati... more In this article, our aims were to analyze and assess the data related to coronary revascularization rates, particularly in recent years. For this purpose, results of important studies, statistics of the Organisation for Economic Co-operation and Development (OECD) countries and data from Turkey's Social Security Agency (SSA) were analyzed for the first time. Until recently, there has been no healthy digital database regarding revascularization rates in Turkey. In the years following the establishment of SSA, it became possible to collect and analyze data obtained from the Medulla database of the Agency. Using the data from the Agency for the period 2009-2011, revascularization rates and cost analyses were performed. Between 2000 and 2010 in European countries as well as in other OECD countries, the percutaneous coronary intervention (PCI) rate was on average 75% of the total revascularization rate and neared 80%. In some countries, the rate has exceeded 85%. In our country, in 2...
A zoonotic infection caused by Brucella spp., brucellosis, is endemic in some areas of the world,... more 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....
Warfarin, an oral anticoagulant, is the therapy of choice to maintain anticoagulation. An individ... more Warfarin, an oral anticoagulant, is the therapy of choice to maintain anticoagulation. An individual requiring five- to 20-fold higher dosage than average for anticoagulation may be considered as having resistance to warfarin. In order to evaluate a subtherapeutic response to high-dose warfarin, the clinician must consider many possible causes of resistance, such as non-compliance, drug interactions, or pharmacokinetic changes. When these factors have been eliminated, an hereditary warfarin resistance might be considered responsible. The case is reported of a 49-year-old woman who received warfarin after mitral valve replacement and experienced mechanical mitral valve thrombosis due to inadequate anticoagulation, possibly caused by warfarin resistance.
Anadolu kardiyoloji dergisi : AKD = the Anatolian journal of cardiology, 2005
To determine whether pulmonary vascular bed contributes to the development of in situ thrombosis ... more To determine whether pulmonary vascular bed contributes to the development of in situ thrombosis and vascular remodelling in secondary pulmonary hypertension (SPH) via changes in its local secretory activities. Seventy-one patients with the diagnosis of secondary pulmonary hypertension (38 females, mean age 40.36+/-1.05 years) were included in the study. Selective right and left heart catheterization was performed to each patient for diagnostic purposes. Blood samples obtained from left ventricle (LV) and pulmonary artery (PA) of each patient were analyzed for levels of plasminogen activator inhibitor-1 (PAI-1), platelet derived growth factor (PDGF), vascular endothelial growth factor (VEGF), D-dimer, von Willebrand factor (vWF), protein-C, antithrombin-III, fibrinogen, and plasminogen. Results were compared between LV and PA. Correlation analysis between each parameter and mean pulmonary artery pressure (MPAP) was performed. Although mean level of VEGF in LV and PA were found to be...
We report a patient having exercise-induced left bundlebranch block found to have normal coronary... more We report a patient having exercise-induced left bundlebranch block found to have normal coronary arteries and slow coronary flow on angiogram. The association of exercise induced left bundle branch block with slow coronary flow in angiography has not been previously reported. Bu vaka raporunda normal koroner arterler ve yavaş koroner akıma sahip bir hastada egzersiz testi sırasında gelişen sol dal bloğu sunulmuştur. Bildiğimiz kadarıyla anjiografide koroner yavaş akım ile egzersizle indüklenen sol dal bloğu birlikteliği daha önce rapor edilmemiştir.
Türk Kardiyoloji Derneği arşivi : Türk Kardiyoloji Derneğinin yayın organıdır, 2009
It has been shown that serum uric acid (SUA) constitutes an important independent risk factor for... more 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 frequ...
Background: Cardiac resynchronization therapy has been increasingly used for patients with heart ... more Background: 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. Methods: 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.
Objective: This prospective study was designed to compare potential predictive effect of lipocali... more Objective: This prospective study was designed to compare potential predictive effect of lipocalin on the development of contrast-induced nephropathy (CIN) following coronary angiography in patients with renal dysfunction. Methods: Eighty-five patients with stable coronary symptoms with a creatinine level ≥1.2 mg/dl were included for this prospective study. Patients underwent routine coronary angiography. Serum creatinine was assessed just before, immediately after and 48 hours after the procedure. CIN was defined as an increase in serum creatinine concentration of ≥25% within 48 hours after the procedure compared to the patient's baseline value. Serum lipocalin levels were measured just before, and 4 hours after the procedure. Results: Following coronary angiography, serum creatinine levels increased significantly in study population. Contrast induced nephropathy developed in 13 patients (15%) within 48 hours. In patient group with contrast induced nephropathy, post angiographic lipocalin levels at 4th hour increased significantly comparing with basal measurements (133.8±89 ng/ml and 267.0±143 ng/ml, p: 0.01, basal and post-angiographic measurements respectively). In contrast this twofold increase in lipocalin level was not observed in patient group without CIN. Post angiographic lipocalin levels did not change significantly comparing with basal measurements in patient group without CIN (213.2±153 ng/ml and 217.4±139.7 ng/ml, p: 0.8 basal and post-angiographic measurements respectively). Conclusions: In summary, lipocalin elevation following coronary angiography may be an early marker of development of CIN in patients with impaired renal function.
Background: The safety and efficacy of clopidogrel therapy in patients with stable coronary arter... more Background: 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. Objectives: 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. Methods: 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. Results: 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).
Background The protective effects and the prognostic importance of collaterals during and after a... more Background The protective effects and the prognostic importance of collaterals during and after acute myocardial infarction (MI) are under debate and heart rate variability (HRV) is a strong predictor of risk of mortality and arrhythmic events after acute MI. We aimed to examine the effects of collateral circulation on HRV in the early period after acute MI. Methods Sixty-four patients admitted to our clinics who were diagnosed with acute anterior MI and underwent thrombolytic therapy were enrolled in this study. We applied 24 h Holter monitoring for HRV analysis to all patients and compared the patients with and without collaterals to the infarct-related artery. Results Mean heart rate, low frequency (LF) (day, night and 24 h) and LF/high frequency (HF) (day, night and 24 h) were higher, SD of all NN intervals (SDNN), root mean square of successive differences (RMSSD), number of NN intervals that differed by more than 50 ms from the adjacent interval divided by the total number of all NN intervals (PNN50) and HF night values were lower in patients without collaterals than in those with collaterals. SDNN was negatively correlated with left anterior descending coronary artery (LAD) stenosis, ventricle score indices and left ventricular ejection fraction (LVEF); LF/HF ratio was positively correlated with ventricle score indices and negatively correlated with LVEF and Thrombolysis in Myocardial Infarction flow grade. Linear regression analysis showed that ventricle score index and coronary collaterals affect HRV and LAD stenosis, ventricle score, LVEF and coronary collaterals affect LF/HF ratio. A SDNN < 80 ms increased the development of ventricular arrhythmias in the early period by 4.7 fold, a LF/HF ratio > 2.7 increased it by 9.8 fold and a LVEF < 35% increased it by 12.8 fold, whereas the presence of well-developed collaterals decreased the arrhythmia development by 2.5 fold. Conclusions The collaterals to the infarct-related artery have great impact on HRV, autonomic nervous system activity and the development of ventricular arrhythmias in patients with acute anterior MI. Our results suggest a protective role of collaterals on myocardial electrophysiology in the early period after acute MI. Coron Artery Dis 15:405-411 c 2004 Lippincott Williams & Wilkins.
Background: Coronary angiography is the gold standard for diagnosing coronary artery fistulas (CA... more Background: Coronary angiography is the gold standard for diagnosing coronary artery fistulas (CAFs). Multidetector computed tomography (MDCT) is a recently developed imaging technique for detecting coronary artery stenosis, coronary artery anomalies, and coronary artery fistulas and their courses. Objective: We aimed to determine accuracy or sensitivity of MDCT in patients having CAF. Method: We evaluated 13 patients with 15 CAFs detected earlier by coronary angiography. MDCT was carried out on all patients and the results were compared with coronary angiography, following which, sensitivity of MDCT was detected. Results: Eleven of 15 CAFs were shown on MDCT and the overall sensitivity of MDCT was found to be 73%. Seven of 8 CAFs that coursed between two vascular structures were detected and the sensitivity of MDCT This manuscript has been accepted as a poster presentation at the second Annual Congress on Update in Cardiology and Cardiovascular Surgery, and the abstract was published in the Clinical Cardiology journal.
he primary goal of reperfusion therapy in acute ST segment elevation myocardial infarction (STEMI... more he primary goal of reperfusion therapy in acute ST segment elevation myocardial infarction (STEMI) is to achieve complete and sustained myocardial reperfusion in a timely fashion. 1 Nevertheless, after standard current fibrinolytic regimens, many patients have suboptimal reperfusion even after successfully restored infarct related artery (IRA) patency, possibly due to loss of microvascular integrity. 2,3 While there is no definitely established advantage in routine immediate coronary angiography after thrombolytic administration, 4 rescue therapy might benefit a limited proportion of patients with suboptimal reperfusion, if they
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Papers by Yucel Balbay