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    Abnormal Heart Rate Recovery in Stable Heart Failure Patients
    (WILEY, 2013) Yilmaz, Ahmet; Erdem, Alim; Kucukdurmaz, Zekeriya; Karapinar, Hekim; Gul, Ibrahim; Sarikaya, Savas; Dizman, Rafet
    Background Heart rate decrease after exercise, that is associated with reactivation of parasympathetic system, is important, as it is also associated with mortality. Previous studies have shown that this is an independent mortality predictor in patients having no coronary artery disease and having normal left ventricular function. In our study, we aimed to study heart rate recovery (HRR) after exercise in patients having impaired left ventricular function. Methods One hundred and two consecutive patients (68 males, 34 females) requested to perform an exercise stress test were included in our study. Patients were divided into two groups as those having a normal heart rate reserve (Group1, n = 72) and those having an abnormal heart rate reserve (Group2, n = 30). Results In Group1 and Group2, resting heart rate averages were found to be 83.61 +/- 18.01/min and 85.10 +/- 13.40/min, respectively (P > 0.05), and maximum heart rates during exercise were 141.42 +/- 19.70/min and 121.17 +/- 19.01/min while those in Group1 had statistically significantly higher heart rates (P < 0.001). A statistically significant positive association was found in the correlation test carried out between the maximum heart rate during the treadmill exercise test and ejection fraction (EF) value (r = 0.201; P < 0.05). Metabolic equivalents of task values obtained during the treadmill exercise test in Group1 and Group2 were 9.48 +/- 2.28 and 8.36 +/- 2.50, respectively, and the difference between the said values was statistically significant (P < 0.05). Conclusions We believe that the association between low EF and abnormal HRR is worth studying and randomized large-scale studies are needed to determine mortality risk.
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    Acute coronary syndrome: Short-term effects of early intravenous metoprolol on maximum P wave duration and P wave dispersion
    (HEALTH COMMUNICATIONS INC, 2007) Turgut, Okan; Yilmaz, M. Birhan; Yilmaz, Ahmet; Yalta, Kenan; Kendirliogiu, Omer; Tandogan, Izzet
    In patients with acute coronary syndrome (ACS), the presence of atrial fibrillation (AF) results in worse inpatient outcomes than in those without AF Two electrocardiographic markers, maximum P wave duration (P-maximum) and P wave dispersion P-dispersion), have been assessed because they reflect conduction abnormalities in patients with paroxysmal AF. beta blockers are known to have beneficial effects in patients with ACS. This prospective study was conducted to investigate whether early intravenous (IV) metoprolol injection acutely decreases P-maximum and P-dispersion in patients with ACS. This study involved 100 consecutive patients with ACS who were divided into 2 groups according to whether or not they received early IV metoprolol. Group 1 consisted of 19 patients who received IV metoprolol within 3 h after onset of symptoms, and group 2 consisted of 81 patients who did not receive IV metoprolol within 3 h after symptom onset because of late admission. P-maximum and P-dispersion, were measured on admission and again at 2 h after admission. Two-dimensional echocardiographic examination was also performed. For patients who received early IV metoprolol, P-maximum and P-dispersion. measured 2 h after admission, were shorter than values at admission (P<.001). Conversely, P-maximum and P-dispersion measured 2 h after admission, did not differ significantly from values at admission in patients who did not receive early IV metoprolol (P=.292 and P=.236, respectively). IV administration of metoprolol reduced values for P-maximum and P-dispersion measured 2 h after admission, among patients with ACS who were admitted within 3 h after onset of symptoms.
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    Acute Effects of Passive Smoking on Endothelial Function
    (SAGE PUBLICATIONS INC, 2011) Guel, Ibrahim; Karapinar, Hekim; Yarlioglues, Mikail; Ozdogru, Ibrahim; Kaya, Mehmet Gungor; Yilmaz, Ahmet; Turgut, Okan Onur; Tandogan, Izzet; Eryol, Namik Kemal
    Impairment of endothelial functions has been shown to occur after acute and chronic exposure to passive smoking (PS), as assessed by flow-mediated dilatation (FMD) of the brachial artery. A total of 61 participants, 30 male and 31 female, mean ages 26 (18-36) were enrolled in the study. All were clinically well and nonsmokers. All participants stayed for 30 minutes in the smoking room. Carbon monoxide (CO) level was 7.42 +/- 0.98 ppm (4.71-10.50). Mean carboxyhemoglobin (COHb) levels of participants were significantly elevated after PS. Mean FMD was 18.6% +/- 9% and decreased to 12.4% +/- 7% after PS (P < .001). In the current study, with more number of participants at lower CO concentrations (7.42 ppm) and with smaller increase in COHb (51%) significant reduction (33%, P < .001) in FMD was observed.
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    Asymptomatic total anomalous pulmonary venous connection with double drainage in a young adult: A case report
    (FORUM MULTIMEDIA PUBLISHING, LLC, 2007) Yalta, Kenan; Turgut, Okan Onur; Yilmaz, Ahmet; Yilmaz, Mehmet Birhan; Manduz, Sinasi; Karadas, Filiz; Dogan, Kasim; Tandogan, Izzet
    Total anomalous pulmonary venous connection is an uncommon congenital anomaly in which all pulmonary venous return drains to the right atrium or one of its tributaries. Survival beyond infancy without surgical palliation is unlikely, so this anomaly is not encountered in the adult population with congenital heart disease. The patient presented here was 22 years old on admission and had no total anomalous pulmonary venous connection-associated symptoms. He underwent transthoracic echocardiographic examination for atypical chest pain. Transthoracic echocardiography along with cardiac catheterization favored the presence of a total anomalous pulmonary venous connection. Surgical correction of pulmonary venous confluence ( draining to both the coronary sinus and right atrium) was performed successfully. This is a rare case of total anomalous pulmonary venous connection with no reported symptoms in contrast to the majority of patients who are symptomatic during the first year of life.
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    Blood pressure response to exercise is exaggerated in normotensive diabetic patients
    (Taylor & Francis Ltd, 2013) Karavelioglu, Yusuf; Karapinar, Hekim; Gul, Ibrahim; Kucukdurmaz, Zekeriya; Yilmaz, Ahmet; Akpek, Mahmut; Kaya, Mehmet Gungor
    Introduction. The aim of this study was to investigate the blood pressure (BP) response to exercise in normotensive patients with type II diabetes mellitus (DM). Materials and methods. A cross-sectional study was carried out on 75 normotensive subjects with type 2 DM (group 1), and 70 age-gender matched normotensive healthy volunteers (group 2). Treadmill exercise test, 24-h ambulatory BP monitoring (ABPM) were performed for each patients and healthy volunteers. Results. There were 67 patients (mean age 52 +/- 9 years and 42% male) in group 1 and 68 healthy volunteers (mean age 51 +/- 7 years and 43% male) in group 2. Eight patients from group 1 and 2 subjects from group 2 were excluded because of high BP on ABPM. Groups were similar for systolic BP (SBP) and diastolic BP (DBP) on office measurements and on ABPM. Groups were similar for rest SBP, DBP, heart rate, exercise duration on exercise test. Peak SBP was significantly higher in group 1 than in group 2, but peak DBP was not (196.9 +/- 18 vs 165.9 +/- 18.6 mmHg, p < 0.001; 88.1 +/- 11.6 vs 86.2 +/- 8.7 mmHg, p = 0.283, respectively). Hypertensive response to exercise (HRE) was more frequent in group 1 than in group 2 [39 (58%) vs 6 (9%), p < 0.001]. Independent predictors of peak SBP were DM, office SBP and male gender, while independent predictors of HRE were DM, office SBP and age in multivariate analysis. Conclusions. SBP response to exercise is exaggerated in normotensive diabetic patients compared with non-diabetic subjects. DM, office SBP and male gender are independent predictors of peak SBP. DM, office SBP and age are independent predictors of HRE.
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    Cardiac findings in children with Crimean-Congo hemorrhagic fever
    (INT SCIENTIFIC LITERATURE, INC, 2011) Gul, Ibrahim; Kaya, Ali; Guven, Ahmet Sami; Karapinar, Hekim; Kucukdurmaz, Zekeriya; Yilmaz, Ahmet; Icagasioglu, Fusun Dilara; Tandogan, Izzet
    Background: Crimean-Congo hemorrhagic fever (CCHF) involves the multi-organ systems. The involvement of the heart in adult patients has been described previously. We investigated the electrocardiographic and echocardiographic findings of pediatric patients with CCHF. Material/Methods: Patients younger than 16 years of age diagnosed with CCHF were enrolled in the study. The diagnosis of CCHF infection was based upon typical clinical and epidemiological Findings and serological tests. All patients underwent a thorough cardiologic evaluation. A standard 12-lead electrocardiography and echocardiography were performed. Results: Twenty-three consecutive patients who were hospitalized with diagnosis of CCHF were enrolled in the study (mean age: 12 2 years, 6 female). All electrocardiographic parameters were within normal ranges according to age. Seven patients (30%) had minimal (<1 cm) pericardial effusion. Fifteen (65%) patients had segmental wall motion abnormalities (hypokinesia). A second echocardiography revealed that all wall motion abnormalities had disappeared; the pericardial effusion persisted in only 2 of 7 patients (28%). Conclusions: Cardiac involvement appears to be more frequent in children with CCHF disease than in adults, but it is slighter and almost totally reversible; however, the course of the disease in children is milder than it is in adults.
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    Clinical importance of elevated CK-MB and troponin I levels in congestive heart failure
    (HEALTH COMMUNICATIONS INC, 2006) Yilmaz, Ahmet; Yalta, Kenan; Turgut, Okan Onur; Yilmaz, Mehmet Birhan; Ozyol, Ali; Kendirlioglu, Omer; Karadas, Filiz; Tandogan, Izzet
    Myocyte necrosis has been considered to play a fundamental role in the pathophysiology of congestive heart failure (CHF), which has usually evolved as a consequence of depletion of compensatory mechanisms and contractile reserve of myocardium. Elevated levels of creatine kinase MB (CK-MB) and troponin I (Tn-I) have been regarded as biochemical markers of myocyte necrosis. This study was planned to investigate the specificity and sensitivity of Tn-I and CK-MB in CHF and to examine the correlation of these markers with disease severity. A total of 104 patients (38 female, 66 male; mean age, 66 y [range, 36-89]) with symptoms and signs of heart failure on admission and with a reduced left ventricular ejection fraction (EF; by transthoracic echocardiography) were labeled "the patient group," and 58 patients (40 female, 18 male; mean age, 61 y [range, 34-77]) with no signs or symptoms of CHF and with a normal EF detected by transthoracic echocardiography were included in the study as "the control group." Left ventricular EFs, end-diastolic diameters, and end-systolic diameters of patients in both groups were measured. Blood samples were drawn from all patients in both groups on admission, so that levels of CK-MB and Tn-I could be measured. All patients in both groups also underwent coronary angiography. Conditions leading to elevation of CK-MB or Tn-I were considered exclusion criteria. The 2 groups failed to show any significant differences in terms of mean age and the presence of coronary artery disease, hypertension, or diabetes mellitus (P >.05). Mean EF in the patient group was lower than that in the control group (P <.05). Mean CK-MB and Tn-I in the patient group were significantly higher than in the control group (P <.05). In the patient group, hypertensive patients were found to have significantly higher mean values of CK-MB than were seen in normotensive patients in the same group (P <.05). In the patient group, 52 cases were considered to be class I-II (New York Heart Association [NYHA]) (group 1), and 52 were considered to be class III-IV (group 2). Group 1, group 2, and the control group did not differ significantly from one another with regard to the presence of coronary artery disease, hypertension, and diabetes mellitus (P >.05). The mean EF in group 2 was significantly lower than that in group I and in the control group (P <.05); the mean EF in group I was significantly lower than that in the control group (P <.05). Group 1 values did not differ significantly from those of group 2 or the control group in terms of enzymatic markers (P >.05), but group 2 had significantly higher mean values of CK-MB and Tn-I than were noted in the control group (P <.05). The uphill course of CK-MB and Tn-I values from the control group to group 2 (NYHA class III-IV) was statistically significant (P <.05). Serum concentrations of CK-MB and Tn-I may become elevated in severely symptomatic patients with CHIF (particularly NYHA class III-IV), demonstrating a relationship between clinical severity of the disease and elevation of myocardial enzymes (CK-MB and Tn-I).
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    Closure of patent ductus arteriosus with oversized Amplatzer occluder in a patient with pulmonary hypertension
    (TERMEDIA PUBLISHING HOUSE LTD, 2013) Karapinar, Hekim; Kucukdurmaz, Zekeriya; Oflaz, Mehmet Burhan; Gul, Ibrahim; Yilmaz, Ahmet
    Diagnosis of patent ductus arteriosus is rare in adulthood. Closure of ductus is difficult when diagnosed at an adult age due to the development of pulmonary hypertension and pulmonary arterial disease that generally occurs. Closure of the ductus might be contraindicated, as it may lead to deterioration of the pulmonary arterial perfusion or to a pulmonary hypertensive crisis. In addition, another risk associated with percutaneous closure for these patients is the risk of embolism of the asymmetrically shaped device to the systemic circulation. We present in this manuscript a case with patent ductus arteriosus diagnosed at an adult age that underwent successful closure by the percutaneous method. During closure, an oversized Amplatzer duct occluder device was used to reduce the risk of device embolism.
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    Comparative effects of levosimendan and dobutamine on right ventricular function in patients with biventricular heart failure
    (SPRINGER, 2009) Yilmaz, Mehmet Birhan; Yontar, Can; Erdem, Alim; Karadas, Filiz; Yalta, Kenan; Turgut, Okan Onur; Yilmaz, Ahmet; Tandogan, Izzet
    Severe heart failure represents a major source of morbidity and mortality. Poor right ventricular function is an independent prognostic marker for mortality in patients with chronic heart failure. In this study, levosimendan (L) and dobutamine (D) in patients with severe chronic biventricular failure were compared. Forty consecutive patients, who were judged for inotropic therapy by their primary physicians, with acutely decompensated systolic heart failure and having moderate-to-severe right ventricular dysfunction with right ventricular fractional area change of a parts per thousand currency sign24%m were randomized to L and D in a 2:1 fashion. Echocardiographic parameters including tricuspid annular motion and clinical issues were considered. Mean age and sex distribution were not different between the two groups. After the infusion, ejection fraction improved and systolic pulmonary artery pressure decreased significantly in both arms. Longitudinal systolic function of tricuspid annulus improved significantly better in patients with L compared to patients with D (15% +/- 12% vs. 2% +/- 6% improvement, P < 0.001). Furthermore, L improved both 24-h urine output and creatinine, whereas D showed only a small, but significant improvement in urine output without any improvement in the creatinine levels. Levosimendan seems to offer more beneficial effects compared to dobutamine in a specific group of patients with biventricular failure.
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    Comparison of myocardial performance index versus ratio of isovolumic contraction time/ejection time in left ventricular systolic dysfunction
    (SPRINGER, 2007) Yilmaz, Ahmet; Yalta, Kenan; Turgut, Okan Onur; Yilmaz, Mehmet Birhan; Ozyol, Ali; Erdem, Alim; Tandogan, Izzet
    Myocardial performance index (MPI) has been regarded as an important parameter in the evaluation of ventricular systolic function in congestive heart failure. This study was designed to investigate the relationship between the ratio of isovolumic contraction time/left ventricular ejection time (IVCT/LVET), MPI, and LV systolic function. A total of 43 patients (patient group) with LV ejection fractions (LVEFs) <55% were compared with 43 patients (control group) with LVEF values >= 55%. LVEF was measured in all cases by 2-dimensional echocardiography via the modified Simpson method. Isovolumic relaxation time (IVRT), IVCT, LVET, ratio of IVCT/LVET, and MPI ([IVRT+IVCT]/LVET) were measured via Doppler echocardiography. The mean value for lVCT was found to be significantly higher (P<.001) and concomitant mean LVET value significantly lower (P=.027) in the patient group. Similarly, the mean value of MPI and the ratio of IVCT/LVET were found to be significantly higher (P<.001 for both) in the patient group. The value of the ratio of IVCT/LVET was found to have a significant negative correlation with the value of LVEF (r=-.947; P<.001) and a significant positive correlation with the value of MPI (r=.796; P<.001). The study reported here clearly demonstrates the noninferiority of the ratio of IVCT/LVET to MPI and the possibility of its substitution for MPI in the evaluation of LV systolic function.
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    Coronary collateral circulation: Any effect on P-wave dispersion?
    (SAGE PUBLICATIONS INC, 2008) Aslan, Halil; Turgut, Okan; Yalta, Kenan; Yilmaz, Mehmet B.; Ozdemir, Ramazan; Ermis, Necip; Sezgin, Alpay T.; Yetkin, Ertan; Tandogan, Izzet; Yilmaz, Ahmet
    Coronary collateral circulation determines the severity of ischemic myocardial damage. Increased P-wave dispersion is an independent predictor for atrial fibrillation. Consistent evidence is little about the relation between coronary collateral circulation and arrhythmia risk. In this article, the effect of coronary collateral circulation on P-wave dispersion was evaluated. Collateral grade and p-wave dispersion were ascertained in 100 patients with >= 85% diameter stenoses in left anterior descending or right coronary arteries. Left ventricular function score was also determined in all patients. Coronary collateral circulation was absent in 32 patients, whereas 68 patients had coronary collateral circulation. Patients with collateral grade A had greater left ventricular function score than did patients with collateral grade 0 (P = .048). However, there was no significant difference between P-wave dispersion of patients with and without coronary collateral circulation (P = .45). The presence of coronary collateral circulation failed to exert a beneficial decreasing effect on P-wave dispersion.
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    Dronedarone: A Promising Alternative for the Management of Atrial Fibrillation
    (SPRINGER, 2009) Yalta, Kenan; Turgut, Okan Onur; Yilmaz, Mehmet Birhan; Yilmaz, Ahmet; Tandogan, Izzet
    Atrial fibrillation (AF) is the most frequently encountered chronic arrhythmia associated with significant morbidity. It is generally encountered in the elderly, and will presumably become more prevalent in the future due to the increasing proportion of the elderly in the population. Major studies on AF have demonstrated no significant difference between rhythm and rate control in terms of mortality. However, young population with new-onset or lone AF, or patients in whom the maintenance of sinus rhythm is a must (due to recurrent thromboembolic events etc.) still gives rise to significant concerns related to the obligatory long-term prophylaxis. The long-term administration of the currently available conventional agents (amiodarone, dofetilide, sotalol, propafenone,flecainide etc.) is considered as a 'double edged sword' due to the presence of life-threatening adverse effects including pro-arrhythmia and organ toxicity associated with these agents. Several molecules are being developed for the management of AF. However, only a few novel agents confer promising results with respect to safety and efficacy issues in the major studies. Dronedarone is an amiodarone analogue without iodine moiety in its structure, and is similar to amiodarone with regard to its structural and electrophysiological properties. Dronedarone is largely denuded of the potentially life-threatening adverse effects of anti-arrhythmics. Major clinical studies have demonstrated both rhythm and rate-controlling efficacy of dronedarone compared to placebo without any serious adverse effects in patients with AF. However, the ANDROMEDA trial, a large scale study including patients hospitalized for symptomatic congestive heart failure (with severely depressed left ventricular systolic functions) was prematurely terminated due to the increased mortality in the dronedarone arm compared to placebo indicating a lack of safety in this group of patients. Conversely, the recently published ATHENA study (including more than 4,600 high risk patients, but excluding those with severe heart failure) demonstrated a significant reduction in cardiovascular hospitalizations and cardiovascular mortality with dronedarone compared to placebo. In contrast, the DIONYSOS study, comparing dronedarone with amiodarone, demonstrated better safety, but lower efficacy of dronedarone for the maintenance of sinus rhythm in patients with AF. Further clinical trials (including head to head comparison with other conventional anti-arrhythmics) are still required to determine the place of dronedarone in the management of AF. The present review focuses on basic and clinical aspects of dronedarone, a novel agent for the management of AF.
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    The effect of collateral circulation on left ventricular systolic function
    (LIPPINCOTT WILLIAMS & WILKINS, 2007) Karadas, Filiz; Yalta, Kenan; Turgut, Okan Onur; Yilmaz, Mehmet Birhan; Yilmaz, Ahmet; Dogan, Kasim; Tandogan, Izzet
    Background Conflicting reports exist on the influence of coronary collateral circulation on preservation of left ventricular systolic function. The aim of this study was to assess the effect of coronary collateral circulation on left ventricular systolic function in coronary artery disease. Methods Seventy-one consecutive patients having left anterior descending arteries with proximal or near-proximal stenosis of at least 95% (excluding 100%) were included in the study. The coronary collateral circulation to left anterior descending artery was evaluated with regard to its effects on left ventricular systolic function. Results Among the 71 patients, 46 patients were found to have a coronary collateral circulation grade of >= 1 (group 1), whereas the remaining 25 patients had coronary collateral circulation grade of 0 (group 2). The mean value of left ventricular function score in group 1 was higher than that of group 2 (3.69 +/- 2.34 vs. 2.00 +/- 1.55, P= 0.002), whereas the mean value of left ventricular ejection fraction in group 1 was lower than that of group 2 (44.67 +/- 12.05 vs. 54.32 +/- 10.22, P=0.001). The value of coronary collateral circulation grade was found to be positively correlated with the value of left ventricular function score (P= 0.01, r= 0.3), and negatively correlated with the value of left ventricular ejection fraction (P= 0.01, r= - 0.3). Conclusion Coronary collateral circulation to the severely stenotic left anterior descending artery was not found to have an improving effect on left ventricular systolic function. In contrast with the previous studies demonstrating the coronary collateral circulation-associated preservation of left ventricular systolic function, presence of coronary collateral circulation was found to accompany or be associated with impairment of left ventricular systolic function. The grade of coronary collateral circulation was also found to be positively correlated with the severity of left ventricular systolic dysfunction. Further research on larger patient populations based on a long-term follow-up is warranted to investigate this issue. Coron Artery Dis 18:169-173 (C) 2007 Lippincott Williams & Wilkins.
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    Electrocardiographic Prognostic Marker in Pulmonary Arterial Hypertension: RS Time
    (Arquivos Brasileiros Cardiologia, 2024) Koyun, Emin; Sahin, Anil; Yilmaz, Ahmet; Dindas, Ferhat; Cerik, Idris Bugra; Koyun, Gorkem Berna
    Background: Pulmonary hypertension is a condition that involves the remodeling of the right ventricle. Ongoing remodeling is also associated with disease prognosis. During the restructuring process, complex changes such as hypertrophy and dilatation may also be reflected in electrocardiographic parameters. Objectives: Our study aimed to investigate the relationship between prognosis and electrocardiographic parameters in patients with pulmonary arterial hypertension. Methods: The study was designed retrospectively and included patients diagnosed with pulmonary arterial hypertension between 2010 and 2022. The patients were divided into two groups based on their survival outcome. Various parameters, including electrocardiographic, demographic, echocardiographic, catheter, and blood parameters, were compared between the two groups. A p-value of <0.05 was considered statistically significant. Results: In the multivariate Cox analyses, the parameters that were found to be independently associated with survival were the 6-minute walk test, mean pulmonary artery pressure, presence of pericardial effusion, and time between the beginning of the QRS and the peak of the S wave (RS time) (p<0.05 for each). Of all the parameters, RS time demonstrated the best diagnostic performance (AUC:0.832). In the survival analysis, a significant correlation was found between RS time and survival when using a cut-off value of 59.5 ms (HR: 0.06 [0.02-0.17], p < 0.001). Conclusions: According to the results of our study, a longer RS time is associated with poor prognosis in patients with pulmonary arterial hypertension. We can obtain information about the course of the disease with a simple, non-invasive parameter.
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    Electrocardiographic Prognostic Marker in Pulmonary Arterial Hypertension: RS Time [2]
    (Arquivos Brasileiros Cardiologia, 2024) Koyun, Emin; Sahin, Anil; Yilmaz, Ahmet; Dindas, Ferhat; Cerik, Idris Bugra; Koyun, Gorkem Berna
    Background: Pulmonary hypertension is a condition that involves the remodeling of the right ventricle. Ongoing remodeling is also associated with disease prognosis. During the restructuring process, complex changes such as hypertrophy and dilatation may also be reflected in electrocardiographic parameters. Objectives: Our study aimed to investigate the relationship between prognosis and electrocardiographic parameters in patients with pulmonary arterial hypertension. Methods: The study was designed retrospectively and included patients diagnosed with pulmonary arterial hypertension between 2010 and 2022. The patients were divided into two groups based on their survival outcome. Various parameters, including electrocardiographic, demographic, echocardiographic, catheter, and blood parameters, were compared between the two groups. A p-value of <0.05 was considered statistically significant. Results: In the multivariate Cox analyses, the parameters that were found to be independently associated with survival were the 6-minute walk test, mean pulmonary artery pressure, presence of pericardial effusion, and time between the beginning of the QRS and the peak of the S wave (RS time) (p<0.05 for each). Of all the parameters, RS time demonstrated the best diagnostic performance (AUC:0.832). In the survival analysis, a significant correlation was found between RS time and survival when using a cut-off value of 59.5 ms (HR: 0.06 [0.02-0.17], p < 0.001). Conclusions: According to the results of our study, a longer RS time is associated with poor prognosis in patients with pulmonary arterial hypertension. We can obtain information about the course of the disease with a simple, non-invasive parameter.
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    Evaluation of Atrial Electromechanical Coupling Times in Hemodialysis Patients
    (WILEY, 2014) Karavelioglu, Yusuf; Karapinar, Hekim; Ozkurt, Sultan; Sarikaya, Savas; Kucukdurmaz, Zekeriya; Arisoy, Arif; Kurt, Recep; Yilmaz, Ahmet; Kaya, Mehmet G.
    BackgroundThere are no definite data about the atrial electromechanical coupling times (AEMCT) in patients with end stage renal failure (ESRF). The aim of this study was to investigate the AEMCT in ESRF patients without hypertension (HT) and diabetes mellitus.MethodsThe study population consisted of 47 normotensive, nondiabetic ESRF patients and 41 healthy age/gender-matched control subjects. The time intervals from the onset of P-wave on the surface electrocardiogram to the beginning of late diastolic A-wave (PA) were obtained from the lateral mitral annulus (PA-lateral, maximum AEMCT), septal annulus (PA-septal), and tricuspid lateral annulus (PA-tricuspid). Time intervals were corrected according to the heart rate. The difference between PA-septal and PA-tricuspid (right AEMCT), PA-lateral and PA-septal (left AEMCT), and PA-lateral and PA-tricuspid (inter AEMCT) were calculated. Corrected time intervals were used for calculations.ResultsGroups were similar for age (5212.3 vs. 49.9 +/- 6years, P>0.05) and gender. Maximum (61 +/- 20 vs. 47 +/- 13ms; P<0.001) AEMCT was significantly higher in the patients compared with the control group, but septal and tricuspid EMCT were not different (P>0.05). Both inter-atrial (37 +/- 21 vs. 24 +/- 16ms, P=0.002) and left atrial (25 +/- 18 vs. 12 +/- 9ms; P<0.001) EMCT were significantly higher in patients when compared with the controls but intra-right atrial EMCT was not different.ConclusionsAtrial conduction parameters such as maximal EMCT, left atrial, and inter-atrial EMCTs were prolonged in ESRF patients. This prolongation is seen in ESRF patients even in the absence of factors that affect atrial coupling, such as HT.
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    Evaluation of Endothelium Functions by Flow-mediated Dilatation in Pediatric Patients With Crimean-Congo Hemorrhagic Fever
    (LIPPINCOTT WILLIAMS & WILKINS, 2015) Karapinar, Hekim; Kaya, Ali; Uysal, Elif Bilge; Kucukdurmaz, Zekeriya; Deveci, Koksal; Guven, Ahmet Sami; Sancakdar, Enver; Yilmaz, Ahmet
    Background: Crimean-Congo hemorrhagic fever (CCHF) is a systemic viral disease that also affects the endothelium. Thrombocytopenia and hemorrhage are seen in this disease. But, the cause of thrombocytopenia is not clear. We hypothesized that endothelium dysfunction may be the cause of thrombocytopenia. We evaluated the endothelium functions by flow-mediated dilatation (FMD) in CCHF. Methods: Consecutive children with suspected CCHF who applied to our hospital were evaluated for recruitment into the study. FMD analysis was done in the active and healing period of the disease. Diagnosis was confirmed or ruled out by polymerase chain reaction and/or ELISA test. Basal brachial artery diameter (BBAD) and dilated brachial artery diameter (DBAD) after ischemic period were measured and percent dilatations [(DBAD-BBAD)/BBAD, FMD%] were computed from all subjects. Results: Fifty-four children (40 male, mean age 12.4 +/- 4.4 years) were recruited into the study. CCHF diagnosis was confirmed in 28 children and ruled out in 26 children. Groups were similar for age and gender. FMD% was significantly decreased in CCHF patients when comparing this with the control patients in the active period (2.65 +/- 2.76 vs. 13.76 +/- 7.95, P < 0.001). FMD% was correlated with platelet count in the active period of the disease (r = 0.599, P = 0.004). FMD% was recovered in the healing period (2.65 +/- 2.76 vs. 14.72 +/- 2.66, P < 0.001) and was not significantly different from basal values of control patients (P > 0.05). Conclusions: FMD is significantly decreased in CCHF and recovers in the healing period. So, endothelium functions are disturbed, and disturbance is correlated with thrombocytopenia in CCHF.
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    Evaluation of left ventricular diastolic function in nonhypertensive nondiabetic hemodialysis patients
    (LIPPINCOTT WILLIAMS & WILKINS, 2013) Karavelioglu, Yusuf; Ozkurt, Sultan; Karapinar, Hekim; Kucukdurmaz, Zekeriya; Arisoy, Arif; Kurt, Recep; Yilmaz, Ahmet; Yarlioglues, Mikail; Akpek, Mahmut; Kaya, Mehmet G.
    Aim Diastolic dysfunction (DD) is common in hemodialysis (HD) patients. Because diabetes mellitus (DM) and hypertension (HT) are also common in this patient group, the exact reason for DD in HD patients is not clear. The present study evaluated left ventricular (LV) diastolic function in HD patients without DM and HT. Methods Fifty patients on HD and 34 age-matched and sex-matched healthy control individuals were enrolled. Echocardiography was performed in all participants. LV systolic and diastolic functions were evaluated by B-mode echocardiography, pulsed wave, and tissue Doppler imaging. The HD patients were divided into two groups according to the presence or absence of left ventricular hypertrophy (LVH) in echocardiography. Results LV dimensions and systolic function were within normal limits and similar between groups. However, the HD patients had significantly worse diastolic function (E/A: 0.78 +/- 0.26 vs. 1.19 +/- 0.28, P < 0.001, e '/a ' septal: 0.77 +/- 0.36 vs. 1.04 +/- 0.21, P < 0.001) and increased filling pressure (E/e ': 8.55 +/- 3.2 vs. 5.79 +/- 1.93, P < 0.001). Thirty-one (62%) patients had LVH, whereas 19 (38%) patients did not have LVH. LV systolic and diastolic functions were similar in HD patients with and without LVH. Seventeen (55%) hypertrophies were concentric and 14 (45%) were eccentric. Diastolic functions were similar in patients with either concentric or eccentric hypertrophy. Conclusion Diastolic function is impaired in HD patients even in the absence of diseases that can cause DD such as HT and DM.
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    Evaluation of Myocardial Perfusion Imaging SPECT Parameters and Pharmacologic Stress Test with Adenosine Versus Coronary Angiography Findings: Are They Diagnostically Concordant?
    (GALENOS YAYINCILIK, 2019) Hasbek, Zekiye; Erturk, Seyit Ahmet; Cakmakcilar, Ali; Gul, Ibrahim; Yilmaz, Ahmet
    Objectives: In this study our first aim was to evaluate the diagnostic concordance of myocardial perfusion scintigraphy (MPS) by pharmacological stress test with adenosine (APST) with coronary angiography (CAG). The secondary aim of this study was to evaluate the correlation between CAG findings and automated analysis parameters such as left ventricular ejection fraction, summed stress score (SSS), summed rest score, summed difference score (SDS), stress MPS defect percentage ratio (extent) and transient ischemic dilation (TID) obtained by myocardial perfusion imaging single-photon emission computed tomography (SPECT). Methods: A total of 129 patients (62 male, 67 female, median age: 60.02) undergoing MPS due to suspicion of coronary ischemia who also underwent subsequent CAG in the last year were included in this study, their MPS data and CAG results were compared. Results: There was no statistically significant diagnostic concordance when visual evaluation of MPS, quantitative MPS parameters and exercise treadmill test (ETT) electrocardiography results were used alone. In fact, diagnostic concordance was higher when automated analysis parameters like TID, SSS and extent values were added to MPS SPECT visual analyses. There was diagnostic concordance in 57.9% of APST patients and 41.7% of ETT patients. There was diagnostic concordance in 75.8% of APST patients and 52.6% of ETT patients who were older than 65 years of age. Conclusion: In our study, we found that the use of APST during MPS increases diagnostic concordance with CAG. Therefore, we think that it would be appropriate to use APST in women and elderly patients with limited exercise habits. The CAG diagnostic mismatch is far above what it should be when MPS reporting is only done with visual data, and it is not supported by quantitative data such as TID, SSS, SDS and extent.
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    Evaluation of the patients' level of knowledge about diagnostic and therapeutic procedures in cardiology
    (Turkish Soc Cardiology, 2006) Yilmaz, Mehmet Birhan; Turgut, Okan Onur; Yilmaz, Ahmet; Karadas, Filiz; Ozyol, Ali; Kendirlioglu, Omer; Bektasoglu, Gokhan
    Objectives: It is sometimes observed that informing patients about cardiovascular procedures is not taken into appropriate consideration. In this study, we assessed the patients' level of knowledge obtained through informing regarding the procedures performed in cardiology. Study design: A 22-item questionnaire was developed to measure the knowledge of patients about cardiovascular procedures. After validation in a group of 10 volunteer patients, the questionnaire was administered to 200 participants (115 males, mean age 53 years; 85 females, mean age 49 years). The patients were inquired about their knowledge of electrocardiography (ECG), Holter, exercise stress test, echocardiography, coronary angiography (CAG), percutaneous coronary interventions (PCI), electrophysiological study, and pacemaker implantation. Results: Of the participants, 33% had hypertension, 7.5% had diabetes mellitus, and 23% had coronary artery disease. Although the majority of the patients (n=159, 79.5%) had a prior electrocardiogram, only 7% (n=14) responded that it gave information about coronary artery disease. Eighty-six percent (n=172) of the participants did not know what Holter was. According to 44%, CAG was performed for visualization, and to 37%, for patency of the coronary arteries. Concerning the PCI procedure, 42% stated that they did not know how it was carried out, and 35% stated that the balloon was blown up during the procedure. Conclusion: Furnishing patients with necessary information about cardiovascular procedures is important for improved health of individuals and the society at large, and there seems to be a considerable gap in this respect.