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Özkan M, Güner A, Gündüz S, Yıldız G, Yıldırım Aİ, Kalçık M, Yesin M, Bayam E, Kalkan S, Gürsoy MO, Kılıçgedik A, Bayram Z, Sarı M, Aytürk M, Karakoyun S, Astarcıoğlu MA, Gündoğdu EC, Biçer A, Gürcü E, Koçak T, Demirbağ R. Combination Anticoagulation Strategy in Pregnancy With Mechanical Valves: The KYBELE Study. Am Heart J 2024:S0002-8703(24)00075-9. [PMID: 38570020 DOI: 10.1016/j.ahj.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Optimal first-trimester anticoagulation is still challenging in pregnant women with mechanical heart valves (MHVs) requiring high-dose warfarin.This multicenter prospective study aims to determine the optimal anticoagulation regimens for pregnant patients with MHVs. METHODS All women were allocated to one of three treatment options during first trimester including lone low-molecular-weight heparin (LMWH), combination of LMWH+2.5 mg warfarin, and LMWH+4 mg warfarin. Primary maternal outcome included a combination of death, thromboembolism, severe bleeding, and need for treatment of mechanical valve thrombosis (MVT).Any fetal loss was determined as primary fetal outcome. RESULTS The study included 78 pregnancies in 65 women with MHVs.Primary maternal outcome rate was 44%, 12.5%, 3.5%, respectively.The rates of primary maternal outcome (44 vs 3.5%, p<0.001), obstructive MVT (16 vs 0%, p=0.04), MVT requiring treatment (28 vs 0%, p=0.003), and cerebral embolism (24 vs 3.4%, p=0.041) were found to be significantly higher in lone LMWH group compared to LMWH+4 mg warfarin group. Moreover, the rates of primary maternal outcome (12.5 vs 44%, p=0.015) and treatment for MHV thrombus (4.2 vs 28%, p=0.049) were significantly lower in LMWH+2.5 mg warfarin group compared to lone LMWH group.The incidences of fetal loss were 8 (32%) in the lone LMWH group, 8 (33.3%) in LMWH+2.5 mg warfarin group, and 11 (37.9%) in LMWH+4 mg warfarin group (p=0.890 for 3-group).Warfarin related-embryopathy was not observed in any case. CONCLUSIONS The combined anticoagulation strategy of LMWH plus low-dose warfarin during the first trimester of pregnancy may result in less maternal complications with comparable fetal outcomes in patients with MHVs. CONDENSED ABSTRACT Low-molecular-weight heparin (LMWH) is thought to be safer for the fetus, however it is suspected to be less protective for the mother. To solve this dilemma, the authors suggested a novel anticoagulation strategy in pregnant women with prosthetic valves. Seventy-eight pregnancies of 65 women [median age 32 (27-35) years] were included in the study. A combination of LMWH and a reduced dose warfarin were associated with low rates of thrombus-related complications in pregnant patients with mechanical heart valves.
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Affiliation(s)
- Mehmet Özkan
- Koşuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, Istanbul, Turkey.; Ardahan University, Faculty of Health Sciences, Ardahan, Turkey
| | - Ahmet Güner
- Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey..
| | - Sabahattin Gündüz
- Koşuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Gazi Yıldız
- Kartal Dr. Lutfi Kirdar Research and Training Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Ayşe İnci Yıldırım
- Koşuyolu Kartal Heart Training and Research Hospital, Department of Pediatric Cardiology, Istanbul, Turkey
| | - Macit Kalçık
- Hitit University, Faculty of Medicine, Department of Cardiology, Corum, Turkey
| | - Mahmut Yesin
- Koşuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Emrah Bayam
- Koşuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Semih Kalkan
- Koşuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Mustafa Ozan Gürsoy
- İzmir Katip Çelebi University, Atatürk Training and Reseach Hospital, Department of Cardiology, Izmir, Turkey
| | - Alev Kılıçgedik
- Koşuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Zübeyde Bayram
- Koşuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Münevver Sarı
- Koşuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Mehmet Aytürk
- Koşuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Süleyman Karakoyun
- Koşuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Mehmet Ali Astarcıoğlu
- Koşuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Elif Cansu Gündoğdu
- Kartal Dr. Lutfi Kirdar Research and Training Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Asuman Biçer
- Harran University, Faculty of Medicine, Department of Cardiology, Şanlıurfa, Turkey
| | - Emre Gürcü
- Koşuyolu Kartal Heart Training and Research Hospital, Department of Anesthesia and Reanimation, Istanbul, Turkey
| | - Tuncer Koçak
- Koşuyolu Kartal Heart Training and Research Hospital, Department of Anesthesia and Reanimation, Istanbul, Turkey
| | - Recep Demirbağ
- Harran University, Faculty of Medicine, Department of Cardiology, Şanlıurfa, Turkey
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İnan D, Demirtola Aİ, Karabulut FÖ, Tuğrul Yavuz S, Büyükpınarbaşılı N, Yanartaş M, Kılıçgedik A. Multimodality Imaging of Intimal Sarcoma Causing Both Severe Mitral Stenosis and Mitral Regurgitation. Turk Kardiyol Dern Ars 2024; 52:213-216. [PMID: 38573094 DOI: 10.5543/tkda.2023.76062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
Intimal sarcomas (IS) are rare, malignant, rapidly progressive mesenchymal tumors that typically occur in the tunica intima of larger vessels, and they rarely involve the heart. IS are frequently misdiagnosed during the initial clinical presentation. This case report describes an uncommonly located IS, highlighting specific findings obtained through multimodality imaging.
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Affiliation(s)
- Duygu İnan
- Department of Cardiology, Başakşehir Çam and Sakura City Hospital, İstanbul, Türkiye
| | - Ayşe İrem Demirtola
- Department of Cardiology, Başakşehir Çam and Sakura City Hospital, İstanbul, Türkiye
| | - Funda Özlem Karabulut
- Department of Cardiology, Başakşehir Çam and Sakura City Hospital, İstanbul, Türkiye
| | - Sevil Tuğrul Yavuz
- Department of Cardiology, Başakşehir Çam and Sakura City Hospital, İstanbul, Türkiye
| | - Nur Büyükpınarbaşılı
- Department of Pathology, Başakşehir Çam and Sakura City Hospital, İstanbul, Türkiye
| | - Mehmet Yanartaş
- Department of Cardiovascular Surgery, Başakşehir Çam and Sakura City Hospital, İstanbul, Türkiye
| | - Alev Kılıçgedik
- Department of Cardiology, Başakşehir Çam and Sakura City Hospital, İstanbul, Türkiye
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3
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Alizade E, Keskin B, Kılıçgedik A, Imanov E. Percutaneous closure of the superior sinus venosus atrial septal defect associated with a partial pulmonary anomalous venous drainage. Acta Cardiol 2024; 79:258-261. [PMID: 35332855 DOI: 10.1080/00015385.2022.2054498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/11/2022] [Indexed: 11/01/2022]
Affiliation(s)
- Elnur Alizade
- Kartal Kosuyolu Research and Education Hospital, İstanbul, Turkey
| | - Berhan Keskin
- Kartal Kosuyolu Research and Education Hospital, İstanbul, Turkey
| | - Alev Kılıçgedik
- Kartal Kosuyolu Research and Education Hospital, İstanbul, Turkey
| | - Elmin Imanov
- Kartal Kosuyolu Research and Education Hospital, İstanbul, Turkey
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Güner A, Kırma C, Ertürk M, Türkmen M, Alıcı G, Karabay CY, Uzun F, Kılıçgedik A, Gündüz S, Güler GB, Kalkan AK, Özkan B, Sarı M, Gürsoy MO, Tekin M, Yıldız M, Can F, Kırali K, Fedakar A, Sarıkaya S, Aydın Ü, Kahraman S, İyigün T, Aksüt M, Karpuzoğlu E, Çiloğlu K, Sungur MA, Tanboğa İH, Özkan M. Transcatheter Closure or Surgery for Symptomatic Paravalvular Leaks: The Multicenter KISS Registry. J Am Heart Assoc 2024; 13:e032262. [PMID: 38156599 PMCID: PMC10863827 DOI: 10.1161/jaha.123.032262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/30/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND The optimal treatment of symptomatic paravalvular leak (PVL) remains controversial between transcatheter closure (TC) and surgery. This large-scale study aimed to retrospectively evaluate the long-term outcomes of the patients who underwent reoperation or TC of PVLs. METHODS AND RESULTS A total of 335 (men, 209 [62.4%]; mean age, 58.15±12.77 years) patients who underwent treatment of PVL at 3 tertiary centers between January 2002 and December 2021 were included. Echocardiographic features, procedure details, and in-hospital or long-term outcomes were assessed. The primary end point was defined as the all-cause death during follow-up. The regression models were adjusted by applying the inverse probability weighted approach to reduce treatment selection bias. The initial management strategy was TC in 171 (51%) patients and surgery in 164 (49%) cases. Three hundred cases (89.6%) had mitral PVL, and 35 (10.4%) had aortic PVL. The mean left ventricular ejection fraction was 52.03±10.79%. Technical (78.9 versus 76.2%; P=0.549) and procedural success (73.7 versus 65.2%; P=0.093) were similar between both groups. In both univariate and multivariable logistic regression analysis, the in-hospital mortality rate in the overall population was significantly higher (15.9 versus 4.7%) in the surgery group compared with the TC group (unadjusted odds ratio, 3.13 [95% CI, 1.75-5.88]; P=0.001; and adjusted odds ratio (inverse probability-weighted), 4.55 [95% CI, 2.27-10.0]; P<0.001). However, the long-term mortality rate in the overall population did not differ between the surgery group and the TC group (unadjusted hazard ratio [HR], 0.86 [95% CI, 0.59-1.25]; P=0.435; and adjusted HR (inverse probability-weighted), 1.11 [95% CI, 0.67-1.81]; P=0.679). CONCLUSIONS The current data suggest that percutaneous closure of PVL was associated with lower early and comparable long-term mortality rates compared with surgery.
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Affiliation(s)
- Ahmet Güner
- Department of CardiologyIstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research HospitalIstanbulTurkey
| | - Cevat Kırma
- Department of CardiologyKoşuyolu Kartal Heart Training and Research HospitalIstanbulTurkey
| | - Mehmet Ertürk
- Department of CardiologyIstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research HospitalIstanbulTurkey
| | - Muhsin Türkmen
- Department of CardiologyKoşuyolu Kartal Heart Training and Research HospitalIstanbulTurkey
| | - Gökhan Alıcı
- Department of CardiologyKoşuyolu Kartal Heart Training and Research HospitalIstanbulTurkey
| | - Can Yücel Karabay
- Department of CardiologyDr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research HospitalIstanbulTurkey
| | - Fatih Uzun
- Department of CardiologyIstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research HospitalIstanbulTurkey
| | - Alev Kılıçgedik
- Department of CardiologyKoşuyolu Kartal Heart Training and Research HospitalIstanbulTurkey
| | - Sabahattin Gündüz
- Department of CardiologyBahçeşehir University, Faculty of MedicineIstanbulTurkey
| | - Gamze Babur Güler
- Department of CardiologyIstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research HospitalIstanbulTurkey
| | - Ali Kemal Kalkan
- Department of CardiologyIstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research HospitalIstanbulTurkey
| | - Birol Özkan
- Department of CardiologyKoşuyolu Kartal Heart Training and Research HospitalIstanbulTurkey
| | - Münevver Sarı
- Department of CardiologyKoşuyolu Kartal Heart Training and Research HospitalIstanbulTurkey
| | - Mustafa Ozan Gürsoy
- Department of CardiologyKoşuyolu Kartal Heart Training and Research HospitalIstanbulTurkey
| | - Meltem Tekin
- Department of CardiologyIstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research HospitalIstanbulTurkey
| | - Mustafa Yıldız
- Department of CardiologyIstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research HospitalIstanbulTurkey
| | - Fatma Can
- Department of CardiologyDr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research HospitalIstanbulTurkey
| | - Kaan Kırali
- Department of Cardiovascular SurgeryKoşuyolu Kartal Heart Training and Research HospitalIstanbulTurkey
| | - Ali Fedakar
- Department of Cardiovascular SurgeryKoşuyolu Kartal Heart Training and Research HospitalIstanbulTurkey
| | - Sabit Sarıkaya
- Department of Cardiovascular SurgeryKoşuyolu Kartal Heart Training and Research HospitalIstanbulTurkey
| | - Ünal Aydın
- Department of Cardiovascular SurgeryIstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research HospitalIstanbulTurkey
| | - Serkan Kahraman
- Department of CardiologyIstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research HospitalIstanbulTurkey
| | - Taner İyigün
- Department of Cardiovascular SurgeryIstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research HospitalIstanbulTurkey
| | - Mehmet Aksüt
- Department of Cardiovascular SurgeryKoşuyolu Kartal Heart Training and Research HospitalIstanbulTurkey
| | - Eren Karpuzoğlu
- Department of Cardiovascular SurgeryDr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research HospitalIstanbulTurkey
| | - Koray Çiloğlu
- Department of CardiologyIstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research HospitalIstanbulTurkey
| | - Mustafa Azmi Sungur
- Department of CardiologyDr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research HospitalIstanbulTurkey
| | - İbrahim Halil Tanboğa
- Department of Cardiology and Biostatistics IstanbulIstanbul Nisantasi UniversityIstanbulTurkey
| | - Mehmet Özkan
- Department of CardiologyKoşuyolu Kartal Heart Training and Research HospitalIstanbulTurkey
- Ardahan University, Faculty of Health SciencesArdahanTurkey
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Demirtola Aİ, İnan D, Pamuk Ö, Tugrul S, Mammadli A, Kılıçgedik A. 3D TEE imaging in a patient with severe tricuspid regurgitation with dextrocardia and tricuspid commissural prolapse. Echocardiography 2023; 40:1112-1116. [PMID: 37646446 DOI: 10.1111/echo.15678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/14/2023] [Indexed: 09/01/2023] Open
Abstract
Although dextrocardia is a rare congenital anomaly, it may be accompanied by numerous pathologies. Tricuspid valve prolapse is an extremely uncommon cause of primary tricuspid valve disease, as is its association with dextrocardia. In this instance, we wished to share our knowledge of tricuspid commissural prolapse together with dextrocardia, which we augmented with 3D images.
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Affiliation(s)
- Ayşe İrem Demirtola
- Department of Cardiology, Basaksehir Cam & Sakura City Hospital, Istanbul, Turkey
| | - Duygu İnan
- Department of Cardiology, Basaksehir Cam & Sakura City Hospital, Istanbul, Turkey
| | - Özlem Pamuk
- Department of Cardiology, Basaksehir Cam & Sakura City Hospital, Istanbul, Turkey
| | - Sevil Tugrul
- Department of Cardiology, Basaksehir Cam & Sakura City Hospital, Istanbul, Turkey
| | - Anar Mammadli
- Department of Cardiology, Bayindir Sogutozu Hospital, Ankara, Turkey
| | - Alev Kılıçgedik
- Department of Cardiology, Basaksehir Cam & Sakura City Hospital, Istanbul, Turkey
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Sonsöz MR, Demirhan UO, Kartal YC, Kılıçgedik A. The importance of identifying a possible shunt in cases of suspicious high-velocity doppler flow in the right heart. Acta Cardiol 2023:1. [PMID: 37581344 DOI: 10.1080/00015385.2023.2246196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 08/03/2023] [Indexed: 08/16/2023]
Affiliation(s)
- Mehmet Rasih Sonsöz
- Department of Cardiology, Başakşehir Çam & Sakura City Hospital, Istanbul, Turkey
| | - Uğur Ozan Demirhan
- Department of Cardiology, Başakşehir Çam & Sakura City Hospital, Istanbul, Turkey
| | - Yiğit Can Kartal
- Department of Radiology, Başakşehir Çam & Sakura City Hospital, Istanbul, Turkey
| | - Alev Kılıçgedik
- Department of Cardiology, Başakşehir Çam & Sakura City Hospital, Istanbul, Turkey
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Koyuncu A, Yildiz C, Ocal L, Kalkan S, Kılıçgedik A, Gürsoy MO, Oflar E, Kahveci G. Does papillary muscle free strain has predictive value in risk stratification of patients with hypertrophic cardiomyopathy? PLoS One 2023; 18:e0282054. [PMID: 36827304 PMCID: PMC9955626 DOI: 10.1371/journal.pone.0282054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 02/07/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Papillary muscle free strain has not been evaluated previously in hypertrophic cardiomyopathy (HCMP) patients. Our aim was to evaluate free papillary muscle free strain in HCMP patients and to find whether it has a value for prediction of sudden cardiac death (SCD) risk score. METHODS Transthoracic echocardiography with tissue Doppler imaging, 2-D speckle tracking imaging (STI) of 55 HCMP patients and 45 controls were performed. HCMP patients were further divided into two groups according to their SCD risk score. Patients with risk score of less than 6 points constituted low/intermediate risk group, whereas patients with risk score of greater or equal to 6 points constituted high risk group. RESULTS Interventricular septum, posterior wall, and left ventricular mass index were significantly higher, whereas mitral E/A ratio was significantly lower in HCMP patients compared to controls. Longitudinal apical 4C, 2C, 3C, global longitudinal LV strain, anterolateral papillary muscle (ALPM), posteromedial papillary muscle (PMPM) free strain were significantly reduced in HCMP group compared to control group. Global longitudinal strain and ALPM free strain were significantly lower in patients with high SCD risk score (-14.6 (-17.4 - -13.1) vs -11.6 (-13.2 - -10.1), p = 0.001 and -17.1 (-20.3 - -14.0) vs -9.2 (-12.6 - -7.5), p<0.001, respectively. Global longitudinal strain and ALPM free strain were statistically significantly correlated with SCD risk score (r = 0.480, p<0.001 and r = 0.462, p<0.001, respectively). Global longitudinal strain value of -12.60% had a sensitivity of 73.3% and specificity of 82.5% for predicting high SCD risk score (AUC: 0.787, 95% CI: 00.643-0.930, p = 0.001). ALPM free strain value of -12.95% had 66.7% sensitivity and 77.5% specificity for predicting high SCD risk score (AUC: 0.766, 95% CI: 0.626-0.905, p = 0.003). CONCLUSION Papillary muscle free strain was reduced in HCMP patients. It might be used in risk stratification of these patients.
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Affiliation(s)
- Atilla Koyuncu
- Department of Cardiology, Bakırkoy Dr Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Cennet Yildiz
- Department of Cardiology, Bakırkoy Dr Sadi Konuk Education and Research Hospital, Istanbul, Turkey
- * E-mail:
| | - Lutfu Ocal
- Department of Cardiology, Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Sedat Kalkan
- Department of Cardiology, Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Alev Kılıçgedik
- Department of Cardiology, Basaksehir Cam and Sakura Education and Research City Hospital, Istanbul, Turkey
| | - Mustafa Ozan Gürsoy
- Department of Cardiology, Izmir Ataturk Education and Research Hospital, Izmir, Turkey
| | - Ersan Oflar
- Department of Cardiology, Bakırkoy Dr Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Gökhan Kahveci
- Department of Cardiology, Istinye University, Liv Hospital, Istanbul, Turkey
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8
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Erdoğan A, Özkan E, Sonsöz MR, Genç Ö, Ibişoğlu E, Özateş Y, Inan D, Göksu MM, Kartal YC, Tekin AF, Erdinç B, Çapar G, Güler A, Kılıçgedik A, Karagöz A. Gender-Dependent Comparison of Coronary Computed Tomography Angiographic Characteristics among Patients with Suspected Atherosclerosis: A Single-Center Experience. Turk Kardiyol Dern Ars 2023; 51:22-31. [PMID: 36689283 DOI: 10.5543/tkda.2022.75572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE In this study, we aimed to examine gender-based differences in coronary artery disease (CAD) risk factors, the presence and severity of atherosclerosis, and the distribution of plaque type in patients presenting with chest pain. METHODS A total of 1496 patients who applied to our cardiology outpatient clinic with chest pain and underwent computed coronary tomographic angiography (CTA) between August 2020 and October 2021 were included in the study. Plaque characteristics, Agatston score, and Coronary Artery Disease-Reporting and Data System (CAD-RADS) score obtained from the patients' CTAs were compared by gender. RESULTS Of the 1496 patients evaluated, 47.9% were female. Coronary atherosclerosis was detected in 35.4% of females and 52.9% of males (P <0.001). Diabetes mellitus [155 (21.8%) vs. 123 (15.7%); P <0.001] and hypertension [271 (38.1%) vs. 249 (32%); P <0.001] rates were higher in females than in males. Plaque burden and high-risk plaque rate were found to be higher in males (P <0.001). Next, the rate of moderate-to-high coronary artery stenosis (CAD-RADS ≥3) was observed at 21.6% in men and 12.2% in women (P <0.001). Agatston score was found to be higher in males than in females for all age groups (P <0.001). The severity of CAD increased sharply with age in females (P interaction = 0.003). CONCLUSION Although female patients demonstrated higher rates of traditional risk factors, the male gender was associated with increased coronary plaque burden, high-risk plaque, CADRADS, and Agatston scores. Therefore, patient-based approaches that consider gender-related differences could provide effective treatment and follow-up.
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Affiliation(s)
- Aslan Erdoğan
- Clinic of Cardiology, Çam and Sakura Training and Research Hospital, Istanbul, Türkiye
| | - Eyup Özkan
- Clinic of Cardiology, Çam and Sakura Training and Research Hospital, Istanbul, Türkiye
| | - Mehmet Rasih Sonsöz
- Clinic of Cardiology, Çam and Sakura Training and Research Hospital, Istanbul, Türkiye
| | - Ömer Genç
- Clinic of Cardiology, Çam and Sakura Training and Research Hospital, Istanbul, Türkiye
| | - Ersin Ibişoğlu
- Clinic of Cardiology, Çam and Sakura Training and Research Hospital, Istanbul, Türkiye
| | - Yelda Özateş
- Clinic of Cardiology, Çam and Sakura Training and Research Hospital, Istanbul, Türkiye
| | - Duygu Inan
- Clinic of Cardiology, Çam and Sakura Training and Research Hospital, Istanbul, Türkiye
| | - Muhammed Mert Göksu
- Clinic of Cardiology, Çam and Sakura Training and Research Hospital, Istanbul, Türkiye
| | - Yiğit Can Kartal
- Clinic of Radiology, Çam and Sakura Training and Research Hospital, Istanbul, Türkiye
| | - Ali Fuat Tekin
- Clinic of Radiology, Çam and Sakura Training and Research Hospital, Istanbul, Türkiye
| | - Berk Erdinç
- Clinic of Cardiology, Çam and Sakura Training and Research Hospital, Istanbul, Türkiye
| | - Gazi Çapar
- Clinic of Cardiology, Çam and Sakura Training and Research Hospital, Istanbul, Türkiye
| | - Ahmet Güler
- Clinic of Cardiology, Çam and Sakura Training and Research Hospital, Istanbul, Türkiye
| | - Alev Kılıçgedik
- Clinic of Cardiology, Çam and Sakura Training and Research Hospital, Istanbul, Türkiye
| | - Ali Karagöz
- Clinic of Cardiology,Kartal Kosuyolu Training and Research Hospital,Istanbul, Türkiye
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9
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Vatansever Ağca F, Babur Güler G, Gürsoy MO, Özden Ö, Al EA, Altın MP, Can İD, Emren SV, Demir ÖF, Derviş E, Dinçer İ, Kahveci G, Kaplan E, Kılıçgedik A, Akbulut Koyuncu İM, Kozluca V, Tan Kürklü TS, Opan S, Memiç Sancar K, Sarıbaş H, Güvendi Şengör B, Tüfekçioğlu O, Yakar Tülüce S, Yılmaz DÇ. Kardiyovasküler İşlemlerde Görüntüleme. Turk Kardiyol Dern Ars 2022; 50:1-56. [PMID: 36540046 DOI: 10.5543/tkda.2022.s3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2022] Open
Affiliation(s)
- Fahriye Vatansever Ağca
- Sağlık Bilimleri Üniversitesi Bursa Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Bursa, Türkiye
| | - Gamze Babur Güler
- Sağlık Bilimleri Üniversitesi, Mehmet Akif Ersoy Göğüs Kalp ve Damar Cerrahisi Eğitim ve Araştırma Hastanesi, Kardiyoloji Anabilim Dalı, İstanbul, Türkiye
| | - Mustafa Ozan Gürsoy
- İzmir Katip Çelebi Üniversitesi Atatürk Eğitim ve Araştırma Hastanesi, Kardiyoloji Anabilim Dalı, İzmir, Türkiye
| | - Özge Özden
- Memorial Bahçelievler Hastanesi, Kardiyoloji Anabilim Dalı, İstanbul, Türkiye
| | - Ertan Andaç Al
- Siirt Kurtalan Devlet Hastanesi, Kardiyoloji Anabilim Dalı, Siirt, Türkiye
| | | | - İrem Dilara Can
- Siirt Kurtalan Devlet Hastanesi, Kardiyoloji Anabilim Dalı, Siirt, Türkiye
| | - Sadık Volkan Emren
- Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Kardiyoloji Kliniği, Bursa, Türkiye
| | - Ömer Furkan Demir
- Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Kardiyoloji Kliniği, Bursa, Türkiye
| | - Emir Derviş
- Medipol Üniversitesi Tıp Fakültesi, Bahçelievler Medipol Hastanesi, Kardiyoloji Anabilim Dalı, İstanbul, Türkiye
| | - İrem Dinçer
- Ankara Üniversitesi Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Ankara, Türkiye
| | - Gökhan Kahveci
- İstinye Üniversitesi Tıp Fakültesi, Liv Hastanesi, Kardiyoloji Anabilim Dalı, İstanbul, Türkiye
| | - Elmas Kaplan
- Siirt Kurtalan Devlet Hastanesi, Kardiyoloji Anabilim Dalı, Siirt, Türkiye
| | - Alev Kılıçgedik
- Başakşehir Çam ve Sakura Şehir Hastanesi, Kardiyoloji Anabilim Dalı, İstanbul, Türkiye
| | | | - Volkan Kozluca
- Ankara Üniversitesi Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Ankara, Türkiye
| | | | - Selçuk Opan
- Şanlıurfa Eğitim ve Araştırma Hastanesi, Kardiyoloji Anabilim Dalı, Şanlıurfa, Türkiye
| | - Kadriye Memiç Sancar
- Sağlık Bilimleri Üniversitesi, Mehmet Akif Ersoy Göğüs Kalp ve Damar Cerrahisi Eğitim ve Araştırma Hastanesi, Kardiyoloji Anabilim Dalı, İstanbul, Türkiye
| | - Halenur Sarıbaş
- Siirt Kurtalan Devlet Hastanesi, Kardiyoloji Anabilim Dalı, Siirt, Türkiye
| | - Büşra Güvendi Şengör
- Kartal Koşuyolu Eğitim ve Araştırma Hastanesi, Kardiyoloji Anabilim Dalı, İstanbul, Türkiye
| | - Omaç Tüfekçioğlu
- Siirt Kurtalan Devlet Hastanesi, Kardiyoloji Anabilim Dalı, Siirt, Türkiye
| | - Selcen Yakar Tülüce
- İzmir Atatürk Eğitim ve Araştırma Hastanesi, Kardiyoloji Anabilim Dalı, İzmir, Türkiye
| | - Dilek Çiçek Yılmaz
- Mersin Üniversitesi Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Mersin Türkiye
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10
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Güner A, Özkan M, Kalçık M, Gürsoy MO, Gündüz S, Kılıçgedik A, Bayam E, Kalkan S, Kırma C, Türkmen M, Adademir T, Aksüt M, Fedakar A, Kırali K. Serum Levels of Cholesterol and Lipoproteins in Patients With Symptomatic Paravalvular Leaks. Am J Cardiol 2022; 173:112-119. [PMID: 35369933 DOI: 10.1016/j.amjcard.2022.02.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 11/25/2022]
Abstract
Paravalvular leak (PVL) is a complication of valve replacement surgery which may lead to serious clinical consequences including hemolytic anemia. This study aimed to retrospectively evaluate the effect of successful intervention on serum lipid parameters in patients with PVL. A total of 106 patients (mean age: 57.2 ± 13.6 years, male: 67) who underwent surgical or transcatheter closure for symptomatic PVL were enrolled in this study. During the follow-up period, hemolysis and lipid parameters were evaluated at each clinical visit. This is the first study describing the effects of PVL on lipid metabolism after surgical or transcatheter closure. In the study, 18 patients (17%) had aortic PVL, 84 patients (79%) had mitral PVL, and 4 patients (3.8%) had both aortic and mitral PVL. A total of 59 patients underwent transcatheter closure and 47 patients were treated surgically. Technical success of the procedures was 83%. After successful PVL closure, hemoglobin and haptoglobin levels increased significantly (9.5 ± 1.3 vs 11.9 ± 2.1 g/dl, p <0.001 and 16.6 ± 7.9 vs 34.1 ± 19.9 mg, p <0.001, respectively). A significant increase in total cholesterol (158.9 ± 42.7 vs 209.3 ± 58.7 mg/dl, p <0.001), low-density lipoprotein cholesterol (99.1 ± 33.8 vs 133.9 ± 45.7 mg/dl, p <0.001), and high-density lipoprotein cholesterol (39.8 ± 12.4 vs 44.8 ± 11.7 mg/dl, p <0.001) levels was observed after successful PVL closure. In conclusion, symptomatic patients with PVL had hypocholesterolemia, reflected by low serum lipoprotein levels. After successful PVL closure, an increase in serum lipoprotein levels was observed. The recovery in levels of lipoproteins could be used as a marker of successful PVL closure, and absence of recovery of lipoprotein levels may indicate incomplete closure.
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11
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Özkan M, Gündüz S, Güner A, Kalçık M, Gürsoy MO, Uygur B, Keleş N, Kaya H, Kılıçgedik A, Bayam E, Kalkan S, Astarcıoğlu MA, Karakoyun S, Yesin M, İnan D, Fedakar A, Sarıkaya S, Aksüt M, Onan B, Koçoğulları CU. Thrombolysis or Surgery in Patients With Obstructive Mechanical Valve Thrombosis: The Multicenter HATTUSHA Study. J Am Coll Cardiol 2022; 79:977-989. [PMID: 35272803 DOI: 10.1016/j.jacc.2021.12.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Prosthetic valve thrombosis (PVT) is one of the life-threatening complications of prosthetic heart valve replacement. Due to the lack of randomized controlled trials, the optimal treatment of PVT remains controversial between thrombolytic therapy (TT) and surgery. OBJECTIVES This study aimed to prospectively evaluate the outcomes of TT and surgery as the first-line treatment strategy in patients with obstructive PVT. METHODS A total of 158 obstructive PVT patients (women: 103 [65.2%]; median age 49 years [IQR: 39-60 years]) were enrolled in this multicenter observational prospective study. TT was performed using slow (6 hours) and/or ultraslow (25 hours) infusion of low-dose tissue plasminogen activator (t-PA) (25 mg) mostly in repeated sessions. The primary endpoint of the study was 3-month mortality following TT or surgery. RESULTS The initial management strategy was TT in 83 (52.5%) patients and surgery in 75 (47.5%) cases. The success rate of TT was 90.4% with a median t-PA dose of 59 mg (IQR: 37.5-100 mg). The incidences of outcomes in surgery and TT groups were as follows: minor complications (29 [38.7%] and 7 [8.4%], respectively), major complications (31 [41.3%] and 5 [6%], respectively), and the 3-month mortality rate (14 [18.7%] and 2 [2.4%], respectively). CONCLUSIONS Low-dose and slow/ultraslow infusion of t-PA were associated with low complications and mortality and high success rates and should be considered as a viable treatment in patients with obstructive PVT.
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Affiliation(s)
- Mehmet Özkan
- Koşuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, Istanbul, Turkey; Ardahan University, Faculty of Health Sciences, Ardahan, Turkey
| | - Sabahattin Gündüz
- Koşuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Ahmet Güner
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey.
| | - Macit Kalçık
- Hitit University, Faculty of Medicine, Department of Cardiology, Corum, Turkey
| | - Mustafa Ozan Gürsoy
- İzmir Katip Çelebi University, Atatürk Training and Research Hospital, Department of Cardiology, Izmir, Turkey
| | - Begüm Uygur
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Nurşen Keleş
- Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Hasan Kaya
- Dicle University, Faculty of Medicine, Department of Cardiology, Diyarbakir, Turkey
| | - Alev Kılıçgedik
- Koşuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Emrah Bayam
- Koşuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Semih Kalkan
- Koşuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | | | - Süleyman Karakoyun
- Kars Kafkas University, Faculty of Medicine, Department of Cardiology, Kars, Turkey
| | - Mahmut Yesin
- Kars Kafkas University, Faculty of Medicine, Department of Cardiology, Kars, Turkey
| | - Duygu İnan
- Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Ali Fedakar
- Koşuyolu Kartal Heart Training and Research Hospital, Department of Cardiovascular Surgery, Istanbul, Turkey
| | - Sabit Sarıkaya
- Koşuyolu Kartal Heart Training and Research Hospital, Department of Cardiovascular Surgery, Istanbul, Turkey
| | - Mehmet Aksüt
- Koşuyolu Kartal Heart Training and Research Hospital, Department of Cardiovascular Surgery, Istanbul, Turkey
| | - Burak Onan
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiovascular Surgery, Istanbul, Turkey
| | - Cevdet Uğur Koçoğulları
- Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiovascular Surgery, Istanbul, Turkey
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12
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Uysal S, Kalkan S, Kılıçgedik A. A tricuspid mitral valve with severe regurgitation. Echocardiography 2022; 39:536-537. [PMID: 35122301 DOI: 10.1111/echo.15313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/09/2022] [Accepted: 01/22/2022] [Indexed: 11/30/2022] Open
Abstract
Tricuspid mitral valve is a rare entity, distinct from isolated clefts of the mitral leaflets. Echocardiographically, it manifests as the presence of three commissures, separate papillary muscles and concordant atrioventricular or ventriculoarterial connections. Three-dimensional transesophageal echocardiography helps distinguish the three cusps from clefts. Herein, we present a case of tricuspid mitral valve that led to severe mitral regurgitation.
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Affiliation(s)
- Samet Uysal
- Departments of Cardiology, Kartal Koşuyolu Training and Research Hospital, İstanbul, Turkey
| | - Sedat Kalkan
- Departments of Cardiology, Kartal Koşuyolu Training and Research Hospital, İstanbul, Turkey
| | - Alev Kılıçgedik
- Departments of Cardiology, Kartal Koşuyolu Training and Research Hospital, İstanbul, Turkey
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13
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Çiçek MB, Karaduman A, Balaban İ, Kılıçgedik A, Kırma C. Multimodality Imaging of Large Left Ventricular Apical Pseudoaneurysm after Thoracic Surgery. Korean Circ J 2020; 50:843-844. [PMID: 32725988 PMCID: PMC7440993 DOI: 10.4070/kcj.2020.0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/27/2020] [Accepted: 04/29/2020] [Indexed: 11/11/2022] Open
Affiliation(s)
- Mahmut Buğrahan Çiçek
- Department of Cardiology, Kartal Kosuyolu Research and Education Hospital, İstanbul, Turkey
| | - Ahmet Karaduman
- Department of Cardiology, Kartal Kosuyolu Research and Education Hospital, İstanbul, Turkey.
| | - İsmail Balaban
- Department of Cardiology, Kartal Kosuyolu Research and Education Hospital, İstanbul, Turkey
| | - Alev Kılıçgedik
- Department of Cardiology, Kartal Kosuyolu Research and Education Hospital, İstanbul, Turkey
| | - Cevat Kırma
- Department of Cardiology, Kartal Kosuyolu Research and Education Hospital, İstanbul, Turkey
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14
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Sarı M, Yılmaz C, Kılıçgedik A, Kahveci G, Pala S. Discrete subaortic membrane complicated by infective endocarditis, aortic pseudoaneurysm, and acute severe aortic regurgitation. Turk Kardiyol Dern Ars 2020; 47:420. [PMID: 31311902 DOI: 10.5543/tkda.2019.52128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Münevver Sarı
- Department of Cardiology, University of Health Sciences Kartal Koşuyolu Training and Research Hospital, Istanbul, Turkey
| | - Cemalettin Yılmaz
- Department of Cardiology, University of Health Sciences Kartal Koşuyolu Training and Research Hospital, Istanbul, Turkey
| | - Alev Kılıçgedik
- Department of Cardiology, University of Health Sciences Kartal Koşuyolu Training and Research Hospital, Istanbul, Turkey
| | - Gökhan Kahveci
- Department of Cardiology, University of Health Sciences Kartal Koşuyolu Training and Research Hospital, Istanbul, Turkey
| | - Selçuk Pala
- Department of Cardiology, University of Health Sciences Kartal Koşuyolu Training and Research Hospital, Istanbul, Turkey
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15
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Bayam E, Kalçık M, Gürbüz AS, Yesin M, Güner A, Gündüz S, Gürsoy MO, Karakoyun S, Cerşit S, Kılıçgedik A, Candan Ö, Yaman A, Özkan M. The relationship between heparanase levels, thrombus burden and thromboembolism in patients receiving unfractionated heparin treatment for prosthetic valve thrombosis. Thromb Res 2018; 171:103-110. [PMID: 30273810 DOI: 10.1016/j.thromres.2018.09.061] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 09/08/2018] [Accepted: 09/25/2018] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Procoagulant activity of heparanase has been recently described in several arterial and venous thrombotic disorders. In this study, we aimed to investigate the role of heparanase with regard to thrombus burden, thromboembolism, and treatment success with unfractionated heparin (UFH) in patients with prosthetic valve thrombosis (PVT). METHODS This study enrolled 79 PVT patients who received UFH for PVT and 82 controls. Plasma samples which were collected from patients both at baseline and after the UFH treatment and from controls at baseline only, were tested for heparanase levels by heparanase enzyme-linked immunosorbent assay. RESULTS The PVT group included 18 obstructive and 61 non-obstructive PVT patients who received UFH infusions for a median duration of 15 (7-20) days. The UFH treatment was successful in 37 (46.8%) patients. Baseline heparanase levels were significantly higher in the patient group than in the controls [0.29 (0.21-0.71) vs. 0.25 (0.17-0.33) ng/mL; p = 0.002]. Baseline heparanase levels were significantly higher in obstructive PVT patients. There was a significant increase in heparanase levels after UFH treatment. Post-UFH heparanase levels were higher in patients who experienced treatment failure compared to successfully treated group. Baseline and post-UFH heparanase levels were significantly higher in patients with a thrombus area ≥1 cm2 and with a recent history of thromboembolism. CONCLUSIONS Increased heparanase levels may be one of the esoteric causes for PVT. UFH treatment may trigger an increase in heparanase levels which may affect the treatment success. Increased heparanase levels may be associated with high risk of thromboembolism and increased thrombus burden in PVT patients.
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Affiliation(s)
- Emrah Bayam
- Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Macit Kalçık
- Department of Cardiology, Hitit University Faculty of Medicine, Çorum, Turkey.
| | - Ahmet Seyfeddin Gürbüz
- Department of Cardiology, Necmeddin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Mahmut Yesin
- Department of Cardiology, Kars Harakani State Hospital, Kars, Turkey
| | - Ahmet Güner
- Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Sabahattin Gündüz
- Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Ozan Gürsoy
- Department of Cardiology, Izmir Katip Çelebi University Atatürk Training and Research Hospital, Izmir, Turkey
| | - Süleyman Karakoyun
- Department of Cardiology, Kars Kafkas University, Faculty of Medicine, Kars, Turkey
| | - Sinan Cerşit
- Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Alev Kılıçgedik
- Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Özkan Candan
- Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Ali Yaman
- Department of Biochemistry, Marmara University, Faculty of Medicine, Istanbul, Turkey
| | - Mehmet Özkan
- Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey; Division of Health Sciences, Ardahan University, Ardahan, Turkey
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16
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Kahyaoğlu M, Kılıçgedik A, Geçmen Ç, Çakmak EÖ, İzgi İA. Case Image: Right atrial appendage thrombus. Turk Kardiyol Dern Ars 2018; 46:328. [PMID: 29853705 DOI: 10.5543/tkda.2017.12893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Muzaffer Kahyaoğlu
- Department of Cardiology, Kartal Koşuyolu Yüksek İhtisas Training and Research Hospital, İstanbul, Turkey.
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17
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Celik M, Güner A, Kılıçgedik A, Gunduz S, Naser A, Eroglu Büyüköner E, Kahyaoglu M, Onal C, Kahveci G. A rare complication of mechanical aortic valve replacement: Separation in the region of the mitral-aortic intervalvular fibrosa. Echocardiography 2017; 34:1232-1233. [DOI: 10.1111/echo.13629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Mehmet Celik
- Department of Cardiology; Kartal Kosuyolu Heart & Research Hospital; Istanbul Turkey
| | - Ahmet Güner
- Department of Cardiology; Kartal Kosuyolu Heart & Research Hospital; Istanbul Turkey
| | - Alev Kılıçgedik
- Department of Cardiology; Kartal Kosuyolu Heart & Research Hospital; Istanbul Turkey
| | - Sabahattin Gunduz
- Department of Cardiology; Kartal Kosuyolu Heart & Research Hospital; Istanbul Turkey
| | - Abdulrahman Naser
- Department of Cardiology; Kartal Kosuyolu Heart & Research Hospital; Istanbul Turkey
| | | | - Muzaffer Kahyaoglu
- Department of Cardiology; Kartal Kosuyolu Heart & Research Hospital; Istanbul Turkey
| | - Cagatay Onal
- Department of Cardiology; Kartal Kosuyolu Heart & Research Hospital; Istanbul Turkey
| | - Gokhan Kahveci
- Department of Cardiology; Kartal Kosuyolu Heart & Research Hospital; Istanbul Turkey
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18
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Toprak C, Kahveci G, Kılıçgedik A, Kırma C, Pala S, Bulut M, Kaymaz C, Özdemir N, İzgi İA, İnanır M, Avcı A, Esen AM. Single-center experience with percutaneous mitral valve repair using the MitraClip in a high-risk series in Turkey. Turk Kardiyol Dern Ars 2017; 44:561-569. [PMID: 27774964 DOI: 10.5543/tkda.2016.77177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Mitral valve regurgitation (MR) is the second most common heart valve disease in Europe. Without intervention, prognosis of severe symptomatic MR is poor. Percutaneous edge-to-edge mitral valve repair with MitraClip is a promising mitral regurgitation treatment technique in select, high-surgical-risk patients. The present objective was to describe the experience of a single center with MitraClip use in a high-risk series in Turkey. METHODS Between May 2013 and September 2014, 28 high-surgical-risk patients with MR of at least grade 3+ and mean EuroSCORE of 26% underwent MitraClip implantation at our institution. In-hospital and follow-up safety and efficacy results are presented. RESULTS Mean patient age was 58 years, and 75% were male. Grade 3 or 4 MR was present in all patients, and was primarily the result of restrictive functional mitral regurgitation (in 89% of cases). Mean left ventricular ejection fraction (LVEF) was 27% and New York Heart Association (NYHA) classification was III or IV in 89% of the population. Acute procedural success was 89%, with 47% of patients receiving a single clip, 39% receiving 2 clips, and 14% receiving 3 clips. One periprocedural death occurred, and 2 deaths occurred during follow-up (mean: 13.9 months). After 1 year, more than 75% of patients had MR severity of ≤2+ and NYHA classification of I or II, but no significant change in left ventricular volume or systolic function. Significant improvement in 6-minute walk test and quality of life was also observed. CONCLUSION Initial experience with the MitraClip system showed promising results in patients considered high-surgical-risk, particularly in those with end-stage heart failure.
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Affiliation(s)
- Cüneyt Toprak
- Department of Cardiology, Kartal Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey.
| | - Gökhan Kahveci
- Department of Cardiology, Kartal Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - Alev Kılıçgedik
- Department of Cardiology, Kartal Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - Cevat Kırma
- Department of Cardiology, Kartal Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - Selçuk Pala
- Department of Cardiology, Kartal Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - Mustafa Bulut
- Department of Cardiology, Kartal Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - Cihangir Kaymaz
- Department of Cardiology, Kartal Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - Nihal Özdemir
- Department of Cardiology, Kartal Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - İbrahim Akın İzgi
- Department of Cardiology, Kartal Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - Mehmet İnanır
- Department of Cardiology, Kartal Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - Anıl Avcı
- Department of Cardiology, Kartal Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - Ali Metin Esen
- Department of Cardiology, Kartal Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
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19
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Karabay CY, Göl G, Kalaycı A, Kılıçgedik A, Çiftci M, Günen H. [Pericardial effusion predicts mortality in patients with chronic obstructive pulmonary disease]. Turk Kardiyol Dern Ars 2015; 43:25-30. [PMID: 25655847 DOI: 10.5543/tkda.2015.27109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Chronic obstructive pulmonary disease (COPD) is an increasingly important cause of morbidity and mortality worldwide. Pericardial effusion (PE) is a current issue proven to be a mortality predictor, especially in pulmonary arterial hypertension. In this study, we aimed to evaluate the prognostic value of PE in COPD. STUDY DESIGN The study cohort consisted of 488 COPD patients and a control group of 50 healthy patients. At the start of the study, 37 patients (7.5%) had PE. Mean follow-up time was 12 months (range; 1-16 months). Clinical spirometric and echocardiographic data were compared between patients with PE(+) group (n=37), patients without PE(-) group (n=451) and the healthy control group. RESULTS Right ventricular functions were more depressed and pulmonary arterial pressure was more elevated in the PE(+) group. Also, Kaplan-Meier survival curve analysis showed that at one-year follow- up, mortality was higher in the PE(+) group: PE(-) group 139 (30.8%), PE(+) group 21 (56.8%) log-Rank p value: 0.009). Age, presence of PE, and oxygen usage were independent predictors of mortality in Cox regression analysis. CONCLUSION Presence of PE predicts mortality in COPD patients at one-year follow-up.
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Affiliation(s)
- Can Yücel Karabay
- Department of Cardiology, Süreyyapaşa Thoracic Surgery Training and Research Hospital, İstanbul, Turkey.
| | - Gökhan Göl
- Department of Cardiology, Süreyyapaşa Thoracic Surgery Training and Research Hospital, İstanbul, Turkey
| | - Arzu Kalaycı
- Department of Cardiology, Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - Alev Kılıçgedik
- Department of Cardiology, Koşuyolu Heart Training and Research Hospital, İstanbul, Turkey
| | - Merve Çiftci
- Department of Cardiology, Süreyyapaşa Thoracic Surgery Training and Research Hospital, İstanbul, Turkey
| | - Hakan Günen
- Department of Cardiology, Süreyyapaşa Thoracic Surgery Training and Research Hospital, İstanbul, Turkey
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Zehir R, Karabay CY, Kalaycı A, Akgün T, Kılıçgedik A, Kırma C. Evaluation of Tpe interval and Tpe/QT ratio in patients with slow coronary flow. Anatol J Cardiol 2014; 15:463-7. [PMID: 25430412 PMCID: PMC5779137 DOI: 10.5152/akd.2014.5503] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Slow coronary flow (SCF) phenomenon is described as the delayed opacification of the distal vasculature and angiographically normal coronary arteries. Considerable studies have suggested that the interval from the peak to the end of the electrocardiographic T wave (Tpe) may correspond to the transmural dispersion of repolarization and that increased Tpe interval and Tpe/QT ratio are associated with malignant ventricular arrhythmias. In this study, we intended to evaluate ventricular repolarization in patients with SCF by using the Tpe interval and Tpe/QT ratio. METHODS The study population included 33 patients with angiographically proven SCF and 33 control patients with angiographically proven normal coronary arteries without associated SCF. Coronary flow rates of patients and the control group were documented by TIMI (Thrombolysis in Myocardial Infarction) frame count. From the electrocardiograms, Tpe interval and Tpe/QT ratio were calculated and compared between groups. RESULTS No statistically significant difference was found between the two groups in terms of basic characteristics. Mean Tpe interval, Tpe/QT ratio, and Tpe/QTc ratio were prolonged in the study group compared to the control group (p<0.001). CONCLUSION Tpe interval and Tpe/QT ratio were increased in SCF patients.
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Affiliation(s)
- Regayip Zehir
- Department of Cardiology, Kartal Koşuyolu Heart and Research Hospital; İstanbul-Turkey.
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Abstract
Chronic heart failure is a common problem and a major cause of death, hospital admission, poor physical function and impaired quality of life. In addition to the direct effect of heart failure on prognosis, several modifiable and non-modifiable factors contribute to the worse prognosis in heart failure. Anemia, which is common in patients with heart failure, may represent a modifiable risk factor for adverse outcome. It is also a marker for co-morbidity burden and greater disease severity. If anemia is a marker, treatment may not obviate the increased risk associated with anemia, but if it is a mediator, treatment may be helpful to reduce morbidity and mortality in heart failure. As anemia has been identified as an independent prognostic factor of both morbidity and mortality for patients with congestive heart failure, there is an increased interest in the hypothesis that the correction of anemia with erythropoietin or iron supplementation might lead to an improvement on patients' symptoms and functional status. Large randomized trials are necessary to show the effect of anemia and the specific treatments on the outcome in these patients. This article reviews the mechanisms, impact on outcomes and therapy of anemia in patients with heart failure.
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Affiliation(s)
- Alev Kılıçgedik
- Clinic of Cardiology, Kocaeli State Hospital, Kocaeli-Turkey.
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Dündar C, Oduncu V, Erkol A, Tanalp AC, Sırma D, Karagöz A, Karabay CY, Kılıçgedik A, Pala S, Tigen K, Izgi A, Kırma C. In-hospital prognostic value of hemoglobin levels on admission in patients with acute ST segment elevation myocardial infarction undergoing primary angioplasty. Clin Res Cardiol 2011; 101:37-44. [PMID: 21931965 DOI: 10.1007/s00392-011-0361-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Accepted: 09/07/2011] [Indexed: 11/24/2022]
Abstract
PURPOSE Anemia is a common comorbidity in patients presenting with ST-elevation myocardial infarction (STEMI). The aim of this study was to investigate the in-hospital prognostic value of admission hemoglobin (Hb) levels in patients with acute STEMI undergoing primary percutaneous coronary intervention (p-PCI). METHODS This is a retrospective study of 1,625 patients with STEMI stratified by quartiles of admission Hb concentration (Q1 ≤12.5 g/dl, Q2 12.6-13.8 g/dl, Q3 13.9-15.0 g/dl, Q4 ≥15.1 g/dl). Main outcome measures were in-hospital rates of all cause mortality, re-infarction, target vessel revascularization, stroke, heart failure (HF) and bleeding complications. RESULTS The incidences of in-hospital mortality according to quartiles from Q1 to Q4 were 8.6, 3.9, 2.4 and 2.6%, respectively (p < 0.001). The incidences of major hemorrhage and HF were significantly higher in Q1, compared to the other quartiles (7.4, 1.9, 3.1, 2.8%, p < 0.001; 16.3, 8.5, 7.7, 9.8%, p < 0.001, respectively). Multiple logistic-regression analysis showed that low admission Hb level (Q1) is an independent and a potent predictor for in-hospital mortality [unadjusted odds ratio (OR): 3.84, 95% confidence interval (CI): 1.78-7.82; p < 0.001]. CONCLUSION Lower concentrations of Hb on admission are associated with higher rates of in-hospital mortality, heart failure and major bleeding after p-PCI.
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Affiliation(s)
- Cihan Dündar
- Department of Cardiology, Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
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Oduncu V, Tanalp AC, Erkol A, Sırma D, Dündar C, Akgün T, Türkyilmaz E, Kılıçgedik A, Gözübüyük G, Tigen K, Izgi A, Kirma C. Impact of chronic pre-treatment of statins on the level of systemic inflammation and myocardial perfusion in patients undergoing primary angioplasty. Am J Cardiol 2011; 107:179-85. [PMID: 21129710 DOI: 10.1016/j.amjcard.2010.09.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2010] [Revised: 09/14/2010] [Accepted: 09/14/2010] [Indexed: 01/04/2023]
Abstract
Statins have many favorable pleiotropic effects beyond their lipid-lowering properties. The aim of this study was to evaluate the impact of long-term statin pretreatment on the level of systemic inflammation and myocardial perfusion in patients with acute myocardial infarctions. This was a retrospective study of 1,617 patients with acute ST-segment elevation myocardial infarctions who underwent primary percutaneous coronary intervention <12 hours after the onset of symptoms. Angiographic no-reflow was defined as postprocedural Thrombolysis In Myocardial Infarction (TIMI) flow grade ≤2. Long-term statin pretreatment was significantly less common in the no-reflow group (6.2% vs 21%, p <0.001). The serum lipid profiles of the groups were similar (p >0.05 for all parameters). Baseline C-reactive protein levels (10 ± 8.2 vs 15 ± 14 mg/L, p <0.001) and the frequency of angiographic no-reflow (3.9% vs 14%, p <0.001) were significantly lower, and myocardial blush grade 3 was more common (50% vs 40%, p = 0.006) in the statin pretreatment group (n = 306). Moreover, the frequency of complete ST-segment resolution (>70%) (70% vs 59%, p <0.001) and the left ventricular ejection fraction were higher (49 ± 7.5% vs 46 ± 8.3%, p <0.001) and peak creatine kinase-MB was lower (186 ± 134 vs 241 ± 187 IU/L, p <0.001) in the statin-treated group. In conclusion, long-term statin pretreatment is associated with lower C-reactive protein levels on admission and better myocardial perfusion after primary percutaneous coronary intervention, leading to lower enzymatic infarct area and a more preserved left ventricular ejection fraction. This is a group effect independent of lipid-lowering properties.
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Affiliation(s)
- Vecih Oduncu
- Department of Cardiology, Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey
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