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Öğe Association between metabolic syndrome and late saphenous vein graft disease(Turkish Soc Cardiology, 2006) Yilmaz, Mehmet Birhan; Guray, Umit; Guray, Yesim; Biyikoglu, Senay Funda; Kisacik, Halil L.; Korkmaz, SuleObjectives: Saphenous vein grafts have been widely used in coronary bypass operations for many years. We investigated the association between metabolic syndrome (MS) and late saphenous graft disease. Study design: The study included 193 patients (16 females, 177 males; mean age 62 +/- 8 years; range 39 to 86 years) in whom at least one saphenous vein graft had been used during coronary bypass operation of at least 10-year history. All the patients underwent coronary angiography for anginal complaints or preoperative assessment. Patients were classified into two groups. Group 1 was comprised of 72 patients with patent saphenous graft, whereas group 2 included 121 patients without patency or with associated lesions. The two groups were compared in terms of their medications, anthropometric measurements, blood biochemistry, and the presence of hypertension, diabetes mellitus, smoking, and MS. Results: Metabolic syndrome was less frequent in group 1 than in group 2 (22% vs. 45.6%, p=0.003). Metabolic syndrome score, derived from the sum of MS components, was higher in group 2 than in group 1 (2.3 +/- 1 vs. 1.8 +/- 1.2, p=0.003). In a multivariate logistic regression analysis, duration from bypass to coronary angiography (beta=0.812, p=0.017) and MS score (beta=0.590, p=0.005) were found to be independent factors related to saphenous graft patency. Conclusion: Metabolic syndrome score seems to be associated with late saphenous vein graft disease. Early measures for MS may affect the prognosis of patients undergoing coronary bypass operations.Öğe Atrial natriuretic peptide predicts impaired atrial remodeling and occurrence of late postoperative atrial fibrillation after surgery for symptomatic aortic stenosis(KARGER, 2006) Yimaz, Mehmet Birhan; Erbay, Ali Riza; Balci, Mustafa; Guray, Yesim; Cihan, Gokhan; Guray, Umit; Kisacik, Halil L.; Korkmaz, SuleBackground. Aortic stenosis (AS) and atrial fibrillation (AF) are commonly encountered in clinical practice. Natriuretic peptides (NP) are endogenous cardiac hormones, which have been shown to increase in patients with heart failure, and valvular or congenital heart disease. We aimed to determine the association between atrial NP (ANP) and late postoperative AF after surgery for AS along with temporal changes in plasma ANP levels and left atrial (LA) volumes. Methods: 22 patients (16 males/6 females, mean age: 61 years) with symptomatic AS and 8 healthy volunteers (5 males/3 females) were enrolled into our study. All the patients studied underwent transthoracic echocardiography, which was repeated during the follow-up. N-terminal ANP (N-ANP) was studied initially and at the 2-month follow-up. Postoperatively, the patients were followed up for 12 months for AF attacks. Results: Patients with AS had significantly higher levels of N-ANP, left ventricular (LV) end-diastolic pressure, E/A ratio, LV mass and LA volumes compared to the controls. Patients with postoperative AF attacks were significantly older, had higher N-ANP levels and LV end-diastolic pressure in addition to higher LA volumes and longer symptom duration compared to patients without AF. Age at the time of operation (p = 0.011) and N-ANP at the 2nd month (p = 0.047) were found to be independent predictors for late AF attacks during follow-up in regression analysis. Besides, N-ANP (p < 0.001) at the 2-month follow-up independently predicted impaired LA remodeling. Conclusion:ANP might be an important factor to identify AS patients at risk for late postoperative AF attacks. Copyright (c) 2006 S. Karger AG, BaselÖğe Cardiac cachexia and gastrointestinal system(ELSEVIER IRELAND LTD, 2011) Ege, Meltem Refiker; Yilmaz, Mehmet Birhan; Guray, Yesim…Öğe Fate of Internal Mammary Artery Grafted to Left Anterior Descending Artery Is Influenced by Native Vessel Stenosis and Viable Myocardium(SAGE PUBLICATIONS INC, 2009) Yilmaz, Mehmet B.; Guray, Yesim; Altay, Hakan; Demirkan, Burcu; Caldir, Vedat; Guray, Umit; Biyikoglu, Senay F.; Sasmaz, Hatice; Kisacik, Halil L.; Korkmaz, SuleIn this study, factors leading to the failure of internal mammary artery grafting was investigated among patients with coronary bypass. In all, 1323 patients were evaluated. It was found that lower grade diameter stenosis in the native vessel during postoperative angiogram and wall motion score index independently affected the fate of internal mammary artery as a graft. Grafting with internal mammary artery to native vessels with lower grade stenosis and to myocardium with poor wall score might not be a rational approach.Öğe Fine vs. coarse atrial fibrillation: Which one is more risky?(KARGER, 2007) Yilmaz, Mehmet Birhan; Guray, Yesim; Guray, Umit; Cay, Serkan; Caldir, Vedat; Biyikoglu, Senay Funda; Sasmaz, Hatice; Korkmaz, SuleBackground: Atrial fibrillation (AF) is a frequent arrhythmia, associated with morbidity and mortality. It is identified by two types on surface electrocardiogram as fine and coarse AF. We aimed to search the association of subtypes of AF with clinical parameters. Methods: Eight hundred and eleven consecutive patients, who had AF attack which lasted longer than 24 h or more, were evaluated along with clinical and laboratory data. Results: Coarse AF was noticed in 51.7% (n = 419), and fine AF in 48.3% (n = 392). Sex was associated with subtype of AF such that coarse AF was present in 46.5% of male patients, but in 56.1% of female patients (p = 0.009). Coarse AF was present in 85.3% of patients with mitral stenosis, whereas it was present in 35.3% of patients with normal heart valve (p < 0.001).). Patients having fine AF were significantly older than those having coarse AF (64 +/- 12, 57 +/- 13 years, p < 0.001). 19.6% of those with coarse AF had history of cerebrovascular event (CVE), whereas 13.5% of those with fine AF had history of CVE (p = 0.021). After controlling for age in the multivariable logistic regression analysis, presence of coarse AF (B = 1.585, p = 0.031) was found to be independently associated with the history of CVE. Conclusion: AF is identified by two morphological forms on the surface electrocardiogram. These two forms were found to be associated with different clinical parameters, acting on vascular endpoints differently. Copyright (c) 2007 S. Karger AG, Basel.Öğe Long-Term Follow-Up of Iatrogenic Atrial Septal Defect after Percutaneous Mitral Balloon Valvuloplasty(TEXAS HEART INST, 2011) Korkmaz, Sule; Demirkan, Burcu; Guray, Yesim; Yilmaz, Mehmet Birhan; Sasmaz, HaticeDuring percutaneous mitral balloon valvuloplasty, the Inoue method leaves patients with an iatrogenic atrial septal defect. In this study, we evaluated the factors affecting the development of iatrogenic atrial septal defect and searched for the possible influence of this defect on long-term outcomes. We reviewed the medical records of 267 patients who had undergone successful percutaneous mitral balloon valvuloplasty for symptomatic moderate or severe mitral stenosis from January 2000 through March 2004. Sixty-three of the 267 patients were enrolled in a face-to-face follow-up study. We noted their clinical and demographic characteristics. All included patients were asked for the endpoints of repeat percutaneous mitral balloon valvuloplasty or mitral valve surgery, cerebro vascular accident or transient ischemic attack, and the need of intervention for the iatrogenic atrial septal defect. They underwent standard 2-dimensional and Doppler echocardiographic examination. The presence of iatrogenic atrial septal defect was evaluated via the color-Doppler technique in the subcostal view and via contrast echocardiography. Patients were subclassified in accordance with the presence (n=15) or absence (n=48) of echocardiographically proven persistent iatrogenic atrial septal defect. When we compared the 2 groups, there were no significant differences in baseline demographic characteristics or in pre- and postprocedural echocardiographic data. We conclude that the presence of persistent iatrogenic atrial septal defects might not be predicted from echocardiographic or demographic data in patients undergoing percutaneous mitral balloon valvuloplasty. Fortunately, these defects are small in size and low in shunt ratio. They appear not to be associated with serious long-term outcomes. (Tex Heart Inst J 2011;38(5):523-7)Öğe Metabolic syndrome increases the risk of significant coronary artery involvement in patients with peripheral artery disease(LIPPINCOTT WILLIAMS & WILKINS, 2006) Yilmaz, Mehmet Birhan; Guray, Yesim; Guray, Umit; Biyikoglu, Senay Funda; Tandogan, Izzet; Korkmaz, SuleBackground Peripheral artery disease is a common condition, mainly associated with clinical cardiovascular risk factors. Patients with peripheral artery disease suffer from coronary artery disease-related complications. On the other hand, metabolic syndrome, as a constellation of specific risk factors, represents a risk factor for cardiovascular mortality. Metabolic syndrome might increase the risk of significant coronary artery disease in patients with peripheral artery disease. We aimed to examine the association of metabolic syndrome with the angiographically shown coronary artery involvement in patients with peripheral artery disease. Methods Two hundred and forty-seven patients with peripheral artery disease (mean age 60 +/- 9.5 years, 223 men/24 women), who were referred to coronary angiography, were evaluated. The resting ankle-brachial pressure index was measured with the patient in supine position. Patients with > 70% diameter stenosis were considered to have significant coronary artery disease. Results In all, there were 223 male/24 female patients with mean ankle-brachial pressure index of 0.7 +/- 0.2, and mean age of 60 +/- 9.5 years. Metabolic syndrome was present in 53% (n = 131) of all patients. Significant coronary artery disease was more frequently encountered in patients with peripheral artery disease and metabolic syndrome than in those without metabolic syndrome (73.3 vs. 40.5%, P < 0.001). The presence of metabolic syndrome increased the risk of having significant coronary artery disease in patients with peripheral artery disease by 4.027 fold. Lower ankle-brachial pressure index (P = 0.038, B = 2.567), older age (P < 0.001, B = 1.075), presence of metabolic syndrome (P = 0.015, B = 2.247), and presence of diabetes mellitus (P < 0.001, B = 1.293) were found to be independent predictors of significant coronary artery disease in patients with peripheral artery disease in multivariable regression. Conclusion Metabolic syndrome seems to increase the risk of significant coronary artery disease in patients with peripheral artery disease.Öğe Red cell distribution width predicts mortality in infective endocarditis(ELSEVIER MASSON, 2014) Guray, Yesim; Ipek, Esra Gucuk; Guray, Umit; Demirkan, Burcu; Kafes, Habibe; Asarcikli, Late Dinc; Cabuk, Gizem; Yilmaz, Mehmet BirhanBackground. - Infective endocarditis (IE) is associated with significant morbidity and mortality. Red cell distribution width (RDW) is a recently recognized biomarker of adverse outcome in a number of acute and chronic conditions. Aim. - To investigate the relationship between RDW and 1-year survival in patients with IE. Methods. - Clinical records from two tertiary centres were used to analyze data from patients with definite IE. Clinical, echocardiographic and biochemical variables were evaluated along with RDW. One-year survival status after index hospitalization was identified for each patient. Results. - One hundred consecutive patients (mean age 47.8 +/- 16.7 years; 61% men) with definite IE were enrolled. According to receiver operating characteristic curve analysis, the optimal RDW cut-off value for predicting mortality was 15.3% (area under the curve 0.70; P=0.001). Forty-one patients (41%) died within 1 year; of these, 88% had ROW results > 15.3%. Univariate Cox proportional-hazards analysis showed that RDW > 15.3%, heart failure, renal failure, cardiac abscess, severe valvular regurgitation and presence of dehiscence were associated with increased mortality. Multivariable Cox proportional-hazards analysis revealed that renal failure (hazard ratio [HR] 3.21, 95% confidence interval [CI] 1.35-7.59; P = 0.008), heart failure (HR 2.77, 95% CI 1.1-6.97; P = 0.03) and RDW > 15.3% (HR 3.07, 95% CI 1.06-8.86; P = 0.03) were independent predictors of mortality in patients with IE. Conclusion. - According to our results, mortality is high in patients with IE. RDW is a promising biomarker for predicting 1-year survival rates in these patients. (C) 2014 Published by Elsevier Masson SAS.Öğe Relationship between TIMI frame count and admission glucose values in acute ST elevation myocardial infarction patients who underwent successful primary percutaneous intervention(AVES YAYINCILIK, 2011) Ege, Meltem; Guray, Umit; Guray, Yesim; Yilmaz, Mehmet Birhan; Demirkan, Burcu; Sasmaz, Ali; Korkmaz, SuleObjective: Admission hyperglycemia is associated with poor prognosis in patients with acute myocardial infarction. Final Thrombolysis in Myocardial Infarction (TIMI) frame counts of culprit coronary arteries may show significant variability despite successful coronary reperfusion after primary percutaneous coronary intervention (PCI). In this prospective observational study, relationship between final TIMI frame counts of the culprit coronary artery and admission glucose values was investigated in patients who underwent successful primary PCI due to acute ST-elevation myocardial infarction (STEMI). Methods: During a 6- month period of time, 73 non-diabetic patients presented with acute STEMI who have undergone primary PCI with final TIMI 3 flow were consecutively included in the study. Patients were divided into two groups according to final TIMI frame counts. Group 1 (n=53) consisted of patients with final TIMI frame counts of the culprit coronary artery within the two standard deviation of predefined values and Group 2 (n=20) consisted of those with higher TIMI frame counts. Statistical analysis was performed using Chi-square, Mann-Whitney U tests and multiple linear regression analysis. Results: Despite similar fasting glucose values, admission glucose levels were significantly higher in Group 2 as compared to Group 1 (138 [114-165] vs. 123 [97-143] mg/dl, p=0.03). In whole group, admission glucose values were significantly correlated with corrected TIMI frame counts of culprit coronary arteries (r=0.30, p=0.01). In addition, there were significant association between admission glucose values and peak creatine kinase-MB (r=0.36, p=0.007) values as well as left ventricular ejection fraction (r=-0.43, p=0.009). In multiple linear regression analysis, only admission glucose value was found to be significantly related to the final TIMI frame count of the culprit artery (beta=0.04, 95% Cl: 0.02-0.085, p=0.04). Conclusion: High admission glucose values were significantly associated with impaired coronary flow even after successful primary PCI in non-diabetic patients with STEMI. (Anadolu Kardiyol Derg 2011; 11:213-7)Öğe Role of mean platelet volume in triagging acute coronary syndromes(SPRINGER, 2008) Yilmaz, Mehmet Birhan; Cihan, Gokhan; Guray, Yesim; Guray, Umit; Kisacik, Halil L.; Sasmaz, Hatice; Korkmaz, SuleBackground: Acute coronary syndromes, characterized by the rupture of unstable plaque and the subsequent thrombotic process involving platelets, have been increasing in relative frequency. The central role of platelet activation has long been noticed in this pathophysiology; hence, many therapies have been directed against it. In this study, we have aimed to search prospectively the value of mean platelet volume (MPV), which is a simple and accurate measure of the functional status of platelets, in patients hospitalized with diagnosis of acute coronary syndromes (ACS). Materials and methods: A total of 216 consecutive patients (156 male, 60 female) hospitalized with the diagnosis of non-ST segment elevation (NSTE) ACS within the first 24 h of their chest pain were enrolled. One hundred and twenty patients, matched according to sex and age, with stable coronary heart disease (CHD) (85 male, 35 female) were enrolled as a control group. Patients were classified into two group: those with unstable angina (USAP, n = 105) and those with non-ST segment elevation myocardial infarction (NSTEMI, n = 111). Results: MPVs were 10.4 +/- 0.6 fL, 10 +/- 0.7 fL, 8.9 +/- 0.7 fL consecutively for NSTEMI, USAP and stable CHD with significant differences. Patients with ischemic attacks in the first day of hospitalization accompanied by > 0.05 mV ST segment shift had significantly higher MPV compared to those without such attacks (P = 0.001). Multivariable logistic regression analysis yielded that MPV (P = 0.016), platelet count (P < 0.001), and the presence of > 0.05 mV ST segment depression at admission (P = 0.002) were independent predictors of development of NSTEMI in patients presenting with NSTE ACS. Conclusion: In patients presenting with NSTE ACS, higher MPV, though there are overlaps among subgroups, indicates not only more risk of having NSTEMI but also ischemic complications.
