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Öğe Asymptomatic pulmonary embolism after ablation(Karger, 2016) Güler Babür, Gamze; Can, Mehmet Mustafa; Güler, Ekrem; Akıncı, Tuğba; Soğukpınar, Özlem; Hatipoğlu, Suzan; Kılıçaslan, Fethi; Serebruany, Victor L.Background: Pulmonary embolism (PE) is a life-threatening event with a broad presentation spectrum ranging from asymptomatic cases to sudden cardiac arrest. It is unclear if right atrial emboli cause PE in patients with atrial fibrillation (AF) or if mild PE itself increases right cardiac pressure provoking AF. Objective: To determine the incidence and predictors of asymptomatic PE in patients undergoing AF ablation. Method and Results: Patients (n = 93) were screened and those with previous or current symptomatic PE or venous thromboembolism, pulmonary hypertension, increased right heart pressures detected on echocardiography, a history of stroke, transient ischemic attack, coagulopathy or cancer and inappropriate contrast for the evaluation of pulmonary arterial tree were excluded. The remaining AF patients (n = 71) underwent guided ablation controlled with 3-dimensional, left atrial and pulmonary venous computed tomography. The asymptomatic PE was defined by using the modified Miller score by 2 independent assessors in 6 patients. Univariate logistic regression showed that age (OR: 1.094, 95% CI 1.007-1.188, p = 0.033), diabetes (OR: 12.000, 95% CI 1.902-75.716, p = 0.008), CHA(2)DS(2)-VASc score (OR: 2.800, 95% CI 1.304-6.013, p = 0.008), and pulmonary artery diameter (OR: 1.221, 95% CI 1.033-1.444, p = 0.019) were significantly associated with PE. However, multivariate analysis revealed that the CHA(2)DS(2)-VASc score (p = 0.047) remained the exclusive significant predictor for asymptomatic PE. Conclusion: The incidence of random asymptomatic PE in AF patients is high (>8%). The CHA(2)DS(2)-VASc score can predict silent PE. Since patients with a high CHA(2)DS(2)-VASc score are already anticoagulated, our results do not change clinical practice but are noteworthy in terms of the cause-effect relationship between AF and PE.Öğe Echocardiographic epicardial fat thickness is related to altered blood pressure responses to exercise stress testing(Taylor & Francis, 2011) Şengül, Cihan; Özveren, Olcay; Duman, Dursun; Eroğlu, Elif; Oduncu, Vecih; Tanboğa, Halil İbrahim; Can, Mehmet Mustafa; Akgün, Taylan; Dindar, İsmetObjective. Hypertensive response at peak exercise and blunted blood pressure (BP) recovery, altered BP responses obtained from exercise stress testing, have been suggested as risk factors for future onset of hypertension in previous studies. Epicardial fat, a new cardiometabolic risk factor, has been linked to hypertension in some recent studies. In this study, we tested the primary hypothesis suggesting that the epicardial fat thickness (EFT) is related to altered BP responses to treadmill exercise testing. We also evaluated the sensitivity and specificity of the EFT as a predictor of hypertensive response to peak exercise. Methods. Normotensive subjects underwent to treadmill stress testing and transthoracic echocardiography. Hypertensive response to peak treadmill exercise testing was defined as ? 210/105 mmHg and ?190/105 mmHg at peak exercise in males and females, respectively. BP recovery index (BPRI) was defined as the ratio of the BP at the 3rd minute of the recovery phase to BP at peak exercise. EFT was measured by echocardiography. Thirty-two subjects with hypertensive response to peak exercise constituted Group 1 and 48 subjects with normal response constituted Group 2. Results. The mean EFT of subjects in Group 1 was significantly higher (8.2 ± 1.1 mm vs 5.1 ± 1.5 mm; p = 0.0001) than subjects in Group 2. In correlation analysis performed in Group 1, EFT was found to be significantly correlated with BPRI (r = 0.51, p < 0.003). An EFT of ?6.5 mm predicted the hypertensive response to peak exercise test with 68.8% sensitivity and 87.5% specificity (receiving operator characteristic area under curve: 0.879, 95% CI 0.7930.965, p < 0.001). Patients with EFT ?6.5 mm showed a significantly increased BPRI (0.89 ± 0.07 vs 0.74 ± 0.09, p < 0.0001) and peak systolic BP (198.4 ± 15.3 mmHg vs 169.4 ± 19.8 mmHg, p < 0.0001). There were significant differences in metabolic equivalents, maximum heart rate, homeostatic model assessment of insulin resistance, high-density lipoprotein-cholesterol, waist circumference and age values between two patients groups dichotomized according to the cut-off value of EFT. BPRI was the only independent variable related to EFT in the multivariate analysis (odds ratio = 1.4, 95% CI 2.757.16, p = 0.001). Conclusions. EFT was found to be related to altered BP responses to exercise stress testing. The echocardiographic measurement of EFT may serve as a useful non-invasive indicator of heightened risk of future hypertension.Öğe Enhanced platelet reactivity in pediatric depression: An observational study(Oxford Univ Press, 2013) Can, Mehmet Mustafa; Güler Babür, Gamze; Güler, Ekrem; Biteker, Murat; Serebruany, VictorDepression is associated with poor prognosis for Cardiovascular Disease (CVD) including mortality. Among multiple mechanisms linking depression and CVD, changes in platelet reactivity are known to be one of the major confounders of such adverse association. However, there are very limited data in children. Thus, we evaluated some conventional hemostatic indices including whole blood platelet aggregation in patients with documented pediatric depression and compared these data with those obtained from healthy children. The pediatric patients fulfilled criteria for major depression with a minimum score of 19 on the 21-item Beck Depression Inventory Scale. Plasma fibrinogen, D-dimer, platelet count, mean platelet volume, and platelet aggregation induced by Adenosine Diphosphate (ADP) and collagen were measured in 67 pediatric patients with depression and matched by age and sex with 78 healthy controlsÖğe Impact of valve surgery on serum osteopontin levels in patients with mitral regurgitation(Karger, 2015) Güneş, Hacı Murat; Güler, Gamze Babür; Güler, Ekrem; Demir, Gültekin Günhan; Hatipo?lu, Suzan; Zehir, Regayip; Kızılırmak, Filiz; Karaca, O?uz; Esen, Ali Metin; Barutçu, İrfan; Türkmen, Muhsin; Can, Mehmet Mustafa; Serebruany, VictorObjective: Osteopontin (OPN), a sialoprotein present within atherosclerotic lesions, especially in calcified plaques, is linked to the progression of coronary artery disease and heart failure. We assessed the impact of valve surgery on serum OPN and left ventricular (LV) function in patients with mitral regurgitation (MR). Methods: Thirty-two patients with severe MR scheduled for surgery were included in the study. Echocardiography markers were assessed preoperatively and at 3 months following the surgery and matched with the serum OPN levels. Results: Valve surgery was associated with a reduction of the ejection fraction (EF) from 55.2 +/- 6.3 to 48.8 +/- 7.1% after surgery, p < 0.001. Following surgery, the OPN level was significantly higher than preoperatively (mean 245, range 36-2,284 ng/ml vs. 76,6-486 ng/ml, p = 0.007). Preoperative OPN exhibited a slight negative correlation with the EF (r = -0.35, p = 0.04), and a moderate correlation with vena contracta (r = -0.38, p = 0.02). There were no other meaningful correlations between conventional echocardiographic parameters and OPN. Conclusion: Following valve surgery due to severe MR, patients exhibited a decrease in EF and an increase in OPN levels. The assessment of preoperative OPN failed to strongly predict probable LV dysfunction. (C) 20155. Karger AG, BaselÖğe Predictive value of C-reactive protein/albumin ratio for no-reflow in patients with Non-ST-elevation myocardial infarction(Tabriz University of Medical Sciences, 2022) Tosu, Aydın Rodi; Çınar, Tufan; Kalyoncuo?lu, Muhsin; Biter, Halil İbrahim; Çakal, Sinem; Çakal, Beytullah; Selçuk, Murat; Belen, Erdal; Can, Mehmet MustafaIntroduction: The focus of this research was to explore the link between CRP (C-reactive protein)/albumin ratio (CAR), a novel inflammatory response marker, and no-reflow (NR) phenomena in non-ST elevation myocardial infarction (non-STEMI) patients during percutaneous coronary intervention (PCI). Methods: The current study recruited 209 non-STEMI participants who underwent PCI. The patients were divided into two groups based on their post-intervention Thrombolysis in Myocardial Infarction (TIMI) flow grade; those with and without NR. Results: In all, 30 non-STEMI patients (6.9%) had NR after PCI. CAR values were substantially greater in the NR group. The CAR was identified to be a determinant of the NR (OR: 1.250, 95% CI: 1.033-1.513, P = 0.02), although CRP and albumin were not independently related with NR in the multivariate analysis. In our investigation, low density lipoprotein-cholesterol levels and high thrombus burden were also predictors of the occurrence of NR. According to receiver operating characteristic curve evaluation, the optimal value of CAR was > 1.4 with 60% sensitivity and 47% specificity in detecting NR in non-STEMI patients following PCI. Conclusion: To the best of knowledge, this is the first investigation to demonstrate that the CAR, a new and useful inflammatory marker, can be utilized as a predictor of NR in patients with non-STEMI prior to PCI.Öğe Role of electrocardiographic changes in discriminating acute or chronic right ventricular pressure overload(Elsevier, 2013) Can, Mehmet Mustafa; Işılak, Zafer; Uz, Ömer; Biteker, Murat; Kırılmaz, AtaObjective: Pulmonary embolism (PE) and severe pulmonary stenosis (PS) are two distinct conditions accompanied by increased pressure load of the right ventricle (RV). Despite major advances in our understanding of the mechanisms of RV adaptation to the increased pressure, substantial gaps in our knowledge remain unsettled. One much less known aspect of pressure overload of RV is its impact on electrocardiographic (ECG) changes. In this study, we aimed to study whether acute and chronic RV overload are accompanied by different ECG patterns. Methods: Thirty-eight patients with PE underwent ECG monitoring and were compared with 20 matched patients with PS. ECG abnormalities suggestive of RV overload were recorded and analyzed in both groups. Results: Among the ECG changes studied, premature atrial contraction (p = 0.008), right axis deviation (p < 0.001), indeterminate axis (p = 0.001), incomplete right bundle branch block (p = 0.02), late R in aVR (p = 0.001), qR in V1 (p = 0.02), and P pulmonale (p = 0.03) were significantly more common in patients with PS than in those with acute PE. Conclusion: Our data indicate that the ECG changes that attributed to the acute RV pressure loading states may be more prevalent in chronic RV overload as compared with acute RV overload.Öğe Switching ticagrelor to 600 mg or 300 mg clopidogrel loading bridge in patients with unstable angina(MDPI AG, 2021) Çakal, Sinem; Çakal, Beytullah; Güven, Zafer; Tosu, Aydın Rodi; Kalyoncuoğlu, Muhsin; Biter, Halil İbrahim; Apaydın, Ziya; Karaca, İbrahim Oğuz; Belen, Erdal; Can, Mehmet MustafaTicagrelor is believed to be a more potent and faster antiplatelet agent compared with clopidogrel and may result in lower ischemic outcomes in patients with acute coronary syndrome. However, the best strategy of switching from ticagrelor to clopidogrel is unclear. Current guidelines advocate clopidogrel bridging with a 600 mg loading dose (LD). This study aimed to compare the safety and feasibility of switching protocols from ticagrelor to clopidogrel 600 mg or 300 mg LD in patients with unstable angina pectoris (USAP). One hundred and eighty patients with USAP undergoing adhoc percutaneous coronary intervention (PCI) received preprocedural ticagrelor 180 mg/daily. The decision to switch antiplatelet therapy to clopidogrel with either 300 mg LD or 600 mg LD at 12 h was left to the discretion of the treating physician. The primary outcome was a composite of an efficacy endpoint major adverse cardiac and cerebrovascular events (MACCEs) and a safety endpoint Bleeding Academic Research Consortium scale (BARC) (>= 1). There were no differences in our composite clinical endpoint of MACCE between the two strategies, with one event occurring in each group. One patient in each group had myocardial infarction due to stent thrombosis, and the patient in the 300 mg switching group died due to stent thrombosis. No difference between the two arms was observed in terms of BARC bleeding criteria. This study showed that among USAP patients undergoing PCI, switching to clopidogrel with 300 mg LD showed no significant difference compared to 600 mg clopidogrel LD. Ticagrelor LD in ad hoc PCI and de-escalation to clopidogrel with 300 mg LD could translate to lower costs for patients with USAP without compromising safety and efficacy.Öğe The effect of recanalization of a chronic total coronary occlusion on P-wave dispersion(Tabriz University of Medical Sciences and Health Services, 2021) Tosu, Aydın Rodi; Kalyoncuoğlu, Muhsin; Biter, Halil İbrahim; Çakal, Sinem; Çakal, Beytullah; Çınar, Tufan; Belen, Erdal; Can, Mehmet MustafaIntroduction: P-wave dispersion (PWD) obtained from the standard 12-lead electrocardiography (ECG) is considered to reflect the homogeneity of the atrial electrical activity. The aim of this investigation was to evaluate the effect of percutaneous chronic total occlusion (CTO) revascularization on the parameters of P wave duration and PWD on ECG in cases before and after procedure at 12th months. Methods: We analyzed 90 consecutive CTO cases who were on sinus rhythm and underwent percutaneous coronary intervention (PCI). P-wave maximum (P-max) and P-wave minimum (P-min), P-wave time, and PWD were determined before and twelve months after the CTO intervention. The study population was categorized into two groups as successful and unsuccessful CTO PCI groups. Results: The CTO PCI was successful in 71% of cases (n = 64) and it was unsuccessful in 29% of cases (n = 26). Both groups, except for age and hypertension, were similar in terms of demographic and clinical aspects. CRP levels were significantly elevated in the unsuccessful CTO PCI group. Pre-PCI ECG parameters showed no significant difference. Irrespective of the target vessel revascularization, we observed that PWD and P-max values were significantly lower in the 12th months follow-up. In all Rentrop classes, PWD values were significantly decreased at 12th months follow-up in comparison to the pre-CTO PCI values. Conclusion: This study has determined that PWD and P-max, which are both risk factors for atrial arrhythmias, are significantly reduced within 12th months after successful CTO PCI regardless of the target vessel.Öğe Uric acid to albumin ratio in coronary slow flow(Elsevier Science Inc., 2023) Biter, Halil İbrahim; Tosu, Aydın Rodi; Kalyoncuoğlu, Muhsin; Çakal, Beytullah; Oğuz, Hüseyin; Çakal, Sinem; Apaydın, Ziya; Kılınç, Ali Yaşar; Can, Mehmet Mustafa[Abstract Not Available]
